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BACKGROUND: Shortages of component two of Sputnik V vaccine (rAd5) are delaying the possibility of achieving full immunisation. The immunogenic response associated with the use of alternative schemes to complete the scheme was not explored. METHODS: We did two non-inferiority randomized clinical trials with outcomes measures blinded to investigators on adults aged 21-65 years, vaccinated with a single dose of rAd26 ≥ 30 days before screening and no history of SARS-CoV-2. Participants were assigned (1:1:1:1:1) to receive either rAd5; ChAdOx1; rAd26; mRNA-1273 or BBIBP-CorV. The primary endpoint was the geometric mean ratio (GMR) of SARS-CoV-2 anti-spike IgG concentration at 28 days after the second dose, when comparing rAd26/rAd5 with rAd26/ChAdOx1, rAd26/rAd26, rAd26/mRNAmRNA-1273 and rAd26/BBIBP-CorV. Serum neutralizing capacity was evaluated using wild type SARS-CoV-2 reference strain 2019 B.1. The safety outcome was 28-day rate of serious adverse. The primary analysis included all participants who received ≥ 1 dose. The studies were registered with NCT04962906 and NCT05027672. Both trials were conducted in Buenos Aires, Argentina. FINDINGS: Between July 6 and August 3, 2021, 540 individuals (age 56·7 [SD 7·3]; 243 (45%) women) were randomly assigned to received rAd5 (n=150); ChAdOx1 (n=150); rAd26 (N=87); mRNAmRNA-1273 (n=87) or BBIBP-CorV (n=65). 524 participants completed the study. As compared with rAd26/rAd5 (1·00), the GMR (95%CI) at day 28 was 0·65 (0·51-0·84) among those who received ChAdOx1; 0·47 (0·34-0·66) in rAd5; 3·53 (2·68-4·65) in mRNA-1273 and 0·23 (0·16-0·33) in BBIBP-CorV. The geometric mean (IU/ml) from baseline to day 28 within each group increased significantly with ChAdOx1 (4·08 (3·07-5·43)); rAd26 (2·69 (1·76-4·11)); mRNA-1273 (21·98 (15·45-31·08)) but not in BBIBP-CorV (1·22 (0·80-1·87)). INTERPRETATION: Except for mRNA-1273 which proved superior, in all other alternatives non-inferiority was rejected. Antibody concentration increased in all non-replicating viral vector and RNA platforms. FUNDING: The trials were supported (including funding, material support in the form of vaccines and testing supplies) by the Buenos Aires City Government.
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Importance: Although there are reports of COVID-19 vaccine implementation in real-world populations, these come from high-income countries or from experience with messenger RNA technology vaccines. Data on outcomes of vaccine deployment in low- or middle-income countries are lacking. Objective: To assess whether the pragmatic application of the 3 COVID-19 vaccines available in Argentina, 2 of which have no reports of evaluation in real-world settings to date, were associated with a reduction in morbidity, all-cause mortality, and mortality due to COVID-19. Design, Setting, and Participants: This cohort study used individual and ecological data to explore outcomes following vaccination with rAd26-rAd5, ChAdOx1, and BBIBP-CorV. To correct for differences in exposure times, results are shown using incidence density per 100â¯000 person-days from the start of the vaccination campaign (December 29, 2020) to the occurrence of an event or the end of follow-up (May 15, 2021). Participants included 663â¯602 people aged at least 60 years residing in the city of Buenos Aires, Argentina. Statistical analysis was performed from June 1 to June 15, 2021. Main Outcomes and Measures: Diagnosis of COVID-19 confirmed by reverse transcription-polymerase chain reaction, death from all causes, and death within 30 days of a diagnosis of COVID-19. Poisson regression models were fitted to estimate associations with all 3 outcomes. Results: Among 663â¯602 residents of the city of Buenos Aires included in the study, 540â¯792 (81.4%) were vaccinated with at least 1 dose, with 457â¯066 receiving 1 dose (mean [SD] age, 74.5 (8.9) years; 61.5% were female [n = 281â¯284]; 68.0% [n = 310â¯987] received the rAd26-rAd5 vaccine; 29.5% [n = 135â¯036] received ChAdOx1; 2.4% [n = 11â¯043] received BBIBP-CorV) and 83â¯726 receiving 2 doses (mean [SD] age, 73.4 [6.8] years; 63.5% were female [n = 53â¯204]). The incidence density of confirmed COVID-19 was 36.25 cases/100â¯000 person-days (95% CI, 35.80-36.70 cases/100â¯000 person-days) among those who did not receive a vaccine, 19.13 cases/100â¯000 person-days (95% CI, 18.63-19.62 