Serious games are more than just games

Serious games (SG) or educational games are complete games designed for a specific purpose that fulfill both their classic function of entertainment and promote the learning of specific concepts or skills and optimize health care in general. In the pediatric setting, these games combine strategies to educate about health issues, promote healthy behaviors, provide therapy or medical treatment. SG have been shown to promote adherence to treatment in children with chronic diseases, reduce anxiety in those undergoing invasive medical procedures, and stimulate the development of cognitive, emotional, or psychomotor skills. However, it is important to emphasize that the success of SG in pediatrics depends to a large extent on game quality, their design based on clear objectives, and their accurate adaptation to the individual needs and preferences of patients.

The metaverse in the world of health: The present future. Challenges and opportunities

The World Health Organization has defined "digital health" as the use of information and communication technologies to improve health. In recent years, there has been a strong acceleration in the adoption of these digital tools, which has had a major impact on traditional healthcare models. We are currently witnessing the emergence of a large immersive virtual environment called the "metaverse." Its emergence creates new and challenging opportunities in health care. This article explores some metaverse-related concepts, provides specific examples of its use in pediatrics, describes experiences in the hospital setting, and finally delves into the resulting challenges and opportunities.

Effectiveness, Costs and Satisfaction of Telemedicine: Review of the Current State

The objective of this study was to summarize the evidence in relation to telemedicine systems as regards their effectiveness, costs and satisfaction in the last decade. A summary of main findings is presented. According to results telemedicine proved to be a feasible and effective tool to provide health care as a replacement or complement to usual care, especially when applied to chronic diseases.

Improving Waiting Time for Chemotherapy with Ahead-of-Time Drug Preparation

Waiting time for chemotherapy infusion is a fundamental factor to measure quality of care. It has been shown that a prolonged waiting time is related to a higher incidence of anticipatory nausea and poor patient adherence to scheduled appointments and recommended oncology treatment programs. Some chemotherapy regimens can be prepared hours ahead-of-time, due to long stability. We aimed to study the effect of an informatic-led workflow redesign intervention, facilitating workflow changes in the Oncology Pharmacy, on patient waiting time. This intervention included changes on EHR processes and the chemotherapy CPOE. Their main effect was allowing ahead-of-time preparation of selected chemotherapy regimes. We conducted a cross sectional study, comparing waiting times pre and post intervention periods. A total of 4600 programmed chemotherapy episodes were included. We found a 26.5 % decrease in the mean wait time in the post intervention period (p > 0.02). We were able to show a decrease in waiting time and a measurable impact of the intervention. This evaluation produced valuable and actionable data for Oncology units and adds a valuable, Latin American experience to the literature.

Integrating Dermoscopic Images into PACS Using DICOM and Modality Worklist

Dermatology is one of the medical fields outside the radiology service that uses image acquisition and analysis in its daily medical practice, mostly through digital dermoscopy imaging modality. The acquisition, transfer, and storage of dermatology images has become an important issue to resolve. We aimed to describe our experience in integrating dermoscopic images into PACS using DICOM as a guide for the health informatics and dermatology community. During 2022 we integrated the video dermoscopy equipment through a strategic plan with an 8-step procedure. We used the DICOM standard with Modality Worklist and Storage commitment. Three systems were involved (video dermoscopy software, the EHR, and PACS). We identified critical steps and faced many challenges, such as the lack of a final model of DICOM standard for dermatology images.

Bioinformatics Architecture for Integrating Genomics Data into Electronic Health Records

The adequate management of patients' genomic information is essential for any health institution pursuing the Precision Medicine model. Here we approach a bioinformatic architecture that allows the Institution to store its whole genetic test data in a scalable database, and also the integration of that genetic data with the Electronic Health Record through a Clinical Decision Support System. The system complements patient care by suggesting referral to genetic counseling for patients who are potentially at risk of hereditary breast/ovarian cancer, and allowing for proper follow-up of patients with pathogenic variants in BRCA1 or BRCA2 genes. The implemented solution uses the FHIR standard and genetic nomenclatures from the Human Genome Variation Society and the HUGO Gene Nomenclature Committee. The architecture is flexible enough to allow any other health institution to integrate -to their information ecosystem- the whole solution or some of the modules according to its degree of digitization progress.

