The advancement of telemedicine has allowed to reach users of various demographics. In this paper we compare two cohorts, adolescents and geriatrics at a virtual care clinic. We calculated frequent chief complaints, modality of communication, and the distribution of gender. Our findings show that elderly female population prefers telemedicine more than men, and adolescents are more likely to use video calls than the geriatric population.
Tuberculosis (TB) represents a global challenge in terms of prevention, care and control. Decision support systems (DSS) can supply the necessary knowledge basis to underpin investigators, policy makers and health personnel actions and to provide crucial elements that can help reducing TB burden. Thus, the objectives of this work are to present the protocol to be followed for carrying out a scoping review to identify topics where DSSs are used, to define appropriate categories and to clarify main outcomes and research gaps. As part of the protocol, five electronic bibliographic databases will be searched for articles from 2006 to 2019 and two investigators will independently screen each work using the study inclusion criteria. Data extraction will be performed, and findings will be reported. The results will be used to provide a broad understanding of how DSSs for TB are being used.
Correct choice and administration of a statistical test are absolutely essential for meaningful interpretation of research data, yet mistakes are still frequent and could be easily found in published scientific papers or PhD theses. The aim of this study was to analyze mistakes made by PhD students in statistical analysis of data collected during research within the framework of their thesis. PhD students frequently use Excel and SPSS for data processing, while SAS, Stata and R are also available. The study was designed as cross-sectional analysis of random sample (n=15) of PhD theses in pre-approval stage at Faculty of Medical Sciences, University of Kragujevac, Serbia. In total 14 (93%) theses had at least one mistake. The most frequent mistakes were as the following: insufficient statistical power due to small sample size, inappropriate presentation of results at tables and graphs, andinappropriate choice of statistical tests. In order to improve the situation, training courses in statistics during PhD studies should be re-evaluated and improved in regard to relevance, delivery methods and motivating potential, and mentors should invest more effort to review the data and guide students through statistical analysis.
A ‘Rapid Recommendation’ has been produced by the GRADE group, in collaboration with MAGIC and BMJ, in response to an RCT showing Dual Anti-Platelet Therapy (DAPT) is superior to Aspirin alone for patients who had suffered acute high risk transient ischaemic attack or minor ischaemic stroke. The interactive MAGIC decision aid that accompanies each Rapid Recommendation is the main route to their clinical implementation. It can facilitate preference-sensitive person-centred care, but only if a Multi-Criteria Decision Analysis-based decision support tool is added. A demonstration version of such an add-on to the MAGIC aid, divested of recommendations, is available online. Exploring the results of different preference inputs into the tool raises questions about the strong recommendation for DAPT.
Composite multi-dimensional constructs, such as ‘global mental health’ and ‘global physical health’, in PROMIS® instruments and ICHOM standard outcome sets, are formative, not reflective. Their preference-insensitivity means they are potentially misleading in both clinical and policy decision making practice. Their frequent validation by reflective psychometric tests is also improper methodologically. The spread of these instruments is occurring without sufficient awareness on the part of patients, clinicians, researchers and policy makers that the need for group-specific preference bases (‘tariffs’) for such measures rules out any possibility of ‘international gold standard metrics’.
A growing number of condition-specific standard outcome sets have been developed by the International Consortium for Health Outcomes Measurement in pursuit of ‘value-based care’. These sets embrace many Patient-Reported Outcome Measures (PROMs), reflecting a simultaneous commitment to ‘patient-centred care’. However, none of these sets embody recognition of the preference-sensitive nature of the decisions that eventually generate the outcome database. ‘Patient-Reported Importance Measures’ (PRIMs) are the valid source of the required preferences. The ICHOM Stroke standard set is input into a hypothetical Multi-Criteria Decision Analysis-based decision support tool to provide simple confirmation that PROMs should be preference-mix adjusted as well as case-mix adjusted. PROMs need PRIMs if value-based care is to be personalised values-based care.
