Class imbalance on medical image classification: towards better evaluation practices for discrimination and calibration performance.

PURPOSE: This work aims to assess standard evaluation practices used by the research community for evaluating medical imaging classifiers, with a specific focus on the implications of class imbalance. The analysis is performed on chest X-rays as a case study and encompasses a comprehensive model performance definition, considering both discriminative capabilities and model calibration. MATERIALS AND METHODS: We conduct a concise literature review to examine prevailing scientific practices used when evaluating X-ray classifiers. Then, we perform a systematic experiment on two major chest X-ray datasets to showcase a didactic example of the behavior of several performance metrics under different class ratios and highlight how widely adopted metrics can conceal performance in the minority class. RESULTS: Our literature study confirms that: (1) even when dealing with highly imbalanced datasets, the community tends to use metrics that are dominated by the majority class; and (2) it is still uncommon to include calibration studies for chest X-ray classifiers, albeit its importance in the context of healthcare. Moreover, our systematic experiments confirm that current evaluation practices may not reflect model performance in real clinical scenarios and suggest complementary metrics to better reflect the performance of the system in such scenarios. CONCLUSION: Our analysis underscores the need for enhanced evaluation practices, particularly in the context of class-imbalanced chest X-ray classifiers. We recommend the inclusion of complementary metrics such as the area under the precision-recall curve (AUC-PR), adjusted AUC-PR, and balanced Brier score, to offer a more accurate depiction of system performance in real clinical scenarios, considering metrics that reflect both, discrimination and calibration performance. CLINICAL RELEVANCE STATEMENT: This study underscores the critical need for refined evaluation metrics in medical imaging classifiers, emphasizing that prevalent metrics may mask poor performance in minority classes, potentially impacting clinical diagnoses and healthcare outcomes. KEY POINTS: Common scientific practices in papers dealing with X-ray computer-assisted diagnosis (CAD) systems may be misleading. We highlight limitations in reporting of evaluation metrics for X-ray CAD systems in highly imbalanced scenarios. We propose adopting alternative metrics based on experimental evaluation on large-scale datasets.

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.

Automatic Speech Recognition System to Record Progress Notes in a Mobile EHR: A Pilot Study.

Creating notes in the EHR is one of the most problematic aspects for health professionals. The main challenges are the time spent on this task and the quality of the records. Automatic speech recognition technologies aim to facilitate clinical documentation for users, optimizing their workflow. In our hospital, we internally developed an automatic speech recognition system (ASR) to record progress notes in a mobile EHR. The objective of this article is to describe the pilot study carried out to evaluate the implementation of ASR to record progress notes in a mobile EHR application. As a result, the specialty that used ASR the most was Home Medicine. The lack of access to a computer at the time of care and the need to perform short and fast evolutions were the main reasons for users to use the system.

Development and Usage Patterns of a Home-Grown Drug Information Tool.

Drug information tools help avoid medication errors, a common cause of avoidable harm in health care systems. We sought to describe the design, development process and architecture of an electronic drug information tool, as well as its overall use by health professionals. We developed a tool that can be accessed by all health professionals in a tertiary level university hospital. The functionalities of eDrugs are organized into two main parts: Drug Summary sheet, and Prescription Simulator. Most users accessed eDrugs to use the Drug summary sheet. Clinical information and antimicrobial drugs were the most accessed drug information and drug group. The analysis of log data provides insights into the information priorities of health professionals.

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.

Unscheduled Emergency Department Revisits Within 48 Hours of Discharge.

This study aimed to analyze early revisits (within 48 hours of discharge) in an Emergency Department. Among the 178,295 visits, 11,686 were revisits, resulting in a rate of 6.55% (95%CI 6.43-6.67). A total of 1,410 revisits required hospitalization, and 252 were due to preventable errors (17.87%). These errors were mainly related to an inadequate therapeutic plan at discharge (47.22%), an incomplete diagnostic process (29.37%), and misdiagnoses (13.10%). These findings represent a technology-enabled clinical audit tool. Electronic Healthcare Records have the potential to: provide quality metrics of hospital performance, help to keep revisit rates updated (assessment through a real-time dashboard), and improve clinical management (by transparency initiatives about errors, and a supportive learning environment regarding lessons learned).

Effect of the COVID-19 Lockdown on Patients Valuation of Usability of Telemedicine.