cases/100â¯000 person-days) among those who received 1 dose, and 4.33 cases/100â¯000 person-days (95% CI, 3.85-4.81 cases/100â¯000 person-days) among those who received 2 doses. All-cause mortality was 11.74 cases/100â¯000 person-days (95% CI, 11.51-11.96 cases/100â¯000 person-days), 4.01 cases/100â¯000 person-days (95% CI, 3.78-4.24 cases/100â¯000 person-days) and 0.40 cases/100â¯000 person-days (95% CI, 0.26-0.55 cases/100â¯000 person-days). COVID-19-related-death rate was 2.31 cases/100â¯000 person-days (95% CI, 2.19-2.42 cases/100â¯000 person-days), 0.59 cases/100â¯000 person-days (95% CI, 0.50-0.67 cases/100â¯000 person-days), and 0.04 cases/100â¯000 person-days (95% CI, 0.0-0.09 cases/100â¯000 person-days) among the same groups. A 2-dose vaccination schedule was associated with an 88.1% (95% CI, 86.8%-89.2%) reduction in documented infection, 96.6% (95% CI, 95.3%-97.5%) reduction in all-cause death, and 98.3% (95% CI, 95.3%-99.4%) reduction in COVID-19-related death. A single dose was associated with a 47.2% (95% CI, 44.2%-50.1%) reduction in documented infection, 65.8% (95% CI, 61.7%-69.5%) reduction in all-cause death, and 74.5% (95% CI, 66%-80.8%) reduction in COVID-19-related death. Conclusions and Relevance: This study found that within the first 5 months after the start of the vaccination campaign, vaccination was associated with a significant reduction in COVID-19 infection as well as a reduction in mortality.
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Vacunas contra la COVID-19 , COVID-19 , Programas de Inmunización , Cobertura de Vacunación/estadística & datos numéricos , Anciano , Argentina/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/mortalidad , COVID-19/prevención & control , Prueba de Ácido Nucleico para COVID-19/métodos , Vacunas contra la COVID-19/clasificación , Vacunas contra la COVID-19/uso terapéutico , Estudios de Cohortes , Seguimiento de Parámetros Ecológicos/métodos , Seguimiento de Parámetros Ecológicos/estadística & datos numéricos , Femenino , Humanos , Programas de Inmunización/métodos , Programas de Inmunización/organización & administración , Programas de Inmunización/estadística & datos numéricos , Incidencia , Masculino , Persona de Mediana Edad , Mortalidad , SARS-CoV-2/inmunología , Potencia de la VacunaRESUMEN
CONTEXT: The Unified Model of Information Systems Continuance (UMISC) is a metamodel for the evaluation of clinical information systems (CISs) that integrates constructs from five models that have previously been published in the literature. UMISC was developed at the Georges Pompidou University Hospital (HEGP) in Paris and was partially validated at the Saint Joseph Hospital Group (HPSJ), another acute care institution using the same CIS as HEGP. OBJECTIVE: The aim of this replication study was twofold: (1) to perform an external validation of UMISC in two different hospitals and country contexts: the Italian Hospital of Buenos Aires (HIBA) in Argentina and the Hospital Sirio Libanes in Sao Paulo, Brazil (HSL); (2) to compare, using the same evaluation model, the determinants of satisfaction, use, and continuance intention observed at HIBA and HSL with those previously observed at HEGP and HPSJ. METHODS: The UMISC evaluation questionnaires were translated from their original languages (English and French) to Brazilian Portuguese and Spanish following the translation/back-translation method. These questionnaires were then applied at each target site. The 21 UMISC-associated hypotheses were tested using structural equation modeling (SEM). RESULTS: A total of 3020 users, 1079 at HIBA and 1941 at the HSL, were included in the analysis. The respondents included 1406 medical staff and 1001 nursing staff. The average profession-adjusted use, overall satisfaction and continuance intention were significantly higher at HIBA than at HSL in the medical and nursing groups. In SEM analysis, UMISC explained 23% and 11% of the CIS use dimension, 72% and 85% of health professionals' satisfaction, and 41% and 60% of continuance intention at HIBA and HSL, respectively. Twenty of the 21 UMISC-related hypotheses were validated in at least one of the four evaluation sites, and 16 were validated in two or more sites. CONCLUSION: The UMISC evaluation metamodel appears to be a robust comparison and explanatory model of satisfaction, use and continuance intention for CISs in late post adoption situations.
