Measuring participation as defined by the World Health Organization in the International Classification of Functioning, Disability and Health. Psychometric properties of the Ghent Participation Scale.

OBJECTIVE: To examine the internal consistency, test-retest reliability, construct validity, discriminant validity and responsiveness of the Ghent Participation Scale. DESIGN: Cross-sectional study with a test-retest sample. SETTING: Six outpatient rehabilitation centres in Belgium. SUBJECTS: A total of 365 outpatients from eight diagnostic groups. MEASURES: The Ghent Participation Scale, the Impact on Participation and Autonomy, the Utrecht Scale for Evaluation of Rehabilitation-Participation and the Medical outcome study Short Form SF-36. RESULTS: The Ghent Participation Scale was found to have good internal consistency (Cronbach's α between 0.75 and 0.83). At item level, the test-retest reliability was good; weighted kappas ranged between 0.57 and 0.88. On the dimension level intraclass correlation coefficients ranged between 0.80 and 0.90. Evidence for construct validity came from high correlations between the subscales of the Ghent Participation Scale and four subscales of the Impact on Participation and Autonomy (range, r = -0.71 to -0.87) and two subscales of the Utrecht Scale for Evaluation of Rehabilitation-Participation (range, r = 0.54 to 0.72). Standardized response mean ranged between 0.23 and 0.68 and the area under the curve ranged between 68% and 88%. CONCLUSION: The Ghent Participation Scale appears to be a valid and reliable method of assessing participation irrespective of the respondent's health condition. The Ghent Participation Scale is responsive and is able to detect changes over time.

Using electronic health records for clinical research: the case of the EHR4CR project.

OBJECTIVES: To describe the IMI EHR4CR project which is designing and developing, and aims to demonstrate, a scalable, widely acceptable and efficient approach to interoperability between EHR systems and clinical research systems. METHODS: The IMI EHR4CR project is combining and extending several previously isolated state-of-the-art technical components through a new approach to develop a platform for reusing EHR data to support medical research. This will be achieved through multiple but unified initiatives across different major disease areas (e.g. cardiovascular, cancer) and clinical research use cases (protocol feasibility, patient identification and recruitment, clinical trial execution and serious adverse event reporting), with various local and national stakeholders across several countries and therefore under various legal frameworks. RESULTS: An initial instance of the platform has been built, providing communication, security and terminology services to the eleven participating hospitals and ten pharmaceutical companies located in seven European countries. Proof-of-concept demonstrators have been built and evaluated for the protocol feasibility and patient recruitment scenarios. The specifications of the clinical trial execution and the adverse event reporting scenarios have been documented and reviewed. CONCLUSIONS: Through a combination of a consortium that brings collectively many years of experience from previous relevant EU projects and of the global conduct of clinical trials, of an approach to ethics that engages many important stakeholders across Europe to ensure acceptability, of a robust iterative design methodology for the platform services that is anchored on requirements of an underlying Service Oriented Architecture that has been designed to be scalable and adaptable, EHR4CR could be well placed to deliver a sound, useful and well accepted pan-European solution for the reuse of hospital EHR data to support clinical research studies.

Classification system of the sagittal standing alignment in young adolescent girls.

PURPOSE: The purpose of this cohort study was to classify sagittal standing alignment of pre-peak height velocity (pre-PHV) girls, and to evaluate whether identified subgroups were associated with measures of spinal pain. This study further aimed at drawing attention to similarities and differences between the current postural classification and a previous system determined among pre-PHV boys. METHODS: 557 pre-PHV girls [mean age, 10.6 years (SD, 0.47 years)] participated in the study. Three gross body segment orientation parameters and five specific lumbopelvic characteristics were quantified during habitual standing. Postural subgroups were determined by cluster analysis. Logistic regression was applied to assess the relationship between postural subgroups and spinal pain measures (pain and seeking care, assessed by self-administered questionnaire). Chi-square statistics, independent samples T test, and distribution-based methods were used for comparison with postural categorization in pre-PHV boys. RESULTS AND CONCLUSION: Among pre-PHV girls, clinically meaningful posture clusters emerged both on the gross body segment and specific lumbopelvic level. The postural subtypes identified among pre-PHV girls closely corresponded to those previously described in pre-PHV boys, thereby allowing the use of the same, working nomenclature. In contrast to previous findings among pre-PHV boys, no associations between posture clusters and spinal pain measures were significant in girls at pre-PHV age. When comparing discrete 'global' alignment scores across corresponding posture types, some intriguing differences were found between genders which might involve different biomechanical loading patterns. Whether habitual posture forms a risk factor for developing spinal pain up to adulthood needs evaluation in prospective multifactorial follow-up research.

