ABSTRACT
Introducción: En los últimos años la explosión de dispositivos con acceso a internet en el mundo ha presentado una oportunidad para el desarrollo de intervenciones en salud. Métodos: Se realizó un estudio observacional transversal de tipo descriptivo; se clasificaron las propuestas de innovación presentadas por estudiantes de último año de medicina como trabajo final de un curso de eSalud. Los proyectos se clasificaron en tres dimensiones: grupo poblacional, problema de salud a resolver y tipo de intervención de salud digital. Resultados: Se analizaron 86 proyectos entre los años 2017 y 2020. El 80,2 % se orienta a la población general, seguidos por la gestante (10,4 %), la infantil (8,14 %) y la geriátrica (1,2 %). El 36 % de los proyectos no mencionaban una condición particular de salud; el 12,8 % se dedicó a la salud sexual y reproductiva; el 10,4 % a las enfermedades cardiovasculares; el 9,3 % a la salud mental y el 4,65 % a aspectos de crecimiento y desarrollo. El 59,3 % de los proyectos se dirigía a apoyar las actividades del prestador de servicios de salud; el 34,9 % estaba orientado hacia las necesidades de los usuarios de los sistemas de salud y el 5,9 % se enfocó en los servicios de datos. Conclusiones: La percepción colectiva de los estudiantes refleja la oportunidad de fortalecer la atención primaria en salud mediante el uso de las tecnologías de la información y las comunicaciones, con énfasis en las poblaciones vulnerables. Los estudiantes empiezan a identificar los servicios de datos como oportunidad de intervención.
Introduction: In recent years, the explosion of devices with Internet access in the world has presented an opportunity for the development of health interventions. Methods: A descriptive cross-sectional observational study was carried out. Innovation proposals submitted by last-year medical students were classified as the final project of an eHealth course. The projects were classified into three dimensions: population group, health problem to be solved, and type of digital health intervention. Results: Eighty-six projects were analyzed from 2017 to 2020. 80.2% were aimed at the general population, followed by pregnant women (10.4%), children (8.14%) and geriatrics (1, 2 %). 36% of the projects did not mention a particular health condition; 12.8% was dedicated to sexual and reproductive health; 10.4% to cardiovascular diseases; 9.3% to mental health and 4.65% to aspects of growth and development. 59.3% of the projects were aimed at supporting the activities of the health service provider; 34.9% were oriented towards the needs of users of health systems and 5.9% focused on data services. Conclusions: The collective perception of the students reflects the opportunity to strengthen primary health care through the use of information and communication technologies, with emphasis on vulnerable populations. Students begin to identify data services as an opportunity for intervention.
ABSTRACT
BACKGROUND: Displeasure with the functionality of clinical decision support systems (CDSSs) is considered the primary challenge in CDSS development. A major difficulty in CDSS design is matching the functionality to the desired and actual clinical workflow. Computer-interpretable guidelines (CIGs) are used to formalize medical knowledge in clinical practice guidelines (CPGs) in a computable language. However, existing CIG frameworks require a specific interpreter for each CIG language, hindering the ease of implementation and interoperability. OBJECTIVE: This paper aims to describe a different approach to the representation of clinical knowledge and data. We intended to change the clinician's perception of a CDSS with sufficient expressivity of the representation while maintaining a small communication and software footprint for both a web application and a mobile app. This approach was originally intended to create a readable and minimal syntax for a web CDSS and future mobile app for antenatal care guidelines with improved human-computer interaction and enhanced usability by aligning the system behavior with clinical workflow. METHODS: We designed and implemented an architecture design for our CDSS, which uses the model-view-controller (MVC) architecture and a knowledge engine in the MVC architecture based on XML. The knowledge engine design also integrated the requirement of matching clinical care workflow that was desired in the CDSS. For this component of the design task, we used a work ontology analysis of the CPGs for antenatal care in our particular target clinical settings. RESULTS: In comparison to other common CIGs used for CDSSs, our XML approach can be used to take advantage of the flexible format of XML to facilitate the electronic sharing of structured data. More importantly, we can take advantage of its flexibility to standardize CIG structure design in a low-level specification language that is ubiquitous, universal, computationally efficient, integrable with web technologies, and human readable. CONCLUSIONS: Our knowledge representation framework incorporates fundamental elements of other CIGs used in CDSSs in medicine and proved adequate to encode a number of antenatal health care CPGs and their associated clinical workflows. The framework appears general enough to be used with other CPGs in medicine. XML proved to be a language expressive enough to describe planning problems in a computable form and restrictive and expressive enough to implement in a clinical system. It can also be effective for mobile apps, where intermittent communication requires a small footprint and an autonomous app. This approach can be used to incorporate overlapping capabilities of more specialized CIGs in medicine.
ABSTRACT
Objetivo. Explorar el acceso a las tecnologías de la información y la comunicación (TIC) de los usuarios de cuidados paliativos. Métodos. Se trabajó sobre el marco de análisis de tareas, usuarios, representaciones y funciones (TURF) usado para caracterizar los usuarios de cuidados paliativos de dos instituciones de salud de Medellín, Colombia. Las instituciones se visitaron entre mayo y septiembre de 2017 de acuerdo con el reporte de nuevas hospitalizaciones o cuando los investigadores detectaban la hospitalización de nuevos pacientes. En total, se realizaron 64 encuestas: 35 pacientes y a 39 cuidadores, el instrumento incluía preguntas acerca de factores demográficos, clínicos, el uso de TIC en la vida cotidiana, variables clínicas y síntomas de los pacientes y cuidadores. Las variables categóricas fueron mostradas de estadísticas descriptivas como porcentajes y frecuencias. Resultados. La mayoría de pacientes fueron mujeres, residentes de áreas urbanas quienes tenían acceso a las tecnologías de información y comunicación, con poca frecuencia en su uso. Los cuidadores fueron usuarios habituales de las tecnologías de información y comunicación, especialmente de redes sociales. Conclusión. Las instituciones que presten cuidados paliativos que busquen implementar las TIC en el cuidado a sus pacientes deberán hacer énfasis en los cuidadores y en el acceso de estos a las redes sociales.
Objective: To explore access to Information and Communication Technologies (ICT) for palliative care users. Method: The framework for the analysis of tasks, users, representation, and function (TURF) was used to characterize the users of palliative care of two health institutions in Medellín, Colombia. The institutions were visited between May and September 2017 according to the report of new hospitalizations or when the researchers detected the hospitalization of new patients. A total of 64 surveys were conducted: 35 patients and 39 caregivers, the instrument included questions about demographic and clinical factors, the use of ICT in daily life, clinical variables, and symptoms of the patients and caregivers. The categorical variables were shown from descriptive statistics as percentages and frequencies. Results: most patients were women, residents of urban areas who had access to information and communication technologies, with little frequency in their use. The caregivers were regular users of Information and Communication Technologies, especially social networks. Conclusion: Institutions that provide palliative care and seek to implement ICT in the care of their patients should center their efforts in caregivers and their access to social networks.
