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2.
Cell Death Dis ; 15(9): 671, 2024 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-39271699

RESUMEN

Long COVID is characterized by persistent that extends symptoms beyond established timeframes. Its varied presentation across different populations and healthcare systems poses significant challenges in understanding its clinical manifestations and implications. In this study, we present a novel application of text mining technique to automatically extract unstructured data from a long COVID survey conducted at a prominent university hospital in São Paulo, Brazil. Our phonetic text clustering (PTC) method enables the exploration of unstructured Electronic Healthcare Records (EHR) data to unify different written forms of similar terms into a single phonemic representation. We used n-gram text analysis to detect compound words and negated terms in Portuguese-BR, focusing on medical conditions and symptoms related to long COVID. By leveraging text mining, we aim to contribute to a deeper understanding of this chronic condition and its implications for healthcare systems globally. The model developed in this study has the potential for scalability and applicability in other healthcare settings, thereby supporting broader research efforts and informing clinical decision-making for long COVID patients.


Asunto(s)
COVID-19 , Minería de Datos , Humanos , Minería de Datos/métodos , COVID-19/epidemiología , COVID-19/virología , Registros Electrónicos de Salud , Hospitalización , SARS-CoV-2/aislamiento & purificación , Brasil/epidemiología , Síndrome Post Agudo de COVID-19
3.
Syst Rev ; 13(1): 237, 2024 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-39294674

RESUMEN

BACKGROUND: The Brazilian Ministry of Health has developed and provided the Citizen's Electronic Health Record (PEC e-SUS APS), a health information system freely available for utilization by all municipalities. Given the substantial financial investment being made to enhance the quality of health services in the country, it is crucial to understand how users evaluate this product. Consequently, this scoping review aims to map studies that have evaluated the PEC e-SUS APS. METHODS: This scoping review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) framework, as well as by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist extension for scoping reviews (PRISMA-ScR). The research question was framed based on the "CoCoPop" mnemonic (Condition, Context, Population). The final question posed is, "How has the Citizen's Electronic Health Record (PEC e-SUS APS) been evaluated?" The search strategy will be executed across various databases (LILACS, PubMed/MEDLINE, Scopus, Web of Science, ACM Digital Library, and IEEE Digital Library), along with gray literature from ProQuest Dissertation and Theses Global and Google Scholar, with assistance from a professional healthcare librarian skilled in supporting systematic reviews. The database search will encompass the period from 2013 to 2024. Articles included will be selected by three independent reviewers in two stages, and the findings will undergo a descriptive analysis and synthesis following a "narrative review" approach. Independent reviewers will chart the data as outlined in the literature. DISCUSSION: The implementation process for the PEC e-SUS APS can be influenced by the varying characteristics of the over 5500 Brazilian municipalities. These factors and other challenges encountered by health professionals and managers may prove pivotal for a municipality's adoption of the PEC e-SUS APS system. With the literature mapping to be obtained from this review, vital insights into how users have evaluated the PEC will be obtained. SYSTEMATIC REVIEW REGISTRATION: The protocol has been registered prospectively at the Open Science Framework platform under the number 10.17605/OSF.IO/NPKRU.


Asunto(s)
Registros Electrónicos de Salud , Humanos , Brasil , Revisiones Sistemáticas como Asunto , Proyectos de Investigación
4.
Stud Health Technol Inform ; 316: 257-261, 2024 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-39176722

RESUMEN

This study aims to assess the value of a help desk in a Personal Health Record (PHR) for monitoring and improving PHR functionalities and processes. Through analysis of 327 help desk tickets categorized by users as telemedicine and PHR requests, we identified four main gaps: information and feedback, access to clinical documents, usability, and ubiquity. The tickets highlighted end users' needs such as timely feedback, contextual information, effective communication, and ease of access to clinical documentation. These findings were crucial for initiating improvement cycles for various functionalities and processes within the PHR.