Posture class prediction of pre-peak height velocity subjects according to gross body segment orientations using linear discriminant analysis.

BACKGROUND/PURPOSE: Measurement and classification of standing posture in the sagittal plane has important clinical implications for adolescent spinal disorders. Previous work using cluster analysis on three gross body segment orientation parameters (lower limbs, trunk, and entire body inclination) has identified three distinct postural groups of healthy subjects before pubertal peak growth: "neutral", "sway-back", and "leaning-forward". Although accurate postural subgrouping may be proposed to be crucial in understanding biomechanical challenges posed by usual standing, there is currently no objective method available for class assignment. Hence, this paper introduces a novel approach to subclassify new cases objectively according to their overall sagittal balance. METHODS: Postural data previously acquired from 1,196 pre-peak height velocity (pre-PHV) subjects were used in this study. To derive a classification rule for assigning a class label ("neutral", "sway-back", or "leaning-forward") to any new pre-PHV subjects, linear discriminant analysis was applied. Predictor variables were pelvic displacement, trunk lean and body lean angle. The performance of the newly developed classification algorithm was verified by adopting a cross-validation procedure. RESULTS: The statistical model correctly classified over 96.2% of original grouped subjects. In the cross-validation procedure used, over 95.9% of subjects were correctly assigned. CONCLUSIONS: Based on three angular measures describing gross body segment orientation, our triage method is capable of reliably classifying pre-PHV subjects as either "neutral", "sway-back", or "leaning-forward". The discriminant prediction equations presented here enable a highly accurate posture class allocation of new cases with a prediction capability higher than 95.9%, thereby removing subjectivity from sagittal plane posture classification.

Frameworks, Dimensions, Definitions of Aspects, and Assessment Methods for the Appraisal of Quality of Health Data for Secondary Use: Comprehensive Overview of Reviews.

BACKGROUND: Health care has not reached the full potential of the secondary use of health data because of-among other issues-concerns about the quality of the data being used. The shift toward digital health has led to an increase in the volume of health data. However, this increase in quantity has not been matched by a proportional improvement in the quality of health data. OBJECTIVE: This review aims to offer a comprehensive overview of the existing frameworks for data quality dimensions and assessment methods for the secondary use of health data. In addition, it aims to consolidate the results into a unified framework. METHODS: A review of reviews was conducted including reviews describing frameworks of data quality dimensions and their assessment methods, specifically from a secondary use perspective. Reviews were excluded if they were not related to the health care ecosystem, lacked relevant information related to our research objective, and were published in languages other than English. RESULTS: A total of 22 reviews were included, comprising 22 frameworks, with 23 different terms for dimensions, and 62 definitions of dimensions. All dimensions were mapped toward the data quality framework of the European Institute for Innovation through Health Data. In total, 8 reviews mentioned 38 different assessment methods, pertaining to 31 definitions of the dimensions. CONCLUSIONS: The findings in this review revealed a lack of consensus in the literature regarding the terminology, definitions, and assessment methods for data quality dimensions. This creates ambiguity and difficulties in developing specific assessment methods. This study goes a step further by assigning all observed definitions to a consolidated framework of 9 data quality dimensions.

A clinical postural model of sagittal alignment in young adolescents before age at peak height velocity.

