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Introduction and aim. Orthorexia nervosa is described as an obsession with consuming solely healthy foods accompanied by restrictive behaviors. Patients with chronic conditions frequently require dietary interventions alongside medication to manage symptoms and slow down disease progression. However, when dietary restrictions are taken to extremes, individuals may develop orthorexia nervosa, resulting in malnutrition and weight loss. This poses risks during treatment, where maintaining a balanced diet is vital. In this review we aim to display the prevalence of orthorexia nervosa in patients suffering from selected chronic diseases. Material and methods. A literature review was performed to investigate the prevalence of orthorexia nervosa among individuals with type 1 diabetes, inflammatory bowel disease, celiac disease, rheumatoid arthritis, and cancer. Description of the State of Knowledge. The occurrence of orthorexia reaches up to 7% in the general population, 72% in patients with type 1 diabetes mellitus, 77% in case of inflammatory bowel disease, 71% among individuals suffering from celiac disease, 75% in those with rheumatoid arthritis, and 50% in case of cancer. Orthorexia nervosa predominantly affects females who are younger, have higher levels of education, select organic foods, prepare their own meals, and have other concurrent chronic illnesses. The distress associated with diagnosis is considered the primary factor contributing to the development of this condition. Orthorexia ultimately leads to malnutrition, weight loss, impaired social functioning, and poses a risk of complications during the management of patients suffering from chronic diseases. Conclusion. The prevalence of orthorexia nervosa in patients suffering from the exhibited chronic illnesses is significantly higher compared to the general population. Therefore, early detection of this condition and intervention are necessary to improve patient management. Further research is needed to assess the frequency of orthorexia among individuals suffering from other chronic diseases. [ABSTRACT FROM AUTHOR]

Background: The adoption of electronic health records (EHRs) has revolutionized healthcare delivery, offering potential benefits for enhancing the quality and safety of pediatric nursing care. However, the effective implementation and utilization of EHRs in pediatric settings present unique challenges. Objectives: This systematic review aims to critically analyze the available literature on the role of EHRs in improving various aspects of pediatric nursing care, including clinical documentation, medication management, care coordination, and patient engagement. Methods: A comprehensive search of multiple electronic databases (PubMed, CINAHL, Embase, and Cochrane Library) was conducted to identify relevant studies published between January 2000 and March 2023. Eligible studies included randomized controlled trials (RCTs), observational studies, and qualitative research investigating the impact of EHRs on pediatric nursing care outcomes. Study selection, data extraction, and quality assessment were performed by two independent reviewers. Results: Out of 1,257 records, 28 studies (12 RCTs, 10 observational, 6 qualitative) were included, involving 3,642 pediatric patients and 1,278 healthcare professionals. EHRs were associated with a 20% improvement in clinical documentation completeness. However, initial implementation was associated with increased documentation time. EHRs with computerized provider order entry (CPOE) reduced medication errors by 30%, but initial training challenges were noted. Redundant testing was reduced by 15%, and care continuity improved by 25% with EHR implementation. Key themes from qualitative research included increased patient involvement in care decisions and improved satisfaction with care processes. Conclusion: EHRs have the potential to enhance various aspects of pediatric nursing care, including improved documentation, medication management, care coordination, and patient engagement. Nonetheless, successful implementation requires addressing system usability, interoperability, and user acceptance through comprehensive training, workflow redesign, and ongoing technical support. Systematic review registration : This review was registered with PROSPERO (CRD42024563092). [ABSTRACT FROM AUTHOR]

The electronic medical record management system plays a crucial role in clinical practice, optimizing the recording and management of healthcare data. To enhance the functionality of the medical record management system, this paper develops a customized schema designed for ophthalmic diseases. A multi-modal knowledge graph is constructed, which is built upon expert-reviewed and de-identified real-world ophthalmology medical data. Based on this data, we propose an auxiliary diagnostic model based on a contrastive graph attention network (CGAT-ADM), which uses the patient's diagnostic results as anchor points and achieves auxiliary medical record diagnosis services through graph clustering. By implementing contrastive methods and feature fusion of node types, text, and numerical information in medical records, the CGAT-ADM model achieved an average precision of 0.8563 for the top 20 similar case retrievals, indicating high performance in identifying analogous diagnoses. Our research findings suggest that medical record management systems underpinned by multimodal knowledge graphs significantly enhance the development of AI services. These systems offer a range of benefits, from facilitating assisted diagnosis and addressing similar patient inquiries to delving into potential case connections and disease patterns. This comprehensive approach empowers healthcare professionals to garner deeper insights and make well-informed decisions. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the COVID-19 pandemic on disability insurance grants and related costs for workerswith cancer. Methods: This ecological time series study uses the inflection point regression model and the federal government's open-access dataset. We analyze the annual grant and cost rates of cancer-related disability insurance in Brazil (2010-2021). Results: In 2020, the number of disability insurance grants due to malignant neoplasms decreased by 62.26%, and the total annual cost decreased by 62.94% compared to those in 2019. All illnesses and injuries were reduced by 2.56% and 20.02%, respectively. Between 2010 and 2021, the COVID-19 pandemic has reversed the increasing trend in annual disability insurance granted due to cancer and its associated expenses to a stable trend. Conclusion: The COVID-19 pandemic has harmed the provision of disability insurance for workers with cancer. [ABSTRACT FROM AUTHOR]

Changes in our informational environment have brought new challenges and opportunities to address systemic issues of information inequity. Thus, when addressing systemic issues of information inequity, it is important to address it not only from the perspective of information access, as it is often considered in information science, but also from the perspective of how information objects are constructed and produced. This essay brings concerns within information science into discussion with journalism studies and critical technology studies to consider: (1) how the production of information, through the case of mainstream journalism, can create information inequity within information representations, and (2) how the dissemination and retrieval of this journalistic information through algorithmically‐mediated online information systems, specifically social media and search platforms, can replicate and reinforce information inequity within a larger information ecosystem. Thus, this essay uses an interdisciplinary lens to suggest new approaches to holistically address information inequity, putting forth a conceptual framework with actionable steps to create a more equitable information ecosystem. [ABSTRACT FROM AUTHOR]

The health care industry is experiencing a transformative shift from traditional fee-for-service models to value-based care (VBC), emphasizing improved patient outcomes, enhanced quality, and reduced costs. While Centers for Medicare & Medicaid Services Innovation Center models focus on financial and quality outcomes, a critical opportunity for reform lies in organizational culture. VBC signifies a cultural and systemic evolution aligned with the quintuple aim of enhancing equitable patient outcomes, improving quality, reducing costs, and prioritizing provider well-being. Cultural impacts play a pivotal role in this transformation. [ABSTRACT FROM AUTHOR]

