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Paton C, Amarakoon P, Braa J, Kobayashi S, Marcelo A, Kane T, Fraser H, Hannan T. Open Source Software in Healthcare: International Case Series from the IMIA Open Source Working Group. Stud Health Technol Inform 2024; 310:1266-1270. [PMID: 38270018 DOI: 10.3233/shti231168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
In this case series, we demonstrate how open-source software has been widely adopted as the primary health information system in many low- and middle-income countries, and for government-developed applications in high-income settings. We discuss the concept of Digital Global Goods and how the general approach of releasing software developed through public funding under open-source licences could improve the delivery of healthcare in all settings through increased transparency and collaboration as well as financial efficiency.
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Aljibe M, Bettin J, Kijsanayotin B, Lee HA, Ng C, Sorsavanh T, Weerabaddana C, Marcelo A. Community of Interoperability Labs: Pragmatic Approach to Achieving Interoperability. Stud Health Technol Inform 2024; 310:38-42. [PMID: 38269761 DOI: 10.3233/shti230923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
To achieve interoperability of health data, stakeholders must overcome various socio-technical challenges. The "Mind the GAPS, Fill the GAPS" framework was created by the Asia eHealth Information Network (AeHIN) in 2017 to help countries with their challenges with interoperability. A year later, AeHIN formed the Community of Interoperability Labs (COIL), a group of labs from six countries to share knowledge and resources. Since interoperability requires data exchange between disparate entities, it is imperative to establish a trustworthy space where stakeholders can come together and solve their common problems. The networked learning approach of the COIL makes possible the potential for interoperability within and between countries contributing to national and international understanding.
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Affiliation(s)
| | | | | | | | - Clube Ng
- eHealth Research Institute, Hong Kong
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Fraser HS, Marcelo A, Kalla M, Kalua K, Celi LA, Ziegler J. Digital determinants of health: Editorial. PLOS Digit Health 2023; 2:e0000373. [PMID: 38016101 PMCID: PMC10684281 DOI: 10.1371/journal.pdig.0000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Hamish S. Fraser
- Brown Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States of America
| | - Alvin Marcelo
- Medical Informatics Unit, University of the Philippines, Manila, The Philippines
| | - Mahima Kalla
- Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre, Malawi
| | - Leo A. Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jennifer Ziegler
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Gallifant J, Zhang J, Whebell S, Quion J, Escobar B, Gichoya J, Herrera K, Jina R, Chidambaram S, Mehndiratta A, Kimera R, Marcelo A, Fernandez-Marcelo PG, Osorio JS, Villanueva C, Nazer L, Dankwa-Mullan I, Celi LA. A new tool for evaluating health equity in academic journals; the Diversity Factor. PLOS Glob Public Health 2023; 3:e0002252. [PMID: 37578942 PMCID: PMC10424852 DOI: 10.1371/journal.pgph.0002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
Current methods to evaluate a journal's impact rely on the downstream citation mapping used to generate the Impact Factor. This approach is a fragile metric prone to being skewed by outlier values and does not speak to a researcher's contribution to furthering health outcomes for all populations. Therefore, we propose the implementation of a Diversity Factor to fulfill this need and supplement the current metrics. It is composed of four key elements: dataset properties, author country, author gender and departmental affiliation. Due to the significance of each individual element, they should be assessed independently of each other as opposed to being combined into a simplified score to be optimized. Herein, we discuss the necessity of such metrics, provide a framework to build upon, evaluate the current landscape through the lens of each key element and publish the findings on a freely available website that enables further evaluation. The OpenAlex database was used to extract the metadata of all papers published from 2000 until August 2022, and Natural language processing was used to identify individual elements. Features were then displayed individually on a static dashboard developed using TableauPublic, which is available at www.equitablescience.com. In total, 130,721 papers were identified from 7,462 journals where significant underrepresentation of LMIC and Female authors was demonstrated. These findings are pervasive and show no positive correlation with the Journal's Impact Factor. The systematic collection of the Diversity Factor concept would allow for more detailed analysis, highlight gaps in knowledge, and reflect confidence in the translation of related research. Conversion of this metric to an active pipeline would account for the fact that how we define those most at risk will change over time and quantify responses to particular initiatives. Therefore, continuous measurement of outcomes across groups and those investigating those outcomes will never lose importance. Moving forward, we encourage further revision and improvement by diverse author groups in order to better refine this concept.
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Affiliation(s)
- Jack Gallifant
- Department of Intensive Care, Imperial College London NHS Trust, London, United Kingdom
| | - Joe Zhang
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Stephen Whebell
- Intensive Care Unit, Townsville University Hospital, Townsville, Queensland, Australia
| | - Justin Quion
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | - Judy Gichoya
- School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Karen Herrera
- Faculty of Medicine, Military Hospital, Managua, Nicaragua
| | - Ruxana Jina
- The Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Services, Gauteng Region, South Africa
- The Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Abha Mehndiratta
- Center for Global Development, Washington, DC, United States of America
| | - Richard Kimera
- Department of Information Technology, Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Advanced Convergence, Handong Global University, Pohang-si, South Korea
| | - Alvin Marcelo
- University of the Philippines Manila, Manila, Philippines
| | - Portia Grace Fernandez-Marcelo
- Department of Family and Community Medicine, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | | | - Cleva Villanueva
- Instituto Politecnico Nacional, Escuela Superior de Medicina, Mexico City, Mexico
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Irene Dankwa-Mullan
- Merative, & Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts, United States of America
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Leo Anthony Celi
- Massachusetts Institute of Technology, Laboratory for Computational Physiology, Cambridge, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Seastedt KP, Schwab P, O’Brien Z, Wakida E, Herrera K, Marcelo PGF, Agha-Mir-Salim L, Frigola XB, Ndulue EB, Marcelo A, Celi LA. Global healthcare fairness: We should be sharing more, not less, data. PLOS Digit Health 2022; 1:e0000102. [PMID: 36812599 PMCID: PMC9931202 DOI: 10.1371/journal.pdig.0000102] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The availability of large, deidentified health datasets has enabled significant innovation in using machine learning (ML) to better understand patients and their diseases. However, questions remain regarding the true privacy of this data, patient control over their data, and how we regulate data sharing in a way that that does not encumber progress or further potentiate biases for underrepresented populations. After reviewing the literature on potential reidentifications of patients in publicly available datasets, we argue that the cost-measured in terms of access to future medical innovations and clinical software-of slowing ML progress is too great to limit sharing data through large publicly available databases for concerns of imperfect data anonymization. This cost is especially great for developing countries where the barriers preventing inclusion in such databases will continue to rise, further excluding these populations and increasing existing biases that favor high-income countries. Preventing artificial intelligence's progress towards precision medicine and sliding back to clinical practice dogma may pose a larger threat than concerns of potential patient reidentification within publicly available datasets. While the risk to patient privacy should be minimized, we believe this risk will never be zero, and society has to determine an acceptable risk threshold below which data sharing can occur-for the benefit of a global medical knowledge system.