INTRODUCTION: From a clinical point of view, knowledge of customary standing positions among healthy young adolescents is of primary importance. The purpose of this study was to document the correlations between sagittal standing posture parameters in a pre-peak height velocity (pre-PHV) cohort. MATERIALS AND METHODS: This cohort study included 639 pre-PHV boys (age 12.6 [SD, 0.54] years) and 557 pre-PHV girls (age 10.6 [SD, 0.47] years). Gross body segment orientations and spinopelvic orientation/shape indexes were quantified using a clinical screening protocol. Pearson's correlation coefficients were determined for all sagittal standing plane alignment parameters, and a postural model was used to analyze the correlations between parameters. RESULTS: Both at the gross body segment and spinopelvic level, an interdependence was found between postural parameters. No correlations were observed between 'global' parameters related to the pelvis, trunk or body anteroposterior translation postures and 'local' spinopelvic geometries. A similar pattern and strength of correlations was obtained in pre-PHV boys and girls, except for the reciprocal relationships between the craniovertebral angle and adjacent anatomic segment characteristics and between thoraco-lumbar geometries. CONCLUSIONS: Although the correlation schemes do not imply a causal relationship, the proposed postural model allows conjecture about standing posture to be organized slightly differently in pre-PHV boys and girls. Whereas the standing posture in pre-PHV boys might be organized predominantly according to an ascending mode, bottom-up and top-down organizations appear to coexist in pre-PHV girls.

Information Resources Among Flemish Pregnant Women: Cross-sectional Study.

BACKGROUND: There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited. OBJECTIVE: The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders. METHODS: A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women's responses. RESULTS: In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2%) for pregnant women, followed by websites/internet (267/311, 85.9%) and apps (233/311, 74.9%). The information that was most searched for was information about the development of the baby (275/311, 88.5%), discomfort/complaints (251/311, 80.7%) and health during pregnancy (248/311, 79.7%), administrative/practical issues (233/311, 74.9%), and breastfeeding (176/311, 56.6%). About half of the women (172/311, 55.3%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0%). Pregnant women who are single asked their mothers (22/30, 73.3%) or other family members (13/30, 43.3%) for significantly more information than did married women (mother [in law]: 82/160, 51.3%, P=.02; family members: 35/160, 21.9%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6% vs 203/237, 85.5%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1% vs 55/237, 23.1%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9% vs 198/237, 83.5%; P=.001). They also followed more prenatal sessions (59/73, 80.8% vs 77/237, 32.5%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89% vs 188/237, 79.5%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4% vs multigravida 40/199, 20.1%; P<.001; other pregnant women: primigravida 58/109, 53.2% vs multigravida 80/199, 40.2%; P<.03). CONCLUSIONS: Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women.

Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients.

BACKGROUND: No consensus exists on how rehabilitation programs for lumbar discectomy patients with persistent complaints after surgery should be composed. A better understanding of normal and abnormal postoperative trunk muscle condition might help direct the treatment goals. METHODS: A three-dimensional CT scan of the lumbar spine was obtained in 18 symptomatic and 18 asymptomatic patients who had undergone a lumbar discectomy 42 months to 83 months (median 63 months) previously. The psoas muscle (PS), the paraspinal muscle mass (PA) and the multifidus muscle (MF) were outlined at the L3, L4 and L5 level. Of these muscles, fat free Cross Sectional Area (CSA) and fat CSA were determined. CSA of the lumbar erector spinae (LES = longissimus thoracis + iliocostalis lumborum) was calculated by subtracting MF CSA from PA CSA. Mean muscle CSA of the left and right sides was calculated at each level. To normalize the data for interpersonal comparison, the mean CSA was divided by the CSA of the L3 vertebral body (mCSA = normalized fat-free muscle CSA; fCSA = normalized fat CSA). Differences in CSA between the pain group and the pain free group were examined using a General Linear Model (GLM). Three levels were examined to investigate the possible role of the level of operation. RESULTS: In lumbar discectomy patients with pain, the mCSA of the MF was significantly smaller than in pain-free subjects (p = 0.009) independently of the level. The mCSA of the LES was significantly smaller in pain patients, but only on the L3 slice (p = 0.018). No significant difference in mCSA of the PS was found between pain patients and pain-free patients (p = 0.462). The fCSA of the MF (p = 0.186) and of the LES (p = 0.256) were not significantly different between both populations. However, the fCSA of the PS was significantly larger in pain patients than in pain-free patients. (p = 0.012).The level of operation was never a significant factor. CONCLUSIONS: CT comparison of MF, LES and PS muscle condition between lumbar discectomy patients without pain and patients with protracted postoperative pain showed a smaller fat-free muscle CSA of the MF at all levels examined, a smaller fat- free muscle CSA of the LES at the L3 level, and more fat in the PS in patients with pain. The level of operation was not found to be of importance. The present results suggest a general lumbar muscle dysfunction in the pain group, in particular of the deep stabilizing muscle system.