Asunto(s)
Registros Electrónicos de Salud , Registros de Salud Personal , Humanos , Interfaz Usuario-Computador , Telemedicina
5.
Stud Health Technol Inform ; 316: 315-319, 2024 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-39176736

RESUMEN

The aim of this paper is to present the evolution of Digital Health (DH) in Brazil, in relation to the adoption of DH as a basis for the development of public policies, with a focus on improving the delivery of health care to patients and expanding its coverage. Data from the ICT in Health survey from the Regional Centre for Studies on the Development of the Information Society (Cetic.br) were analysed. The main challenges identified are related to gaps in patient information, which requires interaction between different facilities and to more complex functionalities related to guidelines and guidance in patient care.


Asunto(s)
Telemedicina , Brasil , Humanos , Telemedicina/tendencias , Atención a la Salud , Registros Electrónicos de Salud , Salud Digital
6.
Ann Hepatol ; 29(5): 101528, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38971372

RESUMEN

INTRODUCTION AND OBJECTIVES: Despite the huge clinical burden of MASLD, validated tools for early risk stratification are lacking, and heterogeneous disease expression and a highly variable rate of progression to clinical outcomes result in prognostic uncertainty. We aimed to investigate longitudinal electronic health record-based outcome prediction in MASLD using a state-of-the-art machine learning model. PATIENTS AND METHODS: n = 940 patients with histologically-defined MASLD were used to develop a deep-learning model for all-cause mortality prediction. Patient timelines, spanning 12 years, were fully-annotated with demographic/clinical characteristics, ICD-9 and -10 codes, blood test results, prescribing data, and secondary care activity. A Transformer neural network (TNN) was trained to output concomitant probabilities of 12-, 24-, and 36-month all-cause mortality. In-sample performance was assessed using 5-fold cross-validation. Out-of-sample performance was assessed in an independent set of n = 528 MASLD patients. RESULTS: In-sample model performance achieved AUROC curve 0.74-0.90 (95 % CI: 0.72-0.94), sensitivity 64 %-82 %, specificity 75 %-92 % and Positive Predictive Value (PPV) 94 %-98 %. Out-of-sample model validation had AUROC 0.70-0.86 (95 % CI: 0.67-0.90), sensitivity 69 %-70 %, specificity 96 %-97 % and PPV 75 %-77 %. Key predictive factors, identified using coefficients of determination, were age, presence of type 2 diabetes, and history of hospital admissions with length of stay >14 days. CONCLUSIONS: A TNN, applied to routinely-collected longitudinal electronic health records, achieved good performance in prediction of 12-, 24-, and 36-month all-cause mortality in patients with MASLD. Extrapolation of our technique to population-level data will enable scalable and accurate risk stratification to identify people most likely to benefit from anticipatory health care and personalized interventions.


Asunto(s)
Registros Electrónicos de Salud , Humanos , Masculino , Femenino , Persona de Mediana Edad , Medición de Riesgo , Anciano , Pronóstico , Causas de Muerte , Aprendizaje Profundo , Factores de Riesgo , Valor Predictivo de las Pruebas , Enfermedad del Hígado Graso no Alcohólico/mortalidad , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Adulto , Redes Neurales de la Computación , Estudios Retrospectivos
7.
Rev Lat Am Enfermagem ; 32: e4239, 2024.
Artículo en Inglés, Español, Portugués | MEDLINE | ID: mdl-38985046

RESUMEN

OBJECTIVE: to describe the development of a predictive nursing workload classifier model, using artificial intelligence. METHOD: retrospective observational study, using secondary sources of electronic patient records, using machine learning. The convenience sample consisted of 43,871 assessments carried out by clinical nurses using the Perroca Patient Classification System, which served as the gold standard, and clinical data from the electronic medical records of 11,774 patients, which constituted the variables. In order to organize the data and carry out the analysis, the Dataiku® data science platform was used. Data analysis occurred in an exploratory, descriptive and predictive manner. The study was approved by the Ethics and Research Committee of the institution where the study was carried out. RESULTS: the use of artificial intelligence enabled the development of the nursing workload assessment classifier model, identifying the variables that most contributed to its prediction. The algorithm correctly classified 72% of the variables and the area under the Receiver Operating Characteristic curve was 82%. CONCLUSION: a predictive model was developed, demonstrating that it is possible to train algorithms with data from the patient's electronic medical record to predict the nursing workload and that artificial intelligence tools can be effective in automating this activity.