ODP109 PARATHYROID HORMONE AND 25 OH VITAMINA D IN PREGNANCY: DATA FROM AN ARGENTINEAN COHORT SUPPORTING SUPPLEMENTATION

 

Vitamin D (Vit D) deficiency has become a global health care issue, as it affects a great number of women during pregnancy and lactation. Vit D levels are critical during pregnancy, being the mother the only source of them for the developing fetus; an enzymatic system for conversion of 25OH VitD into 1-25(OH) 2 VitD is present in the placenta, thus reinforcing the importance of VitD during gestation. VitD deficiency has been associated with obstetric complications and adverse outcomes in offspring, affecting skeletal, immunological and respiratory systems. It is known that prenatal supplements available do not contain enough VitD to fulfil requirements. It is generally accepted that elevated PTH is an indicator of VitD deficiency, and Hysaj O et al (2021) showed that 25OH VitD is a statistically significant determinant of PTH levels in early and late pregnancy.

Aim

To evaluateVitD status and its relationship to parathyroid hormone (PTH) in a cohort of pregnant women representative of multiple Argentinian regions.

Subjects and Methods

Data from samples of 423 pregnant women in 1st and 2nd trimester were collected between 2016 and 2021. VitD was measured in different platforms: DiaSorin Liaison CLIA (n=184), Roche COBAS ECLIA (n=166), Abbott ARCHITECT CMIA (n=33), Biomérieux VIDAS ELFA (n=18) and Siemens CENTAUR CLIA (n=16). PTH (ng/L) was measured in 162 samples by SIEMENS IMMULITE CLIA and Roche COBAS ECLIA. As VitD is light-exposure dependent, we considered warm and high light-exposure season period from December to March and cold and low light season from April to September. VITD (ng/L) levels were classified as Deficient (<20), Insufficient (between 21 and 29) and Sufficient (>30) (Endocrine Society, 2014).

Results

From 423 data collected, 102 were excluded because of lacking information on VitD supplementation. From the remaining non supplemented 321 samples, 48% resulted insufficient, 30% deficient and 22% sufficient for VitD (groups comparison: p< 0. 05, Kruskal Wallis-Dunn test). The seasonal period and pregnancy trimester distributions didn't show significant differences. Similar results of VitD insufficiency were found in the major used platforms, regardless the seasonal period considered. PTH results expressed as median and interquartile range were (ng/L): 32. 0 (13.7-169. 0) in Deficient pregnancies (N=92), 23.7(13.3-88. 0) in Insufficient (n=50) and 18.7 (9.8-55.7) in Sufficient (n=20).

Conclusions

This study shows VitD inadequate levels in 78% in non-supplemented pregnancies, regardless season or measurement platform. Relative elevated levels of PTH were associated to pregnancies with VitD deficiency, evidenciating a regulatory role according to published data. To improve VitD status during pregnancy it would be advisable to pose new strategies for prenatal supplements developed by a multidisciplinary professional team.

Presentation: No date and time listed

The International Academy of Health Sciences Informatics: 2021 Update

OBJECTIVES

To summarize the activities of the International Academy of Health Sciences Informatics (IAHSI) in 2021 and welcome its 2021 Class of Fellows.

METHODS

Report on governance, strategic directions, newly elected fellows, plenary meetings, and other activities of the Academy.

RESULTS

As in 2020, all of the Academy's activities were carried out virtually due to the COVID-19 pandemic. In 2021, new Board members were elected. Strategic activities in data standards and interoperability and in mentorship moved forward. A new class of 26 Fellows was elected, bringing the total membership of the Academy to 204 Fellows from all regions of the world. In addition, a virtual plenary meeting was held.

CONCLUSIONS

The Academy has continued to pursue its role as the honorific society globally for biomedical and health informatics. Expansion of strategic activities and membership will continue moving forward.

Toward a holistic definition for Information Systems for Health in the age of digital interdependence

The article’s main objective is to propose a new definition for Information Systems for Health, which is characterized by the identification and involvement of all the parts of a complex and interconnected process for data collection and decision-making in public health in the information society. The development of the concept was through a seven-step process including document analysis, on-site and virtual sessions for experts, and an online survey of broader health professionals. This new definition seeks to provide a holistic view, process, and approach for managing interoperable applications and databases that ethically considers open and free access to structured and unstructured data from different sectors, strategic information, and information and communication technology (ICT) tools for decision-making for the benefit of public health. It also supports the monitoring of the Sustainable Development Goals and the implementation of universal access to health and universal health coverage as well as Health in All Policies as an approach to promote health-related policies across sectors. Information Systems for Health evolves from preconceptions of health information systems to an integrated and multistakeholder effort that ensures better care and better policy-making and decision-making.