Policy brief on the current status of certification of electronic Health Records in the US and Europe.

If Electronic Health Record systems are to provide an effective contribution to healthcare, a set of benchmarks need to be set to ensure quality control and interoperability of systems. This paper outlines the prevailing status of EHR certification in the US and the EU, compares and contrasts established schemes and poses opportunities for convergence of activity in the domain designed to advance certification endeavours generally. Several EU Member States have in the past proceeded with EHR systems quality labeling and/or certification, but these differ in scope, in legal framework under which they operate, in policies (legislation and financial incentives), in organization, and perhaps most importantly in the quality criteria used for benchmarking. Harmonization, therefore, became a must. Now, through EuroRec (with approaches ranging from self-assessment to third party certification depending on the level of confidence needed) and its Seals, the possibility to achieve this for EHR systems has started in the whole of Europe. The US HITECH Act also attempts to create incentives for all hospitals and eligible providers to adopt and use electronic information. A centerpiece of the Act is to put in place strong financial incentives to adopt and meaningfully use EHRs. The HHS/EHR Certification Programme makes use of ISO/IEC 170XX standards for accreditation, testing and certification. The approved test method addresses the functional and the interoperability requirements defined in the Final Rule criteria and standards. To date six Authorized Testing and Certification Bodies (ATCBs) are testing and certifying products in the US.

A Literature Review on the GDPR, COVID-19 and the Ethical Considerations of Data Protection During a Time of Crisis.

OBJECTIVE: This survey article presents a literature review of relevant publications aiming to explore whether the EU's General Data Protection Regulation (GDPR) has held true during a time of crisis and the implications that arose during the COVID-19 outbreak. METHOD AND RESULTS: Based on the approach taken and the screening of the relevant articles, the results focus on three themes: a critique on GDPR; the ethics surrounding the use of digital health technologies, namely in the form of mobile applications; and the possibility of cross border transfers of said data outside of Europe. Within this context, the article reviews the arising themes, considers the use of data through mobile health applications, and discusses whether data protection may require a revision when balancing societal and personal interests. CONCLUSIONS: In summary, although it is clear that the GDPR has been applied through a mixed and complex experience with data handling during the pandemic, the COVID-19 pandemic has indeed shown that it was a test the GDPR was designed and prepared to undertake. The article suggests that further review and research is needed to first ensure that an understanding of the state of the art in data protection during the pandemic is maintained and second to subsequently explore and carefully create a specific framework for the ethical considerations involved. The paper echoes the literature reviewed and calls for the creation of a unified and harmonised network or database to enable the secure data sharing across borders.

Quality of Hospital Electronic Health Record (EHR) Data Based on the International Consortium for Health Outcomes Measurement (ICHOM) in Heart Failure: Pilot Data Quality Assessment Study.