Medical health records comprise sensitive patient data for precise diagnosis and successive treatment. However, it must be stored and shared securely to protect data privacy. Generally, health records are kept on centralized servers, which raise the risk of security breaches and involve trust in a single authority that cannot efficiently defend data from internal attacks. Blockchain (BC) is extensively used in medical health records management because of its decentralized and tamper-proof properties. This work introduces a public-permissioned BC technology with a decentralized ledger (DL) to manage medical health records in the fog computing layer. The considered BC is decentralized and allows the transmission of records within the decentralized network of records. The data blocks are hashed using the SHA-256 hash algorithm. Especially, an Adaptive RSA Digital Signature Algorithm (ARSA-DS) is developed to prevent data tampering with medical health records in the fog computing layer. Moreover, an Ebola Search Optimization based Key Selection (ESO-KS) technique is employed to find the ideal key from the randomly generated keys to reduce processing time and increase overall efficiency. The proposed decentralized BC framework will help to preserve patient privacy and prevent the tampering of health records by attacks; moreover, it is efficient in terms of confidentiality, integrity, and availability. [ABSTRACT FROM AUTHOR]

Purpose: Managing patients' health information is one of the building blocks of the health system and the adoption of health information technologies like electronic health records (EHRs) is expected to reduce the various challenges in keeping and accessing quality health-care data that aid decision-making among medical practitioners. This study aims to investigate how leadership styles and change management affected the job performance of health information management practitioners on their adoption of EHRs in tertiary hospitals in Nigeria. Design/methodology/approach: The study used primary data collected using a Likert scale questionnaire from 117 health information management officers and health information technicians in selected tertiary hospitals in South-Eastern Nigeria. The data were analysed using bivariate correlation and multiple regression techniques of inferential statistics. Findings: The analyses revealed that transformational leadership style, transactional leadership style and change management had significant positive influence on the job performance of health information management practitioners. However, laissez-faire leadership style did not show any significant positive influence. A further analysis showed that the combined effects of leadership styles and change management were also affirmed to significantly influence the adoption of EHRs for quality health-care delivery in Nigerian tertiary hospitals. Originality/value: The study contributes to health information management and the need to understand how leadership styles and change management can influence the adoption of EHRs. However, there is no adequate research that examined the role of leadership style and change management in influencing the job performance of Nigerian HIM practitioners regarding their usage of EHRs in tertiary hospitals in Nigeria. [ABSTRACT FROM AUTHOR]

With generative artificial intelligence (GenAI), particularly large language models (LLMs), continuing to make inroads in healthcare, assessing LLMs with human evaluations is essential to assuring safety and effectiveness. This study reviews existing literature on human evaluation methodologies for LLMs in healthcare across various medical specialties and addresses factors such as evaluation dimensions, sample types and sizes, selection, and recruitment of evaluators, frameworks and metrics, evaluation process, and statistical analysis type. Our literature review of 142 studies shows gaps in reliability, generalizability, and applicability of current human evaluation practices. To overcome such significant obstacles to healthcare LLM developments and deployments, we propose QUEST, a comprehensive and practical framework for human evaluation of LLMs covering three phases of workflow: Planning, Implementation and Adjudication, and Scoring and Review. QUEST is designed with five proposed evaluation principles: Quality of Information, Understanding and Reasoning, Expression Style and Persona, Safety and Harm, and Trust and Confidence. [ABSTRACT FROM AUTHOR]

Background: This article reports on a study that investigated data professionals in health care. The topic is interesting and relevant because of the ongoing trend towards digitisation of the healthcare domain and efforts for it to become data driven, which entail a wide variety of work with data. Objective: Despite an interest in data science and more broadly in data work, we know surprisingly little about the people who work with data in healthcare. Therefore, we investigated data work at a large national healthcare data organisation in Denmark. Method: An explorative mixed method approach combining a non-probability technique for design of an open survey with a target population of 300+ and 11 semi-structured interviews, was applied. Results: We report findings relevant to educational background, work identity, work tasks, and how staff acquired competences and knowledge, as well as what these attributes comprised. We found recurring themes of healthcare knowledge, data analytical skills, and information technology, reflected in education, competences and knowledge. However, there was considerable variation within and beyond those themes, and indeed most competences were learned "on the job" rather than as part of formal education. Conclusion: Becoming a professional working with data in health care can be the result of different career paths. The most recurring work identity was that of "data analyst"; however, a wide variety of responses indicated that a stable data worker identity has not yet developed. Implications: The findings present implications for educational policy makers and healthcare managers. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHR) are seen as a promising endeavour, in spite of policies, designs, user rights and types of health data varying across countries. In many European countries, including Austria, EHR usage has fallen short when compared to the deployment plans. Objective: By adopting a qualitative approach, this research aimed to explore facilitators and barriers experienced by patients and physicians across the entire EHR usage process in Austria. Method: Two studies were conducted: In Study 1, discussions were held with four homogeneously composed groups of patients (N = 30). In Study 2, eight expert semi-structured interviews were conducted with physicians to gain insights into potential facilitators and barriers Austrian physicians face when utilising personal EHR. Results: A wide range of barriers and facilitators were identified along the entire EHR usage spectrum, emerging on three different levels: the micro-level (individual level), the meso-level (level of the EHR system) and the macro-level (level of the health system). EHR literacy was identified as a booster to support EHR adherence. Health providers were identified as crucial gatekeepers with regard to EHR usage. Conclusion: The implications for mutual benefits arising out of EHR usage among the triad of health policymakers, providers and patients for both theory and practice are discussed. [ABSTRACT FROM AUTHOR]

Background: The implementation of emerging technologies has resulted in an increase of data breaches in healthcare organisations, especially during the COVID-19 pandemic. Health information and cybersecurity managers need to understand if, and to what extent, breach types and locations are associated with their organisation's business type. Objective: To investigate if breach type and breach location are associated with business type, and if so, investigate how these factors affect information systems and protected health information in for-profit versus non-profit organisations. Method: The quantitative study was performed using chi-square tests for association and post-hoc comparison of column proportions analysis on an archival data set of reported healthcare data breaches from 2020 to 2022. Data from the Department of Health and Human Services website was retrieved and each organisation classified as for-profit or non-profit. Results: For-profit organisations experienced a significantly higher number of breaches due to theft, and non-profit organisations experienced a significantly higher number of breaches due to unauthorised access. Furthermore, the number of breaches that occurred on laptops and paper/films was significantly higher in for-profit organisations. Conclusion: While the threat level of hacking techniques is the same in for-profit and non-profit organisations, certain breach types are more likely to occur within specific breach locations based on the organisation's business type. To protect the privacy and security of medical information, health information and cybersecurity managers need to align with industry-leading frameworks and controls to prevent specific breach types that occur in specific locations within their environments. [ABSTRACT FROM AUTHOR]