[The electronic medical record in pediatrics: functionalities and best use practices]

The implementation of electronic medical record tools in pediatric care implies the creation of use recommendations and a clear definition of functional features. The objective of this paper is to describe minimum specific functionalities for an electronic medical record in pediatrics, with the aim to contribute to a definition of design criteria and best practices for its use. In this report, we will go over the generic functionality of the electronic medical record; we will frame the legal context in Argentina; we will approach some implementation aspects; and finally, we will describe minimum pediatric specific functionalities. Despite the adoption barriers in the field of pediatrics when it comes to incorporating electronic medical records into their professional activity, there are multiple resources to enable this digital transformation process. It is also fundamental to understand that, like any other technology, there are responsibilities related to their appropriate use.

[Implementation of telemedicine in the Americas: Barriers and facilitatorsBarreiras e facilitadores para a implementação da telemedicina nas Américas]

Con millones de personas en el mundo en situación de distanciamiento físico por el COVID-19, las tecnologías de la información y comunicaciones (TICs) se han posicionado como uno de los medios principales de interacción y colaboración. Ya al inicio de este milenio se empezaban a mencionar las siguientes ventajas: mayor acceso a la información y a la prestación de servicios; fortalecimiento educativo; control de calidad de los programas de detección y reducción de los costos de la atención de en salud. Sin embargo, entre las principales barreras de adopción de la telemedicina se encuentran las de índole: tecnológicas; humanas y sociales; psico-sociales y antropológicas; de Gobernanza y económicas. En estos 20 años se logró un aumento en los recursos y capacidad técnica, una mejora en la educación digital, un empoderamiento del paciente en su tratamiento y un mayor interés público en esta área. En especial se considera exitosa la conformación de equipos interdisciplinarios, las redes académicas y profesionales y las consultas médicas virtuales. Después de revisar el estado de la telemedicina en la Región de las Américas, los autores recomiendan adoptar medidas urgentes para poner en práctica políticas y programas nacionales de telemedicina, incluyendo el marco normativo y presupuesto necesario, cuya implementación se realice de manera integral e interoperable y que se sustente de redes académicas, de colaboración e instituciones especializadas. Dichas políticas deben generar un contexto habilitante que den sostenibilidad al avance logrado, considerando los aspectos mencionados en las posibles barreras.

Twitter data analysis to assess the interest of citizens on the impact of marine plastic pollution

Few studies have mined social media platforms to assess environmental concerns. In this study, Twitter was scraped to obtain a ~140,000 tweet dataset related specifically to marine plastic pollution. The goal is to understand what kind of users profiles are tweeting and how and when they do it. In addition, topic modelling and graph theory techniques have allowed us to identify main concerns on this topic: i) impact on wildlife, ii) microplastics/water pollution, iii) estimates/reports, iv) legislation/protection, and v) recycling/cleaning initiatives. Results reveal a scarce influence of organizations involved in research and marine environmental awareness, so some guidelines are depicted that could help to adjust their communication plans. This is relevant to engage society through reliable information, change habits and reinforce sustainable behaviour. A visualization tool has been created to analyze the results over time.

Complications during repeated tracheal intubation in the Intensive Care Unit. A prospective, observational study comparing the first intubation and the reintubation

BACKGROUND AND GOAL OF THE STUDY

The goal of the study was to compare the incidence of complications, technical difficulty of intubation and physiologic pre-intubation status between the first intubation and reintubation performed on the same patient in an ICU.

MATERIALS AND METHODS

The study was approved by the ethics committee of Galicia (Santiago-Lugo, code No. 2015-012). Due to the observational, noninterventional, and noninvasive design of this study, the need for written consent was waived by the ethics committee of Galicia. Patients requiring tracheal intubation and reintubation in the ICU were included in this prospective observational study. Main endpoint was to compare the incidence of complications, physiologic pre-intubation status, and the rate of technical difficulty of intubation between the first intubation and reintubation performed on the same patient in an ICU.

RESULTS AND DISCUSSION

504 patients were intubated in our ICU during the study period, and 82 (16%) required reintubation. There was no difference between the first intubation and reintubation regarding number of total complication (35% vs 33%; P = ,86), hypotension (24% vs 24%; P = 1), hypoxia (26% vs 26%; P = 1), esophageal intubation (1% vs 1%; P = 1), and bronchoaspiration (2% vs 1%; P = ,86). Physiologic pre-intubation status and technical difficulty of intubation did not differ between the first intubation and reintubation.

CONCLUSIONS

In our ICU patients requiring tracheal reintubation, incidence of complications, physiologic pre-intubation status, and technical difficulty of intubation did not differ between the first intubation and reintubation.

The International Academy of Health Sciences Informatics (IAHSI): 2020 Report

OBJECTIVES

To summarize the major activities of the International Academy of Health Sciences Informatics (IAHSI) in the 2020 time period and to welcome its 2020 Class of Fellows.

