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Background: Patient no-show behavior is a critical factor complicating hospital resource optimization and causing waste. The inefficiency caused by patients' no-shows and the resulting increased operating costs negatively affect the hospitals' financial structure and service quality. For this reason, health managers must make accurate predictions about whether patients will attend an appointment and plan the appointment system within the framework of these predictions. This research aims to optimize the hospital appointment system by making accurate predictions regarding the no-show behavior of the patients, based on recorded data. Methods: An artificial intelligence-based appointment system has been developed according to patients' demographics and past behavior patterns. The forecast results and realized performance results were compared. The artificial intelligence we have developed continuously improves appointment assignments by learning from past and current data. Results: According to the findings, the artificial intelligence-based appointment system increased the rate of patients attending appointments by 10% per month. Likewise, the hospital capacity utilization rate increased by 6%. Conclusions: Findings from the study confirmed that no-show risks could be managed in the appointment process through artificial intelligence. This artificial intelligence-based design for appointment systems significantly decreases hospital costs and improves service quality performance. [ABSTRACT FROM AUTHOR]

Objective: There is a demand to make hospital management information beyond basic key performance indicators (KPIs) accessible for clinicians. Methods: We developed an interactive application (IAPP) in R Shiny to visualize such information. We provided the IAPP source code online. As a use case, we recorded basic KPIs (numbers of patients (NPs), reimbursed valuation ratios (RVRs), mean length of stay (LOS)), main diagnoses (MDGNs), main procedures (MPRCs), and catchment area (CA) by district from April 2022 to March 2024 at the index department in central Germany, where a neurotrauma and spinal surgery service was resumed on 1 April 2022. Case mix indexes (CMIs) were calculated. We retrieved information about online-reported patient satisfaction (ORPS) from an online physician rating platform between January 2022 and March 2024. Information on longitudes and latitudes of the index department and neighbouring hospitals was collected. We calculated car travelling isochrones (CTIs) of the hospitals as a proxy variable for accessibility. Chi-square and Fisher's exact served as statistical tests. Results: During the observation period, the monthly NPs increased from 26 to 43, the RVR showed a 3.96-fold increase, the CMI showed a 2.41-fold increase, and the LOS reached a steady state in the 2nd year after service resumption. CA (p = 0.03), MDGNs, and MPRCs diversified. ORPS trended towards better overall evaluation after service resumption (p = 0.09). CTI mapping identified a unique market position of the index department. Conclusions: The IAPP makes extended hospital management data accessible to clinicians, can inform other stakeholders in healthcare, and can be tailored to local conditions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop prognostic models for predicting the need for invasive mechanical ventilation (IMV) in intensive care unit (ICU) patients with COVID-19 and compare their performance with the Respiratory rate-OXygenation (ROX) index. Methods: A retrospective cohort study was conducted using data collected between March 2020 and August 2021 at three hospitals in Rio de Janeiro, Brazil. ICU patients aged 18 years and older with a diagnosis of COVID-19 were screened. The exclusion criteria were patients who received IMV within the first 24 h of ICU admission, pregnancy, clinical decision for minimal end-of-life care and missing primary outcome data. Clinical and laboratory variables were collected. Multiple logistic regression analysis was performed to select predictor variables. Models were based on the lowest Akaike Information Criteria (AIC) and lowest AIC with significant p values. Assessment of predictive performance was done for discrimination and calibration. Areas under the curves (AUC)s were compared using DeLong's algorithm. Models were validated externally using an international database. Results: Of 656 patients screened, 346 patients were included; 155 required IMV (44.8%), 191 did not (55.2%), and 207 patients were male (59.8%). According to the lowest AIC, arterial hypertension, diabetes mellitus, obesity, Sequential Organ Failure Assessment (SOFA) score, heart rate, respiratory rate, peripheral oxygen saturation (SpO2), temperature, respiratory effort signals, and leukocytes were identified as predictors of IMV at hospital admission. According to AIC with significant p values, SOFA score, SpO2, and respiratory effort signals were the best predictors of IMV; odds ratios (95% confidence interval): 1.46 (1.07–2.05), 0.81 (0.72–0.90), 9.13 (3.29–28.67), respectively. The ROX index at admission was lower in the IMV group than in the non-IMV group (7.3 [5.2–9.8] versus 9.6 [6.8–12.9], p < 0.001, respectively). In the external validation population, the area under the curve (AUC) of the ROX index was 0.683 (accuracy 63%), the AIC model showed an AUC of 0.703 (accuracy 69%), and the lowest AIC model with significant p values had an AUC of 0.725 (accuracy 79%). Conclusions: In the development population of ICU patients with COVID-19, SOFA score, SpO2, and respiratory effort signals predicted the need for IMV better than the ROX index. In the external validation population, although the AUCs did not differ significantly, the accuracy was higher when using SOFA score, SpO2, and respiratory effort signals compared to the ROX index. This suggests that these variables may be more useful in predicting the need for IMV in ICU patients with COVID-19. ClinicalTrials.gov identifier: NCT05663528. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the current state and challenges of managing electronic quick payment methods within the financial settlement processes of general hospitals, specifically in the context of sports medicine departments. Additionally, it proposes specific optimization strategies to enhance efficiency and security. Methods: The study analyzed the advantages of electronic payment systems within the financial operations of sports medicine services in general hospitals, clarifying the value of quick payment methods in this specialized field. It then delved into the application status, existing problems, and challenges associated with electronic quick payments, focusing on issues pertinent to sports medicine. Based on these insights, targeted optimization paths were developed. Results: The implementation of electronic payment methods in sports medicine departments of general hospitals revealed several issues, including departmental information silos, mismatches between settlement processes and electronic payment systems, and security risks. Moreover, the study identified challenges such as the need for higher levels of hospital information management and robust internal controls. The proposed optimization strategies include enhancing the functionality of hospital medical cards to enable a seamless "one-card" system, optimizing settlement processes within sports medicine departments, strengthening electronic payment security, improving hospital information systems, and reinforcing internal controls. Conclusion: Despite the benefits of electronic quick payments, there are still significant risks and challenges in their application within the financial settlements of sports medicine departments in general hospitals. Strengthening the management of these systems can facilitate their effective use and ensure the financial security of hospital operations, particularly in the specialized area of sports medicine. [ABSTRACT FROM AUTHOR]