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Affiliation(s)
- Kenneth P. Seastedt
- Beth Israel Deaconess Medical Center, Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Patrick Schwab
- GlaxoSmithKline, Artificial Intelligence & Machine Learning, Zug, Switzerland
| | - Zach O’Brien
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edith Wakida
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Karen Herrera
- Quality and Patient Safety, Hospital Militar, Managua, Nicaragua
| | - Portia Grace F. Marcelo
- Department of Family & Community Medicine, University of the Philippines, Manila, Philippines
| | - Louis Agha-Mir-Salim
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Laboratory for Computational Physiology, Harvard-MIT Division of Health Sciences & Technology, Cambridge, Massachusetts, United States of America
| | - Xavier Borrat Frigola
- Laboratory for Computational Physiology, Harvard-MIT Division of Health Sciences & Technology, Cambridge, Massachusetts, United States of America
- Anesthesiology and Critical Care Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Emily Boardman Ndulue
- Department of Journalism, Northeastern University, Boston, Massachusetts, United States of America
| | - Alvin Marcelo
- Department of Surgery, University of the Philippines, Manila, Philippines
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Harvard-MIT Division of Health Sciences & Technology, Cambridge, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biostatistics Harvard T.H, Chan School of Public Health, Boston, Massachusetts, United States of America
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Nakashima N, Maruf RI, Schaper L, Wong CP, Choi IY, Hunter I, Marcelo A, Tiongson N, John O, Gogia SB, Yeh Hsu C, Lin MCM, Hossain Bhuiyan Masud J, Dissanayake VHW, Kijsanayotin B. APAMI. Yearb Med Inform 2022. [DOI: 10.1055/s-0042-1742492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Paton C, Braa J, Muhire A, Marco-Ruiz L, Kobayashi S, Fraser H, Falcón L, Marcelo A. Open Source Digital Health Software for Resilient, Accessible and Equitable Healthcare Systems. Yearb Med Inform 2022; 31:67-73. [PMID: 35654431 DOI: 10.1055/s-0042-1742508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To assess the impact of open-source projects on making healthcare systems more resilient, accessible and equitable. METHODS In response to the International Medical Informatics Association (IMIA) call for working group contributions for the IMIA Yearbook, the Open Source Working Group (OSWG) conducted a rapid review of current open source digital health projects to illustrate how they can contribute to making healthcare systems more resilient, accessible and equitable. We sought case studies from the OSWG membership to illustrate these three concepts and how open source software (OSS) addresses these concepts in the real world. These case studies are discussed against the background of literature identified through the rapid review. RESULTS To illustrate the concept of resilience, we present case studies from the adoption of District Health Information Software version 2 (DHIS2) for managing the Covid pandemic in Rwanda, and the adoption of the OpenEHR open Health IT standard. To illustrate accessibility, we show how open source design systems for user interface design have been used by governments to ensure accessibility of digital health services for patients and healthy individuals, and by the OpenMRS community to standardise their user interface design. Finally, to illustrate the concept of equity, we describe the OpenWHO framework and two open source digital health projects, GNU Health and openIMIS, that both aim to reduce health inequities through the use of open source digital health software. CONCLUSION This review has demonstrated that open source software addresses many of the challenges involved in making healthcare more accessible, equitable and resilient in high and low income settings.
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Affiliation(s)
- Chris Paton
- University of Oxford, United Kingdom.,University of Otago, New Zealand
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Nakashima N, Maruf RI, Schaper L, Wong CP, John O, Gogia SB, Choi IY, Hunter I, Marcelo A, Lin MCM, Kijsanayotin B, Dissanayake VHW. APAMI. Yearb Med Inform 2021. [DOI: 10.1055/s-0041-1726493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kobayashi S, Falcón L, Fraser H, Braa J, Amarakoon P, Marcelo A, Paton C. Using Open Source, Open Data, and Civic Technology to Address the COVID-19 Pandemic and Infodemic. Yearb Med Inform 2021; 30:38-43. [PMID: 33882602 PMCID: PMC8416191 DOI: 10.1055/s-0041-1726488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The emerging COVID-19 pandemic has caused one of the world's worst health disasters compounded by social confusion with misinformation, the so-called "Infodemic". In this paper, we discuss how open technology approaches - including data sharing, visualization, and tooling - can address the COVID-19 pandemic and infodemic. METHODS In response to the call for participation in the 2020 International Medical Informatics Association (IMIA) Yearbook theme issue on Medical Informatics and the Pandemic, the IMIA Open Source Working Group surveyed recent works related to the use of Free/Libre/Open Source Software (FLOSS) for this pandemic. RESULTS FLOSS health care projects including GNU Health, OpenMRS, DHIS2, and others, have responded from the early phase of this pandemic. Data related to COVID-19 have been published from health organizations all over the world. Civic Technology, and the collaborative work of FLOSS and open data groups were considered to support collective intelligence on approaches to managing the pandemic. CONCLUSION FLOSS and open data have been effectively used to contribute to managing the COVID-19 pandemic, and open approaches to collaboration can improve trust in data.
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Affiliation(s)
| | - Luis Falcón
- GNU Solidario, GNU Health, Las Palmas de Gran Canaria, Spain
| | - Hamish Fraser
- Brown Center for Biomedical Informatics, Brown University, Providence, USA
| | | | | | - Alvin Marcelo
- Asia eHealth Information Network, Manilla, Philippines
| | - Chris Paton
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Jonnagaddala J, Guo GN, Batongbacal S, Marcelo A, Liaw ST. Adoption of enterprise architecture for healthcare in AeHIN member countries. BMJ Health Care Inform 2020; 27:bmjhci-2020-100136. [PMID: 32616479 PMCID: PMC7333875 DOI: 10.1136/bmjhci-2020-100136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare organisations are undergoing a major transformational shift in the use of information and digital health technologies. Enterprise architecture (EA) has been incrementally adopted in many healthcare organisations globally to facilitate this change. EA can increase the effectiveness of an organisation’s digital health capabilities and resources. However, little is known about the status of EA adoption in low-income and middle-income countries. This study aimed to evaluate the challenges, goals and benefits associated with adoption of EA for healthcare in the Asia eHealth Information Network (AeHIN) member countries. Methods We developed an EA Adoption Evaluation framework with four principal layers: governance, strategy, EA and performance. The framework guided the development of a questionnaire to investigate the goals, challenges and benefits faced before and during EA adoption by healthcare organisations. Sample 26 participants from 18 healthcare organisations in the Asia-Pacific region representing 11 countries. Organisations included Ministries of Health, Universities, Non-Governmental Organisations and Technical Advisory Groups. Findings Only 5 of the 18 organisations had begun adopting EA. The goals expressed for EA adoption were to address issues such as interoperability, lack of technical infrastructure and poor alignment of business and information technology strategies. Cost reduction was less emphasised. The main challenges to adopting EA was the lack of EA knowledge, leadership and involvement of senior management. Conclusion The adoption of EA is incipient in AeHIN member healthcare organisations. To encourage EA adoption, these organisations need to invest in internal capacity building, senior management training and seek independent EA expert advice to systematically identify and address the barriers to adopting EA.