METHOD

Report from the members of the Academy's Board.

RESULTS

Due to the SARS-CoV-2 pandemic, both Plenary meetings in 2020 had to be organized as virtual meetings. Scientific discussions, focusing on mobilizing computable biomedical knowledge and on data standards and interoperability formed major parts of these meetings. A statement on the use of informatics in pandemic situations was elaborated and sent to the World Health Organization. A panel on data standards and interoperability started its work. 34 Fellows were welcomed in the 2020 Class of Fellows so that the Academy now consists of 179 members.

CONCLUSIONS

There was a shift from supporting to strategic activities in the Academy's work. After having achieved organizational stability, the Academy can now focus on its strategic work and so on its main objective.

Factors associated with mortality in patients hospitalized with COVID-19: A prospective cohort in a Peruvian national referral hospital

Objectives

To describe and assess clinical characteristics and factors associated with mortality in adult patients with COVID-19 admitted to a national referral hospital in Peru.

Methods

We conducted a prospective cohort study that included hospitalized patients older than 18 years with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis. Patients with a positive rapid serological test on admission but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records.

Results

A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (standard deviation: 15.0), and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). On admission, the most frequent symptoms were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the intensive care unit, and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, and inflammatory markers were associated with higher mortality. It was found that for every 10-year age increase, the risk of dying increased 32% (relative risk: 1.32; 95% confidence interval: 1.25 to 1.38). Those who were admitted to the intensive care unit and and were placed on mechanical ventilation had 1.39 (95% confidence interval: 1.13 to 1.69) and 1.97 (95% confidence interval: 1.69 to 2.29) times the risk of dying compared to those who did not, respectively.

Conclusion

We found a high mortality rate among hospitalized patients associated with older age, higher inflammatory markers, and greater lung involvement.

Effect of long-term individual cognitive stimulation intervention for people with mild neurocognitive disorder

INTRODUCTION

Cognitive stimulation may be beneficial in slowing the progression of mild neurocognitive disorder (NCD), but the results of existing research are inconsistent. Furthermore, there are no long-term interventions nor individual (one-on-one) interventions applied by professionals. Objetive. The aim of this study was to assess the efficacy of a long-term individual cognitive stimulation intervention on people with mild NCD.

PATIENTS AND METHODS

A pre-post test design with a non-equivalent control group was conducted. A total of 82 participants with mild NCD were assigned to a cognitive stimulation intervention group or to a control group. The intervention consisted of 88 individual format sessions of approximately 45 minutes, twice per week. Independent evaluators assessed cognition, depressive symptomatology and autonomy level in activities of daily living at pre-intervention, intra-intervention (6 months) and post-intervention (12 months).

RESULTS

At intra- and post-intervention, significant improvement on cognition and depressive symptomatology in the intervention group compared to the control group were found. Younger participants and those with better cognitive function and status in pre-intervention achieved better results. Adherence to the intervention was high.

CONCLUSIONS

Results suggest the efficacy of long-term individual cognitive intervention in people with mild NCD, which could delay the progression towards a major NCD.

Information and communication technologies in neonatal health

Objectives. To identify scientific evidence on the use and results of information and communication technologies for the improvement of neonatal health in general or specific health problems or interventions, and to describe the type of intervention and its results.

Methods. A systematic review of the available evidence was performed. The search was carried out in peerreviewed journals between January 1, 2008 and April 30, 2018, in English and Spanish. The searched key terms were (health informatics OR telemedicine OR mHealth) AND (newborn OR newborn care OR neonatal care).

Results. From a total of 305 articles initially identified, 10 articles fulfilled the inclusion criteria. The main domains of eHealth identified as applied to neonatal health were telemedicine (3 studies), eLearning (1 study) and mHealth (7 studies). Target population were health care providers or parents. The studies aimed at diagnosis, provision of health care and training, promoting adherence to interventions in parents or improving quality of care.

Conclusions. The use of eHealth in general and specifically focused on neonatal health shows important possibilities for development and expansion, given the advances and present needs, and should be considered a key tool for the reduction of inequalities.

International Academy of Health Sciences Informatics (IAHSI): Strategy and Focus Areas, 1st Version

BACKGROUND

The International Academy of Health Sciences Informatics (IAHSI) is the Academy of the International Medical Informatics Association (IMIA). As an international forum for peers in biomedical and health informatics, the Academy shall play an important role in exchanging knowledge, providing education and training, and producing policy documents.

OBJECTIVES

A major priority of the Academy's activities in its inaugural phase was to define its strategy and focus areas in accordance with its objectives and to prioritize the Academy's work, which can then be transferred to respective taskforces.