The aim of this paper was to report patient valuation of usability with our telemedicine system and to explore the effect of pandemic in its behavior. We conducted a cross-sectional study based on the prospective recollection of the results of the Spanish abbreviated version of the Telehealth Usability Questionnaire (TUQ), from October 2019 to July 2020. We observed an inflection point of growth of answers during the pandemic era and a trend of decrease in usability valuations coinciding with the massive and forced implementation of the system after lockdown. This effect was transitory, evidencing an improvement over time. These results might be explained with a sociotechnical approach that includes considering the learning curve and suggest the importance of a telemedicine usability tool to guide decision-making. In conclusion, tools to assess telemedicine services may identify facilitators and barriers to its use in a highly changing social and technological context.

From national and regional commitments to global impact: artificial intelligence for equitable public health at the G20

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Together towards tomorrow: partnerships powering the digital transformation of the health sector

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Mayor uso de teleconsultas programadas y mensajería asincrónica del portal en atención primaria / Increased Use of Scheduled Teleconsultations and Asynchronous Portal Messaging in Primary Care

Introducción: durante la pandemia de COVID-19 hubo un auge sin precedentes de la telemedicina, probablemente por la forzada adopción de tecnología ante las medidas restrictivas. El presente estudio se propuso comparar la interacción y la comunicación entre médicos de cabecera (MC) y pacientes, antes y durante el período de pandemia, en términos de consultas ambulatorias programadas y mensajes del Portal de Salud. Materiales y métodos: corte transversal con muestreo consecutivo de turnos programados y mensajes, ocurridos entre las semanas epidemiológicas (SE) 10 y 23, de 2019 y 2020, respectivamente. Se incluyeron 147 médicos del Servicio de Medicina Familiar y Comunitaria, y una cápita de 73 427 pacientes afiliados al Plan de Salud del Hospital Italiano de Buenos Aires. Se realizó análisis cuantitativo y cualitativo. Resultados: hubo una reducción del 70% de las consultas presenciales (de 76 375 en 2019 a 23 200 en 2020) y un aumento concomitante de teleconsultas (de 255 en la SE13 a 1089 en la SE23). En simultáneo, los mensajes aumentaron sustancialmente (de 28 601 en 2019 a 84 916 en 2020), con un inicio abrupto al comienzo del confinamiento, y una tendencia decreciente a lo largo del tiempo. Antes de la pandemia, el contenido estuvo relacionado con órdenes electrónicas de estudios complementarios, control de resultados, recetas de medicación crónica y/o interconsultas a especialistas, mientras que los dominios más frecuentes durante la pandemia fueron necesidades informativas epidemiológicas, como medidas preventivas para COVID-19, vacuna antineumocócica, vacuna antigripal, casos o sospechas, resultados de hisopados, entre otras. Conclusión: el auge de las tecnologías de la comunicación e información durante la pandemia permitió dar continuidad a los procesos asistenciales en salud pese al distanciamiento físico. Hubo mayor utilización de mensajería por necesidades informativas de los pacientes, y la relación médico-paciente se ha modificado. (AU)

Introduction: during the COVID-19 pandemic, there was an unprecedented boom in telemedicine, probably due to the forced adoption of technology in the face of restrictive measures. This study aimed to compare the interaction and communication between general practitioners and patients before and during the pandemic based on scheduled outpatient consultations and Health Portal messages. Materials and methods: Cross-sectional study with a consecutive sampling of scheduled appointments and messages, occurring between epidemiological weeks (EW) 10 and 23 of 2019 and 2020, respectively. We included 147 physicians from the Family and Community Medicine Service and a capita of 73427 patients affiliated with the Hospital Italiano de Buenos Aires health plan. We conducted a quantitative and qualitative analysis. Results: there was a 70% reduction in face-to-face consultations (from 76375 in 2019 to 23200 in 2020) and a concomitant increase in teleconsultations (from 255 in EW13 to 1089 in EW23). Concurrently, messages increased substantially (from 28601 in 2019 to 84916 in 2020), with an abrupt onset at the beginning of confinement and a decreasing trend over time. Before the pandemic, the content involved electronic orders for complementary studies, outcome monitoring, chronic medication prescriptions, or expert consultations. The most frequent domains during the pandemic were epidemiological information needs, such as preventive measures for COVID-19, pneumococcal vaccine, influenza vaccine, cases or suspicions, and swab results, among others. Conclusion: the rise of communication and information technologies during the pandemic allowed the continuity of healthcare processes despite the physical distance. There was increased use of messaging for patients' information needs, and the doctor-patient relationship has changed. (AU)

A dataset of skin lesion images collected in Argentina for the evaluation of AI tools in this population.