Asunto(s)
Inteligencia Artificial , Carga de Trabajo , Carga de Trabajo/estadística & datos numéricos , Estudios Retrospectivos , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Enfermería , Anciano , Adulto Joven , Registros Electrónicos de Salud/estadística & datos numéricos
8.
Stud Health Technol Inform ; 315: 600-601, 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39049341

RESUMEN

The Omaha System has been providing a useful clinical documentation structure for health practice, education, and research since 1975. To understand its current applications, we updated a literature review from 2013, using the same descriptors ('Omaha System') which resulted in 559 documents. After applying filters and different forms of screening, 35 papers published from 2012 to 2022 composed the final sample for the review. From its critical analysis we realized that the Omaha System is still a valuable tool for the evaluation of health care outcomes in a variety of settings. Its benefits include promoting communication, supporting evidence-based dec;ision-making, and improving the quality of care and it is interoperable with other classifications and terminologies in healthcare. The use of the Omaha System still enables a consistent integration between patient, community, and health professionals, ensuring the collection and analysis of data that contributes to holistic care in a multidisciplinary approach.


Asunto(s)
Registros Electrónicos de Salud , Humanos
9.
Int J Med Inform ; 190: 105525, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39033722

RESUMEN

BACKGROUND: Stroke management requires a coordinated strategy, adhering to clinical pathways (CP) and value-based healthcare (VBHC) principles from onset to rehabilitation. However, the discrepancies between these pathways and actual patient experiences highlight the need for ongoing monitoring and addressing interoperability issues across multiple institutions in stroke care. To address this, the Fast Healthcare Interoperability Resource (FHIR) Implementation Guide (IG) standardizes the information exchange among these systems, considering a specific context of use. OBJECTIVE: Develop an FHIR IG for stroke care rooted in established stroke CP and VBHC principles. METHOD: We represented the stroke patient journey by considering the core stroke CP, the International Consortium for Health Outcomes Measurement (ICHOM) dataset for stroke, and a Brazilian case study using the Business Process Model and Notation (BPMN). Next, we developed a data dictionary that aligns variables with existing FHIR resources and adapts profiling from the Brazilian National Health Data Network (BNHDN). RESULTS: Our BPMN model encompassed three critical phases that represent the entire patient journey from symptom onset to rehabilitation. The stroke data dictionary included 81 variables, which were expressed as questionnaires, profiles, and extensions. The FHIR IG comprised nine pages: Home, Stroke-CP, Data Dictionary, FHIR, ICHOM, Artifacts, Examples, Downloads, and Security. We developed 96 artifacts, including 7 questionnaires, 27 profiles with corresponding example instances, 3 extensions, 18 value sets, and 14 code systems pertinent to ICHOM outcome measures. CONCLUSION: The FHIR IG for stroke in this study represents a significant advancement in healthcare interoperability, streamlining the tracking of patient outcomes for quality enhancement, facilitating informed treatment choices, and enabling the development of dashboards to promote collaborative excellence in patient care.


Asunto(s)
Vías Clínicas , Accidente Cerebrovascular , Atención Médica Basada en Valor , Humanos , Brasil , Registros Electrónicos de Salud , Interoperabilidad de la Información en Salud , Accidente Cerebrovascular/terapia , Atención Médica Basada en Valor/organización & administración
10.
Stud Health Technol Inform ; 315: 352-356, 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39049282

RESUMEN

OBJECTIVE: Apply Graph Theory to analyze and map knowledge about nursing diagnoses and interventions, based on records of consultations carried out by nurses, in women's health, in primary health care. METHODS: Secondary data from a cross-sectional study were used. Records of nursing consultations carried out during the month of October 2016, in 21 health units, in a Brazilian municipality were analyzed. Network analysis was carried out using Graphs from 61 nursing consultations. RESULTS: 175 diagnoses were recorded, an average of three per consultation; and 380 interventions, an average of six per consultation. In the analysis, four diagnostic and four intervention network groupings were identified. CONCLUSIONS: The mapping allowed reflection on phenomena of interest to Nursing and fostering critical thinking in decision making. The findings are useful for teaching and training nurses, as well as strengthening the use of standardized language systems.


