Big data, pharmacoepidemiology and pharmacovigilance / Big data, farmacoepidemiología y farmacovigilancia

Abstract Big data is a term that comprises a group of technological tools capable of processing extremely large heterogeneous data sets, which are continuously collected and are available to be used at any time, and, therefore, constitutes a source of scientific evidence production. In the pharmacoepidemiology field, analyses made using these data sets may result in the development of pharmacological therapies that are more efficient, less expensive, and have a lower occurrence rate of adverse reactions. Likewise, the use of tools such as Text Mining or Machine Learning has led to major advances in pharmacoepidemiology and pharmacovigilance areas, so it is likely that these tools will be increasingly used over time.

Resumen Big data es un término que comprende un grupo de herramientas tecnológicas capaces de procesar conjuntos de datos heterogéneos extremadamente grandes, los cuales se recolectan de manera continua, están disponibles para ser usados y constituyen una fuente de evidencia científica. En el área de la farmacoepidemiología, los análisis generados a partir de estos conjuntos de datos pueden resultar en la obtención de terapias médicas más eficientes, con menor número de reacciones adversas y menos costosas. Asimismo, el uso de herramientas como el Text Mining o el Machine Learning también ha llevado a grandes avances en las áreas de farmacoepidemiología y farmacovigilancia, por lo que es probable que su empleo sea cada vez mayor.

Nivel de concordancia entre personal entrenado y no entrenado en triaje y un sistema informático automatizado / Level of agreement between trained and non-trained personnel in triage with a computerized system / Nível de concordância entre pessoal treinado e não treinado em triagem, e um sistema informático automatizado

El triaje -proceso de clasificación de pacientes según prioridades asistenciales- es una herramienta reconocida para la gestión asistencial y administrativa de los departamentos de emergencia. En el Hospital de Clínicas, luego de ocho años de funcionamiento, se cuenta con un proceso de triaje automatizado y normalizado que se transformó en la base organizativa para el abordaje calificado de las consultas. El objetivo del trabajo fue comparar la concordancia del triaje efectuado por personal de salud entrenado y no entrenado previamente sin apoyo informático versus el sistema informatizado, comparándolo con los resultados del mismo en tiempo real. Se observó que existe un mayor nivel de concordancia del personal entrenado con los resultados del sistema informatizado si lo comparamos con el personal no entrenado. El observador capacitado con más resultados concordantes obtuvo 55,9% de acuerdos con el sistema informatizado de triaje (19 concordantes de 34), y el que obtuvo menos resultados concordantes tuvo 32,4% de similitud (11 concordantes de 34). En el grupo de no expertos el promedio global de concordancia fue de 41,5%. El observador experto tuvo 79,4% (27/34) de resultados iguales y un índice Kappa respecto al sistema informatizado de triaje. El observador experto tuvo un índice Kappa de 0,695, mientras que los observadores capacitados tuvieron un índice Kappa de 0,19 y 0,23 cuando se compararon con el sistema informático y el observador experimentado, respectivamente. Se concluye que un período breve de entrenamiento en triaje no aumenta la concordancia cuando se comparan con los resultados del triaje usando un sistema informático y con el triaje realizado por un observador experimentado. Estos resultados deberían ser validados en series mayores de pacientes. (AU)

"Triage" -the process of quickly examining patients according to their priority of treatment - is a tool that has been recognized for institutional and administrative management in the Emergency Departments. Eight years after its introduction, the Clinicas Hospital has an automatized and normalized process which has become the organizational bases to address consultations in a qualified manner. The study aimed to compare triage done by health professionals who had been trained and the one done by health professionals with no prior training of IT support, to the computerized system, comparing it with results in real time. A higher level of agreement between trained health professionals with the results in the computerized system, when compared to professionals who lacked training was observed. The trained observer with the most matching results achieved 55.9% of agreements with the computerized triage system (19 out of 34), and the observer with the least matching results obtained 32.4% of similarities (11 out of 34). Global agreement level was 41.5% in the group of professionals who were not experts. Experienced observers accounted for 79.4% (27/34) of equal results and kappa index of 0.695, whereas trained observers had 0.19 and 0.23 Kappa indexes when compared to the computerized system and the experiences observer, respectively. Therefore, we find that a short training in triage does not increase agreement when compared to the computerized system and it does increase when we compare it to triage by an experienced observer. These results should be validated in larger series of patients. (AU)

