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J Nurs Adm ; 50(1): 34-39, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31804410


OBJECTIVE: An Automated Data Entry Process Technology tool was developed to free nurses from data entry tasks, thus creating time for patient care and other activities associated with improvements in performance and job satisfaction. BACKGROUND: Manually transferring data from patient measurement devices to electronic health records (EHRs) is an intensive, error-prone task that diverts nurses from patient care while adversely affecting job performance and employee satisfaction. METHODS: Performance improvement analytics were used to compare matched sets of manual and automated EHR data entries for 1933 consecutive vital signs records created by 49 RNs and certified nursing assistants in a 23-bed medical-surgical unit at a large tertiary hospital. Performance and quality effects were evaluated via nurses' responses to a postintervention survey. RESULTS: Data errors decreased from approximately 20% to 0; data transfer times were reduced by 5 minutes to 2 hours per measurement event; nurses had more time for direct patient care; and job satisfaction improved. CONCLUSION: Data entry automation eliminates data errors, substantially reduces delays in getting data into EHRs, and improves job satisfaction by giving nurses more time for direct patient care. Findings are associated with improvements in quality, work performance, and job satisfaction, key goals of nursing leaders.

Benchmarking , Registros Eletrônicos de Saúde , Satisfação no Emprego , Processo de Enfermagem/normas , Recursos Humanos de Enfermagem no Hospital , California , Unidades Hospitalares , Humanos , Processo de Enfermagem/economia
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 12-19, jan.-dez. 2020. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047786


Objetivo: o estudo objetivou identificar quais estratégias estão sendo utilizadas na implementação de registros eletrônicos relacionados ao processo de enfermagem, nas bases de dados: PubMed, Scopus e Web of Science. Método: trata-se de uma revisão integrativa na qual os descritores utilizados foram electronic health records e nursing process. Resultados: Os dados encontrados indicam que os estudos em sua maioria foram pesquisas quantitativas, publicadas no periódico Nursing informatics (Studies in Health Technology and Informatics) desenvolvidas em universidades e no continente americano. Conclusão: os dados apontam que a maior parte das pesquisas são referentes a usabilidade do registro eletrônico em saúde. Outros aspectos abordados foram as fragilidades e perspectivas associados ao uso do registro eletrônico, bem como o processo de enfermagem em sistemas informatizados

Objective: the objective of this study was to identify which strategies are being used in the implementation of electronic records related to the nursing process, in PubMed, Scopus and Web of Science databases. Method: this is an integrative review in which the descriptors used were electronic health records and nursing process. Results: the data found indicate that the studies were mostly quantitative research, published in the journal Nursing informatics (Studies in Health Technology and Informatics) developed in universities and in the American continent. Conclusion: the data indicate that most of the researches are referring to the usability of electronic health records. Other aspects addressed were the weaknesses and perspectives associated with the use of electronic registration, as well as the nursing process in computerized systems

Objetivo: el estudio tuvo como objetivo identificar qué estrategias están siendo utilizadas en la implementación de registros electrónicos relacionados al proceso de enfermería, en las bases de datos: PubMed, Scopus y Web of Science. Métodos: se trata de una revisión integrativa en la cual los descriptores utilizados fueron electronic health records y kind process. Resultados: los datos encontrados indican que los estudios en su mayoría fueron investigaciones cuantitativas, publicadas en el periódico Nursing informatics (Studies in Health Technology and Informática) desarrolladas en universidades y en el continente americano. Conclusiones: los datos apuntan que la mayor parte de las encuestas son referentes a la usabilidad del registro electrónico en salud. Otros aspectos abordados fueron las fragilidades y perspectivas asociadas al uso del registro electrónico, así como el proceso de enfermería en sistemas informatizados

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Registros de Enfermagem , Registros Eletrônicos de Saúde/instrumentação , Processo de Enfermagem , Alfabetização Digital , Educação Continuada em Enfermagem
Adv Exp Med Biol ; 1180: 267-276, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784968


The advances in the Internet and related technologies may lead to changes in professional roles of psychiatrists and psychotherapists. The application of artificial intelligence (AI) and electronic measurement-based care (eMBC) in the treatment of depressive disorder has addressed more interest. AI could play a role in population health management and patient administration as well as assist physicians to make a decision in the real-world clinical practice. The eMBC strengthens MBC through web/mobile devices and telephone consulting services, to monitor disease progression, and customizes the MBC interface in electronic medical record systems (EMRs).