BACKGROUND: There is increasing recognition that health care providers need to focus attention, and be judged against, the impact they have on the health outcomes experienced by patients. The measurement of health outcomes as a routine part of clinical documentation is probably the only scalable way of collecting outcomes evidence, since secondary data collection is expensive and error-prone. However, there is uncertainty about whether routinely collected clinical data within electronic health record (EHR) systems includes the data most relevant to measuring and comparing outcomes and if those items are collected to a good enough data quality to be relied upon for outcomes assessment, since several studies have pointed out significant issues regarding EHR data availability and quality. OBJECTIVE: In this paper, we first describe a practical approach to data quality assessment of health outcomes, based on a literature review of existing frameworks for quality assessment of health data and multistakeholder consultation. Adopting this approach, we performed a pilot study on a subset of 21 International Consortium for Health Outcomes Measurement (ICHOM) outcomes data items from patients with congestive heart failure. METHODS: All available registries compatible with the diagnosis of heart failure within an EHR data repository of a general hospital (142,345 visits and 12,503 patients) were extracted and mapped to the ICHOM format. We focused our pilot assessment on 5 commonly used data quality dimensions: completeness, correctness, consistency, uniqueness, and temporal stability. RESULTS: We found high scores (>95%) for the consistency, completeness, and uniqueness dimensions. Temporal stability analyses showed some changes over time in the reported use of medication to treat heart failure, as well as in the recording of past medical conditions. Finally, the investigation of data correctness suggested several issues concerning the characterization of missing data values. Many of these issues appear to be introduced while mapping the IMASIS-2 relational database contents to the ICHOM format, as the latter requires a level of detail that is not explicitly available in the coded data of an EHR. CONCLUSIONS: Overall, results of this pilot study revealed good data quality for the subset of heart failure outcomes collected at the Hospital del Mar. Nevertheless, some important data errors were identified that were caused by fundamentally different data collection practices in routine clinical care versus research, for which the ICHOM standard set was originally developed. To truly examine to what extent hospitals today are able to routinely collect the evidence of their success in achieving good health outcomes, future research would benefit from performing more extensive data quality assessments, including all data items from the ICHOM standards set and across multiple hospitals.

Sock systems to prevent foot blisters and the impact on overuse injuries of the knee joint.

The incidence of foot blisters and other overuse injuries of the lower limb is very high during basic military training (BMT). One hundred and eighty-nine subjects were divided into two intervention groups wearing alternative sock systems and one control group. Overall, 57% of the 173 recruits who completed the training, developed foot blisters. Binary logistic regression revealed the type of sock, race, previous hiking or military experience, and known orthopedic foot conditions to be predictive variables for foot blisters. Fifty-three percent of the 173 recruits also developed another overuse injury of the lower limb (25.4% related to the knee joint). Previous military or hiking experience and the association of foot blisters revealed to be predictive for the overuse injuries of the knee joint. The results of the present study suggest associated foot blisters are also an important factor in the development of overuse injuries of the knee joint during BMT.

Assessment of the validity of the Biering-Sørensen test for measuring back muscle fatigue based on EMG median frequency characteristics of back and hip muscles.

The aims of the present study were (1) to investigate the differences in median frequency characteristics between back and hip muscles of healthy subjects during a Biering-Sørensen test, (2) to determine if the Biering-Sørensen test is a valid test for measuring back muscle fatigue, and (3) to standardise the Biering-Sørensen test by using objective movement analysis when defining endurance time, and compare this to the original method based on tactile feedback. Twenty healthy subjects participated in this experiment. The electromyographic activity of eight back and hip muscles was bilaterally measured. In addition three-dimensional data of the lumbar region were collected with an ultrasound movement analysis system. Median frequencies were computed from the EMG power spectra. Two methods of determining the endurance time of the Biering-Sørensen test yielded highly correlated but significantly different normalized median frequency slope values (NMF(slope)). Significant differences in NMF(slope) values between several back and hip muscles could be demonstrated. Low to moderate correlation coefficients were shown between NMF(slope) values and endurance time. Multiple stepwise linear regression analyses revealed that only NMF(slope) of the thoracic part of the iliocostalis lumborum muscle could significantly predict the test endurance time. The findings of the present study support the validity of the Biering-Sørensen test for measuring back muscle fatigue.

Test-retest reliability of wavelet - and Fourier based EMG (instantaneous) median frequencies in the evaluation of back and hip muscle fatigue during isometric back extensions.