A "triagem" -processo de classificação de pacientes por prioridades assistenciais- é uma ferramenta reconhecida para a gestão assistencial e administrativa dos Departamentos de Emergência. No Hospital de Clínicas, depois de oito anos de funcionamento, está disponível um processo de triagem automatizado e normalizado que funciona como base da organização para a abordagem qualificada das consultas. O objetivo deste trabalho foi comparar a concordância da triagem realizada por pessoal de saúde treinado e não treinado previamente sem apoio informático, versus sistema informatizado, comparando os resultados em tempo real. Observou-se um maior nível de concordância do pessoal treinado com os resultados do sistema informatizado, se comparamos com o pessoal não treinado. O observador capacitado com mais resultados concordantes teve 55,9% de concordâncias com o sistema informatizado de triagem (19 concordantes de 34), e o que obteve menos resultados concordantes 32,4% de similitude (11 concordantes de 34). No grupo de no expertos a média global de concordância foi 41,5%. O observador experto teve 79,4% (27/34) de resultados iguais e um índice kappa respeito al sistema informatizado de triagem. O observador experto teve um índice de Kappa de 0,695, enquanto os observadores capacitados tiveram um índice kappa de 0.19 y 0.23 quando foram comparados com o sistema informático e o observador experimentado, respectivamente. Conclui-se que um período breve de treinamento em triagem não aumenta a concordância quando se compara com si e com um observador experimentado. Estes resultados deveriam ser validados em series maiores de pacientes. (AU)

Performance evaluation and study on open assembly line system in medical laboratory / 中华检验医学杂志

Objective To investigate the advantages and continuous optimization of laboratory automation system through analysis and assessment of the core data and performance after the application of open assembly line.Methods Collect the data of biochemical and immunoassay in Shuguang Hospital attached to Shanghai University of Traditional Chinese Medicine from April to October 2017.( 1 ) Cost analysis of the assembly line schemes;(2) Analysis of workflow before and after the application of assembly line;(3) Analysis of the volume of samples collecting before and after the application of assembly line ;(4) Analysis of TAT data before and after the application of assembly line; ( 5 ) Analysis of staffs allocation before and after the application of assembly line; (6) Analysis of samples rechecking before and after the application of assembly line .Results (1) Open assembly line costs least on hardware (8 million) and site among various projects;(2) Inspection process is greatly simplified after the application of assembly line;(3) The samples′volume of biochemical and immunoassay inspection were reduced by 31.85％;(4) The items′test cycle decreases after the application of assembly line , the average TAT is reduced by 32 minutes;(5) Staffs for samples pretreatment can be reduced by 50％after the application of assembly line , and the quantity of operators does not change;(6) The number of re-check samples increase except the gray zone and critical values , which ensures the reliability of the results .Conclusion To analyze the core data and to evaluate the performance , the laboratory improve on detection cycle ,staffs,and test efficiency.

Inclusão de etapa de pós-processamento determinístico para o aumento de performance do relacionamento (linkage) probabilístico / Inclusion of a deterministic post-processing stage to increase the performance of probabilistic record linkage / Inclusión de la etapa de postprocesamiento determinístico para el aumento del rendimiento del enlace (linkage) probabilístico

O objetivo do presente estudo foi demonstrar a aplicação de uma etapa de pós-processamento determinístico, baseada em medidas de similaridade, para aumentar a performance do relacionamento probabilístico com e sem a etapa de revisão manual. As bases de dados utilizadas no estudo foram o Sistema de Informação de Agravos de Notificação e o Sistema de Informações sobre Mortalidade, no período de 2007 a 2015, do Município de Palmas, Tocantins, Brasil. O software probabilístico utilizado foi o OpenRecLink; foi desenvolvida e aplicada uma etapa de pós-processamento determinístico aos dados obtidos por três diferentes estratégias de pareamento probabilístico. As três estratégias foram comparadas entre si e acrescidas da etapa de pós-processamento determinístico. A sensibilidade das estratégias probabilísticas sem revisão manual variou entre 69,1% e 77,8%, já as mesmas estratégias, acrescidas da etapa de pós-processamento determinístico, apresentaram uma variação entre 92,9% e 96,3%. A sensibilidade de duas estratégias probabilísticas com revisão manual foi semelhante à obtida pela etapa de pós-processamento determinístico, no entanto, o número de pares destinados à revisão manual pelas duas estratégias probabilísticas variou entre 1.177 e 1.132 registros, contra 149 e 145 após a etapa de pós-processamento determinístico. Nossos resultados sugerem que a etapa de pós-processamento determinístico é uma opção promissora, tanto para aumentar a sensibilidade quanto para reduzir o número de pares que precisam ser revisados manualmente, ou mesmo para eliminar sua necessidade.

The aim of this study was to demonstrate the application of a deterministic post-processing stage, based on measures of similarity, to increase the performance of probabilistic record linkage with and without manual revision. The databases used in the study were the Brazilian Information System for Notificable Diseases and the Brazilian Mortality Information System, from 2007 to 2015, in Palmas, Tocantins State, Brazil. The probabilistic software was OpenRecLink, and a deterministic post-processing stage was applied to the data obtained from three different probabilistic linkage strategies. The three strategies were compared to each other, and the deterministic post-processing stage was added. The sensibility of the probabilistic strategies without manual revision varied from 69.1% and 77.8%, while the same strategies plus the deterministic post-processing stage varied from 92.9% to 96.3%. Sensitivity of the two probabilistic strategies with manual revision was similar to that obtained by the deterministic post-processing stage, but the number of matches that were referred to manual revision by the two probabilistic strategies varied between 1,177 and 1,132 records, compared to 149 and 145 after the deterministic post-processing stage. Our findings suggest that the deterministic post-processing stage is a promising option, both to increase the sensitivity and to reduce the number of matches that need to be reviewed manually, or even to eliminate the need for manual revision altogether.