Introduction: Digitalization in medicine is steadily increasing. Complex treatments, scarce personnel resources and a high level of documentation are a constant burden on healthcare systems. The balancing between correct manual documentation in the digital records and limited staff resources is rarely successful. The aim of this study is to evaluate the adherence between documentation and lack of documentation in the treatment of critical care patients. Material and Methods: For the evaluation, data from the hospital information system (HIS) of several intensive care units (ICU) were examined in conjunction with data collected from a checklist. All boluses of sedatives, analgesics and catecholamines were documented paper based across all shifts and all weekdays and compared with corresponding digital data from the HIS (2019–2022) of previous years. Results: 939 complete digital patient records revealed a massive under-documentation of the medication administration compared to that applied according to the checklist. Only 12% of all administered catecholamines, 11% of α2-agonists, 33% of propofol, 92% of midazolam and 46% of opioids were found in the digital recordings. In comparison, the effect was more pronounced on weekdays compared to weekends. In addition, the highest documentation gap was found in the comparison of early shifts. Comparing neurosurgical vs. internal vs. anesthesiologic ICUs there was a highly significant difference between anesthesiologic ICUs compared with other disciplines (p < 0.0001). Discussion: Our data shows that there is a remarkable documentation gap and incongruence in the area of applied boli. Automated documentation by connecting syringe pumps that enter data directly into the HIS can not only reduce the workload, but also lead to comprehensive and legally required documentation of all administered medication. [ABSTRACT FROM AUTHOR]