Background: Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. Objective: To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. Method: Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. Results: Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. Conclusion: If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. Implications: These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care. [ABSTRACT FROM AUTHOR]

Background: Clinician notes are structured in a variety of ways. This research pilot tested an innovative study design and explored the impact of note formats on diagnostic accuracy and documentation review time. Objective: To compare two formats for clinical documentation (narrative format vs. list of findings) on clinician diagnostic accuracy and documentation review time. Method: Participants diagnosed written clinical cases, half in narrative format, and half in list format. Diagnostic accuracy (defined as including correct case diagnosis among top three diagnoses) and time spent processing the case scenario were measured for each format. Generalised linear mixed regression models and bias-corrected bootstrap percentile confidence intervals for mean paired differences were used to analyse the primary research questions. Results: Odds of correctly diagnosing list format notes were 26% greater than with narrative notes. However, there is insufficient evidence that this difference is significant (75% CI 0.8–1.99). On average the list format notes required 85.6 more seconds to process and arrive at a diagnosis compared to narrative notes (95% CI -162.3, −2.77). Of cases where participants included the correct diagnosis, on average the list format notes required 94.17 more seconds compared to narrative notes (75% CI -195.9, −8.83). Conclusion: This study offers note format considerations for those interested in improving clinical documentation and suggests directions for future research. Balancing the priority of clinician preference with value of structured data may be necessary. Implications: This study provides a method and suggestive results for further investigation in usability of electronic documentation formats. [ABSTRACT FROM AUTHOR]

Background: Quantifying and dealing with lack of consistency in administrative databases (namely, under-coding) requires tracking patients longitudinally without compromising anonymity, which is often a challenging task. Objective: This study aimed to (i) assess and compare different hierarchical clustering methods on the identification of individual patients in an administrative database that does not easily allow tracking of episodes from the same patient; (ii) quantify the frequency of potential under-coding; and (iii) identify factors associated with such phenomena. Method: We analysed the Portuguese National Hospital Morbidity Dataset, an administrative database registering all hospitalisations occurring in Mainland Portugal between 2011–2015. We applied different approaches of hierarchical clustering methods (either isolated or combined with partitional clustering methods), to identify potential individual patients based on demographic variables and comorbidities. Diagnoses codes were grouped into the Charlson an Elixhauser comorbidity defined groups. The algorithm displaying the best performance was used to quantify potential under-coding. A generalised mixed model (GML) of binomial regression was applied to assess factors associated with such potential under-coding. Results: We observed that the hierarchical cluster analysis (HCA) + k-means clustering method with comorbidities grouped according to the Charlson defined groups was the algorithm displaying the best performance (with a Rand Index of 0.99997). We identified potential under-coding in all Charlson comorbidity groups, ranging from 3.5% (overall diabetes) to 27.7% (asthma). Overall, being male, having medical admission, dying during hospitalisation or being admitted at more specific and complex hospitals were associated with increased odds of potential under-coding. Discussion: We assessed several approaches to identify individual patients in an administrative database and, subsequently, by applying HCA + k-means algorithm, we tracked coding inconsistency and potentially improved data quality. We reported consistent potential under-coding in all defined groups of comorbidities and potential factors associated with such lack of completeness. Conclusion: Our proposed methodological framework could both enhance data quality and act as a reference for other studies relying on databases with similar problems. [ABSTRACT FROM AUTHOR]

Background: Healthcare data frequently lack the specificity level needed to achieve clinical and operational objectives such as optimising bed management. Pneumonia is a disease of importance as it accounts for more bed days than any other lung disease and has a varied aetiology. The condition has a range of SNOMED CT concepts with different levels of specificity. Objective: This study aimed to quantify the importance of the specificity of an SNOMED CT concept, against well-established predictors, for forecasting length of stay for pneumonia patients. Method: A retrospective data analysis was conducted of pneumonia admissions to a tertiary hospital between 2011 and 2021. For inclusion, the primary diagnosis was a subtype of bacterial or viral pneumonia, as identified by SNOMED CT concepts. Three linear mixed models were constructed. Model One included known predictors of length of stay. Model Two included the predictors in Model One and SNOMED CT concepts of lower specificity. Model Three included the Model Two predictors and the concepts with higher specificity. Model performances were compared. Results: Sex, ethnicity, deprivation rank and Charlson Comorbidity Index scores (age-adjusted) were meaningful predictors of length of stay in all models. Inclusion of lower specificity SNOMED CT concepts did not significantly improve performance (ΔR2 = 0.41%, p =.058). SNOMED CT concepts with higher specificity explained more variance than each of the individual predictors (ΔR2 = 4.31%, p <.001). Conclusion: SNOMED CT concepts with higher specificity explained more variance in length of stay than a range of well-studied predictors. Implications: Accurate and specific clinical documentation using SNOMED CT can improve predictive modelling and the generation of actionable insights. Resources should be dedicated to optimising and assuring clinical documentation quality at the point of recording. [ABSTRACT FROM AUTHOR]

Background: Patient online access to medical records is assumed to foster patient empowerment and advance patient-centred healthcare. Since July 2020, patients in the Netherlands have been legally entitled to electronically access their medical record in general practice. Experience from pioneering countries has shown that despite high patient interest, user rates often remain low. How to best support implementation depends on individual needs and expectations of patient populations, which are as yet unknown in the Dutch context. Objective: To understand Dutch patients' needs and expectations with regard to online access to their medical record in general practice. Method: Twenty participants completed semi-structured individual interviews via video or telephone call. Transcripts of interviews underwent template analysis combining deductive and inductive coding using Atlas.ti software. Results: Patients' needs and expectations ranged across three overlapping areas: (i) prerequisites for getting online access; (ii) using online access; and (iii) the impact on interaction with healthcare providers. Patients expected benefits from online access such as better overview, empowerment and improved communication with their general practitioner but identified needs regarding technological difficulties, data privacy and complex medical language in their record. Conclusion: The concerns and obstacles participants identified point towards the need for organisational changes in general practice, for example, adjusted documentation practices, and the key role of the general practitioner and staff in promoting and facilitating online access. Implications: Implementation strategies addressing needs identified in this study may help to unlock the full potential of online access to achieve desired outcomes of patient involvement and satisfaction. [ABSTRACT FROM AUTHOR]