El objetivo del presente estudio fue mostrar la aplicación de una etapa de postprocesamiento determinístico, basada en medidas de similitud, con el objeto de aumentar el rendimiento del enlace probabilístico con y sin etapa de revisión manual. Las bases de datos utilizadas en el estudio fueron el Sistema de Información sobre Enfermedades de Notificación Obligatoria y el Sistema de Informaciones sobre Mortalidad, durante el período de 2007 a 2015, en el municipio de Palmas, Tocantins, Brasil. El software probabilístico utilizado fue el OpenRecLink; se desarrolló y aplicó una etapa de postprocesamiento determinístico con los datos obtenidos mediante tres estrategias diferentes de emparejamiento probabilístico. Las tres estrategias se compararon entre sí y se añadieron a la etapa de postprocesamiento determinístico. La sensibilidad de las estrategias probabilísticas sin revisión manual varió entre el 69,1% y el 77,8%, incluso las mismas estrategias, añadidas de la etapa de postprocesamiento determinístico, presentaron una variación entre 92,9% y 96,3%. La sensibilidad de las dos estrategias probabilísticas con revisión manual fue semejante a la obtenida por la etapa de postprocesamiento determinístico, sin embargo, el número de pares destinados a la revisión manual por las dos estrategias probabilísticas varió entre 1.177 y 1.132 registros, frente 149 y 145 tras la etapa de postprocesamiento determinístico. Nuestros resultados sugieren que la etapa de postprocesamiento determinístico es una opción prometedora, tanto para aumentar la sensibilidad, como para reducir el número de pares que necesitan ser revisados manualmente, o incluso para eliminar su necesidad.

Practice of bar code management for implanted high-value consumables in operating room / 中华护理杂志

Objective To establish standardized traceable management procedure for implanted high-value consumables in operating room.Methods The management model combining information-based system operation process and quality control process was designed,and management results before and after implementation were compared.Results There were statistically significant differences in error rates of information recording,bar code sticking and charging of implantable high-value consumables after the implementation of the process management mode (P＜0.05).At the same time,there were statistically significant differences in improvement of traceability of high-value consumables,adverse event reporting and patient satisfaction(P＜0.05).Conclusion Establishment of management model in operating room for implanted high-value consumables can ensure medical safety and increase medical quality.It was proved to improve the level of hospital management.

Development and Evaluation of a Multi-Functional Drug Discrimination System Mounted with Automatic Data Analysis of the Clinical Examination Values for Medications Brought to Hospital / 医薬品情報学

<b>Objective: </b>Numerous new drugs have been developed in recent years, making the available types of prescription drugs quite diverse, with increasingly more complex drug interactions.  From an operations support system perspective, hospitals that cannot incorporate a large-scale custom-order system because of financial or use-efficiency limitations have no choice but to rely on commercial products.  However, this leaves many problems unsolved, such as functional restrictions and limited specifications.  In this study, we used Microsoft®Visual Basic®for Application (VBA) to develop an economical drug discrimination system suited to our situation and equipped with original function from the perspective of clinical pharmacists.<br><b>Design: </b>System design and development.<br><b>Methods: </b>We prototyped the system in VBA and used Microsoft®Excel®to create Query Tables.  The utility of the new system was evaluated based on drug discrimination output and time required in each process.<br><b>Results: </b>The new system is capable of inter-database communication and automated data analysis and uses drop-down lists of pre-defined options for data input in many places.  Compared with the conventional method, the new system enabled us to significantly reduce the average time needed to input and confirm data by as much as 61.9%.  This indicates that the new system can considerably reduce the time required for completing time-intensive processes and is also useful in preparing highly precise drug discrimination reports.<br><b>Conclusion: </b>Based on the results obtained so far, the new, original system, developed with zero design or development costs, is more efficient and offers more reliable information in the clinical setting than the conventional system.  As a result, we are able to maintain operational quality and reduce the amount of time required for drug discrimination.

Implementation of criteria for automatic release of clinical chemistry test results in a laboratory at an academic public hospital / Implantação de critérios de liberação automática de resultados de bioquímica em um laboratório de hospital público universitário

ABSTRACT Introduction: Autoverification is the release of laboratory test results from clinical instruments to hospital interface, or to patients' records, with no human intervention. Verification rules are inserted in the middleware and/or in the laboratory information system (LIS), based on criteria established by the laboratory. As a result, it ensures that every result is consistently reviewed in the same way, improving the entire verification process and patient safety. Objective: Describe the implementation of autoverification of clinical chemistry tests results at the core laboratory of Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), Brazil. Material and methods: Twenty-six automated chemistry assays were chosen. They were fully automated including internal quality control, interfaced with LIS, available 24 hours a day, seven days a week. Rules were set up in the middleware and in the LIS. Instrument flags, evaluation of sample integrity, test linearity, delta check and critical values were used to construct the verification algorithms. Results: An autoverification algorithm was constructed; delta check values were calculated and defined, as well as automatic verification ranges. The results retained for manual verification followed a flowchart prepared for this purpose. Conclusion: Autoverification implementation led to a more consistent reviewing process of test results, efficiency and improved patient safety.