Experiences and outcomes of critically ill patients reflect quality of intensive care. The aim of this study was twofold: a) to investigate factors affecting patients’ experiences to Intensive Care Units (ICUs) and b) to measure patients’ post discharge Health-Related Quality of Life (HRQOL).
Methods: A cross-sectional study with retrospective data collection was carried out. The participants (n=108) were discharged patients from four ICUs of three military hospitals in Athens. Telephone interviews were conducted using the “Patient Empowerment Questionnaire” and “Quality of life Questionnaire”.
Results: Patients suffering from pain (p<0.001), polytraumatized or patients underwent a “non-scheduled surgery” (p=0.001) reported worse sleep at night. Mechanical ventilation was associated positively with pain relief (p=0.021). Extended length of stay (p<0.001), bad health status prior ICU admission (p=0.005), “polytrauma” and “non-scheduled surgery” patients (p=0.032), mechanical ventilation (p=0.005) and pain during ICU stay (p=0.04) were correlated with worse HRQOL after discharge.
Conclusions: ICU staff must consider the factors that affected patients’ experiences during their ICU stay and worsened HRQOL after discharge. Adoption of new technological innovations could help them to improve the quality of intensive care provided.
This paper presents a high-fidelity prototype of a mobile game for teaching children fundamental skills in first aid. The study utilizes expert interviews to define learning scope and evaluate design. The game introduces two situations based on realistic scenarios; a boy who fell on a skateboard, and an elderly man with chest pains. Interactive elements introduce a way for the user to explore and assess a given situation. Gamification keeps motivation for learning high, and choice of graphical elements keeps situations feel familiar but non-frightening. There is a quiz to help children learn how to communicate with emergency services. Experts believe that children can learn essential steps for providing basic first aid, except physically fatiguing techniques, so they found the prototype to be a viable option for learning basic first aid at a young age.
Over time there has been an increase of the number of people affected by chronic obstructive respiratory diseases, burdening healthcare providers. Following the growth of information technologies, it has been sought the development of innovative solutions that help monitoring and treating patients. In this work is proposed the architecture for a coaching module to be integrated in the system developed by the PHE project. With the goal to improve patients’ health condition by providing innovative and intelligent measuring and monitoring tools for preventive healthcare and allow affordable solutions with increased patient involvement. With this work, we define the architecture for a module that can generate recommendations adapted to each patient. By doing so, we believe to be possible to motivate the adoption of behaviors that benefit the health condition of the patient and decrease the risk of complications associated to the disease.
Clinical Practice Guidelines (CPGs) gather latest evidence-based results to guide and support clinicians over the decision-making process to provide best care. Nevertheless, clinical cases may be subject to some biases (understood as non-compliance with CPGs) that can lead to adapt care delivery. In this work an experience-based decision support leaning on the structuration of the Decisional Event concept for tracking and storing each clinical decision is presented. Moreover, a visual analytics tool is provided in order to facilitate the visualization of biases from guideline-based decision support and the identification and inclusion of real-world evidence into the reasoning process by augmenting the knowledge formalized in the implemented guidelines.
Antimicrobial computerized decision support systems (CDSS) have been developed to improve decision-making at the point of prescribing. Uptake of CDSS for antibiotic prescribing remains low, and evidence to suggest that CDSS provides a clear benefit for antimicrobial outcomes is scarce. We reviewed existing evidence on the impact of CDSS on antimicrobial prescribing. Based on the results of our literature search, we discuss the use of CDSS for antimicrobial management in hospitals and antibiotic prescribing practices in ambulatory primary care settings. We identify some of the issues surrounding selecting and defining appropriate outcome measures for assessing the impact of CDSS on antimicrobial prescribing in the hospital setting. In the primary care setting, we observed that CDSS has a modest impact in changing antibiotic prescribing practice, which could be related to the underutilization of antimicrobial CDSS.