Woo-Youn Kim,1,2 Anna Baek,1 Yoonhee Kim,1 Yewon Suh,1,2 Eunsook Lee,1 Eunkyung Euni Lee,1,2 Ju-Yeun Lee,1,2 Jongchan Lee,3– 5 Hee Sun Park,3– 5 Eun Sun Kim,3– 5 Yejee Lim,3– 5 Nak-Hyun Kim,3– 5 Jung Hun Ohn,3– 5 Sun-wook Kim,3– 5 Jiwon Ryu,3– 5 Hye Won Kim3– 5 1Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea; 2College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea; 3Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; 4Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea; 5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South KoreaCorrespondence: Hye Won Kim, Email kimhwhw@gmail.comBackground: Transitional medication safety is crucial, as miscommunication about medication changes can lead to significant risks. Unclear or incomplete documentation during care transitions can result in outdated or incorrect medication lists at discharge, potentially causing medication errors, adverse drug events, and inadequate patient education. These issues are exacerbated by extended hospital stays and multiple care events, making accurate medication recall challenging at discharge.Objective: Thus, we aimed to investigate how real-time documentation of in-hospital medication changes prevents undocumented medication changes at discharge and improves physician-pharmacist communication.Methods: We conducted a retrospective cohort study in a tertiary hospital. Two pharmacists reviewed medical records of patients admitted to the acute medical unit from April to June 2020. In-hospital medication discrepancies were determined by comparing preadmission and hospitalization medication lists and it was verified whether the physician’s intent of medication changes was clarified by documentation. By a documentation rate of medication changes of 100% and < 100%, respectively, fully documented (FD) and partially documented (PD) groups were defined. Any undocumented medication changes at discharge were considered a “documentation error at discharge”. Pharmacists’ survey was conducted to assess the impact of appropriate documentation on the pharmacists.Results: After reviewing 400 medication records, patients were categorized into FD (61.3%) and PD (38.8%) groups. Documentation errors at discharge were significantly higher in the PD than in the FD group. Factors associated with documentation errors at discharge included belonging to the PD group, discharge from a non-hospitalist-managed ward, and having three or more intentional discrepancies. Pharmacists showed favorable attitudes towards physician’s documentation.Conclusion: Appropriate documentation of in-hospital medication changes, facilitated by free-text communication, significantly decreased documentation errors at discharge. This analysis underlines the importance of communication between pharmacists and hospitalists in improving patient safety during transitions of care.Plain language summary: During transitions of care, communication failures among healthcare professionals can lead to medication errors. Therefore, effective sharing of information is essential, especially when intentional changes in prescription orders are made. Documenting medication changes facilitates real-time communication, potentially improving medication reconciliation and reducing discrepancies. However, inadequate documentation of medication changes is common in clinical practice. This retrospective cohort study underlines the importance of real-time documentation of in-hospital medication changes. There was a significant reduction in documentation errors at discharge in fully documented group, where real-time documentation of medication changes was more prevalent. Pharmacists showed favorable attitudes toward the physician’s real-time documenting of medication changes because it provided valuable information on understanding the physician’s intent and improving communication and also saved time for pharmacists. This study concludes that physicians’ documentation on medication changes may reduce documentation errors at discharge, meaning that proper documentation of medication changes could enhance patient safety through effective communication.Keywords: medication reconciliation, medication safety, transitions in care, hospital information systems, hospital discharge, quality audit

Prescribers often face the challenge of predicting creatinine clearance (CrCl) in elderly patients who are 65 years or older and have serum creatinine (SCr) concentrations below 1 mg/dL. Studies have shown that utilizing rounded SCr would underestimate CrCl in this population, which could lead to the under-dosing of some medications like vancomycin. The current study aimed to compare the accuracy of vancomycin dosing using actual SCr versus rounded SCr to 1 mg/dL in elderly patients. A total of 245 patients were included. The therapeutic trough level (10–20 mg/L) was achieved in 138 (56.3%) patients using actual SCr. Sub-therapeutic (<10 mg/L) and supra-therapeutic (>20 mg/L) trough levels were observed in 32 (13.1%) and 75 (30.6%) patients, respectively. The predictive performance of different vancomycin doses based on actual SCr and rounded SCr compared to the targeted maintenance dose (TMD) showed a stronger correlation of dosing based on actual SCr with TMD (r = 0.55 vs. 0.31) compared to rounded SCr dosing; both doses showed similar precision, with ranges of ±552 mg/day for the dosing based on actual SCr and ±691 mg/day for the dosing based on rounded SCr. Furthermore, the dosing based on actual SCr showed a lower error percentage (69%) and a higher accuracy rate (57.6%) within ±10% of the TMD compared to the dosing based on rounded SCr, which had an error percentage of (92.3%) and an accuracy rate of (40%). The prevalence of vancomycin-associated nephrotoxicity (VAN) was seen in 44 (18%) patients. Patients between 75 and 84 years of age, those who were bedridden, and those with vancomycin trough concentrations greater than 20 mg/L had a higher risk of developing VAN. In conclusion, in elderly patients, estimating vancomycin dosing based on actual SCr was more accurate compared to rounded SCr to 1 mg/dL. The efficacy of vancomycin could be negatively affected by rounding up SCr, which could underestimate CrCl and result in the under-dosing of vancomycin. [ABSTRACT FROM AUTHOR]