RESUMO Introdução: A verificação automática dos resultados consiste na liberação dos resultados dos exames diretamente do equipamento, sem intervenção humana. São inseridas regras para avaliar os resultados no middleware e/ou no sistema de informação laboratorial (SIL), com base em critérios estabelecidos pelo laboratório. A autoverificação uniformiza os critérios de liberação e melhora a eficiência no processo, garantindo a segurança do paciente. Objetivo: Descrever a implantação da autoverificação nos testes bioquímicos do menu de urgência no Serviço de Medicina Laboratorial (SML) do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG). Material e métodos: Foram configurados 26 testes bioquímicos disponíveis 24 horas por dia, plenamente interfaceados, inclusive o controle interno da qualidade. Definiram-se parâmetros e algoritmos usados para configuração do SIL e no middleware. No algoritmo elaborado para autoverificação, foram incluídos flags de equipamento, presença de interferentes na amostra, linearidade, delta check e valores críticos. Resultados O algoritmo de liberação automática de resultados, os valores de delta check, os intervalos de liberação automática e o fluxograma para liberação manual dos resultados retidos foram definidos e implantados. Conclusão: A implantação da autoverificação nos testes bioquímicos do menu de urgência no serviço possibilitou padronização e segurança na liberação dos resultados.

Automated biometry of human ocular anterior segment based on spectral domain optical coherence tomography / 中华实验眼科杂志

Background Ultra-long scan depth OCT can achieve imaging of full range of human ocular anterior segment.However,the measurement of the dimension of anterior segment from the OCT image with high speed and precision is a challenge at present.The software of automatic data processing is still lack in analyzing spectral domain OCT.Objective This study was to perform the automatic biometry and data processing of human ocular anterior segment OCT image by using self-developed automatic detection software and evaluate the accuracy and repeatability of this method.Methods Twenty eyes of 10 normal subjects were included in Eye Hospital of Wenzhou Medical University from June to July 2013.The OCT image of anterior eye segments were obtained with custom-made ultra-long scan depth OCT under the informed consent.Anautomatic software algorithm was developed for the biometric measurement on these OCT images,including boundary segmentation,image registration and optical correction of OCT images.The boundary segmentation algorithm utilized the axial gradient information of OCT images and the shortest path search principal based on the dynamic programming to optimize edge finding.Central corneal thickness (CCT),anterior chamber depth (ACD),pupil diameter (PD),lens thickness (LT),radius of lens anterior curvatures (LAC) and radius of lens of posterior curvatures (LPC) were automatically and manually measured,and the validity of automatic detection algorithm was assessed by calculating the intraclass correlation coefficient (ICC) between the automatic and manual measurements,and the repeatability was validated by calculating the coefficient of repeatability (COR) between repeated measurement.This study was approved by the Ethic Committee of Wenzhou Medical University and informed consent was obtained from all subjects.Results There were no significant differences in the results of CCT,ACD,PD,LT,LAC and LPC between the automatic and manual measurements (P =0.205,0.167,0.285,0.127,0.102,0.074).The results were consistent between automatic and manual measurements (all at ICC＞0.75).The repeated measurement values were consistent in CCT,ACD and LT in both automatic and manual modes (all at ICC＞0.75).The reproducibilities of automatic biometry in PD and LAC (ICC =0.793,0.872;COR =2.90,5.79) were better than those of manual mode (ICC =0.631,0.579;COR =5.62,10.46);while the reproducibility of automatic biometry in LPC (ICC =0.663;COR =6.17) was lower than that of manual mode (ICC =0.794,COR =4.79).Conclusions Self-developed automatic detection software appears to be accurate and repeatable in measuring dimension of spectral domain OCT images.This automatic software algorithm can be used for the biometry and monitor of human ocular anterior segment.

Avaliação de uma aplicação openEHR utilizando RESTful web services / Evaluation of an openEHR application using RESTful web services

A padronização dos Registros Eletrônicos em Saúde (RES) tem sido amplamente requerida desde de sua regulamentação pelo Ministério da Saúde. Neste contexto, o modelo de referência openEHR foi definido para a padronização dosRES. OBJETIVO: Avaliar a viabilidade de uma aplicação RESTful utilizando o openEHR (cwOpenEhr RestApi). MÉTODOS: O tempo de Requisição-Resposta (TRR) do cwOpenEhrRestApi foi comparado com uma aplicação que não utiliza REST e com um tempo máximo aceitável por um usuário (15 segundos). RESULTADOS: Há indicação de que o TRR do cwOpenEhrRestApifoi menor do que o tempo máximo aceitável. Além disso, o TRR foi diferente ao de uma aplicação que não utilizou RESTful. CONCLUSÃO: A utilização de RESTful com openEHR foi considerada viável, uma vez que, embora exista uma diferença estatisticamente significativa do TRR com relação à abordagem sem RESTful, o TRR do cwOpenEhrRestApi foi significativamente menor que o tempo máximo aceitável por um usuário.