Asunto(s)
Diagnóstico de Enfermería , Salud de la Mujer , Humanos , Femenino , Brasil , Estudios Transversales , Registros Electrónicos de Salud
11.
Rev Saude Publica ; 58: 23, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-38922270

RESUMEN

OBJECTIVE: Contextualize the adherence to the Prontuário Eletrônico do Cidadão (PEC - Citizen's Electronic Health Record) by Brazilian municipalities and the evolution of the electronic strategy of the Unified Health System (e-SUS) for Primary Healthcare (PHC) during its 10 years. METHODS: This descriptive study added information on adherence to the use of medical records extracted from the database of the Secretaria de Atenção Primária à Saúde (SAPS- Primary Healthcare Secretary) of the Federal Government between 2017 and 2022. We analized the number of computerized basic healthcare units that used some electronic medical records, the number of those that used simplified data collection (SDC), and those that implemented the citizen's electronic health record (PEC) in the same period. A descriptive synthesis of the functionalities and modules implemented in the system during its 10 years of development was also carried out. RESULTS: The adherence of Brazilian municipalities to the PEC has grown exponentially in the last five years, going from 8,930 healthcare units in 2017 to 26,091 in 2022. As expected, while the main functionalities and improvements developed in this decade sought to implement new flows and modules of administrative, clinical care, and care management processes and health service administration, improving aspects of usability and technological infrastructure of the application architecture was also crucial for the success of the system. CONCLUSIONS: In 2023, the milestone of a decade will be celebrated since the beginning of health records implementation by Brazilian municipalities, marked by technological and infrastructure challenges and improvements and new functionalities that highlight the technological evolution of the e-SUS PHC system and strategy. Despite many other tools, the PEC is arguably Brazil's leading electronic medical record today, as it has always invested in evolution, updating itself in technological and usability opportunities.


Asunto(s)
Registros Electrónicos de Salud , Programas Nacionales de Salud , Atención Primaria de Salud , Brasil , Humanos
12.
J Pediatr ; 274: 114155, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-38897380

RESUMEN

OBJECTIVE: To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia. STUDY DESIGN: In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record. In October 2021, a second phase comprised additional education and order set revisions. A narrow spectrum antibiotic (eg, amoxicillin) was recommended in most circumstances. Electronic health record data were used to identify pneumonia cases and antibiotics ordered. Using interrupted time series analyses, antibiotic choice and duration after phase one (September 2020-September 2021) and after phase two (October 2021-October 2022) were compared with a preintervention prepandemic period (January 2016-early March 2020). RESULTS: Overall, 3570 cases of community-acquired pneumonia were identified: 3246 cases preintervention, 98 post-phase one, and 226 post-phase two. The proportion receiving narrow spectrum monotherapy increased from 40.6% preintervention to 68.4% post-phase one to 69.0% post-phase two (P < .001). For children with an initial narrow spectrum antibiotic, duration decreased from preintervention (mean duration 9.9 days, SD 0.5 days) to post-phase one (mean 8.2, SD 1.9) to post-phase two (mean 6.8, SD 2.3) periods (P < .001). CONCLUSIONS: A two-phase intervention with educational sessions combined with clinical decision support was associated with sustained improvements in antibiotic choice and duration among children with community-acquired pneumonia.