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Affiliation(s)
- Jitendra Jonnagaddala
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia .,WHO Collaborating Centre for eHealth, UNSW Sydney, Sydney, New South Wales, Australia
| | - Guan N Guo
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,WHO Collaborating Centre for eHealth, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sean Batongbacal
- School of Computer Science & Engineering, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alvin Marcelo
- Standards and Interoperability Lab for Asia, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,WHO Collaborating Centre for eHealth, UNSW Sydney, Sydney, New South Wales, Australia
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John O, Schaper L, Wong CP, Siribaddana P, Choi IY, Marcelo A, Dissanayake VHW. APAMI. Yearb Med Inform 2020. [DOI: 10.1055/s-0040-1701977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sylim P, Liu F, Marcelo A, Fontelo P. Blockchain Technology for Detecting Falsified and Substandard Drugs in Distribution: Pharmaceutical Supply Chain Intervention. JMIR Res Protoc 2018; 7:e10163. [PMID: 30213780 PMCID: PMC6231844 DOI: 10.2196/10163] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 11/22/2022] Open
Abstract
Background Drug counterfeiting is a global problem with significant risks to consumers and the general public. In the Philippines, 30% of inspected drug stores in 2003 were found with substandard/spurious/falsely-labeled/falsified/counterfeit drugs. The economic burden on the population drug expenditures and on governments is high. The Philippine Food and Drug Administration (FDA) encourages the public to check the certificates of product registration and report any instances of counterfeiting. The National Police of Philippines responds to such reports through a special task force. However, no literature on its impact on the distribution of such drugs were found. Blockchain technology is a cryptographic ledger that is allegedly immutable through repeated sequential hashing and fault-tolerant through a consensus algorithm. This project will develop and test a pharmacosurveillance blockchain system that will support information sharing along the official drug distribution network. Objective This study aims to develop a pharmacosurveillance blockchain system and test its functions in a simulated network. Methods We are developing a Distributed Application (DApp) that will run on smart contracts, employing Swarm as the Distributed File System (DFS). Two instances will be developed: one for Ethereum and another for Hyperledger Fabric. The proof-of-work (PoW) consensus algorithm of Ethereum will be modified into a delegated proof-of-stake (DPoS) or practical Byzantine fault tolerance (PBFT) consensus algorithm as it is scalable and fits the drug supply chain environment. The system will adopt the GS1 pedigree standard and will satisfy the data points in the data standardization guidelines from the US FDA. Simulations will use the following 5 nodes: for FDA, manufacturer, wholesaler, retailer, and the consumer portal. Results Development is underway. The design of the system will place FDA in a supervisory data verification role, with each pedigree type–specific data source serving a primary data verification role. The supply chain process will be initiated by the manufacturer, with recursive verification for every transaction. It will allow consumers to scan a code printed on the receipt of their purchases to review the drug distribution history. Conclusions Development and testing will be conducted in a simulated network, and thus, results may differ from actual practice. The project being proposed is disruptive; once tested, the team intends to engage the Philippine FDA to discuss implementation plans and formulate policies to facilitate adoption and sustainability. Registered Report Identifier RR1-10.2196/10163
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Affiliation(s)
- Patrick Sylim
- National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Fang Liu
- National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Alvin Marcelo
- Standards and Interoperability Lab for Asia, University of the Philippines, Manila, Philippines
| | - Paul Fontelo
- National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
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Almerares A, Luna D, Marcelo A, Househ M, Mandirola H, Otero C. Health Informatics in Developing Countries: A Review of Unintended Consequences of IT Implementations, as They Affect Patient Safety and Recommendations on How to Address Them. Yearb Med Inform 2018. [DOI: 10.1055/s-0038-1641611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryBackground: Patient safety concerns every healthcare organization. Adoption of Health information technology (HIT) appears to have the potential to address this issue, however unanticipated and undesirable consequences from implementing HIT could lead to new and more complex hazards. This could be particularly problematic in developing countries, where regulations, policies and implementations are few, less standandarized and in some cases almost non-existing.Methods: Based on the available information and our own experience, we conducted a review of unintended consequences of HIT implementations, as they affect patient safety in developing countries.Results: We found that user dependency on the system, alert fatigue, less communications among healthcare actors and workarounds topics should be prioritize. Institution should consider existing knowledge, learn from other experiences and model their implementations to avoid known consequences. We also recommend that they monitor and communicate their own efforts to expand knowledge in the region.
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Fernandez-Marcelo PG, Ho BL, Faustorilla JF, Evangelista AL, Pedrena M, Marcelo A. Emerging eHealth Directions in the Philippines. Yearb Med Inform 2018. [DOI: 10.1055/s-0038-1639446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryThis paper aims to provide an overview of research and education initiatives in the Philippines. Moreover, it outlines the various agencies and organizations that spearhead the eHealth projects.The researchers utilized internet-based review of literature, key informant interviews and proceedings from two eHealth conferences among Filipino researchers in 2011 organized by the authors.eHealth capacities in the areas of research, education and service have progressed dramatically in the last four decades as a result of improved access to information and communication technology. The National Unified Health Research Agenda initiatives have been led largely by higher educational institutions and organizations specializing in eHealth. Educational reforms have been seen with the establishment of the Masters of Science in Health Informatics, infusion of Nursing Informatics into the nursing under-graduate curriculum and offering of short courses on eHealth. Service-oriented organizations and innovations have also been formulated to meet the needs of the practitioners as information and communication technologies are embedded into the healthcare de-livery system.Experts, researchers, practitioners and enthusiasts have successfully promoted awareness and uplifted the standards in the practice of eHealth in research, education and service. However, three main areas of improvement need to be given priority: (1) Policy and standards creation, (2) capability building and (3) multi-sectoral collaborations.