In recent years, numerous dermatological image databases have been published to make possible the development and validation of artificial intelligence-based technologies to support healthcare professionals in the diagnosis of skin diseases. However, the generation of these datasets confined to certain countries as well as the lack of demographic information accompanying the images, prevents having a real knowledge of in which populations these models could be used. Consequently, this hinders the translation of the models to the clinical setting. This has led the scientific community to encourage the detailed and transparent reporting of the databases used for artificial intelligence developments, as well as to promote the formation of genuinely international databases that can be representative of the world population. Through this work, we seek to provide details of the processing stages of the first public database of dermoscopy and clinical images created in a hospital in Argentina. The dataset comprises 1,616 images corresponding to 1,246 unique lesions collected from 623 patients.

Efecto de la inactivación de las órdenes múltiples para solicitud de estudios complementarios en una central de emergencias.

Introducción. La plantilla de órdenes múltiples es una herramienta informática que podría producir consecuencias inadvertidas pese a sus innumerables beneficios. Nos propusimos explorar el efecto de su inactivación sobre las solicitudes de estudios complementarios y los costos asociados. Métodos. Corte transversal en la Central de Emergencias de Adultos del Hospital Italiano de Buenos Aires, que incluyó muestra consecutiva de consultas pre-intervención (Enero-Febrero 2020) y post-intervención (2021). Mediante el uso de bases secundarias, las variables incluidas fueron los débitos administrativos y sus respectivos precios de facturación. Resultados. Hubo 27.671 consultas en 2020 con una mediana de valor total de 474$, y 20.819 con 1.639$ en 2021. Tras el análisis restringido al área de consultorios de moderada complejidad (excluyendo consultas por COVID-19), se encontró: una disminución en la mediana del número de prácticas por consulta (mediana de 11 vs 10, p=0,001), una disminución en la solicitud de al menos una práctica de laboratorio (45% versus 39%, p=0,001), sin encontrar cambios significativos en costos globales (mediana 1.419$ vs 1.081$; p=0,122) ni en costos específicos de laboratorio (mediana 1.071$ vs 1.089$, p=0,710). Conclusión. Pese a la inflación interanual, se logró una reducción significativa en el número de prácticas y se mantuvieron los costos globales por consulta. Estos hallazgos demuestran la efectividad de la intervención, pero serán necesarias medidas educativas que apunten al recordatorio de los potenciales daños en la sobreutilización, y los costos sanitarios de los estudios innecesarios.

Edible and medicinal mushrooms (Pleurotus ostreatus, Ustilago maydis, Ganoderma lucidum) reduce endoplasmic reticulum stress and inflammation in adipose tissue of obese Wistar rats fed with a high fat plus saccharose diet.

Obesity is an increasing global public health problem. A strategy to treat obesity is the use of functional foods. Edible and medicinal mushrooms contain diverse bioactive compounds showing important antihyperlipidemic, antioxidant, and prebiotic properties. We analysed the effects of adding (10%) of Pleurotus ostreatus (Po, basidiomata), Ganoderma lucidum (Gl, basidiomata), or Ustilago maydis (Um, galls), milled, to a high fat plus saccharose diet (HFD + S) for 6 months in a model of obesity with Wistar rats. We assessed weight gain, body composition, lipid parameters, endoplasmic reticulum stress (proteins and inflammatory markers: BiP, XBP-1, JNK, p-JNK, TNF-α), and adiponectin in subcutaneous adipose tissue (SAT). The consumption of edible and medicinal mushrooms decreased weight gain (-17.2-30.1%) and fat mass (-23.7-43.1%), maintained fat-free mass, reduced levels of serum biochemical parameters (TC: -40.1-44.1%, TG: -37.7-51.6%, LDL-C: -64.5-71.1%), and prevented adipocyte hypertrophy (-30.9-36.9%) and collagen deposition (-70.9-73.7%) in SAT. Compared with the HFD + S group, mushroom consumption by Wistar rats significantly reduced the expression of proteins associated with endoplasmic reticulum stress and inflammation (BiP: -72.2-88.2%; XBP-1: -71.5-81.8%; JNK: -71.2-90.0%; p-JNK: -37.3-81.0%; TNF-α: -80.7-91.5%), whereas significantly increased adiponectin protein expression (246.4-654.2%) in SAT. These effects outperformed those obtained through the commercial lipid-lowering drug atorvastatin, contributing synergistically to prevent further obesity-related dysfunctions, such as insulin resistance derived from inflammation and ER stress in adipose tissue. Bioactive compounds from edible, functional and medicinal mushrooms represent new emerging therapies for obesity treatments using natural products.