The present study aimed at assessing the test-retest reliability of wavelet - and Fourier derived (instantaneous) median frequencies of surface electromyographic (EMG) measurements of back and hip muscles during isometric back extensions. Twenty healthy subjects (10 males and 10 females) performed a modified Biering-Sørensen test on two separate days, with a 1-week interval between the two tests. Surface EMG measurements were bilaterally performed from the latissimus dorsi, the thoracic and lumbar parts of the longissimus thoracis, the thoracic and lumbar parts of the iliocostalis lumborum, the multifidus, the gluteus maximus and the biceps femoris. In addition, three-dimensional kinematic data were recorded of the subjects' lumbar vertebrae. The (instantaneous) median frequencies were calculated from the EMG signals using continuous wavelet (IMDF) - and short-time Fourier transforms (MDF). Linear regressions performed on the IMDF and MDF data as a function of time yielded slopes (IMDF(slope) and MDF(slope)) and intercepts (IMDF(init) and MDF(init)) of the regression lines. Test-retest reliability was assessed on the normalized slopes and intercept parameters by means of intraclass correlation coefficients (ICC) and standard errors of measurements expressed as percentages of the mean values (% SEM). The results of IMDF(slope) and MDF(slope) parameters indicated ICCs for back and hip muscles between .443 and .727 for IMDF(slope), values between .273 and .734 for MDF(slope), % SEM between 7.6% and 58.9% for IMDF(slope) and % SEM between 8.2% and 25.3% for MDF(slope), respectively. The ICCs for IMDF(init) and MDF(init) parameters varied between .376 and .907 for IMDF(init) and between .383 and .883 for MDF(init), and % SEM ranged from 2.7% to 6.3% for IMDF(init) and from 2.6% to 4.7% for MDF(init), respectively. These results indicate that both wavelet - and Fourier based (instantaneous) median frequency parameters generally are reliable in the analysis of back and hip muscle fatigue during a modified Biering-Sørensen test.

Correlations between short-time Fourier- and continuous wavelet transforms in the analysis of localized back and hip muscle fatigue during isometric contractions.

The aims of the current study were to examine the stationarities of surface electromyographic (EMG) signals obtained from eight bilateral back and hip muscles during a modified Biering-Sørensen test, and to investigate whether short-time Fourier (STFT) and continuous wavelet transforms (CWT) provided similar information with regard to EMG spectral parameters in the analysis of localized muscle fatigue. Twenty healthy subjects participated in the study after giving their informed consent. Reverse arrangement tests showed that 91.6% of the EMG signal epochs demonstrated no significant trends (all p>0.05), meaning 91.6% of the EMG signal epochs could be considered as stationary signals. Pearson correlation coefficients showed that STFT and CWT in general provide similar information with respect to the EMG spectral variables during isometric back extensions, and as a consequence STFT can still be used.

The effect of increasing resistance on trunk muscle activity during extension and flexion exercises on training devices.

Although progressive resistance training of trunk muscles on devices is very common, today, the effects of increasing resistance on trunk muscle activity during dynamic extension and flexion movements on training devices have not been reported yet. Thirty healthy subjects participated in maximal isometric and submaximal dynamic (at 30%, 50% and 70% of maximum mean torque (MMT)) extension and flexion exercises on Tergumed lumbar training devices. The normalized (as a percentage of maximal voluntary isometric contractions (MVIC)) electromyographic activity of 16 abdominal and back muscles was investigated. The results of the present study indicated that in general, with increasing resistance from 30% MMT to 50% MMT and 70% MMT, the activity of all back muscles during the extension exercises and the activity of all abdominal muscles during the flexion exercises increased significantly. To train strength (>60% of MVIC), low intensities (30% and 50% MMT) appeared sufficient to affect the back muscles, but for the abdominals higher resistance (70% MMT) was required. In contrast to the other back muscles, the lumbar multifidus demonstrated high activity levels during both the extension and the flexion exercises. As the lumbar multifidus is demonstrated to be an important muscle in segmental stabilization of the lumbar spine, this finding may help in understanding the efficacy of rehabilitation programs using specific training devices.

Trans-eCare: creating a transparent data exchange platform.

Home health care (HHC) organizations as well as hospitals encounter information-tracking problems regarding their patients. When a patient is admitted to the hospital, it is not always possible/easy to find out if this person already had HHC and if so, by which organization it was provided. HHC organizations also not always know to which hospital a person is admitted. At discharge, although discharge documents exist, HHC organizations not always receive the necessary information. However, sharing information between the different care-partners involved is important, among others for the continuity of care. Hospitals will gain better insight in the provided home care before admission, and HHC organizations will get a more complete and direct insight in the course of care at the hospital. In doing so, they are better prepared to provide the necessary care for the patient admitted to the hospital or returning at home. Discussion with the partners involved in the IBBT-Trans-eCare project resulted in tracking the current problems, defining goals and presenting a solution to meet the defined problems.