Inteligência Artificial , Transtorno Depressivo/terapia , Internet , Tomada de Decisão Clínica , Registros Eletrônicos de Saúde , Humanos
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 415-421, Out.-Dez. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1024301


Introduction: Upper airway obstruction at multiple sites, including the velum, the oropharynx, the tongue base, the lingual tonsils, or the supraglottis, has been resulting in residual obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (TA). The role of combined lingual tonsillectomy and tongue base volume reduction for treatment of OSA has not been studied in nonsyndromic children with residual OSA after TA. Objective: To evaluate the outcomes of tongue base volume reduction and lingual tonsillectomy in children with residual OSA after TA. Methods: A retrospective chart review was conducted to obtain information on history and physical examination, past medical history, findings of drug-induced sleep endoscopy (DISE), of polysomnography (PSG), and surgical management. Pre- and postoperative PSGs were evaluated to assess the resolution of OSA and to determine the improvement in the obstructive apnea-hypopnea index (oAHI) before and after the surgery. Results: A total of 10 children (5 male, 5 female, age range: 10­17 years old, mean age: 14.5 ± 2.6 years old) underwent tongue base reduction and lingual tonsillectomy. Drug-induced sleep endoscopy (DISE) revealed airway obstruction due to posterior displacement of the tongue and to the hypertrophy of the lingual tonsils. All of the patients reported subjective improvement in the OSA symptoms. All of the patients had improvement in the oAHI. The postoperative oAHI was lower than the preoperative oAHI ( p < 0.002). The postoperative apnea-hypopnea index during rapid eye movement sleep (REM-AHI) was lower than the preoperative REM-AHI ( p = 0.004). Obstructive sleep apnea was resolved in children with normal weight. Overweight and obese children had residual OSA. Nonsyndromic children had resolution of OSA or mild OSA after the surgery. Conclusions: Tongue base reduction and lingual tonsillectomy resulted in subjective and objective improvement of OSA in children with airway obstruction due to posterior displacement of the tongue and to hypertrophy of the lingual tonsils (AU)

Humanos , Masculino , Feminino , Criança , Adolescente , Tonsilectomia , Adenoidectomia , Apneia Obstrutiva do Sono/cirurgia , Língua/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Registros Eletrônicos de Saúde
J Opioid Manag ; 15(6): 479-485, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850509


INTRODUCTION: In response to the US opioid epidemic, the Centers for Disease Control and Prevention issued a guideline (CDCG) for prescribing opioids for chronic pain. Successful implementation of the CDCG requires identification of the information, skills, and support physicians need to carry out its recommendations. However, such data are currently lacking. METHODS: The authors performed one-on-one interviews with nine practicing physicians regarding their needs and perspectives for successful CDCG implementation, including the perceived barriers, focusing on communication strategies. Interviews were audio recorded, transcribed, and a thematic qualitative analysis was performed. FINDINGS: Three major themes were identified: communication, knowledge, and information technology (IT). Physicians reported that open communication with patients about opioids was difficult and burdensome, but essential; they shared their communication strategies. Knowledge gaps included patient-specific topics (eg, availability of/insurance coverage for non-opioid treatments) and more general areas (eg, opioid dosing/equivalencies, prescribing naloxone). Finally, physicians discussed the importance of innovation in IT, focusing on the electronic medical record for decision support and to allow safer opioid prescribing within the time constraints of clinical practice. DISCUSSION: These qualitative data document practical issues that should be considered in the development of implementation plans for safer opioid prescribing practices. Specifically, healthcare systems may need to provide opioid-relevant communication strategies and training, education on key topics such as naloxone prescribing, resources for referrals to appropriate nonpharmacologic treatments, and innovative IT solutions. Future research is needed to establish that such measures will be effective in producing better outcomes for patients on opioids for chronic pain.

Analgésicos Opioides , Comunicação , Registros Eletrônicos de Saúde , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Tomada de Decisões , Humanos , Naloxona , Médicos , Pesquisa Qualitativa
JAMA ; 322(20): 2024, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31769818
JAMA ; 322(13): 1313-1314, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573631
Br J Anaesth ; 123(6): 877-886, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31627890


BACKGROUND: Rapid, preoperative identification of patients with the highest risk for medical complications is necessary to ensure that limited infrastructure and human resources are directed towards those most likely to benefit. Existing risk scores either lack specificity at the patient level or utilise the American Society of Anesthesiologists (ASA) physical status classification, which requires a clinician to review the chart. METHODS: We report on the use of machine learning algorithms, specifically random forests, to create a fully automated score that predicts postoperative in-hospital mortality based solely on structured data available at the time of surgery. Electronic health record data from 53 097 surgical patients (2.01% mortality rate) who underwent general anaesthesia between April 1, 2013 and December 10, 2018 in a large US academic medical centre were used to extract 58 preoperative features. RESULTS: Using a random forest classifier we found that automatically obtained preoperative features (area under the curve [AUC] of 0.932, 95% confidence interval [CI] 0.910-0.951) outperforms Preoperative Score to Predict Postoperative Mortality (POSPOM) scores (AUC of 0.660, 95% CI 0.598-0.722), Charlson comorbidity scores (AUC of 0.742, 95% CI 0.658-0.812), and ASA physical status (AUC of 0.866, 95% CI 0.829-0.897). Including the ASA physical status with the preoperative features achieves an AUC of 0.936 (95% CI 0.917-0.955). CONCLUSIONS: This automated score outperforms the ASA physical status score, the Charlson comorbidity score, and the POSPOM score for predicting in-hospital mortality. Additionally, we integrate this score with a previously published postoperative score to demonstrate the extent to which patient risk changes during the perioperative period.