METHOD

This document reflects the major outcomes of intensive discussions that occurred during 2019. It was presented at the Academy's 3rd Plenary on August 25th, 2019, in Lyon, France.

RESULTS

Regardless of the 'living nature' of the strategy and focus areas document, it was concluded during the Plenary that the first version, which will be used as a base for decisions on the Academy's future activities, should be made available to a broad audience. Three out of eight 'Visions for IAHSI', presented in the IMIA Yearbook of Medical Informatics 2018, were identified as central for developing, implementing, and evaluating the Academy's strategic directions: (1) advise governments and organizations on developing health and health sciences through informatics, (2) stimulate progress in biomedical and health informatics research, education, and practice, and (3) share and exchange knowledge. Taskforces shall be implemented to work in the following areas, which were considered as priority themes: (1) artificial intelligence in health: future collaboration of entities with natural and with artificial intelligence in health care, and (2) current landscape of standards for digital health.

CONCLUSIONS

Taskforces are now being established. Besides specific key performance indicators, suggested for monitoring the work of theses taskforces, the strategy to monitor the progress of the Academy itself has to be measured by relevant and acceptable metrics.

The International Academy of Health Sciences Informatics (IAHSI): IMIAs Academy is Now Established and on Track

OBJECTIVES

To summarize the major activities of the International Academy of Health Sciences Informatics (IAHSI) from 2018 until 2019, and to provide an outline of actions planned for 2020.

METHOD

Reporting about these activities and actions by the members of the Academy's first Board.

RESULTS

Academy bylaws were accepted by the Academy Plenary and the IMIA General Assembly on August 25th, 2019 and August 26th, 2019, respectively. Academy's strategy and focus areas were developed. Based on the Academy's eligibility criteria, the 2018/2019 Class made of 26 new Academy Fellows was elected. Future activities will concentrate on building taskforces for developing and implementing major Academy focus areas.

CONCLUSIONS

We are glad to report that the Academy is strong and thriving.

Change Management in Healthcare Organizations: Soft Skills Training Strategies Through Blended Learning Environments

Teaching soft skills for change management in healthcare organizations is becoming increasingly necessary, even more, when implementing health information systems (HIS). There is little evidence that these skills can be learned through online teaching environments. This paper describes the experience of having taught soft skills to health informatics master's degree students, through blended learning environments.

Female authorship in Latin American pediatric journals

INTRODUCTION

The participation of women in science increases every day. Here we estimated their participation in authorship in three Latin American pediatric journals indexed in PubMed.

METHODS

All articles published in 2015 in the Archivos Argentinos de Pediatría, the Jornal de Pediatría and the Revista Chilena de Pediatría were identified, and the first and last authors and the total number of authors by sex were determined.

RESULTS

A total of 329 articles were identified. Out of 1432 authors, 59.9% were women. Also, 54.4% of all first authors and 48% of last authors were women. No significant difference was observed in female authorship ratio among the three journals. Archivos Argentinos de Pediatría had a significantly lower number of women as first and last authors.

CONCLUSION

Women authorship ratio across three Latin American pediatric journals reached 59.9%. Their role as first or last authors was significantly lower in the Archivos Argentinos de Pediatría.

Are «off hours» intubations a risk factor for complications during intubation? A prospective, observational study

OBJECTIVE

To compare the complications and the difficulty of orotracheal intubation procedures performed in the Intensive Care Unit during the off-hours period and the on-hours period.

DESIGN

A prospective, observational and non-interventional cohort study covering a period of 27 months was carried out. Working days between 8:00 a. m. and 7:59 p. m. were considered «on-hours», while the remaining shifts were regarded as «off-hours».

SCOPE

An 18-bed surgical in a Intensive Care Unit of a third-level hospital.

PATIENTS

All orotracheal intubation patients admitted to the ICU from January 2015 to March 2017 were included. Patients were stratified into 2groups according to whether intubation was performed on-hours or off-hours.

INTERVENTIONS

Non-interventional study.

VARIABLES OF INTEREST

The reason for intubation, time and day on which intubation was performed, degree of intubation difficulty (number of attempts, Cormack-Lehane laryngoscopic vision, need for accessory material) and complications during intubation.

RESULTS

A total of 252 patients were intubated; of these, 132 were included in the on-hours group and 120 patients in the off-hours group. In the off-hours group we observed a greater percentage of urgent and emergent intubations compared to the on-hours group. However, no differences were found between the 2groups in relation to the other variables studied.