[Value of hospital electronic health records for clinical research: contribution of the European project EHR4CR]. / Intérêt des dossiers de santé électroniques hospitaliers pour la recherche clinique - Le projet européen EHR4CR.

Electronic health records in hospitals contribute to improving the quality of care by enabling better management of clinical information. The databases thus constituted facilitate the exchange of health information with healthcare providers and optimize multidisciplinary coordination for better therapeutic results. The EHR4CR (Electronic Health Records for Clinical Research) European project has developed an innovative pilot platform enabling the reuse of this digital information for clinical research. By enhancing and speeding up clinical research procedures, this innovative approach makes it possible to conduct clinical trials more efficiently, faster, and more economically.

Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: Loading compliance.

BACKGROUND: Load-bearing exercises are performed by transfemoral amputees fitted with an osseointegrated implant to facilitate bone remodelling. OBJECTIVE: This study presents the loading compliance comparing loads prescribed and applied on the three axes of the implant during static load-bearing exercises with a specific emphasis on axial and vectorial comparisons. STUDY DESIGN: Cohort study. METHODS: A total of 11 fully rehabilitated unilateral transfemoral amputees fitted with an osseointegrated implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included 'axial' and 'vectorial' comparisons corresponding to the difference between the force applied on the long axis of the implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively. RESULTS: The results demonstrated that axial and vectorial differences were significant in all conditions ( p < 0.05), except for the vectorial difference for the 40 kg condition ( p = 0.182). CONCLUSION: The significant lack of axial compliance led to systematic underloading of the long axis of the implant. Clinical relevance This study contributes to a better understanding of the load applied on an osseointegrated implant during the static load-bearing exercises that could contribute to improve the design of apparatus to monitor loading exercises as well as clinical guidelines for the loading progression during rehabilitation.

Business analysis for a sustainable, multi-stakeholder ecosystem for leveraging the Electronic Health Records for Clinical Research (EHR4CR) platform in Europe.

INTRODUCTION: The Electronic Health Records for Clinical Research (EHR4CR) technological platform has been developed to enable the trustworthy reuse of hospital electronic health records data for clinical research. The EHR4CR platform can enhance and speed up clinical research scenarios: protocol feasibility assessment, patient identification for recruitment in clinical trials, and clinical data exchange, including for reporting serious adverse events. Our objective was to seed a multi-stakeholder ecosystem to enable the scalable exploitation of the EHR4CR platform in Europe, and to assess its economic sustainability. MATERIALS AND METHODS: Market analyses were conducted by a multidisciplinary task force to define an EHR4CR emerging ecosystem and multi-stakeholder value chain. This involved mapping stakeholder groups and defining their unmet needs, incentives, potential barriers for adopting innovative solutions, roles and interdependencies. A comprehensive business model, value propositions, and sustainability strategies were developed accordingly. Using simulation modelling (including Monte Carlo simulations) and a 5-year horizon, the potential financial outcomes of the business model were forecasted from the perspective of an EHR4CR service provider. RESULTS: A business ecosystem was defined to leverage the EHR4CR multi-stakeholder value chain. Value propositions were developed describing the expected benefits of EHR4CR solutions for all stakeholders. From an EHR4CR service provider's viewpoint, the business model simulation estimated that a profitability ratio of up to 1.8 could be achieved at year 1, with potential for growth in subsequent years depending on projected market uptake. CONCLUSIONS: By enhancing and speeding up existing processes, EHR4CR solutions promise to transform the clinical research landscape. The ecosystem defined provides the organisational framework for optimising the value and benefits for all stakeholders involved, in a sustainable manner. Our study suggests that the exploitation of EHR4CR solutions appears profitable and sustainable in Europe, with a growth potential depending on the rates of market and hospital adoption.