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Schmuhl H, Marcelo A, Dal Molin J, Wright G, Karopka T. Towards Open Collaborative Health Informatics - The Role of Free/Libre Open Source Principles. Yearb Med Inform 2018. [DOI: 10.1055/s-0038-1638740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryTo analyze the contribution of Free/Libre Open Source Software in health care (FLOSS-HC) and to give perspectives for future developments.The paper summarizes FLOSS-related trends in health care as anticipated by members of the IMIA Open Source Working Group. Data were obtained through literature review and personal experience and observations of the authors in the last two decades. A status quo is given by a frequency analysis of the database of Medfloss.org, one of the world’s largest platforms dedicated to FLOSS-HC. The authors discuss current problems in the field of health care and finally give a prospective roadmap, a projection of the potential influences of FLOSS in health care.FLOSS-HC already exists for more than 2 decades. Several projects have shown that FLOSS may produce highly competitive alternatives to proprietary solutions that are at least equivalent in usability and have a better total cost of ownership ratio. The Medfloss.org database currently lists 221 projects of diverse application types.FLOSS principles hold a great potential for addressing several of the most critical problems in health care IT. The authors argue that an ecosystem perspective is relevant and that FLOSS principles are best suited to create health IT systems that are able to evolve over time as medical knowledge, technologies, insights, workflows etc. continuously change. All these factors that inherently influence the development of health IT systems are changing at an ever growing pace. Traditional models of software engineering are not able to follow these changes and provide up-to-date systems for an acceptable cost/value ratio. To allow FLOSS to positively influence Health IT in the future a "FLOSS-friendly" environment has to be provided. Policy makers should resolve uncertainties in the legal framework that disfavor FLOSS. Certification procedures should be specified in a way that they do not raise additional barriers for FLOSS.
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Liaw ST, Marcelo A, Narasimhan P, Ashraf MM, Ray P. Global eHealth, Social Business and Citizen Engagement: A Natural Convergence? Stud Health Technol Inform 2017; 245:773-777. [PMID: 29295203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper draws on the vision, mission and experience with the WHO Collaborating Centre on eHealth (WHOCC-eHealth) and Yunus Social Business Health Hub (YSBHH) based at UNSW Australia, and the Asia electronic Health Information Network (AeHIN). Global eHealth aims to provide equitable access to ICT and health care, particularly to the poor, vulnerable and disadvantaged. Social business aims to solve social and economic problem. Its best known product is microcredit financial services for the poor which are small loans that enable them to "produce something, sell something, earn something to develop self-reliance and a life of dignity". Citizen engagement and community participation is integral to both constructs within the context of global partnerships for Integrated People-Centred Health Services (IPCHS) and Sustainable Development Goals (SDGs). The eHealth dimension is consumer heath informatics, social media, mHealth and the Internet of Things. The convergence is multidimensional, mutually beneficial and requires good governance and leadership.
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Affiliation(s)
- Siaw-Teng Liaw
- UNSW Medicine School of Public Health & Community Medicine (including WHO Collaborating Centre on eHealth & Yunus Social Business Health Hub), Randwick, NSW, Australia
| | | | - Padmanesan Narasimhan
- UNSW Medicine School of Public Health & Community Medicine (including WHO Collaborating Centre on eHealth & Yunus Social Business Health Hub), Randwick, NSW, Australia
| | - Md Mahfuz Ashraf
- UNSW Medicine School of Public Health & Community Medicine (including WHO Collaborating Centre on eHealth & Yunus Social Business Health Hub), Randwick, NSW, Australia
| | - Pradeep Ray
- UNSW Medicine School of Public Health & Community Medicine (including WHO Collaborating Centre on eHealth & Yunus Social Business Health Hub), Randwick, NSW, Australia
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Mandirola Brieux HF, Benitez S, Otero C, Luna D, Masud JHB, Marcelo A, Househ M, Hullin C, Villalba C, Indarte S, Guillen S, Otero P, Campos F, Baum A, Gonzalez Bernaldo de Quirós F. Cultural Problems Associated with the Implementation of eHealth. Stud Health Technol Inform 2017; 245:1213. [PMID: 29295300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A major hurdle in eHealth implementation is that it is difficult to put into practice. In this study, the primary aim was to identify the main barrier associated with implementing eHealth. This study surveyed IMIA members from May to November 2015. From the results, it is clear that medical professionals were recording most of their data by hand. This paper culture is a paradigm that is difficult to break. Cultural factors are the primary barrier in eHealth implementation.
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Affiliation(s)
| | - S Benitez
- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - C Otero
- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - D Luna
- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - J H B Masud
- Public Health Informatics Foundation (PHIF), Bangladesh
| | - A Marcelo
- University of the Philippines, Manila, Philippines
| | - M Househ
- King Saud Bin Abdulaziz University for Health Sciences, College of Public Health and Health Informatics, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - C Hullin
- UC Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - C Villalba
- Facultad Politécnica, Universidad Nacional de Asunción, Paraguay
| | | | | | - P Otero
- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - F Campos
- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - A Baum
- Hospital Italiano (HIBA), Buenos Aires, Argentina
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Ho K, Al-Shorjabji N, Brown E, Zelmer J, Gabor N, Maeder A, Marcelo A, Ritz D, Messina L, Loyola M, Abbott P, Nazira J, McKinnon A, Dissanayake V, Akeel A, Gardner N, Doyle T. Applying the Resilient Health System Framework for Universal Health Coverage. Stud Health Technol Inform 2016; 231:54-62. [PMID: 27782016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Since the 1978 Declaration of Alma-Ata affirming health as a fundamental human right, policy-makers and stakeholders have proposed many different strategies to achieve the goal of 'health for all'. However, globally there still remains a lack of access to health information and quality health care, especially in low- and middle-income countries (LMIC). Digital health holds great promise to improve access and quality of care. We propose using the "resilient health system framework" as a guide to scale-up digital health as a means to achieve universal health care (UHC) and health for all. This article serves as a call to action for all governments to include population-based digital health tools as a foundational element in on-going health system priorities and service delivery.
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Affiliation(s)
- Kendall Ho
- Digital Emergency Medicine, Faculty of Medicine, Univ. of British Columbia, Canada
| | | | - Ed Brown
- Ontario Telemedicine Network, Canada
| | | | | | - Anthony Maeder
- School of Health Sciences, Flinders University, Australia
| | - Alvin Marcelo
- Medical Informatics Unit, University of the Philippines Manila, Philippines
| | | | | | | | | | | | | | | | - Aisha Akeel
- Information Technology and Services, University of Hull, United Kingdom
| | | | - Thomas Doyle
- Department of Electrical and Computer Engineering, McMaster University, Canada
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Otero C, Luna D, Marcelo A, Househ M, Mandirola H, Curioso W, Pazos P, Villalba C. Why Patient Centered Care Coordination Is Important in Developing Countries? Contribution of the IMIA Health Informatics for Development Working Group. Yearb Med Inform 2015; 10:30-3. [PMID: 26123907 DOI: 10.15265/iy-2015-013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Patient Centered Care Coordination (PCCC) focuses on the patient health care needs. PCCC involves the organization, the patients and their families, that must coordinate resources in order to accomplish the goals of PCCC. In developing countries, where disparities are frequent, PCCC could improve clinical outcomes, costs and patients satisfaction. OBJECTIVE the IMIA working group Health Informatics for Development analyzes the benefits, identifies the barriers and proposes strategies to reach PCCC. METHODS Discussions about PCCC emerged from a brief guide that posed questions about what is PCCC, why consider PCCC important, barriers to grow in this direction and ask about resources considered relevant in the topic. RESULTS PCCC encompasses a broad definition, includes physical, mental, socio-environmental and self care. Even benefits are proved, in developing countries the lack of a comprehensive and integrated healthcare network is one of the main barriers to reach this objective. Working hard to reach strong health policies, focus on patients, and optimizing the use of resources could improve the performance in the devolvement of PCCC programs. International collaboration could bring benefits. We believe information IT, and education in this field will play an important role in PCCC. CONCLUSION PCCC in developing countries has the potential to improve quality of care. Education, IT, policies and cultural issues must be addressed in an international collaborative context in order to reach this goal.