CONCLUSIONS

During the off-hours period, orotracheal intubation was not associated to a greater number of complications or to greater difficulty of the technique in our Unit.

How to Teach Health IT Evaluation: Recommendations for Health IT Evaluation Courses

Systematic health IT evaluation studies are needed to ensure system quality and safety and to provide the basis for evidence-based health informatics. Well-trained health informatics specialists are required to guarantee that health IT evaluation studies are conducted in accordance with robust standards. Also, policy makers and managers need to appreciate how good evidence is obtained by scientific process and used as an essential justification for policy decisions. In a consensus-based approach with over 80 experts in health IT evaluation, recommendations for the structure, scope and content of health IT evaluation courses on the master or postgraduate level have been developed, supported by a structured analysis of available courses and of available literature. The recommendations comprise 15 mandatory topics and 15 optional topics for a health IT evaluation course.

Cultural Problems Associated with the Implementation of eHealth

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.

Toxin profile in samples collected in fresh and brackish water in Germany

The simultaneous detection of cyanotoxins is an important issue in order to prevent intoxications. In the present paper an Ultra Performance liquid Chromatography tandem mass spectrometry UPLC-MS/MS method was developed in order to simultaneously identify and quantify cylindrospermopsin (CYN), several microcystins (MC-LR, MC-RR, MC-YR) and some anatoxin-a (ATX-a) analogues. By using this new method all these toxins can be quickly separate. In addition the amino acid phenylalanine (Phe) can also be separate and therefore misidentifications with ATX-a can be avoided. By using this new method the presence of these toxins was studied in samples collected in several German localizations within the sampling program of the European Project μAqua (Universal microarrays for the evaluation of fresh-water quality based on detection of pathogens and their toxins). In these conditions, several ATX-a analogues, Phe, MC-LR and MC-RR were reported in samples collected.

From Dyadic Ties to Information Infrastructures: Care-Coordination between Patients, Providers, Students and Researchers. Contribution of the Health Informatics Education Working Group

OBJECTIVE

To share how an effectual merging of local and online networks in low resource regions can supplement and strengthen the local practice of patient centered care through the use of an online digital infrastructure powered by all stakeholders in healthcare. User Driven Health Care offers the dynamic integration of patient values and evidence based solutions for improved medical communication in medical care.

INTRODUCTION

This paper conceptualizes patient care-coordination through the lens of engaged stakeholders using digital infrastructures tools to integrate information technology. We distinguish this lens from the prevalent conceptualization of dyadic ties between clinician-patient, patient-nurse, clinician-nurse, and offer the holistic integration of all stakeholder inputs, in the clinic and augmented by online communication in a multi-national setting.

METHODS

We analyze an instance of the user-driven health care (UDHC), a network of providers, patients, students and researchers working together to help manage patient care. The network currently focuses on patients from LMICs, but the provider network is global in reach. We describe UDHC and its opportunities and challenges in care-coordination to reduce costs, bring equity, and improve care quality and share evidence.

CONCLUSION

UDHC has resulted in coordinated global based local care, affecting multiple facets of medical practice. Shared information resources between providers with disparate knowledge, results in better understanding by patients, unique and challenging cases for students, innovative community based research and discovery learning for all.

False positive in the measurement of thyroglobulin induced by rheumatoid factor

BACKGROUND

We report a case of interference in thyroglobulin (Tg) measurement in a woman with differentiated thyroid cancer and rheumatoid arthritis history. Due to discordant Tg in relation to TSH concentrations and negative images, we investigated possible interference in the measurement of Tg.

METHODS

During the follow-up we measured Tg by chemiluminescence (TgQL) using Immulite 2000 immunoassay system. To investigate possible interference in Tg measurement, we made serial dilutions, re-testing of Tg by an alternative method: electrochemiluminescence, Cobas 6000 analyzer (TgEQL), recovery test of Tg and polyethylene glycol (PEG) 6000 precipitation.

RESULTS

During the patient follow-up, the TgQL ranged between <0.3 and 16.1ng/ml. In the evaluated serum samples very high titers of rheumatoid factor (RF) were found. When RF titers were lowered post PEG precipitation, Tg QL concentrations became undetectable.

CONCLUSION

We describe an unusual case of interference in Tg assay due to RF. When disagreement among Tg concentrations, images and clinical features is observed, we suggest taking into account the evaluation of possible Tg interference to avoid unnecessary complementary exams and inappropriate treatment.

Long-term efficacy of indicated prevention of depression in non-professional caregivers: randomized controlled trial

BACKGROUND

Although depression is a common problem among non-professional caregivers, only one trial has evaluated the efficacy of indicated prevention targeting this population and the long-term efficacy is unknown. The aim of this study was to evaluate the long-term efficacy of a brief intervention for the indicated prevention of depression in a sample of female caregivers.