Standardize Electronic Health Records (EHR) has been widely required since its regulation by the Brazilian Ministry of Health. In this context, openEHR's reference model has been defined to standardize the EHR. OBJECTIVE: Evaluate the feasibility of a RESTful openEHR solution (cwOpenEhrRestApi). METHODS: The Request-Response Time(RRT) of cwOpenEhrRestApi was compared to an application that does not use RESTful and to a maximum acceptable time for a user (15 seconds). RESULTS: There is an indication that the RRT of cwOpenEhrRestApi was lower than the maximum acceptable time. Furthermore, the time was different to a non-based RESTful application. CONCLUSION: The use ofRESTful with openEHR was considered feasible, since, despite the fact that there is a statistically significant differenceregarding the non-based RESTFul RRT, the RRT of cwOpenEhrRestApi was significantly lower than the maximum acceptabletime for a user.

O impacto do gerenciamento da informação em saúde no exercício da enfermagem brasileira no período de 2004-2009 / Impact of health information management on Brazilian nursing practice from 2004 to 2009 / Impacto del gerenciamento de la información en salud en la práctica de la enfermería brasilena entre los anos 2004 y 2009

A crescente busca de qualidade no atendimento à saúde abrange o gerenciamento da informação em saúde como elemento constitucional de realidades profissionais e assistenciais aprimoradas. Em face de o engajamento profissional assumir papel tático nessa conjuntura, desenvolveu-se uma revisão integrativa da literatura com o objetivo de analisar os impactos do gerenciamento da informação em saúde que permearam os processos de trabalho da Enfermagem brasileira no período de 2004 a 2009. Identificaram-se os reflexos da integração de sistemas e tecnologias de informação no contexto da atuação do profissional enfermeiro. Efetuou-se levantamento bibliográfico na base de dados da Biblioteca Virtual em Saúde, sendo que 20 produções somadas à Política Nacional de Informação e Informática em Saúde versão 2.0 foram analisadas mediante três linhas de significado. Relevou-se o empoderamento da enfermagem brasileira em 60% dos estudos, em 25% ficaram expressas as desarticulações laborais da profissão frente aos Sistemas de Informação em Saúde nacionais e 15% das produções remeteram a um cenário caracterizado por percalços experimentados pela Enfermagem. Evidenciou-se o interesse da Enfermagem em gerar conhecimentos e programar estratégias consoantes os fenômenos gerenciais da informação em saúde. Todavia, o enfermeiro não se apoderou veementemente dos mecanismos mais acertados para tal processo.

Health information management is an essential practice in the constant questfor quality patient care. In this context professional commitment is fundamental; the present study is an integrative literature review that aims at analysing the impact of health information management in nursing practice in Brazil from 2004 to 2009, identifying the consequences of system integration and the advances in information technology applied to nursing work process. The authors did a bibliographic survey based on data from the Health Virtual Library. Other twenty papers from the National Information Policy and the Health Informatics version 2.0 were selected and analysed using three different significance models. A total of 60% of the studies dealt with the empowering of the nursing professional; 25% revealed the professionals' lack of training to deal with the National Information System; 15% identified the various hindrances to nursing practice. The research highlighted professionals' commitment with knowledge generation and in the development of strategies to deal with health information management. However, nurses still do not have the appropriate means to carry out the process.

La búsqueda creaente de la calidad en la atención sanitaria incluye el manejo de la información como elemento constituyente de la realidad profesional y asistenaal mejorada. Por ello, el compromiso profesional asume un rol táctico en esta coyuntura. El presente estudio es una revisión integradora de la literatura con miras a analizar el impacto del manejo de la información en salud sobre el proceso de trabajo de la enfermería brasilena entre 2004 y 2009. Se identificaron los reflejos de la integración de sistemas y tecnologias de la información dentro del contexto de la actuación del enfermero profesional. Se realizó un relevamiento bibliográfico en la base de datos de la Biblioteca Virtual en Salud (Brasil) y se analizaron 20 producaones vinculadas a la Política Nacional de Información e Informática en Salud, versión 2.0, en tres aspectos distintos. En 60% de los estudios se observa el empoderamiento de la enfermería brasilena, en 25% es evidente la desarticulación laboral de la profesión ante los sistemas de información en salud en Brasil y un 15% mostró el escenario de dificultades que enfrentan los enfermeros. Ha quedado evidente el interés de Enfermería en generar conocimientos y planificar estrategias relativas al manejo de la información en salud. Sin embargo, el enfermero todavía no se ha empoderado de forma vehemente de los mecanismos más acertados para tal proceso.