Aims. This study aimed to identify and analyze the factors significantly influencing long‐term insulin medication adherence among outpatients and to evaluate whether pharmaceutical interventions targeting these factors can improve patient medication adherence and glycemic control. Methods. A cohort of 180 patients was recruited from a tertiary hospital in Nanjing, China. Factors potentially influencing insulin adherence were scrutinized employing the KAP (knowledge, attitude/belief, and practice) health behavior model. Baseline characteristics were extracted from the hospital information system, while patient knowledge of the disease and medication, medication adherence, medication beliefs, and management self‐efficacy were assessed, respectively, using self‐developed questionnaires, MMAS‐8, C‐DMSES, and BMQ scales. Univariate and multivariate analyses were conducted to determine the impact of these factors on insulin adherence. Following this, participants were randomly allocated to either the intervention or control group. The intervention group received three months of weekly telephone sessions and educational interventions targeting facets such as medication knowledge and beliefs, while the control group received standard care. After the intervention, insulin adherence and glycemic control conditions of both groups were collected and re‐evaluated. Results. After excluding lost‐to‐follow‐up patients, 152 individuals were analyzed (intervention: 75 and control: 77). Multivariate analyses revealed factors influencing insulin adherence, including age, diabetes duration, health insurance status, HbA1c level, disease and medication knowledge, diabetes management self‐efficacy, and medication beliefs (P < 0.05). Before targeted pharmaceutical care, no significant differences existed in insulin adherence, HbA1c levels, management self‐efficacy, knowledge, or medication beliefs between intervention and control groups (P > 0.05). However, subsequent pharmaceutical intervention notably improved adherence, HbA1c levels, self‐efficacy, knowledge, and medication beliefs (P < 0.05). Conclusion. This study examines the impact of glycemic control, health insurance status, management self‐efficacy, level of knowledge, and medication beliefs on improving insulin medication adherence in patients with type 2 diabetes mellitus. Targeted pharmaceutical intervention can enhance medication adherence, improve glucose control, and promote rational insulin use. This trial is registered with ChiCTR2300074444. [ABSTRACT FROM AUTHOR]

Copyright of Ahi Evran Medical Journal is the property of Ahi Evran University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: D-dimer is a marker of coagulation and fibrinolysis widely used in clinical practice for assessing thrombotic activity. While it is commonly ordered in the Emergency Department (ED) for suspected venous thromboembolism (VTE), elevated D-dimer levels can occur due to various other disorders. The aim of this study was to find out the causes of elevated D-dimer in patients presenting to a large ED in Saudi Arabia and evaluate the accuracy of D-dimer in diagnosing these conditions. Methods: Data was collected from an electronic hospital information system of patients who visited the ED from January 2016 to December 2022. Demographic information, comorbidities, D-dimer levels, and diagnoses were analyzed. Statistical analysis was performed using the SPSS software. The different diagnoses associated with D-dimer levels were analyzed by plotting the median D-dimer levels for each diagnosis category and their interquartile ranges (IQR). The receiver operating characteristic (ROC) curves were calculated and their area under the curve (AUC) values were demonstrated. The optimal cut-off points for specific diseases were determined based on the ROC analysis, along with their corresponding sensitivities and specificities. Results: A total of 19,258 patients with D-dimer results were included in the study. The mean age of the participants was 50 years with a standard deviation of ± 18. Of the patients, 66% were female and 21.2% were aged 65 or above. Additionally, 21% had diabetes mellitus, 20.4% were hypertensive, and 15.1% had been diagnosed with dyslipidemia. The median D-dimer levels varied across different diagnoses, with the highest level observed in aortic aneurysm 5.46 g/L. Pulmonary embolism (PE) and deep vein thrombosis (DVT) were found in 729 patients (3.8%) of our study population and their median D-dimer levels 3.07 g/L (IQR: 1.35–7.05 g/L) and 3.36 g/L (IQR: 1.06–8.38 g/L) respectively. On the other hand, 1767 patients (9.2%) were diagnosed with respiratory infections and 936 patients (4.9%) were diagnosed with shortness of breath (not specified) with median D-dimer levels of 0.76 g/L (IQR: 0.40–1.47 g/L) and 0.51 g/L (IQR: 0.29–1.06 g/L), respectively. D-dimer levels showed superior or excellent discrimination for PE (AUC = 0.844), leukemia (AUC = 0.848), and aortic aneurysm (AUC = 0.963). DVT and aortic dissection demonstrated acceptable discrimination, with AUC values of 0.795 and 0.737, respectively. D-dimer levels in respiratory infections and shortness of breath (not specified) exhibited poor to discriminatory performance. Conclusion: This is the first paper to identify multiple causes of elevated D-dimer levels in Saudi Arabia population within the ED and it clearly highlights their accurate and diagnostic values. These findings draw attention to the importance of considering the specific clinical context and utilizing additional diagnostic tools when evaluating patients with elevated D-dimer levels. [ABSTRACT FROM AUTHOR]