Asunto(s)
Antibacterianos , Infecciones Comunitarias Adquiridas , Neumonía , Pautas de la Práctica en Medicina , Humanos , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Antibacterianos/uso terapéutico , Niño , Preescolar , Lactante , Adolescente , Femenino , Masculino , Neumonía/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Ambulatoria , Registros Electrónicos de Salud , Análisis de Series de Tiempo Interrumpido , Programas de Optimización del Uso de los Antimicrobianos/métodos , Pacientes Ambulatorios , Mejoramiento de la Calidad
13.
Rev Assoc Med Bras (1992) ; 70(4): e20231136, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38716938

RESUMEN

OBJECTIVE: The objective was to analyze the implementation and use of the electronic patient record in the health services of the Brazilian Air Force. METHODS: This is a cross-sectional study carried out with 234 physicians, between March and May 2021. The data collection instrument was sent by email. The electronic patient record was implemented in the Air Force approximately 3 years ago (64.5%), and about 81% of the physicians received training to operate it. RESULTS: The most common records involve data related to consultations (90.1%) and interviews with physical examination (67.1%). Physicians cited that information storage (75.6%), agility, and feasibility of recording (55.1%) were the main advantages of the electronic patient record. As disadvantages, problems in electronic equipment (69.7%) and system errors (65%) were reported. Most participants considered that the implementation had a positive impact on work dynamics (75.6%) and productivity (66.7%), mainly regarding the components "Work processes" (57.3%) and "Amount of carried out activities" (21.4%). Keeping records was significantly associated with the job position (p<0.001), type of unit (p=0.008), time of implementation (p<0.001), and participation in training (p=0.028). CONCLUSION: The implementation of the electronic patient record in the Air Force was recently done, and just over half of the physicians were trained prior to the implementation. The tool is considered compatible with work processes and has a positive effect on productivity.


Asunto(s)
Registros Electrónicos de Salud , Humanos , Estudios Transversales , Brasil , Registros Electrónicos de Salud/estadística & datos numéricos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Encuestas y Cuestionarios , Médicos/estadística & datos numéricos , Actitud del Personal de Salud
14.
Artículo en Inglés | MEDLINE | ID: mdl-38765539

RESUMEN

Objective: Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital. Methods: A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors. Results: The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Conclusion: Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as "high-risk" received adequate medical care, consequently.


Asunto(s)
Registros Electrónicos de Salud , Hemorragia Posparto , Humanos , Femenino , Estudios Retrospectivos , Hemorragia Posparto/epidemiología , Hemorragia Posparto/etiología , Adulto , Factores de Riesgo , Embarazo , Adulto Joven , Admisión del Paciente/estadística & datos numéricos , Prevalencia , Medición de Riesgo , Estudios de Cohortes
15.
Rev. Ciênc. Plur ; 10 (1) 2024;10(1): 34416, 2024 abr. 30. tab
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1553426

RESUMEN

Introdução: Infecções nosocomiais, adquiridas após a internação hospitalar, são o evento adverso mais comum que ameaça a saúde dos pacientes hospitalizados, sendo a pneumonia, incluindo a causada pelo SARS-Cov-2, responsável por mais de 80% das infecções nosocomiais. A pandemia declarada pela OMS em março de 2020 reflete o rápido aumento de casos, impulsionado pela disseminação do vírus através de gotículas e aerossóis. A transmissão nosocomial do SARS-Cov-2 foi observada desde o início do surto em Wuhan, representando um desafio adicional na qualidade de vida dos pacientes. Estudos internacionais em hospitais reportam incidências de infecção nosocomial por COVID-19 entre 11% e 44%.Objetivo: Identificar a proporção de infecção nosocomial por SARS-COV-2 no Brasil entre março de 2020 até dezembro de 2022.Metodologia:Trata-se de um estudo analítico, retrospectivo, de corte transversal, sobre a proporção de infecção nosocomial por Sars-Cov-2 no Brasil, através de dados secundários oriundos do Sistema de Informação da Vigilância Epidemiológica da Gripe. No presente estudo a variável dependente analisada foi a proporção de infecção nosocomial por Sars-cov-2. Como variáveis independentes exploratórias foram utilizadas: faixa etária, sexo, comorbidades e macrorregião de residência. Resultados: O estudo identificou uma proporção de casos nosocomiais de 2,58%, sendo maior no terceiro ano da pandemia 2022 (5,5%) na região Norte (7,57%), entre os indivíduos de 18-59 anos de idade (6,93%)Conclusões: Este estudo sobre casos nosocomiais de COVID-19 no Brasil revela uma proporção de 2,58% entre 2020 e 2022, com associações identificadas em relação à região, idade e comorbidades. Diferenças em relação a estudos internacionais sugerem questões metodológicas específicas. Essa pesquisa é de importância crítica, visto ser de abrangência nacional com grande amplitude, e estabelece uma base sólida para futuros estudos epidemiológicos (AU).