The aim is to recognize the unknown atterns in a real breast cancer dataset using data mining algorithms as a new method in medicine. Due to excessive missing data in the collection only data on 665 of 809 patients were available. The other missing values were estimated using the EM algorithm in SPSS21 software. Fields have been converted into discrete fields and finally the APRIORI algorithm has been used to analyze and explore the unknown patterns. After the rule extraction, experts in the field of breast cancer eliminated redundant and meaningless relations. 100 association rules with a confidence value of more than 0.9 explored by the APRIORI algorithm and after the clinical expert feedback, 10 clinically meaningful relations have been detected and reported. Due to the high number of risk factors, the use of data mining is effective for cancer data. These patterns provide the future study hypotheses of specific clinical studies.
The roots of interdisciplinary of medical informatics are sought through the analysis of the themes approached by the pioneers of this field. The data included in the study comes mostly from “personal stories” of European these scientists collected by IMIA WG History as well as from some biographical notes. Most researchers came from the technical-scientific field, but the double specialization was very common. The proportions of the main topic approaches are discussed. The roots of medical informatics interdisciplinary were formed during the pioneering period, when most major concepts and chapters of medical informatics took contour.
Healthcare professionals play a key role in supporting self-care among patients and clients. Their attitudes and behaviors may influence a patient’s capacity to use electronic services (e-services) and may increase patients’ trust toward a technical solution. The technology acceptance model explains information systems use and the important variables that play a role in an individual’s acceptance of e-services. This survey was designed to capture the expectations of healthcare personnel. Participants (n = 91) suggested that patients would benefit from this e-service. The e-services enabled participants to find patient health records more easily than before, and they perceived that the care relationship improved as a result.
Immunisation is a key preventive health measure for children. E-health applications have been used for over 50 years, yet still there is no harmonization or standardization, while uncoordinated policy initiatives proliferate. Two EU research projects (Trillium II and MOCHA) have come together with experts and stakeholders, and used EU-wide situation analysis research to seek to stimulate development of data and process standards as a harmonizing force in a supporting policy environment, putting the child as the central data collation unit.
A potentially useful resource for health promotion and guidance is eHealth. However, this field also presents challenges, and one of the most important obstacles is the lack of regulation, without which citizens including young people may be exposed to misleading or risky information and applications. The aim of this study was to investigate the extent of accreditation processes for mobile applications (apps) and websites in European countries, to determine whether regulation is on the agenda. A survey was conducted in 28 European Member States and 2 European Economic Area countries, between 2017 and 2018. Twenty-seven responses were collected. Six countries have accreditation processes for apps and eight countries have accreditation processes for websites. However, processes are fragmented and there is variety within and amongst countries.
Health decision-making is heavily premised on routinely reported data from lower levels of healthcare delivery to the national level. The reported data are of best use if their quality is high. Unfortunately, in many resource-limited settings in sub-Saharan Africa, the quality of reported data is often poor. Among the reasons attributed for poor data quality is use of sub-optimal modalities for collecting and transmitting data, such as paper-based and Short Message Service (SMS). Through a user-centered approach, we developed and implemented an Unstructured Supplementary Service Data (USSD)-based health data reporting intervention in a district in Uganda. The impact of the developed system on report accuracy, timeliness and completeness was evaluated against the expected 100% rates by the Ministry of Health (MoH). A total of 224 reports were submitted over the two-month study period. Of the submitted reports, 171 (76.3%) were complete (p<0.0001) compared to MoH’s required 100%). 161 (71.9%) were accurate (P<0.0001), and 158 (70.5%) of the reports were submitted on time (p<0.0001). The deficiencies were largely attributed to a few facilities, as only 17.9% of facilities had data discrepancies with a mean of − 2.11 (P=0.38), 96.4% (0.130) of the facilities had complete reports and 87.4% (0.100) of the facilities reported on time. Poor network coverage was an outstanding challenge to reporting.