Effect of computerized physician order entry inactivation to order complementary studies in an emergency department / [Efecto de la inactivación de las órdenes múltiples para solicitud de estudios complementarios en una central de emergencias.]

Introduction: The computerized provider order entry (CPOE) is a computing tool that could lead to unintended consequences despite its myriad benefits. We aimed to explore the effect of its inactivation on requests for complementary studies and the associated costs. Methods: Cross sectional study at the Emergency Department of Hospital Italiano de Buenos Aires, which included a consecutive sample of pre-intervention (January-February 2020) and post-intervention (2021) consultations. Using secondary bases, the variables included were administrative debits and their respective billing prices. Results: There were 27,671 consultations in 2020 with a total median value of $474, and 20,819 with $1,639 in 2021. After the analysis restricted to the area of ​​moderately complex clinics (excluding COVID-19 consultations), the following was found: a decrease in the median number of practices per consultation (median of 11 vs. 10, p=0.001), a decrease in the request for at least one laboratory practice (45% vs. 39%, p=0.001), without finding significant changes in global costs (median $1,419 vs. $1,081; p=0.122) or in specific laboratory costs (median $1,071 vs. $1,089, p=0.710). Conclusion: Despite inflation, a significant reduction in the number of practices was achieved and overall costs per consultation were maintained. These findings demonstrate the effectiveness of the intervention, but an educational intervention aimed at reminding the potential harm of overuse and the health costs of unnecessary studies will be necessary.

Introducción: La plantilla de órdenes múltiples es una herramienta informática que podría producir consecuencias inadvertidas pese a sus innumerables beneficios. Nos propusimos explorar el efecto de su inactivación sobre las solicitudes de estudios complementarios y los costos asociados. Métodos: Corte transversal en la Central de Emergencias de Adultos del Hospital Italiano de Buenos Aires, que incluyó muestra consecutiva de consultas pre-intervención (Enero-Febrero 2020) y post-intervención (2021). Mediante el uso de bases secundarias, las variables incluidas fueron los débitos administrativos y sus respectivos precios de facturación. Resultados: Hubo 27.671 consultas en 2020 con una mediana de valor total de 474$, y 20.819 con 1.639$ en 2021. Tras el análisis restringido al área de consultorios de moderada complejidad (excluyendo consultas por COVID-19), se encontró: una disminución en la mediana del número de prácticas por consulta (mediana de 11 vs 10, p=0,001), una disminución en la solicitud de al menos una práctica de laboratorio (45% versus 39%, p=0,001), sin encontrar cambios significativos en costos globales (mediana 1.419$ vs 1.081$; p=0,122) ni en costos específicos de laboratorio (mediana 1.071$ vs 1.089$, p=0,710). Conclusión: Pese a la inflación interanual, se logró una reducción significativa en el número de prácticas y se mantuvieron los costos globales por consulta. Estos hallazgos demuestran la efectividad de la intervención, pero serán necesarias medidas educativas que apunten al recordatorio de los potenciales daños en la sobreutilización, y los costos sanitarios de los estudios innecesarios.

Development and validation of nonattendance predictive models for scheduled adult outpatient appointments in different medical specialties.