Introduction: Nosocomial infections, acquired after hospital admission, are the most common adverse events threatening patient health, with pneumonia, including that caused by SARS-CoV-2, responsible for over 80% of nosocomial infections. The pandemic declared by the WHO in March 2020 reflects the rapid rise in cases driven by the virus's spread through droplets and aerosols. Nosocomial transmission of SARS-CoV-2 has been observed since the outbreak's onset in Wuhan, posing an additional challenge to patient quality of life. International hospital studies report nosocomial COVID-19 infection rates between 11% and 44%. Objective: Identifying the proportion of nosocomial SARS-CoV-2 infection in Brazil between March 2020 and December 2022.Methodology:This is an analytical, retrospective, cross-sectional study on the proportion of nosocomial SARS-CoV-2 infection in Brazil, using secondary data from the Influenza Epidemiological Surveillance Information System. In this study, the analyzed dependent variable was the proportionof nosocomial SARS-CoV-2 infection. The exploratory independent variables included: age group, gender, comorbidities, and macro-region of residence.Results:The study identified a proportion of nosocomial cases of 2.58%, with a higher proportion in the third year of the pandemic, 2022 (5.5%) in the North region (7.57%), among individuals aged 18-59 years (6.93%). Conclusions: This study on nosocomial cases of COVID-19 in Brazil reveals a proportion of 2.58% between 2020 and 2022, with associations identified regarding region, age, and comorbidities. Differences compared to international studies suggest specific methodological issues. This research is of critical importance, given its national scope and broad coverage, and establishes a solid foundation for future epidemiological studies (AU).


Introducción: Las infecciones nosocomiales, adquiridas tras la hospitalización, son el evento adverso más común que amenaza la salud de los pacientes hospitalizados, siendo la neumonía, incluida la causada por el SARS-Cov-2, la responsable de más del 80% de las infecciones. La pandemia declarada por la OMS en marzo de 2020 refleja el rápido aumento de casos, impulsado por la propagación del virus a través de gotitas y aerosoles. La transmisión nosocomial del SRAS-Cov-2 se ha observado desde el inicio del brote en Wuhan, lo que supone un reto adicional para la calidad de vida de los pacientes. Estudios internacionales realizados en hospitales informan de incidencias de infecciones nosocomiales por COVID-19 de entre el 11% y el 44%. Objetivo: Identificar la proporción de infección nosocomial por SARS-CoV-2 en Brasil entre marzo de 2020 y diciembre de 2022. Metodología: Se trata de un estudio analítico, retrospectivo y transversal sobre la proporción de infección nosocomial por SARS-CoV -2 en Brasil, utilizando datos secundarios del Sistema de Información de Vigilancia Epidemiológica de Influenza. La variable dependiente analizada fue la proporción de infección nosocomial por SARS-CoV-2. Como variables independientes exploratorias se utilizaron: grupo de edad, sexo, comorbilidades y macrorregión de residencia. Resultados:El estudio identificó una proporción de casos nosocomiales del 2,58%, siendo mayor en el tercer año de la pandemia de 2022 (5,5%) en la región Norte (7,57%), entre individuos de 18 a 59 años (6,93%). Conclusiones:Este estudio de casos de COVID-19 hospitalizados en Brasil revela una proporción de 2,58% entre 2020 y 2022, con asociaciones identificadas en relación a la región, edad y comorbilidades. Las disparidades en relación a estudios internacionales sugieren la presencia de cuestiones metodológicas específicas. Esta investigación es de extrema importancia para orientar estrategias preventivas y mejorar el control de las infecciones hospitalarias (AU).