The purpose of the study was to investigate the experiences of discharged patients from Intensive Care Units (ICUs). A study with retrospective data collection (n=112) was conducted via interviews using the Intensive Care Experience Questionnaire. 93% of participants reported positive experiences from the ICU. Frightening experiences were restricted to minimum levels (mean score=9/25), while the feeling of security was prevalent (96.5%) and care satisfaction was high (mean score=18.2/20). Communicating the aforementioned experiences, professionals may better understand patients’ needs in order to improve the IT systems and patients’ hospitalization.
One of the major problems that a national health system face is the lack of a unified clinical data management. In Greece, the critical and sensitive medical data generated during a patient lifetime are fragmented in one or more hospitals and healthcare services are not characterized by a ‘continuity’ factor. There is not the appropriate technological and administrative infrastructure for a unified patient medical history, prescriptions, laboratory tests or therapeutic plan. Technological, administrative and economic factors have led to this situation. We propose the integration and implementation of a blockchain network as a complementary technology to the existing information systems, so reliable and effective information management could be provided by a healthcare organization or the national healthcare system. Blockchain technology could be implemented as a bridge that can provide information systems interoperability within a hospital or between different hospitals.
The blockchain is one of the most popular information technologies and, at the same time, it was discredited by stories about crashes of multiple cryptocurrency projects. Even though this technology has recently found application in many areas not related to cryptocurrencies, mainly for security purposes, the attitude towards it remains wary. Herein we shall try to demonstrate that blockchain is something going far beyond cryptocurrency and security issues, and may become one of the fundamental information technologies in future healthcare.
Nowadays, medical informatics is unavoidable topic when talking about health innovations and modern practice. Education of professionals in medical informatics is a challenging issue since they need to be capable to respond to challenges of modern health care systems, heterogeneous health information systems with integrated devices and remote access/controls, rapid development of both technology and the character of applications, etc. However, variety of medical informatics educational programs are established all over the world, and there is no general approach that shall be followed and applied. This paper presents key findings and results of comprehensive review and analyses of well-known EU best practices in medical informatics education, on which bases innovative star model is created for educational system in medical informatics at national level.
Optimal antibiotic use for the treatment of nosocomial infections plays a central role in the effort to control the rapidly increasing prevalence of multidrug-resistant bacteria. Antibiotic selection should be based on accurate knowledge of local susceptibility rates. Traditional methods of resistance reporting, which are in routine use by microbiology laboratories could be enhanced by using statistically significant results. We present a method of reporting based on antibiotic susceptibility data analysis which offers an accurate tool that reduces clinician uncertainty and enables optimization of the antibiotic selection process.
The very act of using indicators by converting the raw data collected to information for purposes such as monitoring, evaluation, decision-making and management make indicators essential tools for health care services and health systems. In addition, Health Data Warehouses (HDWs) play an important role in development, and use of indicators in healthcare. Despite the numerous studies revolving around use of indicators in health care, analysis of usage of indicators by various studies in healthcare, which have leveraged HDWs are limited. To bridge this gap, we conducted a literature review to provide an analysis of usage of clinical indicators, and health indicators by various studies, which leverage HDWs in their development or use. We further discuss the benefits, and challenges of indicator use faced in these studies. As a result of the analysis, this paper thus aims to promote leveraging HDWs in development, and use of indicators for decision-making, and monitoring and evaluation efforts in health care.
Road accidents are one of the major causes of loss of life, injuries and damage of property. The aim of this paper is to assess the overall health status (physical and psychological) of road accident victims and to propose a Health IT system to managing the assessment procedure. A prospective observational study was conducted among 474 people attended to the emergency department, after a road accident. 30% of the participants were 18–28 years old. After the road accident, most patients (67.1%) did not develop depression and 3 and 6 months after the accident, depression levels were higher. In contrast, the patients’ QoL showed improvement over time. As road accidents seems to be a high risk incidents that can affect the health status of people, an Health IT system is suggested to contribute on the management of the assessment of the patients’ health status.
The article presents the semantic model of diagnostics and treatment of patients with gastrointestinal bleedings when the reasons of bleeding cannot be establihed by means of a laboratory tests, endoscopy and colonoscopy.