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Actitud del Personal de Salud , Personal de Salud/estadística & datos numéricos , Sistemas de Información en Hospital/estadística & datos numéricos , Hospitales Universitarios/normas , Modelos Organizacionales , Satisfacción Personal , Adulto , Argentina , Brasil , Femenino , Humanos , Agencias Internacionales , Masculino , Encuestas y CuestionariosRESUMEN
Medicine has evolved considerably in recent decades in part thanks to information and communication technologies in health (ICTs). However, face-to-face consultations continue to be the predominant model, since alternatives such as telemedicine are still the subject of debate. On the other hand, in some very specific specialties, centralization is relevant, mainly due to the low frequency and prevalence of diseases, as well as the need to have highly specialized professionals, causing problems in terms of accessibility and costs for the health system. In this study we have analyzed the first consultations to an orthopedics oncology service at a tertiary institution and performed an analysis of economic costs was carried out between 2 possible scenarios: face-to-face consultations versus telemedicine. Analyzing the 2 scenarios, there would be a cost-benefit in the use of telemedicine leading to a decrease in healthcare cost between 12.2% and 72%.
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Citas y Horarios , Telemedicina , Comunicación , Análisis Costo-Beneficio , OrtopediaRESUMEN
One of the challenges of implementing health information and communication technology is the need for a skilled workforce that understands health care and ITC. There are also people and organizational challenges involved. This work describes the strategies to create such a workforce for the public network of healthcare facilities in the City of Buenos Aires, which include promoting the adoption of technologies and providing lines of contention for continuous training.
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Sistemas de Información en Salud , Salud Pública , Argentina , Ciudades , Desarrollo de Personal , Recursos HumanosRESUMEN
BACKGROUND: Hip fractures are among the most serious bone fractures in the elderly, producing significant morbidity and mortality. Several observational studies have found that mild hyponatremia can adversely affect bone, with fractures occurring as a potential complication. We examined if there is an independent association between prolonged chronic hyponatremia (>90 days duration) and risk of hip fracture in the elderly. METHODS: We performed a retrospective cohort study in adults >60 years of age from a prepaid health maintenance organization who had two or more measurements of plasma sodium between 2005 and 2012. The incidence of hip fractures was assessed in a very restrictive population: subjects with prolonged chronic hyponatremia, defined as plasma sodium values <135 mmol/L, lasting >90 days. Multivariable Cox regression was performed to determine the hazard ratio (HR) for hip fracture risk associated with prolonged chronic hyponatremia after adjustment for the propensity to have hyponatremia, fracture risk factors and relevant baseline characteristics. RESULTS: Among 31 527 eligible patients, only 228 (0.9%) had prolonged chronic hyponatremia. Mean plasma sodium was 132 ± 5 mmol/L in hyponatremic patients and 139 ± 3 mmol/L in normonatremic patients (P < 0.001). The absolute risk for hip fracture was 7/282 in patients with prolonged chronic hyponatremia and 411/313 299 in normonatremic patients. Hyponatremic patients had a substantially elevated rate of hip fracture [adjusted HR 4.52 (95% CI 2.14-9.6)], which was even higher in those with moderate hyponatremia (<130 mmol/L) [adjusted HR 7.61 (95% CI 2.8-20.5)]. CONCLUSION: Mild prolonged chronic hyponatremia is independently associated with hip fracture risk in the elderly population, although the absolute risk is low. However, proof that correcting hyponatremia will result in a reduction of hip fractures is lacking.