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infección Hospitalaria/transmisión , Registros Electrónicos de Salud/instrumentación , Sistemas de Información en Salud , COVID-19/transmisión , Brasil/epidemiología , Estudios Retrospectivos , Síndrome Respiratorio Agudo Grave/etiología
16.
BMC Infect Dis ; 24(1): 359, 2024 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-38549109

RESUMEN

BACKGROUND: The COVID-19 pandemic has caused significant disruptions to everyday life and has had social, political, and financial consequences that will persist for years. Several initiatives with intensive use of technology were quickly developed in this scenario. However, technologies that enhance epidemiological surveillance in contexts with low testing capacity and healthcare resources are scarce. Therefore, this study aims to address this gap by developing a data science model that uses routinely generated healthcare encounter records to detect possible new outbreaks early in real-time. METHODS: We defined an epidemiological indicator that is a proxy for suspected cases of COVID-19 using the health records of Emergency Care Unit (ECU) patients and text mining techniques. The open-field dataset comprises 2,760,862 medical records from nine ECUs, where each record has information about the patient's age, reported symptoms, and the time and date of admission. We also used a dataset where 1,026,804 cases of COVID-19 were officially confirmed. The records range from January 2020 to May 2022. Sample cross-correlation between two finite stochastic time series was used to evaluate the models. RESULTS: For patients with age 18 years, we find time-lag () = 72 days and cross-correlation () ~ 0.82, = 25 days and ~ 0.93, and = 17 days and ~ 0.88 for the first, second, and third waves, respectively. CONCLUSIONS: In conclusion, the developed model can aid in the early detection of signs of possible new COVID-19 outbreaks, weeks before traditional surveillance systems, thereby anticipating in initiating preventive and control actions in public health with a higher likelihood of success.


Asunto(s)
COVID-19 , Humanos , Adolescente , COVID-19/epidemiología , Registros Electrónicos de Salud , Pandemias , Brotes de Enfermedades , Minería de Datos
17.
J Int Med Res ; 52(3): 3000605241241920, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38548473

RESUMEN

The target trial framework has emerged as a powerful tool for addressing causal questions in clinical practice and in public health. In the healthcare sector, where decision-making is increasingly data-driven, transactional databases, such as electronic health records (EHR) and insurance claims, present an untapped potential for answering complex causal questions. This narrative review explores the potential of the integration of the target trial framework with real-world data to enhance healthcare decision-making processes. We outline essential elements of the target trial framework, and identify pertinent challenges in data quality, privacy concerns, and methodological limitations, proposing solutions to overcome these obstacles and optimize the framework's application.


Asunto(s)
Registros Electrónicos de Salud , Humanos , Bases de Datos Factuales
18.
J Pediatr ; 269: 113973, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38401785

RESUMEN

OBJECTIVE: To test whether different clinical decision support tools increase clinician orders and patient completions relative to standard practice and each other. STUDY DESIGN: A pragmatic, patient-randomized clinical trial in the electronic health record was conducted between October 2019 and April 2020 at Geisinger Health System in Pennsylvania, with 4 arms: care gap-a passive listing recommending screening; alert-a panel promoting and enabling lipid screen orders; both; and a standard practice-no guideline-based notification-control arm. Data were analyzed for 13 346 9- to 11-year-old patients seen within Geisinger primary care, cardiology, urgent care, or nutrition clinics, or who had an endocrinology visit. Principal outcomes were lipid screening orders by clinicians and completions by patients within 1 week of orders. RESULTS: Active (care gap and/or alert) vs control arm patients were significantly more likely (P < .05) to have lipid screening tests ordered and completed, with ORs ranging from 1.67 (95% CI 1.28-2.19) to 5.73 (95% CI 4.46-7.36) for orders and 1.54 (95% CI 1.04-2.27) to 2.90 (95% CI 2.02-4.15) for completions. Alerts, with or without care gaps listed, outperformed care gaps alone on orders, with odds ratios ranging from 2.92 (95% CI 2.32-3.66) to 3.43 (95% CI 2.73-4.29). CONCLUSIONS: Electronic alerts can increase lipid screening orders and completions, suggesting clinical decision support can improve guideline-concordant screening. The study also highlights electronic record-based patient randomization as a way to determine relative effectiveness of support tools. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04118348.


