Blockchain en salud: transformando la seguridad y la gestión de datos clínicos / Blockchain in health: Transforming security and clinical data management

Introducción Los avances tecnológicos continúan transformando la sociedad, incluyendo el sector de la salud. La naturaleza descentralizada y verificable de la tecnología blockchain presenta un gran potencial para abordar desafíos actuales en la gestión de datos sanitarios. Discusión Este artículo indaga sobre cómo la adopción generalizada de blockchain se enfrenta a importantes desafíos y barreras que deben abordarse, como la falta de regulación, la complejidad técnica, la salvaguarda de la privacidad y los costos tanto económicos como tecnológicos. La colaboración entre profesionales médicos, tecnólogos y legisladores es esencial para establecer un marco normativo sólido y una capacitación adecuada. Conclusión La tecnología blockchain tiene potencial de revolucionar la gestión de datos en el sector de la salud, mejorando la calidad de la atención médica, empoderando a los usuarios y fomentando la compartición segura de datos. Es necesario un cambio cultural y regulatorio, junto a más evidencia, para concluir sus ventajas frente a las alternativas tecnológicas existentes. (AU)

Introduction Technological advances continue to transform society, including the health sector. The decentralized and verifiable nature of blockchain technology presents great potential for addressing current challenges in healthcare data management. Discussion This article reports on how the generalized adoption of blockchain faces important challenges and barriers that must be addressed, such as the lack of regulation, technical complexity, safeguarding privacy, and economic and technological costs. Collaboration between medical professionals, technologists and legislators is essential to establish a solid regulatory framework and adequate training. Conclusion Blockchain technology has the potential to revolutionize data management in the healthcare sector, improving the quality of medical care, empowering users, and promoting the secure sharing of data, but an important cultural change is needed, along with more evidence, to reveal its advantages in front of the existing technological alternative. (AU)

Chronic liver disease-associated severe thrombocytopenia in Spain: Results from a retrospective study using machine learning and natural language processing / Trombocitopenia grave asociada a enfermedad hepática crónica en España: Resultados de un estudio retrospectivo utilizando aprendizaje automático y procesamiento de lenguaje natural

Background Patients with chronic liver disease (CLD) often develop thrombocytopenia (TCP) as a complication. Severe TCP (platelet count<50×109/L) can increase morbidity and complicate CLD management, increasing bleeding risk during invasive procedures. Objectives To describe the real-world scenario of CLD-associated severe TCP patients’ clinical characteristics. To evaluate the association between invasive procedures, prophylactic treatments, and bleeding events in this group of patients. To describe their need of medical resource use in Spain. Methods This is a retrospective, multicenter study including patients who had confirmed diagnosis of CLD and severe TCP in four hospitals within the Spanish National Healthcare Network from January 2014 to December 2018. We analyzed the free-text information from Electronic Health Records (EHRs) of patients using Natural Language Processing (NLP), machine learning techniques, and SNOMED-CT terminology. Demographics, comorbidities, analytical parameters and characteristics of CLD were extracted at baseline and need for invasive procedures, prophylactic treatments, bleeding events and medical resources used in the follow up period. Frequency tables were generated for categorical variables, whereas continuous variables were described in summary tables as mean (SD) and median (Q1–Q3). Results Out of 1,765,675 patients, 1787 had CLD and severe TCP; 65.2% were male with a mean age of 54.7 years old. Cirrhosis was detected in 46% (n=820) of patients and 9.1% (n=163) had hepatocellular carcinoma. Invasive procedures were needed in 85.6% of patients during the follow up period. Patients undergoing procedures compared to those patients without invasive procedures presented higher rates of bleeding events (33% vs 8%, p<0.0001) and higher number of bleedings. While prophylactic platelet transfusions were given to 25.6% of patients undergoing procedures, TPO receptor agonist use was only detected in 3.1% of them... (AU)