Named entity recognition is a critical task in the electronic medical record management system for rehabilitation robots. Handwritten documents often contain spelling errors and illegible handwriting, and healthcare professionals frequently use different terminologies. These issues adversely affect the robot's judgment and precise operations. Additionally, the same entity can have different meanings in various contexts, leading to category inconsistencies, which further increase the system's complexity. To address these challenges, a novel medical entity recognition algorithm for Chinese electronic medical records is developed to enhance the processing and understanding capabilities of rehabilitation robots for patient data. This algorithm is based on a fusion classification strategy. Specifically, a preprocessing strategy is proposed according to clinical medical knowledge, which includes redefining entities, removing outliers, and eliminating invalid characters. Subsequently, a medical entity recognition model is developed to identify Chinese electronic medical records, thereby enhancing the data analysis capabilities of rehabilitation robots. To extract semantic information, the ALBERT network is utilized, and BILSTM and MHA networks are combined to capture the dependency relationships between words, overcoming the problem of different meanings for the same entity in different contexts. The CRF network is employed to determine the boundaries of different entities. The research results indicate that the proposed model significantly enhances the recognition accuracy of electronic medical texts by rehabilitation robots, particularly in accurately identifying entities and handling terminology diversity and contextual differences. This model effectively addresses the key challenges faced by rehabilitation robots in processing Chinese electronic medical texts, and holds important theoretical and practical value. [ABSTRACT FROM AUTHOR]

Online Health Information Seeking (OHIS) serves as an alternative form of social capital that can help older adults alleviate offline medical-related stress. This study collected and analyzed user interaction data from Patient-to-Doctor and Patient-to-Peer platforms and compared the roles of social support between them. Significant differences were identified in the dimensions of social support (information, emotional, and companion) on the Patient-to-Peer platforms compared with Patient-to-Doctor platforms (p < 0.05). The overall and core–core network density values for social support on Patient-to-Peer platforms were higher than those on Patient-to-Doctor platforms. Patient-to-Doctor interactions focused on information support, displaying a more centralized and efficient network with structural holes pertaining to treatment effects. By contrast, Patient-to-Peer interactions provided more emotional support, with a dispersed and redundant network containing structural holes related to individual information. Companion support was found to be weaker on both platforms. Additionally, digital literacy, surrogate seeking, and altruistic information significantly explained the variances between the two platforms (p < 0.01), with surrogate seeking playing a crucial role. These findings enhance our understanding of OHIS disparities among older adults and their surrogates, offering valuable insights for developing effective support systems and regulatory frameworks for health information platforms. [ABSTRACT FROM AUTHOR]

The article discusses the urgent need for environmental accountability in nephrology clinical trials. It highlights the significant carbon dioxide equivalent (CO2e) emissions associated with clinical trials and emphasizes the lack of studies assessing the environmental impact of these trials. The article suggests various strategies to mitigate the environmental effects, such as optimizing trial site locations, reducing unnecessary data and sample collection, favoring local lab work, and minimizing travel for patients and the trial team. It also explores the potential benefits of digitalization, artificial intelligence (AI), and machine learning in improving the sustainability of clinical trials. The article calls for collective efforts from the nephrology community, including researchers, pharmaceutical companies, and funding bodies, to prioritize sustainability in clinical trials. [Extracted from the article]

Communities of practice are commonly used to support members in responding to public health issues. This study evaluated the outcomes of five co-designed communities of practice to determine if members' expectations were met, if knowledge sharing between members extended to knowledge translation, and if that supported members in addressing public health issues. Data were collected through an initial needs assessment, observations were made during community of practice sessions over 1 year, and qualitative interviews were conducted at the end of that year. The findings provided evidence that members' expectations were met, knowledge sharing took place within the communities of practice, and personal benefits gained supported members in advancing knowledge sharing with other members to knowledge translation outside their community of practice. Results demonstrate three outcomes of knowledge translation for members: disseminating knowledge to others, applying knowledge to make small-scale changes in practice and leveraging the knowledge to expand its reach beyond members' organizations. While the scale and speed of expanding outcomes were below initial expectations as indicated in the initial needs assessments, members remained optimistic about achieving larger-scale impacts in the future. This study showed that communities of practice achieve gradual progress rather than quick wins. Co-design supports the facilitators in meeting members' needs, which can positively contribute to members sharing knowledge and translating that knowledge to support their practice to address public health issues. [ABSTRACT FROM AUTHOR]

Accessible, up-to-date information on traumatic brain injury (TBI) can be challenging to find and is needed to address TBI knowledge gaps and improve outcomes for people who experience a TBI. The Understanding TBI Massive Open Online Course (TBI MOOC) was developed to increase TBI knowledge across a diverse global audience. We sought to characterize the TBI MOOC participant cohort, to understand the reach of the course among this target audience. Examining the characteristics of TBI MOOC enrollees showed that participants came from a wide range of demographic backgrounds, had a variety of TBI experiences and had multiple reasons for enrolling in the MOOC. The majority of course participants shared some characteristics with other groups of health information seekers. Four distinct demographic profiles were identified among TBI MOOC participants (education seekers, TBI-aware participants, TBI care providers and retirees) using a novel approach combining chi-squared tests and network modularity. Participants assigned to the TBI-aware and retiree profiles were most likely to complete all modules of the MOOC, and the TBI-aware profile was more highly represented in more recent iterations of the MOOC. Together, these data indicate that the TBI MOOC provided information to a wide range of people, and particularly engaged participants with personal or family experience of TBI. However, engagement with this course was minimal among some hard-to-reach populations, including men and people with low levels of education, indicating that additional strategies are needed to ensure equity in health promotion. [ABSTRACT FROM AUTHOR]

Do politicians behave opportunistically regarding their tax proposals during the election cycle, or do they maintain ideological sincerity? We examine U.S. governors' revenue proposals between the years of 1989 and 2018 to assess gubernatorial behavior during election years. We find that governors, in general, do indeed follow a political budget cycle where they request lower revenues during election years. However, this finding is largely driven by Democratic governors asking for significantly lower revenues during election years when compared to non‐election years. Republican governors are more ideologically sincere, maintaining behaviors that are consistent across the election cycle. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic demanded quick exchanges between experts and institutions supporting governments to provide evidence-based information in response to the crisis. Initially, there was no regular cross-country forum in the field of population health. This paper describes the set-up and benefits of implementing such a forum. Methods A group of public health practitioners from academia, national public health institutes and ministries of health decided in April 2020 to meet bi-monthly to discuss a vast array of population health topics in a structured format called a Rapid Exchange Forum (REF). An ad-hoc mailing group was established to collect responses to questions brought forward in the forum from at least five countries within 24 h. This endeavour, which evolved as network of networks was awarded an EU grant in autumn 2020 and was called PHIRI (Population Health Information Research Infrastructure). Results Responses from up to 31 countries were compiled and shared immediately via the European Health Information Portal. This exchange was complemented by special REFs that focused on the advantages and disadvantages of vaccination, for example. By July 2023, 54 REFs had taken place with topics going beyond COVID-19. Conclusion The REF demonstrated its value for quick yet evidence-based cross-country exchange in times of crisis and was highly appreciated by countries and European Commission. It demonstrated its sustainability even after the acute crisis by expanding the topics covered and managing to continue exchange with the aim of capacity building and mutual learning, making it a true EU response and coordination mechanism. [ABSTRACT FROM AUTHOR]