Asunto(s)
Sistemas de Apoyo a Decisiones Clínicas , Tamizaje Masivo , Niño , Femenino , Humanos , Masculino , Registros Electrónicos de Salud , Lípidos/sangre , Tamizaje Masivo/métodos
19.
JCO Clin Cancer Inform ; 8: e2300130, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38194615

RESUMEN

PURPOSE: A critical task in oncology is extracting information related to cancer metastasis from electronic health records. Metastasis-related information is crucial for planning treatment, evaluating patient prognoses, and cancer research. However, the unstructured way in which findings of distant metastasis are often written in radiology reports makes it difficult to extract information automatically. The main aim of this study was to extract distant metastasis findings from free-text imaging and nuclear medicine reports to classify the patient status according to the presence or absence of distant metastasis. MATERIALS AND METHODS: We created a distant metastasis annotated corpus using positron emission tomography-computed tomography and computed tomography reports of patients with prostate, colorectal, and breast cancers. Entities were labeled M1 or M0 according to affirmative or negative metastasis descriptions. We used a named entity recognition model on the basis of a bidirectional long short-term memory model and conditional random fields to identify entities. Mentions were subsequently used to classify whole reports into M1 or M0. RESULTS: The model detected distant metastasis mentions with a weighted average F1 score performance of 0.84. Whole reports were classified with an F1 score of 0.92 for M0 documents and 0.90 for M1 documents. CONCLUSION: These results show the usefulness of the model in detecting distant metastasis findings in three different types of cancer and the consequent classification of reports. The relevance of this study is to generate structured distant metastasis information from free-text imaging reports in Spanish. In addition, the manually annotated corpus, annotation guidelines, and code are freely released to the research community.


Asunto(s)
Neoplasias de la Mama , Radiología , Masculino , Humanos , Tomografía Computarizada por Rayos X , Registros Electrónicos de Salud , Oncología Médica
20.
Cien Saude Colet ; 29(1): e04492023, 2024 Jan.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-38198323

RESUMEN

The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Cross-sectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization.


O uso de prontuários eletrônicos (PE) na atenção primária em saúde (APS) visa maior integração e qualidade dos serviços. Um dos pontos mais críticos da APS brasileira segue sendo o acesso. O objetivo deste artigo é analisar através dos dados do terceiro ciclo avaliativo do Programa de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB) a relação entre o uso de prontuário eletrônico e os parâmetros de acesso e acolhimento das unidades participantes. Estudo transversal analítico com dados secundários. Foram avaliados dados provenientes de 38.865 equipes de atenção primária, 30.346 unidades de saúde e 140.444 usuários entrevistados. O uso de PE esteve associado a maior realização de atendimento à demanda espontânea (OR 1,664; IC95% 1,485-1,866), avaliação de risco e vulnerabilidade (OR 1,329; IC95% 1,122-1,574) e utilização de protocolos de conduta (OR 1,656; IC95% 1,530-1,793), além de maior possibilidade de agendamento por telefone (OR 3,179; IC95% 3,030-3,335). Serviços que utilizam PE tem maior chance de ser o primeiro contato dos pacientes (OR 1,226; IC95% 1,171-1,283) e de serem buscados quando o usuário tem problemas de urgência (OR 1,198; IC95% 1,161-1,236). Há uma possibilidade concreta de melhoria do acesso através da informatização.


Asunto(s)
Registros Electrónicos de Salud , Calidad de la Atención de Salud , Humanos , Estudios Transversales , Brasil , Atención Primaria de Salud
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