Antecedentes Los pacientes con enfermedad hepática crónica (EHC) a menudo desarrollan trombocitopenia (TCP) como agravante de su enfermedad. La TCP grave (definida por un recuento de plaquetas < 50 x 109/L) puede aumentar la morbilidad y complicar el manejo de la EPC, incrementando el riesgo de hemorragia durante los procedimientos invasivos. Objetivos Describir el escenario de mundo real de las características clínicas de los pacientes con TCP grave asociado a EHC. Evaluar la asociación entre procedimientos invasivos, tratamientos profilácticos y eventos hemorrágicos en este grupo de pacientes, así como describir el uso de recursos médicos en España. Métodos Se plantea un estudio multicéntrico retrospectivo que incluye pacientes con diagnóstico confirmado de EHC y TCP grave en cuatro hospitales de la Red Nacional de Salud de España desde enero de 2014 hasta diciembre de 2018. Analizamos la información de texto libre de la Historia Clínica Electrónica (HCE) de pacientes que utilizan procesamiento de lenguaje natural (PLN), técnicas de aprendizaje automático y terminología de SNOMED-CT. Los datos demográficos, las comorbilidades, los parámetros analíticos y las características de la EHC se extrajeron al inicio del estudio, así como la necesidad de procedimientos invasivos, tratamientos profilácticos, eventos hemorrágicos y recursos médicos utilizados en el periodo de seguimiento. Se generaron tablas de frecuencia para las variables categóricas, mientras que las variables continuas se describieron en tablas resumen como media (SD) y mediana (Q1-Q3). Resultados De 1.765.675 pacientes identificados, 1.787 tenían EHC y TCP grave, siendo el 65,2% varones con una edad media de 54,7 años. Se detectó cirrosis en el 46% (n = 820) de los pacientes y el 9,1% (n = 163) de ellos presentaron un diagnóstico de carcinoma hepatocelular... (AU)

[Blockchain in health: Transforming security and clinical data management]. / Blockchain en salud: transformando la seguridad y la gestión de datos clínicos.

INTRODUCTION: Technological advances continue to transform society, including the health sector. The decentralized and verifiable nature of blockchain technology presents great potential for addressing current challenges in healthcare data management. DISCUSSION: This article reports on how the generalized adoption of blockchain faces important challenges and barriers that must be addressed, such as the lack of regulation, technical complexity, safeguarding privacy, and economic and technological costs. Collaboration between medical professionals, technologists and legislators is essential to establish a solid regulatory framework and adequate training. CONCLUSION: Blockchain technology has the potential to revolutionize data management in the healthcare sector, improving the quality of medical care, empowering users, and promoting the secure sharing of data, but an important cultural change is needed, along with more evidence, to reveal its advantages in front of the existing technological alternative.

Chronic liver disease-associated severe thrombocytopenia in Spain: Results from a retrospective study using machine learning and natural language processing.

BACKGROUND: Patients with chronic liver disease (CLD) often develop thrombocytopenia (TCP) as a complication. Severe TCP (platelet count<50×109/L) can increase morbidity and complicate CLD management, increasing bleeding risk during invasive procedures. OBJECTIVES: To describe the real-world scenario of CLD-associated severe TCP patients' clinical characteristics. To evaluate the association between invasive procedures, prophylactic treatments, and bleeding events in this group of patients. To describe their need of medical resource use in Spain. METHODS: This is a retrospective, multicenter study including patients who had confirmed diagnosis of CLD and severe TCP in four hospitals within the Spanish National Healthcare Network from January 2014 to December 2018. We analyzed the free-text information from Electronic Health Records (EHRs) of patients using Natural Language Processing (NLP), machine learning techniques, and SNOMED-CT terminology. Demographics, comorbidities, analytical parameters and characteristics of CLD were extracted at baseline and need for invasive procedures, prophylactic treatments, bleeding events and medical resources used in the follow up period. Frequency tables were generated for categorical variables, whereas continuous variables were described in summary tables as mean (SD) and median (Q1-Q3). RESULTS: Out of 1,765,675 patients, 1787 had CLD and severe TCP; 65.2% were male with a mean age of 54.7 years old. Cirrhosis was detected in 46% (n=820) of patients and 9.1% (n=163) had hepatocellular carcinoma. Invasive procedures were needed in 85.6% of patients during the follow up period. Patients undergoing procedures compared to those patients without invasive procedures presented higher rates of bleeding events (33% vs 8%, p<0.0001) and higher number of bleedings. While prophylactic platelet transfusions were given to 25.6% of patients undergoing procedures, TPO receptor agonist use was only detected in 3.1% of them. Most patients (60.9%) required at least one hospital admission during the follow up and 14.4% of admissions were due to bleeding events with a hospital length of stay of 6 (3, 9) days. CONCLUSIONS: NLP and machine learning are useful tools to describe real-world data in patients with CLD and severe TCP in Spain. Bleeding events are frequent in those patients who need invasive procedures, even receiving platelet transfusions as a prophylactic treatment, increasing the further use of medical resources. Because that, new prophylactic treatments that are not yet generalized, are needed.