Una experiencia de implementación del registro médico electrónico en Perú / An experience with implementation of electronic medical records in Peru

OBJETIVO: Analizar el proceso de implementación de sistemas de información del prestador de servicios de salud en Perú. MÉTODOS: Se realizó un estudio cualitativo sobre la implementación de un sistema de información del prestador de salud en regiones de la costa, sierra y selva de Perú. RESULTADOS: Se identificaron factores que dificultan y que facilitan el proceso de implementación. Los factores críticos de éxito identificados fueron la planificación de la implementación, el compromiso ejecutivo, el compromiso del líder de la implementación, la cultura organizacional y la capacidad de los recursos humanos. CONCLUSIONES: Los procesos de implementación de sistemas de información del prestador muestran diversas dificultades asociadas fundamentalmente con barreras humanas.

OBJECTIVE: Analyze the process for implementation of health provider information systems in Peru. METHODS: A qualitative study was conducted on implementation of a health provider information system in coastal, mountain, and jungle regions of Peru. RESULTS: Factors were identified that hinder and that facilitate the implementation process. Critical success factors included planning of implementation, executive commitment, commitment of the implementation leader, organizational culture, and human resources capacity. CONCLUSIONS: Implementation processes for provider information systems demonstrate various difficulties associated primarily with human barriers.

The standardization of clinical laboratory information system / 中华检验医学杂志

Clinical laboratory information system is the key to the realization of total laboratory automation,standardization,intelligent and digitization.In recent years,with the establishment,application,popularization and upgrading of clinical laboratory information system,it is very important to establish the construction criterion of clinical laboratory as soon as possible.Now according to the requirements of construction and management of modern clinical laboratory and combining with the practical application of clinical laboratory information system in our hospital at domestic settings,the standardization construction of clinical laboratory information system was discussed in this article.

Development and Feasibility of a Web-based Program 'Diet Evaluation System (DES)' in Urban and Community Nutrition Survey in Korea

BACKGROUND: Repeated 24 hour recall has been considered as a preferred method for obtaining accurate dietary information while time and cost for coding and data processing have been a major barrier for their use in large studies. This burden can be resolved by automating the interview and data processing. However, there has been no report about a computerized interview system for dietary survey in a free-living population in Korea. METHODS: This study attempts to test the feasibility of a newly-developed web-based dietary assessment program, Diet Evaluation System (DES) for subjects in a mixed region of urban and rural areas via wireless internet. We conducted total of 134 interviews, twice for each of 67 subjects of various age. As another aspect of feasibility, the group discussion among interviewers was done. RESULTS: Success rate of total attempted interviews was about 70%. Major reasons for problem with DES were instability of wireless internet and consequent inefficient booting of laptops in some areas. It took 14 minute 56 seconds on average to complete an interview and data processing conducted automatically. Subjects' age and internet environment influenced the DES interview time. The group discussion revealed that one-stop system with DES is fast and convenient assuming good wireless internet environment. CONCLUSIONS: Web-based dietary assessment was feasible in this community nutrition survey. To confirm the feasibility in large scale, studies with more comprehensive area and subjects are needed with various wireless condition.

Archetype Model-Driven Development Framework for EHR Web System / 대한의료정보학회지

OBJECTIVES: This article describes the Web application framework for Electronic Health Records (EHRs) we have developed to reduce construction costs for EHR sytems. METHODS: The openEHR project has developed clinical model driven architecture for future-proof interoperable EHR systems. This project provides the specifications to standardize clinical domain model implementations, upon which the ISO/CEN 13606 standards are based. The reference implementation has been formally described in Eiffel. Moreover C# and Java implementations have been developed as reference. While scripting languages had been more popular because of their higher efficiency and faster development in recent years, they had not been involved in the openEHR implementations. From 2007, we have used the Ruby language and Ruby on Rails (RoR) as an agile development platform to implement EHR systems, which is in conformity with the openEHR specifications. RESULTS: We implemented almost all of the specifications, the Archetype Definition Language parser, and RoR scaffold generator from archetype. Although some problems have emerged, most of them have been resolved. CONCLUSIONS: We have provided an agile EHR Web framework, which can build up Web systems from archetype models using RoR. The feasibility of the archetype model to provide semantic interoperability of EHRs has been demonstrated and we have verified that that it is suitable for the construction of EHR systems.

Implementação do sistema de gestão de materiais informatizado do Hospital Universitário da Universidade de São Paulo / Implementation of computerized material management system at the University of São Paulo University Hospital / Implementación de un sistema de gestión de materiales informatizado del Hospital Universitario de la Universidad de São Paulo

Trata-se do relato do processo de implementação do sistema informatizado de gestão de materiais no Hospital Universitário da USP. O sistema foi intitulado Sistema de Gestão de Materiais (SGM). A implementação apresentou quatro fases: a escolha do modelo e da ferramenta informacional, a reestruturação do processo logístico de materiais do hospital, a reestruturação das áreas de apoio e a implantação do próprio sistema SGM. O estudo realizado no Centro Cirúrgico após a implantação do sistema demonstrou que, comparando o consumo e o estoque de materiais do SGM em relação ao Sistema Tradicional, houve uma diminuição da quantidade consumida e do custo dos materiais estocados na Unidade.