Background Timely and high-quality population-level health information is needed to support evidence-informed decision-making, for planning and evaluation of prevention, care and cure activities as well as for research to generate new knowledge. FAIR (Findable, Accessible, Interoperable and Reusable) principles are one of the key elements supporting health research and making it more cost-effective through the reuse of already existing data. Currently, health data are in many countries dispersed and difficult to find and access. Methods Two EU Public Health Programmes co-funded Joint Actions, Information for Action (InfAct) and Population Health Information Research Infrastructure (PHIRI) have established a European Health Information Portal, a web-based service, to facilitate better findability, access, interoperability and reuse of existing health information. Results The European Health Information Portal (www.healthinformationportal.eu) has been established including sections on National Nodes, data sources, publications, health information projects within countries and across Europe, research networks and research infrastructures, ethical and legal issues for health information exchange and use, capacity-building activities in all areas of population health and a dedicated COVID-19 section. Conclusions The European Health Information Portal, being a central place for a wide range of population health information from EU Member States, is an information source for researchers, policy-makers and other relevant stakeholders. It is important to ensure the sustainability of the portal, especially in light of the European Health Data Space (EHDS) Regulation proposal and its requirements regarding the secondary use of health data. [ABSTRACT FROM AUTHOR]

This study aims to analyze the implementation, implementation process, obstacles, and impacts of Electronic Customer Relationship Management (E-CRM) on the formation of Positive Word of Mouth at PT Mandiri Utama Finance. This study uses a qualitative approach with a descriptive research method. The research approach is carried out with case study approach. This research is expected to provide solutions to businesses at the company in determining strategic steps as well as making regulations or implementing appropriate policies, and providing input for the next implementation of E-CRM. The results show that the company's overall satisfaction was 6.35 or equivalent to 96%. The implementation process and obstacles in forming a positive word of mouth are identified as the main obstacles in the implementation process. The use of social media and other digital media plays an important role in the development of positive words of mouth. [ABSTRACT FROM AUTHOR]

The article discusses how the Medical Library Association (MLA) is adapting and navigating to changes and innovations. Topics discussed include the role of the board of directors in leading the direction of MLA, the strategies of MLA to grow the organization, address its financial challenges and achieve long-term sustainability, and its strategic goals from 2015 to 2024.

Professional associations provide resources to support members' career development and facilitate ways for members to engage with and learn from one another. This article describes Medical Library Association (MLA) activities related to the revision of professional competencies and the restructuring of the organization's communities during the past twenty-five years. Grounded in MLA's Platform for Change, the MLA competency statement underwent two revisions with core themes remaining consistent. Major efforts went into rethinking the structure of MLA communities, and it became a strategic goal of the association. Numerous groups spent considerable time guiding the changes in MLA's community structure. Sections and special interest groups were transformed into caucuses. Domain hubs were established to facilitate project coordination across caucuses and create more leadership opportunities for MLA members, but their implementation did not meet expectations. Member engagement and leadership are ongoing challenges for MLA. The next twenty-five years will undoubtedly see additional revisions to the competencies and continued iterations of the community structure. [ABSTRACT FROM AUTHOR]

As healthcare shifts to digital platforms, the healthcare sector is suffering from multiple security vulnerabilities that make it vulnerable to various types of cyberattacks. Therefore, robust security solutions need to be implemented to resolve these vulnerabilities. In this context, blockchain technology has emerged as a promising solution in several sectors, including the healthcare sector. This study harnesses blockchain technology to improve medical record management. By integrating blockchain, we address issues like data breaches and inefficient data sharing. The proposed study ensures a seamless health record exchange that is secure, transparent, and beneficial to both patients and healthcare providers. The goal of this study is to empower patients to be more in control of their data while streamlining processes and enhancing security for healthcare institutions. Medical records are increasingly secure, interoperable, and accessible when blockchain technology and big data are used. According to the study, healthcare workers recognize the importance of protecting medical records through blockchain technology and big data, which can improve security, interoperability, and accessibility. This minimizes concerns related to data manipulation while providing a more costeffective and efficient method of managing medical records. Medical records management is made more cost-effective and efficient by reducing concerns related to data manipulation. [ABSTRACT FROM AUTHOR]

Precision livestock farming (PLF) tools are increasingly used in daily herd management to improve health, welfare, and overall production. While not intended to reduce greenhouse gas (GHG) emissions on farm, PLF tools can do so indirectly by improving overall efficiency, thereby reducing the emissions per unit of product. This work modelled the potential effects of commercially available PLF tools on whole enterprise and product emissions of two average Scottish dairy farm systems (an 8,000 L and 10,000 L herd) using the Agrecalc carbon footprinting tool. Scenarios modelled included an improvement in fertility and an improvement in fertility and yield from the introduction of an accelerometer-based sensor, and an improvement in health from introduction of an accelerometer-based sensor, with and without the use of management interventions. Use of a sensor intended to improve fertility had the largest reduction in total emissions (kg CO2e) of -1.42% for a 10,000 L farm, with management changes applied. The largest reduction in emissions from milk production (kg CO2e) of -2.31% was observed via fertility technology application in an 8,000 L farm, without management changes. The largest reduction in kg CO2e per kg fat and protein corrected milk of -6.72% was observed from an improvement in fertility and yield in a 10,000 L herd, with management changes. This study has highlighted the realistic opportunities available to dairy farmers in low and high input dairy systems to reduce their emissions through adoption of animal mounted PLF technologies. [ABSTRACT FROM AUTHOR]

The capability of artificial intelligence (AI) is rapidly increasing and is now sitting on the threshold of the medical writing field. This article presents an AI integration framework that breaks down adoption of this new technology into manageable steps that ensure an informed and thorough approach. Using this framework, individuals and corporations can leverage the benefits of this evolving technology while minimizing risks. The first step, AI literacy, provides a foundation for informed decision making and appropriate expectations for AI capabilities. This knowledge inspires creative exploration of which use cases would be a suitable application of AI tools. Once the scope of potential uses is defined, risks can be assessed, including incorrect content generation, data leakage, and bias. AI tools can then be evaluated to find tools that can both satisfy the use cases and mitigate critical threats. The final step is to integrate the tools transparently with appropriate guardrails. Then the cycle begins again as AI technology evolves and new applications become possible. As medical writers are ushered further into the AI era, clear and consistent advocacy for a synergy point between the efficiency of AI and the experience, ability, and humanity of a medical writer will maximize the impact of these innovative models. [ABSTRACT FROM AUTHOR]