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Affiliation(s)
- C Otero
- Dr. Carlos Martín Otero, Departamento de Informática en Salud, Hospital Italiano de Buenos Aires, E-mail:
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Marcelo A, Ganesh J, Mohan J, Kadam DB, Ratta BS, Kulatunga G, John S, Chandra A, Primadi O, Mohamed AAS, Khan MAH, Azad AA, Marcelo P. Governance and management of national telehealth programs in Asia. Stud Health Technol Inform 2015; 209:95-101. [PMID: 25980710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Telehealth and telemedicine are increasingly becoming accepted practices in Asia, but challenges remain in deploying these services to the farthest areas of many developing countries. With the increasing popularity of universal health coverage, there is a resurgence in promoting telehealth services. But while telehealth that reaches the remotest part of a nation is the ideal endpoint, such goals are burdened by various constraints ranging from governance to funding to infrastructure and operational efficiency. OBJECTIVES enumerate the public funded national telehealth programs in Asia and determine the state of their governance and management. METHOD Review of literature, review of official program websites and request for information from key informants. CONCLUSIONS While there are national telehealth programs already in operation in Asia, most experience challenges with governance and subsequently, with management and sustainability of operations. It is important to learn from successful programs that have built and maintained their services over time. An IT governance framework may assist countries to achieve success in offering telehealth and telemedicine to their citizens.
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Affiliation(s)
| | - Jai Ganesh
- Sri Sathya Sai Central Trust, Prasanthi Nilayam, Andhra Pradesh, India
| | - Jai Mohan
- International Medical University, Malaysia
| | | | | | | | - Sheila John
- Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Andry Chandra
- Directorate Ancillary and Health Facility, Ministry of Health Indonesia
| | - Oscar Primadi
- Center of Data & Information, Ministry of Health Indonesia
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Otero C, Marcelo A, Luna D. Health Informatics in Developing Countries: Systematic Review of Reviews Contribution of the IMIA Working Group Health Informatics for Development. Yearb Med Inform 2013. [DOI: 10.1055/s-0038-1638829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Summary
Objectives: An evidence-base is important for medicine and health informatics. Despite numerous publications showing the benefits of health informatics, the emergence of health information systems in developing countries has been slower than expected. The aim of this paper is to identify systematic reviews on the domain of health informatics in developing countries, and classify the different types of applications covered.
Methods: A systematic review of reviews was conducted. The literature search spanned the time period between 2000 and 2012 and included PubMed, EMBASE, CINAHL, Scopus, Cochrane Systematic Reviews, LILACS, and Google Scholar. The search term was ‘systematic reviews of health informatics in developing countries’, and transparent and systematic procedures were applied to limit bias at all stages.
Results: Of the 982 identified articles, only 10 met the inclusion criteria and one more article was added in a second manual search, resulting in a total of 11 systematic reviews for the analysis.
Conclusions: Although it was difficult to find high quality resources on the selected domain, the best evidence available allowed us to generate this report and create an incipient review of the state of the art in health informatics in the developing countries. More studies will be needed to optimize the results.
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Marcelo A, Gavino A, Isip-Tan IT, Apostol-Nicodemus L, Mesa-Gaerlan FJ, Firaza PN, Faustorilla JF, Callaghan FM, Fontelo P. A comparison of the accuracy of clinical decisions based on full-text articles and on journal abstracts alone: a study among residents in a tertiary care hospital. Evid Based Med 2013; 18:48-53. [PMID: 22782923 PMCID: PMC3607116 DOI: 10.1136/eb-2012-100537] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many clinicians depend solely on journal abstracts to guide clinical decisions. OBJECTIVES This study aims to determine if there are differences in the accuracy of responses to simulated cases between resident physicians provided with an abstract only and those with full-text articles. It also attempts to describe their information-seeking behaviour. METHODS Seventy-seven resident physicians from four specialty departments of a tertiary care hospital completed a paper-based questionnaire with clinical simulation cases, then randomly assigned to two intervention groups-access to abstracts-only and access to both abstracts and full-text. While having access to medical literature, they completed an online version of the same questionnaire. FINDINGS The average improvement across departments was not significantly different between the abstracts-only group and the full-text group (p=0.44), but when accounting for an interaction between intervention and department, the effect was significant (p=0.049) with improvement greater with full-text in the surgery department. Overall, the accuracy of responses was greater after the provision of either abstracts-only or full-text (p<0.0001). Although some residents indicated that 'accumulated knowledge' was sufficient to respond to the patient management questions, in most instances (83% of cases) they still sought medical literature. CONCLUSIONS Our findings support studies that doctors will use evidence when convenient and current evidence improved clinical decisions. The accuracy of decisions improved after the provision of evidence. Clinical decisions guided by full-text articles were more accurate than those guided by abstracts alone, but the results seem to be driven by a significant difference in one department.
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Affiliation(s)
- Alvin Marcelo
- National Telehealth Center, University of the Philippines, Manila, Philippines
- Department of Surgery, Philippine General Hospital, Manila, Philippines
| | - Alex Gavino
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | - Paul Nimrod Firaza
- National Telehealth Center, University of the Philippines, Manila, Philippines
| | | | - Fiona M Callaghan
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul Fontelo
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
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Luna D, Otero C, Marcelo A. Health Informatics in Developing Countries: Systematic Review of Reviews. Contribution of the IMIA Working Group Health Informatics for Development. Yearb Med Inform 2013; 8:28-33. [PMID: 23974545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES An evidence-base is important for medicine and health informatics. Despite numerous publications showing the benefits of health informatics, the emergence of health information systems in developing countries has been slower than expected. The aim of this paper is to identify systematic reviews on the domain of health informatics in developing countries, and classify the different types of applications covered. METHODS A systematic review of reviews was conducted. The literature search spanned the time period between 2000 and 2012 and included PubMed, EMBASE, CINAHL, Scopus, Cochrane Systematic Reviews, LILACS, and Google Scholar. The search term was 'systematic reviews of health informatics in developing countries', and transparent and systematic procedures were applied to limit bias at all stages. RESULTS Of the 982 identified articles, only 10 met the inclusion criteria and one more article was added in a second manual search, resulting in a total of 11 systematic reviews for the analysis. CONCLUSIONS Although it was difficult to find high quality resources on the selected domain, the best evidence available allowed us to generate this report and create an incipient review of the state of the art in health informatics in the developing countries. More studies will be needed to optimize the results.