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Fracturas de Cadera/etiología , Hiponatremia/complicaciones , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Venous thromboembolism (VTE) is the most common cause of preventable mortality in hospitalized patients, and pulmonary embolism is responsible for 5-10 % of all hospital deaths. To estimate the hospital mortality in hospitalized patients who developed VTE during hospitalization. Prospective cohort of all adult inpatients >17 years admitted to the hospital between August 2006 and August 2013, and follow-up until discharge to measure death. VTE incident cases were captured prospectively from the Institutional Registry of Thromboembolic disease in a tertiary hospital care in Buenos Aires. In hospital global mortality and fatality rate of inpatients with VTE was calculated. The cumulative incidence of VTE was 1.8 % (95 % CI 1.77-1.93 %), representing 1.32 % (95 % CI 1.23-1.41 %) in the subgroup of surgical patients and 2.1 % (95 % CI 1.9-2.2 %) in clinical inpatients. The overall hospital mortality was 2.4 % (95 % CI 2.35-2.53); being 3.95 % (95 % CI 3.78-4.12) in clinical inpatients and 1.15 % (95 % CI 1.06-1.23) in surgical patients. The death in patients who had developed VTE, represented between 4 and 7 % of hospital deaths, and it increases with age in both clinical and surgical patients. In Argentina there are few data of hospital mortality in patients with VTE. This information is useful when assessing the need for resources for prevention, diagnosis and treatment in inpatients.
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Mortalidad Hospitalaria , Tromboembolia Venosa/mortalidad , Adulto , Factores de Edad , Argentina/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Tromboembolia Venosa/etiologíaRESUMEN
BACKGROUND: The prognosis of patients with suspected pulmonary embolism (PE) in whom PE has been ruled out (RPE) is unclear. We aimed to evaluate survival and diagnosis of new cancer in suspected PE patients at follow up. METHODS: A prospective cohort study nested in a prospective Institutional Registry of Venous Thromboembolic Disease was performed between 2006 and 2011. This study was designed to evaluate all consecutive, incident cases of suspected PE in adults. The study was performed at the Hospital Italiano de Buenos Aires, a tertiary level hospital, in hospitalized patients and outpatients. Suspected PE cases were collected using a computerized system that alerts whenever a physician requests pulmonary angiography, angiotomography, or ventilation-perfusion scintigraphy. PE was defined by pre-specified criteria and RPE was defined when diagnostic tests were negative for PE. RESULTS: We included 1736 cases of suspected PE. The prevalence of PE was 29% (n = 504). There was no difference in the overall survival at 30 days and follow-up between PE and RPE patients. The presence of provoked or unprovoked venous thromboembolic disease in these patients did not affect survival. The main causes of death were PE in the confirmed PE group (60%), and neoplasm (42%) and sepsis (37%) in the RPE group. Survival at 90 days was 63% for PE (95% CI 58-67%) and 67% for RPE patients (95% CT 64-69%). At follow-up, there was no difference in diagnosis of new cancer between PE and RPE patients (2% vs 2%, p = 0.82), even when taking into account the unprovoked group. CONCLUSIONS: Even when the main cause of death in PE patients is PE itself, the overall mortality is similar between PE and RPE patients. The reason for this finding could be because of the more frequent and severe comorbidities in RPE than in PE patients. TRIAL REGISTRATION: HomeClinicalTrial.gov: NCT01372514.
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Neoplasias/mortalidad , Embolia Pulmonar/epidemiología , Sepsis/mortalidad , Tromboembolia Venosa/epidemiología , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Causas de Muerte , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Prevalencia , Pronóstico , Estudios Prospectivos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidad , Tasa de SupervivenciaRESUMEN
UNLABELLED: The objective of the study is to assess a nutritional risk alert using an Informatics System in hospitalized patients versus the conventional methodology. METHOD: We studied 400 medical patients at the Belgrano Hospital Critical Care Unit. We considered two groups of 200 patients. In the first the group (Control Group), nutritional risk was diagnosed in a traditional way. In the second group (Alarm Group), nutritional risk was diagnosed with an alert system. The alert was triggered when a patient showed low levels of, at least, two of the following variables: albumin, cholesterol, triglyceride, lymphocyte or low body mass index (BMI). RESULTS: Nutritional risk was detected in 20.3% of the Control Group patients while, in the Alert Group, nutritional risk was detected in 34.3% of the patients; the difference between the two groups was significant (p<0.001), with a sensitivity rate of 99% and a specificity rate of 98%. CONCLUSION: Malnutrition is more easily detected when using an alert system.