METHOD

A randomized controlled trial was conducted involving 173 participants (mean age 53.9 years) who were allocated to the intervention (n = 89) or the usual-care control group (n = 84). Blinded interviewers conducted assessments at 1, 3, 6 and 12 months of follow-up. The main outcome measure was the incidence of major depression and the secondary outcomes were compliance with treatment, depressive symptoms, emotional distress and caregiver burden.

RESULTS

At the 12-month follow-up, a lower incidence of depression as evaluated using the Structured Clinical Interview for Axis I Disorders of the DSM-IV was found in the intervention group compared with the control group (10.1% v. 25.0%). The relative risk was 0.40 and statistically significant [χ2 = 6.68, degrees of freedom = 1, p = 0.010, 95% confidence interval (CI) 0.20-0.81], and the number needed to treat was 7 (95% CI 4-27). There was a significant delay in the onset of depression in the intervention group (p = 0.008). The good complier caregivers had a lower incidence of depression. The intervention effect on depressive symptoms, emotional distress and caregiver burden were maintained for 12 months.

CONCLUSIONS

This is the first study to demonstrate that a brief problem-solving intervention can prevent the onset of depression among non-professional caregivers over the longer term.

Challenges and Hurdles of eHealth Implementation in Developing Countries

Health informatics has the potential to improve the security and quality of patient care, but its impact has varied between developed and developing countries. Related to this, the objective of this study is to identify the challenges and hurdles to improve eHealth in developing countries. We surveyed experts to discover their opinions about five general questions: economic support by Government for eHealth, Government education or training projects in the field, issues related to cultural or educational problems for the implementation of eHealth, policies in terminology or messaging standards and eHealth status policies for long periods. The respondents answered affirmatively in these proportions: 1. Economic support policies 58%, 2. Training policies 25%, 3. Cultural and educational problems 95%, 4. Standards policies, 38%, 5. Policies for long periods, 50%

CONCLUSION

Our survey has shown that the important problems that need to be addressed in order to implement e-Health in developing countries are firstly, cultural and educational, secondly, economic resources and thirdly policies for long periods.

Assessment of hospital daily cleaning practices using ATP bioluminescence in a developing country

Visual assessment of surfaces may not be enough to document the level of cleanliness in the hospital setting. It is necessary to introduce quantitative methods to document the results of this practice.

OBJECTIVE

To evaluate the efficacy of hospital terminal cleaning procedures, using an adenosine triphosphate (ATP) bioluminescence method in a teaching hospital.

METHOD

During 2008 we conducted an evaluation using ATP bioluminescence LIGHTNING MVP™ (Arquimed) of external and internal housekeeping service. After conducting an initial evaluation we implemented education of cleaning practices and finally we did a post intervention evaluation. Using chi-square method we compared prior versus after cleaning, quality of cleaning performed by external versus internal personnel, single versus double terminal cleaning procedures and prior versus after intervention. A finding of three RLU or less was considered a clean surface.

RESULTS

We performed 198 evaluations in 33 patient units and nine OR. Internal personnel accomplished 25.37% of clean surfaces before and 80% after the education intervention (p=0.01). In contrast, external personnel obtained 68.8% before and 73.33% after intervention (p=0.3).

CONCLUSIONS

This study suggests that visual assessment is not enough to ensure quality of the process and it is necessary to document the level of cleanliness by quantitative methods.

Coastal exposure to oil spill impacts from the Finisterre Traffic Separation Scheme

This study analyzes the coastal exposure to potential oil spills coming from the various corridors that constitute the Finisterre Traffic Separation Scheme (NW Iberia). A Lagrangian model was executed with results from a realistic configuration of an ocean model during 2012, validated here against High-Frequency (HF) radar-derived surface currents. Virtual particles were released each hour and followed during the next 4 days. A series of maps summarize which regions would be impacted and when. We have learnt, for example, that Cape Finisterre is the most affected area under a wide range of scenarios and that a sensitive area such as the National Park of the Atlantic Islands would require protective actions in less than 24 h if oil spills from the south eventually occurred. A complete analysis by corridor and during specific wind events is available through a web tool, which could be useful for decision makers in case of contingency.

Big Data: Are Biomedical and Health Informatics Training Programs Ready? Contribution of the IMIA Working Group for Health and Medical Informatics Education

OBJECTIVE

The growing volume and diversity of health and biomedical data indicate that the era of Big Data has arrived for healthcare. This has many implications for informatics, not only in terms of implementing and evaluating information systems, but also for the work and training of informatics researchers and professionals. This article addresses the question: What do biomedical and health informaticians working in analytics and Big Data need to know?