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Affiliation(s)
- D Luna
- Health Informatics Department, Hospital Italiano de Buenos Aires, Gascon 450, CABA, Buenos Aires, Argentina (C1181ACH). E-mail:
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24
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Fontelo P, Faustorilla J, Gavino A, Marcelo A. Digital pathology - implementation challenges in low-resource countries. Anal Cell Pathol (Amst) 2012; 35:31-6. [PMID: 22233702 PMCID: PMC4605723 DOI: 10.3233/acp-2011-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Medical education in pathology and histology in low-resource countries face many obstacles because of equipment cost and telecommunication deficiencies. Digital Pathology may provide solutions. We report student experience to virtual slides on a local network and a remote image server. Methods: Using an iPad tablet device, fifty 3rd and 4th year medical students viewed digital pathology slides from a Web server at the National Library of Medicine and a mirror server on the local network. Results: The quality of images from both servers was found to be satisfactory, but the local server was deemed faster and preferred by the participants in this study (p < 0.005). Conclusions: Virtual slides on a local network server may provide solutions to equipment and technical obstacles and could enhance student learning in developing countries.
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Affiliation(s)
- Paul Fontelo
- National Library of Medicine, Bethesda, MD 20894, USA.
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25
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Fernandez-Marcelo PG, Ho BL, Faustorilla JF, Evangelista AL, Pedrena M, Marcelo A. Emerging eHealth Directions in the Philippines. Yearb Med Inform 2012; 7:144-152. [PMID: 22890357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES This paper aims to provide an overview of research and education initiatives in the Philippines. Moreover, it outlines the various agencies and organizations that spearhead the eHealth projects. METHODS The researchers utilized internet-based review of literature, key informant interviews and proceedings from two eHealth conferences among Filipino researchers in 2011 organized by the authors. RESULTS eHealth capacities in the areas of research, education and service have progressed dramatically in the last four decades as a result of improved access to information and communication technology. The National Unified Health Research Agenda initiatives have been led largely by higher educational institutions and organizations specializing in eHealth. Educational reforms have been seen with the establishment of the Masters of Science in Health Informatics, infusion of Nursing Informatics into the nursing undergraduate curriculum and offering of short courses on eHealth. Service- oriented organizations and innovations have also been formulated to meet the needs of the practitioners as information and communication technologies are embedded into the healthcare delivery system. CONCLUSIONS Experts, researchers, practitioners and enthusiasts have successfully promoted awareness and uplifted the standards in the practice of eHealth in research, education and service. However, three main areas of improvement need to be given priority: (1) Policy and standards creation, (2) capability building and (3) multi-sectoral collaborations.
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Affiliation(s)
- P G Fernandez-Marcelo
- University of the Philippines Manila, National Telehealth Center, 3rd Flr., IT Complex, Philippine General Hospital Compound, Manila, The Philippines. E-mail:
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Adejumo A, Luna D, Marcelo A. Health Informatics for Development: a Threepronged Strategy of Partnerships, Standards, and Mobile Health. Yearb Med Inform 2011. [DOI: 10.1055/s-0038-1638745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryDescribe the issues surrounding health informatics in developing countries and the challenges faced by practitioners in building internal capacity. From these issues, the authors propose cost-effective strategies that can fast track health informatics development in these low to medium income countries (LMICs).The authors conducted a review of literature and consulted key opinion leaders who have experience with health informatics implementations around the world.Despite geographic and cultural differences, many LMICs share similar challenges and opportunities in developing health informatics.Partnerships, standards, and inter-operability are well known components of successful informatics programs. Establishing partnerships can be comprised of formal inter-institutional collaborations on training and research, collaborative open source software development, and effective use of social networking. Lacking legacy systems, LMICs can discuss standards and inter-operability more openly and have greater potential for success. Lastly, since cellphones are pervasive in developing countries, they can be leveraged as access points for delivering and documenting health services in remote under-served areas. Mobile health or mHealth gives LMICs a unique opportunity to leapfrog through most issues that have plagued health informaticsin developed countries. By employing this proposed roadmap, LMICs can now develop capacity for health informaticsusing appropriate and cost-effective technologies.
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Kimura M, Croll P, Li B, Wong CP, Gogia S, Faud A, Kwak YS, Chu S, Marcelo A, Chow YH, Paoin W, Li YC. Survey on medical records and EHR in Asia-Pacific region: languages, purposes, IDs and regulations. Methods Inf Med 2011; 50:386-91. [PMID: 21792467 DOI: 10.3414/me11-02-0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 04/03/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To clarify health record background information in the Asia-Pacific region, for planning and evaluation of medical information systems. METHODS The survey was carried out in the summer of 2009. Of the 14 APAMI (Asia-Pacific Association for Medical Informatics) delegates 12 responded which were Australia, China, Hong Kong, India, Indonesia, Japan, Korea, New Zealand, the Philippines, Singapore, Thailand, and Taiwan. RESULTS English is used for records and education in Australia, Hong Kong, India, New Zealand, the Philippines, Singapore and Taiwan. Most of the countries/regions are British Commonwealth. Nine out of 12 delegates responded that the second purpose of medical records was for the billing of medical services. Seven out of nine responders to this question answered that the second purpose of EHR (Electronic Health Records) was healthcare cost cutting. In Singapore, a versatile resident ID is used which can be applied to a variety of uses. Seven other regions have resident IDs which are used for a varying range of purposes. Regarding healthcare ID, resident ID is simply used as healthcare ID in Hong Kong, Singapore and Thailand. In most cases, disclosure of medical data with patient's name identified is allowed only for the purpose of disease control within a legal framework and for disclosure to the patient and referred doctors. Secondary use of medical information with the patient's identification anonymized is usually allowed in particular cases for specific purposes. CONCLUSION This survey on the health record background information has yielded the above mentioned results. This information contributes to the planning and evaluation of medical information systems in the Asia-Pacific region.