INTRODUCTION: Nonattendance is a critical problem that affects health care worldwide. Our aim was to build and validate predictive models of nonattendance in all outpatients appointments, general practitioners, and clinical and surgical specialties. METHODS: A cohort study of adult patients, who had scheduled outpatient appointments for General Practitioners, Clinical and Surgical specialties, was conducted between January 2015 and December 2016, at the Italian Hospital of Buenos Aires. We evaluated potential predictors grouped in baseline patient characteristics, characteristics of the appointment scheduling process, patient history, characteristics of the appointment, and comorbidities. Patients were divided between those who attended their appointments, and those who did not. We generated predictive models for nonattendance for all appointments and the three subgroups. RESULTS: Of 2,526,549 appointments included, 703,449 were missed (27.8%). The predictive model for all appointments contains 30 variables, with an area under the ROC (AUROC) curve of 0.71, calibration-in-the-large (CITL) of 0.046, and calibration slope of 1.03 in the validation cohort. For General Practitioners the model has 28 variables (AUROC of 0.72, CITL of 0.053, and calibration slope of 1.01). For clinical subspecialties, the model has 23 variables (AUROC of 0.71, CITL of 0.039, and calibration slope of 1), and for surgical specialties, the model has 22 variables (AUROC of 0.70, CITL of 0.023, and calibration slope of 1.01). CONCLUSION: We build robust predictive models of nonattendance with adequate precision and calibration for each of the subgroups.

[Telemedicine: validation of a questionnaire to evaluate the experience of health professionalsTelemedicina: validação de um questionário para avaliar a experiência dos profissionais de saúde]. / Telemedicina: validación de un cuestionario para evaluar la experiencia de los profesionales de la salud.

Objective: This objective of this work is to develop and validate a questionnaire to evaluate health professionals' experience with telemedicine systems. Methods: Based on an abbreviated, locally validated Spanish-language version of the patient questionnaire developed by Parmanto et al., a group of experts developed a version to evaluate the experience of health professionals who provide telemedicine services. The psychometric behavior of the items was tested in an initial sample of 129 professionals, using exploratory factor analysis. The comprehensibility of the items was then assessed through cognitive interviews. Finally, in a new sample of 329 professionals, the construct validity of the questionnaire was evaluated by means of confirmatory factor analysis (CFA); its criteria of external validity were assessed by comparing the score with that of a summary question. Results: A 12-item questionnaire was obtained, with a two-factor structure and acceptable adjustment indicators documented through CFA. Reliability, convergent validity, and discriminant validity were appropriate. The criteria of external validity showed optimal results. Conclusions: The instrument obtained has adequate psychometric properties and will contribute to the objective evaluation of the experience of health professionals who perform telemedicine.

Objetivo: Desenvolver e validar um questionário para avaliar a experiência dos profissionais de saúde com os sistemas de telemedicina. Métodos: Com base na versão abreviada em espanhol ­ e validada localmente ­ do questionário para pacientes desenvolvido por Parmanto et al., um grupo de especialistas gerou uma versão de consenso para avaliar a experiência de profissionais de saúde que prestam serviços de telemedicina. O comportamento psicométrico dos itens foi testado em uma primeira amostra de 129 profissionais, por meio de análise fatorial exploratória. Em seguida, sua compreensibilidade foi avaliada por meio de entrevistas cognitivas. Por fim, em uma nova amostra de 329 profissionais, avaliou-se a validade de construto do questionário por meio de uma análise fatorial confirmatória (AFC), e sua validade de critério externo, mediante a avaliação de sua pontuação com a de uma pergunta resumo. Resultados: Obteve-se um questionário de 12 itens com estrutura de dois fatores, com indicadores de ajuste aceitáveis, documentados pela AFC. A confiabilidade, a validade convergente e a validade discriminante foram adequadas. A validade de critério externo apresentou ótimos resultados. Conclusões: O instrumento obtido possui propriedades psicométricas adequadas e contribuirá para a avaliação objetiva da experiência dos profissionais que realizam telemedicina.

Telemedicina: validación de un cuestionario para evaluar la experiencia de los profesionales de la salud

[RESUMEN]. Objetivo. El siguiente trabajo tiene como objetivo desarrollar y validar un cuestionario para evaluar la experiencia de los profesionales de la salud con los sistemas de telemedicina. Métodos. A partir de la versión abreviada en español y validada localmente del cuestionario para pacientes desarrollado por Parmanto y col., un grupo de expertos consensuó una versión para evaluar la experiencia de profesionales de la salud que brindan servicios de telemedicina. El comportamiento psicométrico de los ítems se testeó en una primera muestra de 129 profesionales a través de un análisis factorial exploratorio. Luego, se evaluó su comprensibilidad a través de entrevistas cognitivas. Por último, en una nueva muestra de 329 profesionales, se evaluó la validez de constructo del cuestionario mediante un análisis factorial confirmatorio (AFC), y su validez de criterio externo, mediante la evaluación de su puntaje con el de una pregunta de resumen. Resultados. Se obtuvo un cuestionario de 12 ítems con una estructura de dos factores con indicadores de ajuste aceptables, documentada mediante AFC. La fiabilidad, la validez convergente y la validez discrimi- nante fueron apropiadas. La validez de criterio externo mostró resultados óptimos. Conclusiones. El instrumento obtenido cuenta con propiedades psicométricas adecuadas y contribuirá a la evaluación objetiva de la experiencia de los profesionales que realizan telemedicina.