COVID-19 disproportionately affects people experiencing homelessness or incarceration. While homelessness or incarceration alone may not impact vaccine effectiveness, medical comorbidities along with social conditions associated with homelessness or incarceration may impact estimated vaccine effectiveness. COVID-19 vaccines reduce rates of hospitalization and death; vaccine effectiveness (VE) against severe outcomes in people experiencing homelessness or incarceration is unknown. We conducted a retrospective, observational cohort study evaluating COVID-19 vaccine VE against SARS-CoV-2 related hospitalization (positive SARS-CoV-2 molecular test same week or within 3 weeks prior to hospital admission) among patients who had experienced homelessness or incarceration. We utilized data from 8 health systems in the Minnesota Electronic Health Record Consortium linked to data from Minnesota's immunization information system, Homeless Management Information System, and Department of Corrections. We included patients 18 years and older with a history of experiencing homelessness or incarceration. VE and 95% Confidence Intervals (CI) against SARS-CoV-2 hospitalization were estimated for primary series and one booster dose from Cox proportional hazard models as 100*(1-Hazard Ratio) during August 26, 2021, through October 8, 2022 adjusting for patient age, sex, comorbid medical conditions, and race/ethnicity. We included 80,051 individuals who had experienced homelessness or incarceration. Adjusted VE was 52% (95% CI, 41–60%) among those 22 weeks or more since their primary series, 66% (95% CI, 53–75%) among those less than 22 weeks since their primary series, and 69% (95% CI: 60–76%) among those with one booster. VE estimates were consistently lower during the Omicron predominance period compared with the combined Omicron and Delta periods. Despite higher exposure risk, COVID-19 vaccines provided good effectiveness against SARS-CoV-2 related hospitalizations in persons who have experienced homelessness or incarceration. [ABSTRACT FROM AUTHOR]

Sensitive images represent a new challenge in enterprise imaging. These images, often containing nudity or gruesome content, have the potential to cause emotional harm to patients and people who view the images. Unfortunately, the interoperability standards used in imaging informatics have not yet addressed this issue. Because of this, the software solutions used in healthcare information technology are not able to offer patients and other viewers of image protections. In this Health Information Management Systems Society (HIMSS)/Society for Imaging Informatics in Medicine (SIIM) Enterprise Imaging Community Whitepaper, we define sensitive images, identify unique challenges related to their management, and provide recommendations for future solutions to protect our patients. [ABSTRACT FROM AUTHOR]

Healthcare is a critical area where blockchain technology (BT) is being heralded as a potential game-changer for facilitating secure and efficient data sharing. The purpose of this review is to examine BT applications, performance challenges, and solutions in healthcare. To begin, This review paper explores popular blockchain networks for data exchange, encompassing both public and permissioned platforms, such as Ethereum and Hyperledger Fabric. This paper analyzes the potential applications of BT's decentralized, immutable, and smart contract capabilities in healthcare settings, including secure and interoperable health data exchange, patient consent management, drug supply chain oversight, and clinical trial management. The healthcare industry might greatly benefit from the increased privacy, transparency, and accessibility that these technologies provide. Despite BT's promising medical uses, the technology is not without its drawbacks. High energy consumption, throughput, and scalability are all concerns. We wrapped up by discussing the solutions that have been implemented, including consensus processes, scalability measures like sharding, and off-chain transactions that are designed to mitigate the drawbacks. [ABSTRACT FROM AUTHOR]

Electronic state property management in Indonesia uses the State Property Management and Accounting Information System (SIMAK-BMN). SIMAK-BMN has succeeded in attracting the attention of many parties because it is believed to be able to facilitate the process of administering state property in an institution. Agencies that implemented electronic state property management have faced several challenges in the fields of human resources and information systems. This article aims to determine the effectiveness of electronic state property management in Indonesia. The research method used is a descriptive method with a qualitative approach. Data collection was carried out by studying secondary data literature, including scientific articles/journals, legal regulations, books, and websites related to state property management. The research results show that electronic state property management in Indonesia has been running effectively despite the challenges. Therefore, efforts to maximize the function of SIMAK-BMN continue to be carried out sustainably. [ABSTRACT FROM AUTHOR]

Background: Low-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala. Methods: This qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model. Results: Three themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology. Conclusion: Despite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs' demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts. [ABSTRACT FROM AUTHOR]

Nowadays, the adoption of the Internet of Things (IoT) framework in various healthcare industries has increased rapidly in recent years. The IoT devices generate vast amounts of sensitive data, such as personal health information. It is mandatory to protect medical records from unauthorized access and use. However, the finite resources nature of these devices can make it hard to implement robust security measures, such as encryption and authentication. A blockchain is a propitious approach for the secure management of medical records in an immutable way. This problem can be resolved with ciphertext-policy attribute-based encryption (CP-ABE), which permits granular access control in IoT. The local gateways that are directly interfaced with the Ethereum blockchain-based smart contract platform are utilized to create and implement a distributed and dependable user authentication and an access control mechanism for IoMT. In this paper, a DBC-based CP-ABE approach offers a secure and decentralized solution for secure communication and data protection and provides a more secure and trustworthy system. The system works on the concept of an Elliptical Curve Cryptography-based CP-ABE method to reduce complexity and provide data security in remote patient monitoring. On the other hand, blockchain-based smart contracts offer a dynamic, optimal, and self-adjusted access control in smart healthcare systems. It lowers the overhead of conducting resource-intensive authentication procedures and blockchain communications at IoT devices. The result provides the efficiency of the proposed work in computation as well as processing time and its resistance to various security intrusions over existing schemes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine patient and provider perspectives on privacy and security considerations in telemedicine during the COVID-19 pandemic. STUDY DESIGN: Qualitative study with patients and providers from primary care practices in 3 National Patient- Centered Clinical Research Network sites in New York, New York; North Carolina; and Florida. METHODS: Semistructured interviews were conducted, audio recorded, transcribed verbatim, and coded using an inductive process. Data related to privacy and information security were analyzed. RESULTS: Sixty-five patients and 21 providers participated. Patients and providers faced technology-related security concerns as well as difficulties ensuring privacy in the transformed shared space of telemedicine. Patients expressed increased comfort doing telemedicine from home but often did not like their providers to offer virtual visits from outside an office setting. Providers initially struggled to find secure and Health Insurance Portability and Accountability Act--compliant platforms and devices to host the software. Whereas some patients preferred familiar platforms such as FaceTime, others recognized potential security concerns. Audio-only encounters sometimes raised patient concerns that they would not be able to confirm the identity of the provider. CONCLUSIONS: Telemedicine led to novel concerns about privacy because patients and providers were often at home or in public spaces, and they shared concerns about software and hardware security. In addition to technological safeguards, our study emphasizes the critical role of physical infrastructure in ensuring privacy and security. As telemedicine continues to evolve, it is important to address and mitigate concerns around privacy and security to ensure high-quality and safe delivery of care to patients in remote settings. [ABSTRACT FROM AUTHOR]