A avaliação e registo da dor no serviço de urgência: um estudo transversal

Resumo: Introdução: A dor constitui-se como o principal motivo de procura de cuidados de saúde no serviço de urgência. Os enfermeiros têm um papel essencial na promoção e intervenção no controlo da dor dado serem profissionais com uma relação privilegiada com as pessoas. Objetivo: Descrever como foi avaliada e registada a dor na área de ambulatório de um serviço de urgência geral pela equipa de enfermagem. Metodologia: Estudo quantitativo, descritivo e transversal. Foram analisados os registos de avaliação da dor de 105 pessoas. Procedeu-se à análise dos dados utilizando estatística descritiva. Resultados: A dor foi avaliada em 53 episódios (50,48 %). A Escala de Avaliação Numérica foi o instrumento mais utilizado (43,81 %). As características da dor foram descritas em 39,05 % dos episódios. Em 1,90 % dos episódios houve registo de reavaliação da dor após implementação de medidas farmacológicas. Conclusão: A avaliação da dor foi subnotificada nas diferentes dimensões descritas no estudo. Neste sentido, torna-se essencial a definição de estratégias para a formação e treino dos enfermeiros sobre avaliação da dor.

Resumen: Introducción: El dolor es el principal motivo de búsqueda de atención sanitaria en un servicio de urgencias. Las enfermeras tienen un papel crucial en la promoción e intervención en el control del dolor, ya que son profesionales con una relación privilegiada con las personas. Objetivo: Describir cómo el equipo de enfermería valoró y registró el dolor en el área de menores de un servicio de Urgencias. Metodología: Estudio cuantitativo, descriptivo y transversal. Se analizaron los registros de valoración del dolor de 105 personas. El análisis de los datos se realizó mediante estadística descriptiva. Resultados: El dolor fue evaluado en 53 episodios (50,48 %). La Escala Numérica fue el instrumento más utilizado (43,81 %). Las características del dolor se describieron en el 39,05 % de los episodios. En el 1,90 % de las crisis se registró una reevaluación del dolor tras la aplicación de medidas farmacológicas. Conclusiones: La evaluación del dolor fue subestimada en las dimensiones presentadas en el estudio. Por ello, es imprescindible definir estrategias para la educación y formación de las enfermeras en la valoración del dolor.

Abstract: Introduction: Pain is the main reason for seeking healthcare in an emergency service. Nurses have a crucial role in promoting and intervening in pain control as they are professionals with a privileged relationship with people. Objective: Describe how the nursing team assessed and recorded pain in the minor's area of an Accident and Emergency service. Methodology: Quantitative, descriptive, and cross-sectional study. The pain assessment records of 105 people were analyzed. Data analysis was conducted using descriptive statistics. Results: Pain was assessed in 53 episodes (50.48 %). The Numerical Rating Scale was the most used instrument (43.81 %). The characteristics of pain were described in 39.05 % of the episodes. In 1.90 % of the attacks, there was a record of pain reassessment after implementing pharmacological measures. Conclusion: Pain assessment was underreported in the different dimensions described in the study. Thus, it is essential to define strategies for the education and training of nurses on pain assessment.