METHODS

We hypothesize a set of skills that we hope will be discussed among academic and other informaticians.

RESULTS

The set of skills includes: Programming - especially with data-oriented tools, such as SQL and statistical programming languages; Statistics - working knowledge to apply tools and techniques; Domain knowledge - depending on one's area of work, bioscience or health care; and Communication - being able to understand needs of people and organizations, and articulate results back to them.

CONCLUSION

Biomedical and health informatics educational programs must introduce concepts of analytics, Big Data, and the underlying skills to use and apply them into their curricula. The development of new coursework should focus on those who will become experts, with training aiming to provide skills in "deep analytical talent" as well as those who need knowledge to support such individuals.

Professional burnout in pediatric intensive care units in Argentina

INTRODUCTION

There is currently a deficiency of physicians in pediatric intensive care units (PICU). The cause of this deficit is multifactorial, although the burnout phenomenon has been described as relevant.

OBJECTIVE

To analyze the situation of human resource in the pediatric intensive care units in Argentina and measure the level of burnout.

METHODS

An observational cross-sectional study through surveys administered electronically; the Maslach Burnout Inventory was used. Physicians that work at public o private pediatric intensive care units in Argentina during at least 24 hours per week were invited to participate.

RESULTS

A total of 162 surveys were completed (response rate 60%). We observed a high risk of burnout in emotional exhaustion in 40 therapists (25%), in fulfillment in 9 (6%), and depersonalization in 31 (19%). In combination, 66 professionals (41%) had a high risk of burnout to some extent; there were independent protective factors of this risk as to be certified in the specialty (ORA 0.38, 95% CI 0.19 to 0.75) and work in public sector PICU (ORA 0.31, 95% CI 0.15 to 0.65), while working more than 36 hours/week on duty increased the risk (ORA 1.94, 95% CI 1.1 to 3.85). Additionally, 31% said that they did not plan to continue working in intensive care, and 86% did not think to continue with on call duties in the following years. Over 60% of respondents reported that changes in professional practice (salary, staff positions, early retirement, fewer loads on call) could prolong the expectation of continuing activities in PICU.

CONCLUSIONS

A significant percentage of doctors working in the PICU of Argentina have a high risk of burnout syndrome and a low expectation of continuing in the field.

Developing a survey to assess factors that contribute to physician involvement in clinical research

BACKGROUND

Investment in research, including clinical research, has positive effects both on health of a population and economic growth of a country. Several factors have been suggested as being related to the performance of clinical research. The goal of this work was to develop and perform initial validation of a survey that measures both current research involvement of physicians, as well as previously noted factors and additional informatics factors affecting this involvement. The survey was developed in both English and Spanish with the goal of its use in Latin America.

METHODS

The initial survey was developed primarily from experience with other validated surveys developed for similar purposes. It was validated in three stages with modification or elimination of questions as indicated by this testing.

RESULTS

The final survey contains 33 questions in the categories of research experience, education in research, environmental factors, computer experience, and collaboration.

Building a health informatics workforce in developing countries

Information and communication technology can be used to improve the quality and safety of health care and to lower costs. But in both developed and developing countries, there is an inadequate supply of skilled individuals who have the technical skills to use this technology to improve health care. Some studies project workforce needs of tens of thousands in English-speaking developed countries, but it is not known what size workforce will be required in the developing world. It is important to identify and develop the skills, training, and competencies-consistent with local cultures, languages, and health systems-that will be needed to realize the full benefits of these technologies. We present a framework for answering these questions and for developing estimates of the size and scope of the workforce that may be needed.

[Facebook and Twitter, are they already in the pediatrician's office? Survey on the use of social networks]

The Web 2.0 has democratized the use of services and applications, being Facebook and Twitter its leading exponents and it even has been proposed that there exists a Medicine 2.0. A survey for professionals subscribed to discussion lists of Argentine Pediatric Society (SAP) and for visitors to the Website was carried out to know the use of Web 2.0. In 377 responses (76% pediatricians), 81.3% of users use Facebook and Twitter 16.5%. Facebook is used in an 85% for personal purposes, while the professional use of it is 41.2%. Pediatricians frequently use other web 2.0 applications such as YouTube (80.3%), sharing images (52.2%) and listening to Podcasts (34.8%). Around 50% of the professionasl surveyed showed interest in receiving information on the professional activites carried out by SAP. Clinicians should recognize these new tools to incorporate them into their professional activities.