The current regulatory path for new drug registration in East Asian countries has led to significant delay of the new medicines in these countries. A unified regulatory path and allowance of mutual usage of clinical data in East Asian countries would lead to cost saving in drug development and expedite the new drug registration in these countries. The objectives of the present analysis are to compare the approval dates of a selection of products developed by Pfizer in the United States and East Asian countries (China, Japan, Korea) and compare the pharmacokinetics and recommended doses of these products in East Asian countries. Eighteen products (20 drugs, 2 products with 2 combination drugs) with exposure data available in at least 2 of the 3 East Asian countries across different therapeutic areas were included in the analyses. The results showed that most products had delayed approval in East Asian countries (up to 8 years) after US or EU approval. No distinct differences were observed in the drug exposure and recommended doses for the selected products in East Asian countries. These results together with literature data of genetic similarity of the East Asian populations support the mutual usage of the clinical data in the East Asian countries for expedited regulatory submission and approval. [ABSTRACT FROM AUTHOR]

Objectives: Management of medical records at Sandi Karsa Hospital Makassar is still lacking in the process of assembling, reporting, and filing. This study aims to analyze the inpatient medical record management system at Sandi Karsa Hospital, Makassar. Methods: The type of research used in this research is qualitative research and data collection using interviews, observation, and documentation with key informants and supporting informants using purposive sampling techniques. Result: There is a shortage of medical records officers, and they have not received training. There are fewer computers available, SIMRS is only integrated with patient registration, and the management room is combined with the filing room. The assembly process has not been carried out in the last few months, reporting has been delayed, and there is a backlog of files. Implementation of management SOPs has not been optimal, and socialization activities have not been carried out. Completeness and returns are not up to standard. Medical record quality indicators are low, and there are no feedback activities. Conclusion: Lack of staff they have never participated in training and socialization regarding SOPs. There is a lack of facilities such as computers, the medical record room has lots of files, SIMRS is not yet integrated with medical record management, and there are delays in returns and incomplete filling out of medical record files. The hospital can provide outreach and hold regularly scheduled meetings to evaluate or assess officers' performance managing medical records. [ABSTRACT FROM AUTHOR]

Background: Medical certification of cause of death (MCCD) provides valuable data regarding disease burden in a community and for formulating health policy. Inaccurate MCCDs can significantly impair the precision of national health information. Objective: To evaluate the accuracy of cause of death certificates prepared at two tertiary cancer care hospitals in Northern India during the study period (May 2018 to December 2020). Method: A retrospective observational study at two tertiary cancer care hospitals in Varanasi, India, over a period of two and a half years. Medical records and cause of death certificates of all decedents were examined. Demographic characteristics, administrative details and cause of death data were collected using the WHO recommended death certificates. Accuracy of death certification was validated by electronic medical records and errors were graded. Results: A total of 778 deaths occurred in the two centres during the study period. Of these, only 30 (3.9%) certificates were error-free; 591 (75.9%) certificates had an inappropriate immediate cause of death; 231 (29.7%) certificates had incorrectly labelled modes of death as the immediate cause of death; and 585 (75.2%) certificates had an incorrect underlying cause of death. The majority of certificates were prepared by junior doctors and were significantly associated with higher certification errors. Conclusion: A high rate of errors was identified in death certification at the cancer care hospitals during the study period. Inaccurate MCCDs related to cancers can potentially influence cancer statistics and thereby affect policy making for cancer control. Implications: This study has identified the pressing need for appropriate interventions to improve quality of certification through training of doctors. [ABSTRACT FROM AUTHOR]

Background: The Australian hospital-acquired complication (HAC) policy was introduced to facilitate negative funding adjustments in Australian hospitals using ICD-10-AM codes. Objective: The aim of this study was to determine the positive predictive value (PPV) of the ICD-10-AM codes in the HAC framework to detect hospital-acquired pneumonia in patients with cancer and to describe any change in PPV before and after implementation of an electronic medical record (EMR) at our centre. Method: A retrospective case review of all coded pneumonia episodes at the Peter MacCallum Cancer Centre in Melbourne, Australia spanning two time periods (01 July 2015 to 30 June 2017 [pre-EMR period] and 01 September 2020 to 28 February 2021 [EMR period]) was performed to determine the proportion of events satisfying standardised surveillance definitions. Results: HAC-coded pneumonia occurred in 3.66% (n = 151) of 41,260 separations during the study period. Of the 151 coded pneumonia separations, 27 satisfied consensus surveillance criteria, corresponding to an overall PPV of 0.18 (95% CI: 0.12, 0.25). The PPV was approximately three times higher following EMR implementation (0.34 [95% CI: 0.19, 0.53] versus 0.13 [95% CI: 0.08, 0.21]; p =.013). Conclusion: The current HAC definition is a poor-to-moderate classifier for hospital-acquired pneumonia in patients with cancer and, therefore, may not accurately reflect hospital-level quality improvement. Implementation of an EMR did enhance case detection, and future refinements to administratively coded data in support of robust monitoring frameworks should focus on EMR systems. Implications: Although ICD-10-AM data are readily available in Australian healthcare settings, these data are not sufficient for monitoring and reporting of hospital-acquired pneumonia in haematology-oncology patients. [ABSTRACT FROM AUTHOR]

Objective: This article describes the first digital clinical information system tailored to support the operational needs of a forensic unit in Greece and to maintain its archives. Method: The development of our system was initiated towards the end of 2018, as a close collaboration between the Medical School of the University of Crete and the Forensic Medicine Unit of the University Hospital of Heraklion, Crete, where forensic pathologists assumed active roles during the specification and testing of the system. Results: The final prototype of the system was able to manage the life cycle of any forensic case by allowing users to create new records, assign them to forensic pathologists, upload reports, multimedia and any required files; mark the end of processing, issue certificates or appropriate legal documents, produce reports and generate statistics. For the first 4 years of digitised data (2017–2021), the system recorded 2936 forensic examinations categorised as 106 crime scene investigations, 259 external examinations, 912 autopsies, 102 post-mortem CT examinations, 804 histological examinations, 116 clinical examinations, 12 anthropological examinations and 625 embalmings. Conclusion: This research represents the first systematic effort to record forensic cases through a digital clinical information system in Greece, and to demonstrate its effectiveness, daily usability and vast potential for data extraction and for future research. [ABSTRACT FROM AUTHOR]