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Sistemas de Apoyo a Decisiones Clínicas/organización & administración , Diagnóstico por Computador/métodos , Registros Electrónicos de Salud/organización & administración , Sistemas de Comunicación en Hospital/organización & administración , Sistemas de Información en Hospital/organización & administración , Desnutrición/diagnóstico , Evaluación Nutricional , Adulto , Anciano , Anciano de 80 o más Años , Argentina , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: The role of the Wells score for patients who develop signs and symptoms of pulmonary embolism (PE) during hospitalization has not been sufficiently validated. The aim of this study is to evaluate the performance of the Wells score for inpatients with suspected PE and to evaluate the prevalence of pulmonary embolism. MATERIALS AND METHODS: We conducted a cross sectional study nested in the prospective Institutional Registry of Thromboembolic Disease at Hospital Italiano de Buenos Aires from June 2006 to March 2011. We included patients who developed symptoms of pulmonary embolism during hospitalization. Patients were stratified based on the Wells score as PE likely (>4 points) or PE unlikely (≤4 points). The presence of pulmonary embolism was defined by pre-specified criteria. RESULTS: Six hundred and thirteen patients met the inclusion criteria, with an overall prevalence of PE of 36%. Two hundred and nineteen (34%) were classified as PE likely and 394 (66%) as PE unlikely with a prevalence of PE of 66% and 20%, respectively. The Wells score showed a sensitivity of 65 (95% CI 59-72), specificity 81 (95% CI 77-85), positive predictive value 66 (95% CI 60-72) and negative predictive value 80 (95% CI 77-84). CONCLUSIONS: The Wells Score is accurate to predict the probability of PE in hospitalized patients and this population had a higher prevalence of PE than other cohorts. However, the score is not sufficiently predictive to rule out a potentially fatal disorder.
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Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiología , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Estudios Transversales , Femenino , Hospitalización , Hospitales Comunitarios , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , PrevalenciaRESUMEN
INTRODUCTION: Nonattendance at scheduled outpatient appointments for primary care is a major health care problem worldwide. Our aim was to estimate the prevalence of nonattendance at scheduled appointments for outpatients seeking primary care, to identify associated factors and build a model that predicts nonattendance at scheduled appointments. METHODS: A cohort study of adult patients, who had a scheduled outpatient appointment for primary care, was conducted between January 2010 and July 2011, at the Italian Hospital of Buenos Aires. We evaluated the history and characteristics of these patients, and their scheduling and attendance at appointments. Patients were divided into two groups: those who attended their scheduled appointments, and those who did not. We estimated the odds ratios (OR) and corresponding 95% confidence intervals (95% CI), and generated a predictive model for nonattendance, with logistic regression, using factors associated with lack of attendance, and those considered clinically relevant. Alternative models were compared using Akaike's Information Criterion. A generation cohort and a validation cohort were assigned randomly. RESULTS: Of 113,716 appointments included in the study, 25,687 were missed (22.7%; 95% CI: 22.34%-22.83%). We found a statistically significant association between nonattendance and age (OR: 0.99; 95% CI: 0.99-0.99), number of issues in the personal health record (OR: 0.98; 95% CI: 0.98-0.99), time between the request for and date of appointment (OR: 1; 95% CI: 1-1), history of nonattendance (OR: 1.07; 95% CI: 1.07-1.07), appointment scheduled later than 4 pm (OR: 1.30; 95% CI: 1.24-1.35), and specific days of the week (OR: 1.00; 95% CI: 1.06-1.1). The predictive model for nonattendance included characteristics of the patient requesting the appointment, the appointment request, and the actual appointment date. The area under the receiver operating characteristic curve of the predictive model in the generation cohort was 0.892 (95% CI: 0.890-0.894). CONCLUSION: Evidence related to patient characteristics, and the identification of appointments with a higher likelihood of nonattendance, should promote guided strategies to reduce the rate of nonattendance, as well as to future research on this topic. The use of predictive models could further guide management strategies to reduce the rate of nonattendance.
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The adaptation of the 10x10 certificate program in health information systems for a Puerto Rican audience is described. The 10x10 program was initially developed in the USA by the Oregon Health Sciences University (OHSU), then adapted to Latin America by Hospital Italiano de Buenos Aires. Puerto Rico is in the intersection of the United States and Latin America, in terms of government, health care system, culture and language. Therefore, it seemed reasonable to re-adapt the program back to the USA, in Spanish, taking into account these facts and the experience of the team in delivering blended learning adapted to local needs. Forty professionals from Puerto Rico are currently taking the first version of the course, supported by the Regional Extension Center for Puerto Rico and the US Virgin Islands, and endorsed by the American Medical Informatics Association (AMIA).