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Affiliation(s)
- M Kimura
- Hamamatsu University School of Medicine, Medical Informatics Department, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
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Karopka T, Schmuhl H, Marcelo A, Molin JD, Wright G. Towards open collaborative health informatics - The Role of free/libre open source principles. Contribution of the IMIA Open Source Health Informatics Working Group. Yearb Med Inform 2011; 6:63-72. [PMID: 21938327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES : To analyze the contribution of Free/Libre Open Source Software in health care (FLOSS-HC) and to give perspectives for future developments. METHODS The paper summarizes FLOSS-related trends in health care as anticipated by members of the IMIA Open Source Working Group. Data were obtained through literature review and personal experience and observations of the authors in the last two decades. A status quo is given by a frequency analysis of the database of Medfloss.org, one of the world's largest platforms dedicated to FLOSS-HC. The authors discuss current problems in the field of health care and finally give a prospective roadmap, a projection of the potential influences of FLOSS in health care. RESULTS FLOSS-HC already exists for more than 2 decades. Several projects have shown that FLOSS may produce highly competitive alternatives to proprietary solutions that are at least equivalent in usability and have a better total cost of ownership ratio. The Medfloss.org database currently lists 221 projects of diverse application types. CONCLUSIONS FLOSS principles hold a great potential for addressing several of the most critical problems in health care IT. The authors argue that an ecosystem perspective is relevant and that FLOSS principles are best suited to create health IT systems that are able to evolve over time as medical knowledge, technologies, insights, workflows etc. continuously change. All these factors that inherently influence the development of health IT systems are changing at an ever growing pace. Traditional models of software engineering are not able to follow these changes and provide up-to-date systems for an acceptable cost/value ratio. To allow FLOSS to positively influence Health IT in the future a "FLOSS-friendly" environment has to be provided. Policy makers should resolve uncertainties in the legal framework that disfavor FLOSS. Certification procedures should be specified in a way that they do not raise additional barriers for FLOSS.
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Affiliation(s)
- T Karopka
- Stralsunder Str. 18, 18445 Prohn, Germany.
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Marcelo A, Adejumo A, Luna D. Health Informatics for Development: a Three-pronged Strategy of Partnerships, Standards, and Mobile Health. Contribution of the IMIA Working Group on Health Informatics for Development. Yearb Med Inform 2011; 6:96-101. [PMID: 21938332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Describe the issues surrounding health informatics in developing countries and the challenges faced by practitioners in building internal capacity. From these issues, the authors propose cost-effective strategies that can fast track health informatics development in these low to medium income countries (LMICs). METHODS The authors conducted a review of literature and consulted key opinion leaders who have experience with health informatics implementations around the world. RESULTS Despite geographic and cultural differences, many LMICs share similar challenges and opportunities in developing health informatics. CONCLUSIONS Partnerships, standards, and inter-operability are well known components of successful informatics programs. Establishing partnerships can be comprised of formal inter-institutional collaborations on training and research, collaborative open source software development, and effective use of social networking. Lacking legacy systems, LMICs can discuss standards and inter-operability more openly and have greater potential for success. Lastly, since cellphones are pervasive in developing countries, they can be leveraged as access points for delivering and documenting health services in remote under-served areas. Mobile health or mHealth gives LMICs a unique opportunity to leapfrog through most issues that have plagued health informatics in developed countries. By employing this proposed roadmap, LMICs can now develop capacity for health informatics using appropriate and cost-effective technologies.
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Affiliation(s)
- A Marcelo
- IMIA Health Informatics for Development Working Group Chair, National Telehealth Center,University of the Philippines Manila, Philippines.
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Marcelo A, Fatmi Z, Firaza PN, Shaikh S, Dandan AJ, Irfan M, Bari V, Scott RE. An online method for diagnosis of difficult TB cases for developing countries. Stud Health Technol Inform 2011; 164:168-173. [PMID: 21335706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Optimal use of limited human, technical and financial resources is a major concern for tuberculosis (TB) control in developing nations. Further impediments include a lack of trained physicians, and logistical difficulties in arranging face-to-face (f-2-f) TB Diagnostic Committee (TBDC) consultations. Use of e-Health for virtual TBDCs (Internet and "iPath"), to address such issues is being studied in the Philippines and Pakistan. In Pakistan, radiological diagnosis of 88 sputum smear negative but suspected TB patients has been compared with the 'gold standards' (TB culture, and 2-month clinical follow up). Of 88 diagnostic decisions made by primary physicians at the spoke site and electronic TBDC (e-TBDC) at hub site, there was agreement in 71 cases and disagreement on 17 cases. The turn-around time (TAT; patient registration at spoke site for f-2-f diagnosis to receiving the electronic diagnosis), averaged 34.6 hours; ranging 9 minutes to 289.2 hours. Average TAT at the rural site (59.15 hours) was more than the urban site (15.9 hours). Comparison of e-TBDC and f-2-f diagnosis with the gold standards showed only slight differences. Using culture as the gold standard, e-TBDC decisions showed greater accuracy (sensitivity - 32.4%) as compared to f-2-f (27.6%); using 2-month clinical follow-up as the gold standard, f-2-f diagnosis showed slightly better improvement in patient symptoms and weight as compared to e-TBDC. In Philippines "iPath" was trialed and demonstrated that e-TBDCs have potential. Such groups could review cases, diagnose, and write comments remotely, reducing the diagnosis and treatment delay compared to usual care.
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Celi LA, Sarmenta L, Rotberg J, Marcelo A, Clifford G. Mobile Care (Moca) for Remote Diagnosis and Screening. J Health Inform Dev Ctries 2009; 3:17-21. [PMID: 21822397 PMCID: PMC3149792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Moca is a cell phone-facilitated clinical information system to improve diagnostic, screening and therapeutic capabilities in remote resource-poor settings. The software allows transmission of any medical file, whether a photo, x-ray, audio or video file, through a cell phone to (1) a central server for archiving and incorporation into an electronic medical record (to facilitate longitudinal care, quality control, and data mining), and (2) a remote specialist for real-time decision support (to leverage expertise). The open source software is designed as an end-to-end clinical information system that seamlessly connects health care workers to medical professionals. It is integrated with OpenMRS, an existing open source medical records system commonly used in developing countries.
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Tolentino H, Marcelo A, Marcelo P, Maramba I. Linking primary care information systems and public health vertical programs in the Philippines: an open-source experience. AMIA Annu Symp Proc 2005; 2005:311-5. [PMID: 16779052 PMCID: PMC1560490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Community-based primary care information systems are one of the building blocks for national health information systems. In the Philippines, after the devolution of health care to local governments, we observed "health information system islands" connected to national vertical programs being implemented in devolved health units. These structures lead to a huge amount of "information work" in the transformation of health information at the community level. This paper describes work done to develop and implement the open-source Community Based Health Information Tracking System (CHITS) Project, which was implemented to address this information management problem and its outcomes. Several lessons learned from the field as well as software development strategies are highlighted in building community level information systems that link to national level health information systems.