This is an experience report on the process of implementing a computerized materials management system at the University Hospital of the University of São Paulo. The system was called Materials Management System (SGM). The process comprised four phases: choice of the model and information tool; restructuring of the logistic materials process at the hospital; restructuring of the support areas and establishment of the SGM system itself. A study carried out at the Surgical Center after the establishment demonstrated that, when comparing materials consumption and inventories in the SGM with the Traditional System, the consumed quantity and the cost of inventory materials at the Unit decreased.

Se trata de un informe de experiencia del proceso de implementación de un sistema informatizado de gestión de materiales en el Hospital Universitario de la Universidad de São Paulo, Brasil. El sistema llevó por nombre Sistema de Gestión de Materiales (SGM). La implementación necesitó de cuatro fases: la elección del modelo y de las herramientas informáticas, la reestructuración del proceso logístico de materiales hospitalarios, la reestructuración de las áreas de apoyo y la implantación del propio sistema SMG. Un estudio realizado en los Quirófanos luego de la implementación demostró que, comparando el consumo y el stock de materiales del SMG en relación al Sistema Tradicional, hubo una disminución de las cantidades consumidas y del costo de los materiales en stock en la Unidad.

Tendência da mortalidade relacionada à doença de Chagas, Estado de São Paulo, Brasil, 1985 a 2006: estudo usando causas múltiplas de morte / Chagas disease-related mortality trends, state of São Paulo, Brazil, 1985 to 2006: a study using multiple causes of death

OBJETIVO: Estudar a tendência da mortalidade relacionada à doença de Chagas informada em qualquer linha ou parte do atestado médico da declaração de óbito. MÉTODOS: Os dados provieram dos bancos de causas múltiplas de morte da Fundação Sistema Estadual de Análise de Dados de São Paulo (SEADE) entre 1985 e 2006. As causas de morte foram caracterizadas como básicas, associadas (não-básicas) e total de suas menções. RESULTADOS: No período de 22 anos, ocorreram 40 002 óbitos relacionados à doença de Chagas, dos quais 34 917 (87,29 por cento) como causa básica e 5 085 (12,71 por cento) como causa associada. Foi observado um declínio de 56,07 por cento do coeficiente de mortalidade pela causa básica e estabilidade pela causa associada. O número de óbitos foi 44,5 por cento maior entre os homens em relação às mulheres. O fato de 83,5 por cento dos óbitos terem ocorrido a partir dos 45 anos de idade revela um efeito de coorte. As principais causas associadas da doença de Chagas como causa básica foram as complicações diretas do comprometimento cardíaco, como transtornos da condução, arritmias e insuficiência cardíaca. Para a doença de Chagas como causa associada, foram identificadas como causas básicas as doenças isquêmicas do coração, as doenças cerebrovasculares e as neoplasias. CONCLUSÕES: Para o total de suas menções, verificou-se uma queda do coeficiente de mortalidade de 51,34 por cento, ao passo que a queda no número de óbitos foi de apenas 5,91 por cento, tendo sido menor entre as mulheres, com um deslocamento das mortes para as idades mais avançadas. A metodologia das causas múltiplas de morte contribuiu para ampliar o conhecimento da história natural da doença de Chagas.

OBJECTIVES: To study mortality trends related to Chagas disease taking into account all mentions of this cause listed on any line or part of the death certificate. METHODS: Mortality data for 1985-2006 were obtained from the multiple cause-of-death database maintained by the São Paulo State Data Analysis System (SEADE). Chagas disease was classified as the underlying cause-of-death or as an associated cause-of-death (non-underlying). The total number of times Chagas disease was mentioned on the death certificates was also considered. RESULTS: During this 22-year period, there were 40 002 deaths related to Chagas disease: 34 917 (87.29 percent) classified as the underlying cause-of-death and 5 085 (12.71 percent) as an associated cause-of-death. The results show a 56.07 percent decline in the death rate due to Chagas disease as the underlying cause and a stabilized rate as associated cause. The number of deaths was 44.5 percent higher among men. The fact that 83.5 percent of the deaths occurred after 45 years of age reflects a cohort effect. The main causes associated with Chagas disease as the underlying cause-of-death were direct complications due to cardiac involvement, such as conduction disorders, arrhythmias and heart failure. Ischemic heart disease, cerebrovascular disorders and neoplasms were the main underlying causes when Chagas was an associated cause-of-death. CONCLUSIONS: For the total mentions to Chagas disease, a 51.34 percent decline in the death rate was observed, whereas the decline in the number of deaths was only 5.91 percent, being lower among women and showing a shift of deaths to older age brackets. Using the multiple cause-of-death method contributed to the understanding of the natural history of Chagas disease.