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Certificación/organización & administración , Certificación/normas , Curriculum/normas , Evaluación Educacional/normas , Informática Médica/educación , Informática Médica/normas , Traducción , Puerto Rico , Estados UnidosRESUMEN
The use of three-dimensional preoperative planning and bone tumor resection guided by navigation has increased in the last ten years. However, no study to date, as far as we know, has directly provided evidence of accuracy of this method. The objective of this study was to describe a method capable of determining the accuracy of osteotomies performed for tumor resection planned and guided by navigation. We hypothesize that matching the 3D reconstructed surgical specimen is an acceptable method to determine the accuracy of virtual planning and navigation. A total of seven patients and 14 osteotomies were evaluated. After surgery, all surgical specimens were 3D reconstructed from CT images. The mean of quantitative comparisons between osteotomies planned and osteotomies obtained through the resected specimen was in a global mean of 1.56 millimeters (SD: 2.91) for all the cases. Based on our observations, a three-dimensional model obtained from the tumor surgical specimen is a useful tool to determine accuracy of 3D planning and surgical navigation.
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Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Imagenología Tridimensional/métodos , Modelos Biológicos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Interfaz Usuario-Computador , Adolescente , Adulto , Niño , Simulación por Computador , Femenino , Humanos , Masculino , Osteotomía/métodos , Cuidados Preoperatorios/métodos , Estudios RetrospectivosRESUMEN
UNLABELLED: Physicians do not always keep the problem list accurate, complete and updated. OBJECTIVE: To analyze natural language processing (NLP) techniques and inference rules as strategies to maintain completeness and accuracy of the problem list in EHRs. METHODS: Non systematic literature review in PubMed, in the last 10 years. Strategies to maintain the EHRs problem list were analyzed in two ways: inputting and removing problems from the problem list. RESULTS: NLP and inference rules have acceptable performance for inputting problems into the problem list. No studies using these techniques for removing problems were published Conclusion: Both tools, NLP and inference rules have had acceptable results as tools for maintain the completeness and accuracy of the problem list.
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Algoritmos , Registros Electrónicos de Salud/organización & administración , Almacenamiento y Recuperación de la Información/métodos , Registros Médicos Orientados a Problemas , Procesamiento de Lenguaje Natural , Garantía de la Calidad de Atención de Salud/métodos , Vocabulario Controlado , Inteligencia Artificial , Reconocimiento de Normas Patrones Automatizadas/métodos , Reconocimiento de Normas Patrones Automatizadas/normas , Interfaz Usuario-ComputadorRESUMEN
Health information exchange ensuring its authenticity and integrity is not a simple task. Many institutions have implemented different solutions to perform this exchange using partial or summary information, and rarely include metadata that establish the context in which they performed the primary data capture. In this setting, we proposed the creation of an alternative architecture, parallel, yet integrated with a traditional electronic health record, based on the relational data model. We used a clinical documents standard, the CDA, whose architecture allows having a scalable document-based electronic clinical data repository, plausible to be shared with the patient, other institutions, other healthcare professionals or funders, with secure and controlled access and that remains unchanged over time. Furthermore, in addition to achieving this redundant clinical data repository, it was possible to reduce printing charts thanks to the portability that this standard allows.
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Documentación/normas , Registros Electrónicos de Salud/normas , Intercambio de Información en Salud , Almacenamiento y Recuperación de la Información/normas , Registro Médico Coordinado/normas , Guías de Práctica Clínica como Asunto , Argentina , InternacionalidadRESUMEN
BACKGROUND: Venous thromboembolism (VTE) has been associated with a higher risk of developing malignancy and mortality, and patients with VTE may therefore benefit from increased surveillance. We aimed to construct a clinical predictive score that could classify patients with VTE according to their risk for developing these outcomes. METHODS: Observational cohort study using an existing clinical registry in a tertiary academic teaching hospital in Buenos Aires, Argentina. 1264 adult patients greater than 17 years of age presented new VTE between June 2006 and December 2011 and were included in the registry. We excluded patients with previous or incident cancer, those who died during the first month, and those with less than one year of follow up (< 5%). 540 patients were included. Primary outcome was new cancer diagnosis during one year of follow-up, secondary composite outcome was any new cancer diagnosis or death. The score was developed using a multivariable logistic regression model to predict cancer or death. RESULTS: During follow-up, one-quarter (26.4%) of patients developed cancer (9.2%) or died (23.7%). Patients with the primary outcome had more comorbidities, were more likely to have previous thromboembolism and less likely to have recent surgery. The final score developed for predicting cancer alone included previous episode of VTE, recent surgery and comorbidity (Charlson comorbidity score), [AUC of 0.75 (95% CI 0.66-0.84) and 0.79 (95% CI 0.63-0.95) in the derivation and validation cohorts, respectively]. The version of this score developed to predict cancer or death included age, albumin level, comorbidity, previous episode of VTE, and recent surgery [AUC = 0.72 (95% CI 0.66-0.78) and 0.71 (95% CI 0.63-0.79) in the derivation and validation cohorts, respectively]. CONCLUSIONS: A simple clinical predictive score accurately estimates patients' risk of developing cancer or death following newly diagnosed VTE. This tool could be used to help reassure low risk patients, or to identify high-risk patients that might benefit from closer surveillance and additional investigations. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01372514.