Prevalencia e incidencia de sobrepeso y obesidad en 2, 5 millones de niños y adolescentes en España / The prevalence and incidence rate of overweight and obesity among 2.5 million children and adolescents in Spain

Introducción y objetivos: Las tendencias de la obesidad infantil se están estancando en España, pero hay poca información sobre las diferencias por comunidad autónoma. Este estudio evaluó en 8 comunidades autónomas la prevalencia y la incidencia de sobrepeso y obesidad en niños y adolescentes entre 2005-2017. Métodos: Este estudio longitudinal utilizó las determinaciones de estatura y peso de 2,5 millones de niños de 2-17 años para calcular el sobrepeso y la obesidad según las guías de la OMS. Los datos proceden de 2 bases de datos de historias clínicas electrónicas: la Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria y el Sistema de Información para la Investigación en Atención Primaria. Se calcularon la prevalencia, la tasa de incidencia y las tendencias entre 2005-2017, y se estratificaron por edad, sexo y comunidad autónoma. Resultados: La prevalencia general de obesidad aumentó en niños y niñas desde los 2 años (0,8%; IC95%, 0,8-0,9% en ambos sexos) hasta alcanzar su punto máximo a los 7 años en las niñas (17,3%; IC95%, 17,1-17,5%) y a los 9 años en los niños (24,1%; IC95%, 23,9-24,3%). Las prevalencias de obesidad más altas y más bajas se observaron en Murcia y Navarra respectivamente. Las tendencias generales de la prevalencia de obesidad disminuyeron de 2005 a 2017 en todos los grupos de edad y sexo y en la mayoría de las comunidades autónomas. Las tasas de incidencia de obesidad más altas se encontraron en niños de 6-7 años (4,5 [4,5-4,5] y 3,5 [3,5-3,5] nuevos casos de obesidad cada 100 personas-año en niños y niñas respectivamente). Los niños tenían cifras de prevalencia e incidencia más altas que las niñas en todas las comunidades autónomas. Los valores de prevalencia e incidencia de sobrepeso/obesidad y sus tendencias fueron constantemente mayores que los de obesidad, aunque se observó un patrón similar según edad y sexo. Conclusiones: La prevalencia de sobrepeso y obesidad se redujo ligeramente en España (AU)

Introduction and objectives: Childhood obesity trends are plateauing in Spain, but limited information is available about how they differ by region. This study assessed childhood and adolescent the prevalence and incidence of overweight and obesity from 2005 to 2017 across 8 Spanish regions. Methods: This longitudinal study used height and weight measurements from 2.5 million children aged 2 to 17 years to calculate overweight and obesity, according to the World Health Organization (WHO) guidelines. Data were obtained from The Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria, and the Information System for Research in Primary Care. Prevalence and incidence rates and trends from 2005 to 2017 were calculated and stratified by age, sex, and region. Results: The overall obesity prevalence increased in boys and girls from age 2 (0.8%; 95%CI, 0.8-0.9 in both sexes) until peaking at age 7 in girls (17.3%; 95%CI, 17.1-17.5) and age 9 in boys (24.1%; 95%CI 23.9-24.3). The highest and lowest obesity prevalences were observed in Murcia and Navarre. Overall obesity prevalence trends decreased from 2005 to 2017 in all age-sex groups and in most regions. Highest obesity incidence rates were found in children aged 6 to 7 years, (4.5 [4.5-4.5] and 3.5 [3.5-3.5] new obesity cases per 100 person-years in boys and girls, respectively). Boys had higher prevalence and incidence rates than girls across all regions. Overweight/obesity prevalence and incidence rates and their trends were consistently higher than the obesity results, although a similar pattern was observed across sex and age.Conclusions: Overweight and obesity prevalence slightly decreased in Spain from 2005 to 2017, but regional, sex, and age differences persisted. Because incidence peaked around the age of 6 years, it may be important to begin health promotion programs at an early age (AU)

The prevalence and incidence rate of overweight and obesity among 2.5 million children and adolescents in Spain.