[ABSTRACT]. Objective. This objective of this work is to develop and validate a questionnaire to evaluate health professionals' experience with telemedicine systems. Methods. Based on an abbreviated, locally validated Spanish-language version of the patient questionnaire developed by Parmanto et al., a group of experts developed a version to evaluate the experience of health professionals who provide telemedicine services. The psychometric behavior of the items was tested in an ini- tial sample of 129 professionals, using exploratory factor analysis. The comprehensibility of the items was then assessed through cognitive interviews. Finally, in a new sample of 329 professionals, the construct validity of the questionnaire was evaluated by means of confirmatory factor analysis (CFA); its criteria of external validity were assessed by comparing the score with that of a summary question. Results. A 12-item questionnaire was obtained, with a two-factor structure and acceptable adjustment indica- tors documented through CFA. Reliability, convergent validity, and discriminant validity were appropriate. The criteria of external validity showed optimal results. Conclusions. The instrument obtained has adequate psychometric properties and will contribute to the objec- tive evaluation of the experience of health professionals who perform telemedicine.

[RESUMO]. Objetivo. Desenvolver e validar um questionário para avaliar a experiência dos profissionais de saúde com os sistemas de telemedicina. Métodos. Com base na versão abreviada em espanhol e validada localmente do questionário para pacientes desenvolvido por Parmanto et al., um grupo de especialistas gerou uma versão de consenso para avaliar a experiência de profissionais de saúde que prestam serviços de telemedicina. O comportamento psicométrico dos itens foi testado em uma primeira amostra de 129 profissionais, por meio de análise fatorial exploratória. Em seguida, sua compreensibilidade foi avaliada por meio de entrevistas cognitivas. Por fim, em uma nova amostra de 329 profissionais, avaliouse a validade de construto do questionário por meio de uma análise fatorial confirmatória (AFC), e sua validade de critério externo, mediante a avaliação de sua pontuação com a de uma pergunta resumo. Resultados. Obteve-se um questionário de 12 itens com estrutura de dois fatores, com indicadores de ajuste aceitáveis, documentados pela AFC. A confiabilidade, a validade convergente e a validade discriminante foram adequadas. A validade de critério externo apresentou ótimos resultados. Conclusões. O instrumento obtido possui propriedades psicométricas adequadas e contribuirá para a ava- liação objetiva da experiência dos profissionais que realizam telemedicina.

Can CPOE Based on Electronic Order Sets Cause Unintended Consequences (Expensive and Unnecessary Tests) at the Emergency Department?

Computerized Provider Order Entry (CPOE) systems may cause unintended consequences. This study aimed to describe the on-going system for CPOE order sets, and to explore an economic evaluation at the Emergency Department. First, we developed a costs dashboard which showed us the significant and excessive use of medical tests per consultation. We identified the top 10 most widely used and most expensive tests. Additionally we noticed that the labs seemed to continually increase. Then, we found that 27% of the consultations have at least one item of laboratory practice between January and February 2020, and this represents more than 80% of the consultation costs. Health care spending has reached epic proportions globally. We think that it is time to rethink effective strategies. Maybe it is time to deactivate/remove electronic order sets (EOSs) and the functionality to develop and create their own "private" order sets, in order to eliminate waste and inefficiencies.

An Improved Immunization Record to Support Vaccination During the COVID-19 Pandemic at a University Hospital in Argentina.

WHO and UNICEF highlight vaccination as the most cost-effective method of prevention of infectious diseases. An effective public health strategy requires efficient tracking of vaccination to assess coverage, safety, and efficacy of these vaccines. Paper-based immunization records are still being used in most low and middle-income countries. Adequate Electronic Logistic Management Information Systems, Immunization Registries and Records are crucial for proper data collection and analysis, and for making better decisions at an individual and at a population level. In this paper we share our experience in the redesign of an interoperable immunization record to track vaccination, including the recently developed vaccines for the novel coronavirus SARS-CoV-2 (COVID-19).