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Neoplasias/complicaciones , Neoplasias/epidemiología , Tromboembolia Venosa/complicaciones , Tromboembolia Venosa/epidemiología , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Sistema de RegistrosRESUMEN
Biomedical informatics in Health (BIH) is the discipline in charge of capturing, handling and using information in health and biomedicine in order to improve the processes involved with assistance and management. Informatic nephrology has appeared as a product of the combination between conventional nephrology with BIH and its development has been considerable in the assistance as well as in the academic field. Regarding the former, there is increasing evidence that informatics technology can make nephrological assistance be better in quality (effective, accessible, safe and satisfying), improve patient's adherence, optimize patient's and practitioner's time, improve physical space and achieve health cost reduction. Among its main elements, we find electronic medical and personal health records, clinical decision support system, tele-nephrology, and recording and monitoring devices. Additionally, regarding the academic field, informatics and Internet contribute to education and research in the nephrological field. In conclusion, informatics nephrology represents a new field which will influence the future of nephrology.
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Internet , Informática Médica/tendencias , Nefrología/educación , Sistemas de Apoyo a Decisiones Clínicas/normas , Sistemas de Apoyo a Decisiones Clínicas/tendencias , Registros Electrónicos de Salud/normas , Registros Electrónicos de Salud/tendencias , Femenino , Predicción , Registros de Salud Personal , Humanos , Masculino , Informática Médica/normas , Monitoreo Fisiológico/instrumentación , Mejoramiento de la Calidad , Telemedicina/normas , Telemedicina/tendenciasRESUMEN
Tumor excision is the primary treatment of aggressive or recurrent benign bone tumors and malignant bone sarcomas. This requires a surgical resection with the potential for large residual osseous defects that could be reconstructed using fresh frozen allografts. Virtual bone banks enable the creation of databases allowing a 3D pre-surgery evaluation of such allgorafts, based on segmentation of DICOM-CT images. This study demonstrates the usefulness of patient specific 3D models for an accurate host-donor allograft match. We describe one way to select the best match according to size and shape. The results suggest that a robust and reliable technique has been established. Since it is difficult to plan an allograft on a distal femur deformed by the tumor, we propose to plan the surgery on the contralateral side. Our results support this limb symmetry hypothesis. The use of this measurement protocol enables accurate selection of allografts from a contralateral healthy femur 3D CT model achieving the best match possible considering the geometry of available allograft candidate femur specimens.
Asunto(s)
Bancos de Huesos , Fémur/diagnóstico por imagen , Fémur/trasplante , Imagenología Tridimensional/métodos , Tomografía Computarizada por Rayos X , Adolescente , Bancos de Huesos/normas , Trasplante Óseo/métodos , Femenino , Humanos , Masculino , Tamaño de los Órganos , Trasplante Homólogo , Adulto JovenRESUMEN
This paper describes the development and implementation of a web based electronic health record for the Homecare Service program in the Hospital Italiano de Buenos Aires. It reviews the process of the integration of the new electronic health record to the hospital information system, allowing physicians to access the clinical data repository from their Pc's at home and with the capability of consulting past and present history of the patient health care, order, tests, and referrals with others professionals trough the new Electronic Health Record. We also discuss how workflow processes were changed and improved for the physicians, nurses, and administrative personnel of the Homecare Services and the educational methods used to improve acceptance and adoption of these new technologies. We also briefly describe the validation of physicians and their field work with electronic signatures.