Registros Eletrônicos de Saúde/estatística & dados numéricos , Nível de Saúde , Mortalidade Hospitalar , Aprendizado de Máquina , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Medição de Risco , Fatores de Risco , Adulto Jovem
Orv Hetil ; 160(43): 1706-1710, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31630551


Introduction: The term "spam" is applied to unwanted commercial e-mails sent to all whose e-mail addresses have been acquired by the spammers. The number of undesirable e-mails is growing in the health-care related areas as well. The targets of health-care related spams are laymen, physicians and academic researchers alike. Method: On the basis of 12,986 unwanted letters received in one year, the authors concluded that percentage of health-related spam is the second most common spam (27%) in relation to all spam. Most of the spam (63%) aggressively promoted purchasing of various consumer goods, but health-related spam are far ahead of the rest. The collected data were grouped by year and topic and they are analyzed by simple descriptive statistics. Spam form of cyber attacks on health care issues were divided into two: spam what is jeopardized individuals' health (e.g. medical compounds without any curing effect, misleading statement on medical device, fraudulent panacea offers, and cheating cure methods, etc.) and onslaught on medical scientific activity (pseudo-scientific congress invitation, predator journal invitation etc.). Results: The topics of spams addressed to laymen are offered for perfect healing by strange treatments, cures (31%), panaceas (19%), lifestyle advice (19%), massage (16%), brand new health-care devices (4%) and drugs for sexual dysfunction (11%). The topics of spams addressed to physicians and researchers are deluged by pseudoscientific materials: invitation for articles to be sent to no-name/fake open-access journals (68%), invitation to participate at an obscure congress (27%) or newsletters on miscellanous medical topics (5%). Conclusion: The spams offer very often relief or solution to medical problems that the present-day medical practice cannot solve perfectly (oncological, musculo-sceletal, endocrin or metabolic problems). Understandably, the patients would hold on to fake hopes - and the authentic patient education and health promotion will be neglected. These unwanted messages practically cannot be unsubscribed, and - while the spam filters are far from perfection - the victim must go through the filtered spam-dustbin in order not to miss some real messages. Unfortunately no legal regulation (neither local, nor GDPR) can block or stop the spams. The spams are misleading the laymen and jeopardise the effects of professional and responsible health promotion and health education. Orv Hetil. 2019; 160(43): 1706-1710.

Segurança Computacional , Correio Eletrônico/normas , Educação em Saúde , Internet/normas , Médicos/psicologia , Registros Eletrônicos de Saúde , Promoção da Saúde , Humanos , Pesquisadores
Pediatr Dent ; 41(5): 371-375, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31648668


Purpose: Many dentists utilize health history forms completed by patients' parents/guardians to obtain medical histories. It is unknown if parent-derived health histories are consistent with histories completed by health care providers. The purpose of this study was to compare patient medical electronic health records (EHRs) with parent-/guardian-derived dental health histories in order to identify, quantify, and compare discrepancies of patient medical conditions, medications, and allergies. Methods: Two-hundred randomly selected patient dental charts and corresponding EHRs were reviewed retrospectively from a preexisting patient pool. The number of conditions, medications, and allergies in the dental chart and on the patient's accompanying EHRs were quantified and recorded. Results: Discrepancies between the two records were present for 97.5 percent of patient charts. All charts without discrepancies were for those patients who did not have any past medical history, take any medications, or have any allergies. Chart discrepancies often included conditions involving the head, cardiac, and respiratory systems. Conclusion: It is important for dentists not to rely solely on parent-derived information or medical records. At the initial encounter, dentists should request a history from the patient's physician and review it with the parents for accuracy. Updates should be obtained at each appointment to obtain an accurate medical history. (Pediatr Dent 2019;41(5):371-5).