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Affiliation(s)
- Herman Tolentino
- Medical Informatics Unit, University of the Philippines Manila College
of Medicine, Manila, Philippines
| | - Alvin Marcelo
- Medical Informatics Unit, University of the Philippines Manila College
of Medicine, Manila, Philippines
| | - Portia Marcelo
- Department of Family and Community Medicine, University of the Philippines
Manila College of Medicine, Manila, Philippines
| | - Inocencio Maramba
- Medical Informatics Unit, University of the Philippines Manila College
of Medicine, Manila, Philippines
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Tolentino H, Marcelo A, Marcelo P, Maramba I. Linking primary care information systems and public health information networks: lessons from the Philippines. Stud Health Technol Inform 2005; 116:955-60. [PMID: 16160381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Community-based primary care information systems are one of the building blocks for national health information systems. In the Philippines, after the devolution of health care to local governments, we observed "health information system islands" connected to national vertical programs being implemented in devolved health units. These structures lead to a huge amount of "information work" in the transformation of health information at the community level. This paper describes work done to develop and implement the open-source Community Based Health Information Tracking System (CHITS) Project, which was implemented to address this information management problem and its outcomes. Several lessons learned from the field as well as software development strategies are highlighted in building community level information systems that link to national level health information systems.
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Affiliation(s)
- Herman Tolentino
- Medical Informatics Unit, University of the Philippines, College of Medicine, Pedro Gil Street, Manila,
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Laing G, Yarleque A, Marcelo A, Rodriguez E, Warrell D, Theakston R. Erratum to “Preclinical testing of three south American antivenoms against the venoms of five medically-important Peruvian snake venoms” [Toxicon 44 (2004) 103–106]. Toxicon 2004. [DOI: 10.1016/j.toxicon.2004.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Laing GD, Yarleque A, Marcelo A, Rodriguez E, Warrell DA, Theakston RDG. Preclinical testing of three south American antivenoms against the venoms of five medically-important Peruvian snake venoms. Toxicon 2004; 44:103-6. [PMID: 15225568 DOI: 10.1016/j.toxicon.2004.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 03/22/2004] [Indexed: 11/20/2022]
Abstract
World Health Organization (WHO)-recommended preclinical in vivo and in vitro studies were carried out to compare the efficacy of Brazilian, Peruvian and Colombian antivenoms in neutralizing the venom toxins responsible for the lethal, haemorrhagic, necrotizing, coagulant and defibrinogenating effects of five medically-important Peruvian snake venoms. Overall, the Brazilian antivenom was found to be the most effective followed by the Peruvian and Colombian antivenoms. However, it was concluded that all three antivenoms would be acceptable for use in a randomised clinical trial in envenomed humans in Peru.
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Affiliation(s)
- G D Laing
- Alistair Reid Venom Research unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
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Garcia EH, Perna E, Eduardo F, Ricardo O, Stella M, Jorge P, Marcelo A, Ariel P, Eduardo T, Leonardo. R. REDUCED SYSTOLIC PERFOMANCE BY TISSUE DOPPLER IN PATIENTS WITH PRESERVED AND ABNORMAL EJECTION FRACTION: NEW INSIGHTS IN CHRONIC HEART FAILURE. Echocardiography 2004. [DOI: 10.1111/j.0742-2822.2004.t01-4-20040211.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Castro J, Wolf F, Karras B, Tolentino H, Marcelo A, Maramba I. Critically Appraised Topics (CAT) peer-to-peer network. AMIA Annu Symp Proc 2003; 2003:806. [PMID: 14728311 PMCID: PMC1480064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
A peer-to-peer network of Critically Appraised Topics or CATs would allow sharing of relevant clinical information regarding specific clinical problems among physicians. This proposed network would enable clinicians to develop and share CATs to other users within the network. This poster describes a proposed implementation of a peer-to-peer internet based sharing of critically appraised topics in the Philippines.
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Affiliation(s)
- Jonathan Castro
- Medical Education and Biomedical Informatics, University of Washington, Seattle, WA, USA
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Abstract
CONTEXT For practitioners deploying store-and-forward telepathology systems, optimization methods such as image compression need to be studied. OBJECTIVE To determine if Joint Photographic Expert Group (JPG or JPEG) compression, a glossy image compression algorithm, negatively affects the accuracy of diagnosis in telepathology. DESIGN Double-blind, randomized, controlled trial. SETTING University-based pathology departments. PARTICIPANTS Resident and staff pathologists at the University of Illinois, Chicago, and University of Cincinnati, Cincinnati, Ohio. INTERVENTION Compression of raw images using the JPEG algorithm. MAIN OUTCOME MEASURES Image acceptability, accuracy of diagnosis, confidence level of pathologist, image quality. RESULTS There was no statistically significant difference in the diagnostic accuracy between noncompressed (bit map) and compressed (JPG) images. There were also no differences in the acceptability, confidence level, and perception of image quality. Additionally, rater experience did not significantly correlate with degree of accuracy. CONCLUSIONS For providers practicing telepathology, JPG image compression does not negatively affect the accuracy and confidence level of diagnosis. The acceptability and quality of images were also not affected.
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Affiliation(s)
- A Marcelo
- High Performance Computing and Communications, National Library of Medicine, Bethesda, MD 20894, USA
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Canales M, Aguilar J, Prada A, Marcelo A, Huamán C, Carbajal L. [Nutritional evaluation of Lepidium meyenii (MACA) in albino mice and their descendants]. Arch Latinoam Nutr 2000; 50:126-33. [PMID: 11048583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The Maca (Lepidium meyenii) is a Peruvian hypocotyl that grows exclusively between the 3700 and 4500 masl at the Peruvian Andes. Traditionally it is attributed nutritional, energizing, fertilizing properties among others. With the purpose of evaluate scientifically the nutritional property of Maca, we carried out a controlled study in two generations of albino Swiss mice (parents and breeding). The parents were aleatorily assigned to one of three nutritional schedules. The food of each group was prepared based on powder from a commercial balanced food (CBF) of which 30% was replaced by raw or cooked Maca according to the corresponding group or pure CBF in the control group. The groups were this way: 1) Raw Maca Group; 2) Cooked Maca Group; and, 3) Control Group. The results showed that the curves of growth were similar and adequate for the three groups. However, the cooked Maca group showed the best curve. These data were better observable in the second generation of animals, with significant statistical difference (p < 0.05). The CBF group had a better growth than raw Maca group. No signs of malnutrition nor overweight were observed in none of the groups. The serum values of total proteins and albumin were statistically superior for the mice group eating cooked Maca than that of the raw Maca and CBF groups. This study demonstrates, in a scientifical evaluation, one of the traditionally attributed properties of Maca, the nutritional capability.
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Affiliation(s)
- M Canales
- Instituto de Medicina Tropical Alexander von Humboldt, Lima-Perú
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