Background: Historically, national programs for collecting stroke data in Australia required the use of multiple online tools. Clinicians were required to enter overlapping variables for the same patient in the different databases. From 2013 to 2016, the Australian Stroke Data Tool (AuSDaT) was built as an integrated data management solution. Objective: In this article, we have described the development, implementation, and evaluation phases of establishing the AuSDaT. Method: In the development phase, a governance structure with representatives from different data collection programs was established. Harmonisation of data variables, drawn from six programs used in hospitals for monitoring stroke care, was facilitated through creating a National Stroke Data Dictionary. The implementation phase involved a staged deployment for two national programs over 12 months. The evaluation included an online survey of people who had used the AuSDaT between March 2018 and May 2018. Results: By July 2016, data entered for an individual patient was, for the first time, shared between national programs. Overall, 119/422 users (90% female, 61% aged 30–49 years, 57% nurses) completed the online evaluation survey. The two most positive features reported about the AuSDaT were (i) accessibility of the system (including simultaneous user access), and (ii) the ability to download reports to benchmark local data against peer hospitals or national performance. More than three quarters of respondents (n = 92, 77%) reported overall satisfaction with the data collection tool. Conclusion: The AuSDaT reduces duplication and enables users from different national programs for stroke to enter standardised data into a single system. Implications: This example may assist others who seek to establish a harmonised data management solution for different disease areas where multiple programs of data collection exist. The importance of undertaking continuous evaluation of end-users to identify preferences and aspects of the tool that are not meeting current requirements were illustrated. We also highlighted the opportunities to increase interoperability, utility, and facilitate the exchange of accurate and meaningful data. [ABSTRACT FROM AUTHOR]

Background: The professional identity and motivation of qualified health information managers (HIMs) is largely unexplored. Objectives: A larger study has investigated the motivators of HIMs in the construction of their professional identity and associated relationships to job satisfaction and engagement with their profession. The aims of this component of the study were to: (i) identify and analyse the characteristics of members of the profession who have different motivation profiles; (ii) obtain HIMs' perspectives on their professional identity; and (iii) measure correlation between HIMs' professional identity and different motivating factors. Method: A cross-sectional study design, with a convergent mixed-methods approach to data collection was employed. An online survey was administered to the 1985, 1995, 2005 and 2015 Australian health information management and medical record administration graduate cohorts from one university in Victoria. Results: Response rate: 72.7% (n = 72). There were no statistically significant correlations between the HIMs' motivation profile and professional identity. The HIMs were largely motivated by a need for achievement (striving for excellence) and continuous improvement; maintained high standards of work quality (95.8%); valued their work (94.4%) and work collaborations (84.7%); satisfactorily applied skills-knowledge (94%); demonstrated a very strong professional association (92% were proud to belong to the profession). Key factors in motivation that were consistently reported by members of all cohorts in the open-ended questions were as follows: intrinsic motivation; colleagues and teamwork; the variety of work performed; and contribution to the bigger picture. Overall, and notwithstanding between-cohort differences: 65.3% confidently directed others, 45.8% aspired to leadership and 38% actively networked. They related difficulty in explaining the profession to outsiders. Conclusion: There was no correlation between motivation profile and professional identity. Significantly, the HIMs demonstrated exceptionally strong positive professional identity, reflected particularly in pride in membership of the profession and their belief in the importance of their professional work. [ABSTRACT FROM AUTHOR]

Context: Access to real-time data that provide accurate and timely information about the status and extent of disease spread could assist management of the COVID-19 pandemic and inform decision-making. Aim: To demonstrate our experience with regard to implementation of technical and architectural infrastructure for a near real-time electronic health record-based surveillance system for COVID-19 in Iran. Method: This COVID-19 surveillance system was developed from hospital information and electronic health record (EHR) systems available in the study hospitals in conjunction with a set of open-source solutions; and designed to integrate data from multiple resources to provide near real-time access to COVID-19 patients' data, as well as a pool of health data for analytical and decision-making purposes. Outcomes: Using this surveillance system, we were able to monitor confirmed and suspected cases of COVID-19 in our population and to automatically notify stakeholders. Based on aggregated data collected, this surveillance system was able to facilitate many activities, such as resource allocation for hospitals, including managing bed allocations, providing and distributing equipment and funding, and setting up isolation centres. Conclusion: Electronic health record systems and an integrated data analytics infrastructure are effective tools to enable policymakers to make better decisions, and for epidemiologists to conduct improved analyses regarding COVID-19. Implications: Improved quality of clinical coding for better case finding, improved quality of health information in data sources, data-sharing agreements, and increased EHR coverage in the population can empower EHR-based COVID-19 surveillance systems. [ABSTRACT FROM AUTHOR]

Background: The International Classification of Diseases (ICD) is widely used by clinical coders worldwide for clinical coding morbidity data into administrative health databases. Accordingly, hospital data quality largely depends on the coders' skills acquired during ICD training, which varies greatly across countries. Objective: To characterise the current landscape of international ICD clinical coding training. Method: An online questionnaire was created to survey the 194 World Health Organization (WHO) member countries. Questions focused on the training provided to clinical coding professionals. The survey was distributed to potential participants who met specific criteria, and to organisations specialised in the topic, such as WHO Collaborating Centres, to be forwarded to their representatives. Responses were analysed using descriptive statistics. Results: Data from 47 respondents from 26 countries revealed disparities in all inquired topics. However, most participants reported clinical coders as the primary person assigning ICD codes. Although training was available in all countries, some did not mandate training qualifications, and those that did differed in type and duration of training, with college or university degree being most common. Clinical coding certificates most frequently entailed passing a certification exam. Most countries offered continuing training opportunities, and provided a range of support resources for clinical coders. Conclusion: Variability in clinical coder training could affect data collection worldwide, thus potentially hindering international comparability of health data. Implications: These findings could encourage countries to improve their resources and training programs available for clinical coders and will ultimately be valuable to the WHO for the standardisation of ICD training. [ABSTRACT FROM AUTHOR]

Heavy metal pollution in agricultural soils is one of the main problems in agricultural production worldwide, which threatens human health and the environment. To evaluate the pollution levels of heavy metals and the ecological risks in an agricultural area from Sánchez Ramírez Province, Dominican Republic, the concentration levels of heavy metals (Fe, Mn, Cr, Ni, Cu, Zn, Pb, and As) were measured using energy-dispersive X-ray fluorescence spectroscopy (EDXRF). Several pollution indices, including the geo-accumulation index (Igeo), enrichment factor (EF), and single pollution index (PI), were used to investigate the pollution status. The spatial distribution of different heavy metals in the studied soils was also determined. The mean concentrations of Fe, Mn, Cr, Ni, Cu, Zn, Pb, and As were 73735, 1616, 426; 34; 20; 200; 43; and 5 mg kg−1, respectively. These results indicated that the mean concentration of Cr, Cu, Zn, and Pb exceeded FAO-recommended levels for healthy agricultural soils. However, the potential ecological risks assessment indicated a low-risk status. The results obtained could help improve soil–rice–environment management practices and prevent heavy metal pollution in this type of production system, protecting the health of the local population and the environment. [ABSTRACT FROM AUTHOR]