Registros Eletrônicos de Saúde , Pais , Odontólogos , Humanos , Saúde Bucal , Estudos Retrospectivos
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1226-1235, out.-dez. 2019. ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022343


Objetivo: Analisar a percepção dos enfermeiros sobre a implantação e o uso do Prontuário Eletrônico do Cidadão (PEC) no cuidado de enfermagem. Método: Pesquisa de abordagem qualitativa realizada com 11 enfermeiros da Atenção Básica. Resultados: Emergiram três categoriais: O Prontuário Eletrônico do Cidadão sob a ótica dos enfermeiros da Atenção Básica (AB); A Implantação do Prontuário Eletrônico do Cidadão nas Unidades de Atenção Básica (UBS); Contribuições e desafios na utilização do PEC para o cuidado de enfermagem. Identificou-se que PEC é uma ferramenta que pode contribuir para a melhoria do funcionamento das UBS e para a qualificação do cuidado de enfermagem.Conclusão: O PEC colabora nos processos de trabalho do enfermeiro no assistir, administrar e pesquisar. Para funcionamento do PEC nas UBS é preciso implementar suporte e manutenção da rede lógica e internet; capacitação dos profissionais no uso da informática e organização de educação permanente

Objective: The study's purpose has been to analyze the nurses' viewpoint regarding both implementation and use of the Electronic Citizen Record (ECR) in nursing care. Methods: It is a descriptive research with a qualitative approach that was carried out with 11 nurses from the primary health care service. Results: The following three categories appeared: The ECR from the primary care nurses' viewpoint; Implementation of the ECR in the basic health units; Contributions and challenges by using the ECR for nursing care. It was identified that the ECR is a tool that can contribute to the improvement of basic health units functioning, as well as, to the nursing care qualification. Conclusion: The ECR collaborates in the nurses' work processes by assisting, administering and researching. In order to make sure the ECR functioning in basic health units, it is necessary to implement support and maintenance of the logical network and internet; to promote training for health professionals using data processing, and also organizing the permanent education activity

Objetivo: Analizar la percepción de los enfermeros sobre la implantación y el uso del registro electrónico del ciudadano (REC) en la atención de enfermería.Método: Investigación de enfoque cualitativo realizada com 11 enfermeras . Resultados: Surgieron tres categorias: REC bajo la percepción de losenfermeros de Atención Primária de Salud; implantación del REC em las Unidades de Atención Primária (UNAPS); contribuciones y desafios em la utilización del REC en la atención de enfermería. Se identifico que REC es uma herramienta que podrá contribuir para lamejoría del funcionamento de las UNAPS y para la cualificación de La atención de enfermería.Conclusión: El REC colabora en los procesos de trabajo del enfermero en el asistir, administrar e investigar.Para el funcionamento del REC es necessariosoporte y manutención de lared lógica y del internet; capacitación de losprofissionalesen informática y organización de educación permanente

Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Atenção Primária à Saúde , Registros de Enfermagem , Registros Eletrônicos de Saúde/instrumentação , Alfabetização Digital , Educação Continuada , Processo de Enfermagem
Prensa méd. argent ; 105(9 especial): 546-555, oct 2019. fig
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1046472


The article is devoted to the review of the most developed systems of registration and control of patients suffering from oncological diseases. The creation of registries is based on the public health needs of countries in monitoring, storing and analyzing national data on such serious chronic diseases as cancer. The world and national experience in creating data storage systems shows the need to unify the information collection, to consolidate sources, and to use high quality information technologies that make it possible to exchange, analyze, protect and store data. In European countries and the USA, registries have specialized websites and provide information on epidemiology, trends, forecasts, and survival rate. This information is public.

Humanos , Institutos de Câncer/estatística & dados numéricos , Literatura de Revisão como Assunto , Registros Eletrônicos de Saúde , Acesso a Medicamentos Essenciais e Tecnologias em Saúde
Einstein (Sao Paulo) ; 17(4): eAE4791, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553359


Data collection for clinical research can be difficult, and electronic health record systems can facilitate this process. The aim of this study was to describe and evaluate the secondary use of electronic health records in data collection for an observational clinical study. We used Cerner Millennium®, an electronic health record software, following these steps: (1) data crossing between the study's case report forms and the electronic health record; (2) development of a manual collection method for data not recorded in Cerner Millennium®; (3) development of a study interface for automatic data collection in the electronic health records; (4) employee training; (5) data quality assessment; and (6) filling out the electronic case report form at the end of the study. Three case report forms were consolidated into the electronic case report form at the end of the study. Researchers performed daily qualitative and quantitative analyses of the data. Data were collected from 94 patients. In the first case report form, 76.5% of variables were obtained electronically, in the second, 95.5%, and in the third, 100%. The daily quality assessment of the whole process showed complete and correct data, widespread employee compliance and minimal interference in their practice. The secondary use of electronic health records is safe and effective, reduces manual labor, and provides data reliability. Anesthetic care and data collection may be done by the same professional.

Registros Eletrônicos de Saúde/normas , Controle de Formulários e Registros/métodos , Sistemas Computadorizados de Registros Médicos/normas , Anestesia Geral/normas , Confiabilidade dos Dados , Formulários como Assunto , Humanos , Complicações Pós-Operatórias , Estudos Prospectivos , Reprodutibilidade dos Testes , Respiração Artificial/normas , Procedimentos Cirúrgicos Robóticos/normas , Fatores de Tempo