Informatização de tarefa administrativo-burocrática em enfermagem: proposta de construção de protótipo de sistema de elaboração de escala mensal de Pessoal / Informatization of administrative-bureaucratic tasks in nursing: proposal for the construction of a prototype system for the elaboration of a monthly personnel roster

Este trabalho é um estudo descritivo que propõe a construção de um sistema informatizado para auxílio na confecção de escala de pessoal em enfermagem, partindo do pressuposto que esta categoria se encontra sobrecarregada por atividades administrativas, sobretudo as de cunho burocrático, as quais consomem tempo demasiado tendendo a afastar o profissional de sua função doutrinal de prestar assistência ao cliente. Foram levantados por meio de revisão bibliográfica e análise crítica as possíveis determinantes e conseqüências desta sobrecarga enfocando as contribuições que podem ser oferecidas pela informática para um aproveitamento mais eficiente do tempo. Observou-se que, dentre as principais causas do mau uso do tempo do enfermeiro estão as imposições institucionais, as incongruências existentes entre a formação acadêmica e as exigências do mercado de trabalho, o comprometimento dos profissionais com os objetivos e prioridades da organização e de outras categorias profissionais em detrimento dos objetivos e prioridades da profissão, a falta de posicionamento ético-político com a adoção de posturas passivas, a escassez de recursos humanos e materiais, além da explosão da informação provocada pela era da informática. Tais fatos ocasionam, em conjunto, sobrecarga de trabalho e desvios funcionais. Concluiu-se que há uma necessidade premente de repensar as práticas e posturas tradicionalmente adotadas na enfermagem fazendo-se também necessário incorporar os recursos oferecidos pela informática como mais uma ferramenta de auxílio na execução das atividades administrativas do enfermeiro.

This work describes the making of a computerized information system that intends to help nurses to perform staff schedule, assuming that this professional category is frequently overloaded for administrative activities, above all bureaucratic tasks, that tends to consume a great amount of time moving nurses away from his real and doctrinal activity that is to assist the clients in their needs. Bibliographical researches and critical analyses was made to know the most probable causes and consequences of the work overload among nurses, focusing the contributions that could be offered by informatics to a more efficient use of the nurse's time. Was observed that, among the main reasons for the bad use of time are the institutional impositions, incongruity between academical formation and the market work demands, the compromising of some professionals with organizational objectives and priorities and with the objectives and priorities of another professional categories on detriment of nursing objectives and priorities, the lack of ethical and political positioning with the adoption of passive postures, the shortage of human resources and the explosion of information caused for the informatics era. These facts, jointly, induce a work overload and functional deviations. The conclusion is that there is an urgent need to rethink our practice and the traditionally adopted postures in nursing, being needful to join the resources offered by informatics as one more tool to carry out the nurses administrative activities.

The distinguishing of gastric cancer associated genes by digital gene expression displayer using serial analysis of gene expression database / 中国医师杂志

Objective To proceed deep data mining in large database obtained by Cancer Genome Anatomy Project and to distinguish the difference expression genes of gastric carcinoma.Methods The 300,783 serial analysis of gene expression records from 4 libraries of gastric cancer and 2 libraries of normal gastric tissue in database of the Cancer Genome Anatomy Project were analyzed by digital gene expression displayer.Results The 201 difference expression tags represented 136 genes(54 up-regulated and 82 down-regulated) and 65 ESTs(24 up-regulated and 41 down-regulated) were distinguished,and these genes were involved in biological process and signal transduction pathways,such as cell cycle regulation,cell proliferation and apoptosis.The gene expression profile in whole body normal and cancer tissues of PTMA were constructed by digital Northern based on serial analysis of gene expression database and by virtual Northern based on cDNA database,respectively.Conclusion The difference expression genes of gastric cancer can be distinguished effectively with bioinformatics,and the results will guide our further molecular biology research.If validated by molecular biology experiment,the difference expression genes will be used as molecular targets of gastric carcinoma.

CT and MR image fusion technique and its clinical application / 中华放射学杂志

Objective To provide new diagnose informations for clinician by using image fusion. Methods 30 cases with brain lesion (men 18,women were studied 12). Twenty cases were examined by CT or MR in 1_2 weeks, the others were checked by MR, after being diagnosed with CT. These image data were input into computer the center and main axis of image were located by Legendre moment then the CT and MR images were registered by translation, scaling and rotation. Results Of 30 image fusions, supplementary informations were provided to each other in 28 cases,prediction of disease progress in 19 cases. There were 4 cases confirmed at surgery. But in 2 cases no obvious advantage was obtained by image fusion.Conclusion CT and MR image fusion provides useful information for definitive diagnosis, planning of surgery and radiotherapy. To fuse the images of CT and MR, the Legendre moment approach is direct, simple and fast.

Design and application of automatic exposure control circuit for filming / 中华放射学杂志

Objective To design an automatic exposure control circuit for X ray equipment to improve the performance of equipment and the quality of film. Methods The device acted in series control. During exposuring process,the X ray reaching the film through patient body was measured by ray sensor. After it was treated with integration, amplification and contrast management,the signal of X ray quantity drived the device to cut off exposure circuit, so that the exposure time was automatic any controlled. Results The effect of the device has been proved by its application in several hospitals. Conclusion The device is simple and effective and has practical value.