INTRODUCTION AND OBJECTIVES: Childhood obesity trends are plateauing in Spain, but limited information is available about how they differ by region. This study assessed childhood and adolescent the prevalence and incidence of overweight and obesity from 2005 to 2017 across 8 Spanish regions. METHODS: This longitudinal study used height and weight measurements from 2.5 million children aged 2 to 17 years to calculate overweight and obesity, according to the World Health Organization (WHO) guidelines. Data were obtained from The Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria, and the Information System for Research in Primary Care. Prevalence and incidence rates and trends from 2005 to 2017 were calculated and stratified by age, sex, and region. RESULTS: The overall obesity prevalence increased in boys and girls from age 2 (0.8%; 95%CI, 0.8-0.9 in both sexes) until peaking at age 7 in girls (17.3%; 95%CI, 17.1-17.5) and age 9 in boys (24.1%; 95%CI 23.9-24.3). The highest and lowest obesity prevalences were observed in Murcia and Navarre. Overall obesity prevalence trends decreased from 2005 to 2017 in all age-sex groups and in most regions. Highest obesity incidence rates were found in children aged 6 to 7 years, (4.5 [4.5-4.5] and 3.5 [3.5-3.5] new obesity cases per 100 person-years in boys and girls, respectively). Boys had higher prevalence and incidence rates than girls across all regions. Overweight/obesity prevalence and incidence rates and their trends were consistently higher than the obesity results, although a similar pattern was observed across sex and age. CONCLUSIONS: Overweight and obesity prevalence slightly decreased in Spain from 2005 to 2017, but regional, sex, and age differences persisted. Because incidence peaked around the age of 6 years, it may be important to begin health promotion programs at an early age.

Evaluación automática de la adherencia a las recomendaciones de manejo en falla cardiaca a partir de las historias clínicas electrónicas: herramienta EXEMED / Automatic evaluation of the adherence to recommendations for managing heart failure from the electronic health records: The EXEMED tool

Resumen Objetivo: La implementación de las guías de práctica clínica está limitada por la falta de herramientas que faciliten los procesos de auditoría y retroalimentación a los profesionales de salud. Este estudio evalúa la herramienta automatizada (EXEMED), diseñada para valorar la adherencia a las guías de práctica clínica a partir de la información consignada en las historias clínicas electrónicas. Métodos: En un grupo de 35 pacientes hospitalizados entre enero y marzo de 2016 se evaluó la adherencia a cinco recomendaciones contenidas en las guías de práctica clínica de falla cardiaca del Hospital Universitario San Ignacio. Se utilizó la herramienta automatizada EXEMED y se evaluó la validez de la misma comparando los resultados con la valoración realizada por una junta médica independiente. Se determinó concordancia entre los dos métodos usando el coeficiente kappa. Resultados: La adherencia a las diferentes recomendaciones osciló entre 0% para la determinación del perímetro abdominal al ingreso, hasta 97% para el uso de betabloqueadores al egreso. La proporción de acuerdo entre los dos métodos de evaluación estuvo por encima del 90% para todas las recomendaciones. El kappa para las diferentes recomendaciones fue de 0,78 (IC 95% 0,62-0,95) y 0,64 (0,48-0,80). El tiempo de evaluación se redujo de veinte a dos minutos por paciente con el uso de la herramienta EXEMED. Conclusiones: EXEMED es una herramienta válida y eficiente en la evaluación de la adherencia a las guías de práctica clínica. Se requieren nuevos estudios para evaluar el impacto de su uso asociado a retroalimentación a los clínicos, en la evolución a largo plazo de los pacientes con falla cardiaca.

Abstract Objective: The implementation of clinical practice guidelines is limited due to the lack of tools to carry out audits and provide feedback to the health professionals. In this study, an evaluation is performed using the automated (EXEMED) tool in order to assess the adherence to clinical practice guidelines from the information entered in the electronic health records. Methods: The adherence to 5 recommendations contained in the heart failure clinical practice guidelines was evaluated in a group of 35 patients admitted to the Hospital Universitario San Ignacio between January 2016 and March 2016. The automated EXEMED tool was used to assess this, by comparing the results obtained with the evaluation carried out by an independent medical committee. The kappa coefficient was used to determine the agreement between the two methods. Results: The adherence to the different recommendations varied between 0%, for the determination of the abdominal circumference, up to 97%, for the use of beta-blockers at discharge. Percentage agreement between the two evaluation methods was above 90% for all the recommendations. The kappa for the different recommendations was 0.78 (95% CI; 0.62-0.95) and 0.64 (0.48-0.80). The evaluation time was reduced from 20 minutes to 2 minutes with the use of the EXEMED tool. Conclusions: EXEMED is a valid and effective tool in the evaluation of adherence to clinical practice guidelines. Further studies are required to assess the impact of its used associated with feedback to the clinicians, in the long-term outcomes of patients with heart failure.