Hospitals must timely provide qualified health services to the community, so pharmaceutical supply management is very important. Appropriate drug supply control has a major impact on service quality to the patients. This study aimed to analyze the drug inventory control system in the planning and procurement stages by analyzing ABC, VEN, and ABC-VEN combinations. This study is an observational descriptive study using retrospective data collected at the pharmaceutical installation of X Private Hospital in Waru, Sidoarjo Regency, in 2019-2020. The drugs analyzed were orals, injections, and infusions, and the inventory control was analyzed using ABC, VEN, and ABC-VEN Analysis in 2019-2020. This study showed differences in ABC-VEN drug class, changes in the parenteral multivitamin group from C-N to A-V, and antibiotics (Ceftriaxone) from B-E to A-V groups. Group changes caused changes in priorities in procurement and inventory control, which happened due to the Covid-19 pandemic occurring in Indonesia and throughout the world. Based on SWOT analysis, strategic development is to develop a Hospital Information System and increase the competence and skills of pharmaceutical staff. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the risk factors associated with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). A retrospective analysis was performed on a cohort of 335 patients who underwent PELD between January 2016 and January 2023. Data were derived from the Hospital Information System (HIS), and a comprehensive statistical assessment was performed using IBM SPSS Statistics version 25.0. Both univariate and multivariate logistic regression analyses assessed a range of risk determinants, such as age, body mass index (BMI), comorbidities, laboratory test parameters and surgery‐related variables. The incidence of SSI after PELD was 2.7% (9/335). Univariate analysis highlighted BMI, diabetes mellitus, long‐term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant predictors of SSI. Multivariate logistic regression identified BMI, diabetes mellitus, long‐term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant risk factors for SSI after PELD. High BMI, diabetes mellitus, long‐term corticosteroid consumption, long surgical time and postoperative cerebrospinal fluid leakage are predisposing factors for SSI in patients undergoing PELD. Precise interventions focused on such risk components, including careful preoperative assessment and strategic postoperative care, are essential to reduce the incidence of SSI and improve surgical efficacy. [ABSTRACT FROM AUTHOR]

Despite significant advancements in antiretroviral therapy (ART) for HIV, adherence remains a challenge. While Brazil has validated scales for treatment adherence, few assess treatment adherence barriers. This underscores the necessity for validated questionnaires on adherence barriers to identify patient-specific challenges and enhance strategies for ART adherence. This study aimed to adapt and validate the Adherence Barriers Questionnaire for HIV Patients on Antiretroviral Therapy (ABQ-HIV), a 17-item questionnaire assessing the adherence barriers to ART, for the Brazilian context and to evaluate its psychometric properties in HIV patients. A methodological study on the psychometric properties and factorial structure of ABQ-HIV was conducted. The study followed seven steps: consent of the original authors, two translations, synthesis of the translations, expert committee, back-translation, pre-test, and reliability test. A high content validity index (0.93) was achieved with the expert committee. The study sample consisted of 230 adults with HIV, with 37.0 (29.3-45.0) years as the median age (IQR), and 52.2% were male. The exploratory factor analysis with a three subscales structure of 17 items showed good interpretability (Bartlett’s sphericity (1167.2 [136]; p < 0.001) and Kaiser-Meyer-Olkin = 0.602) and internal consistency (α = 0.76; Ω = 0.76). The fit indicators were satisfactory (χ2 = 89.931; df = 88; p > 0.005; RMSEA = 0.010; RMSR = 0.07; CFI = 0.996; GFI = 0.940; AGFI = 0.907; NNFI = 0.995). The Brazilian version of ABQ-HIV is a potential instrument for identifying specific barriers to adherence to ART in adults living with HIV in Brazil.

ABSTRACT Objective To validate the Brazilian National Health System Hospital Information System (SIH/SUS) for maternal morbidity surveillance. Methods This was a cross-sectional study conducted in 2021/2022, taking as its reference a national study on maternal morbidity (MMG) conducted in 50 public and 28 private hospitals; we compared SIH/SUS and MMG data for hospitalization frequency, reason and type of discharge and calculated sensitivity, specificity, positive and negative likelihood ratios for seven diagnoses and four procedures. Results Hospitalizations identified on SIH/SUS (32,212) corresponded to 95.1% of hospitalizations assessed by MMG (33,867), with lower recording on SIH/SUS (85.5%) for private hospitals [10,036 (SIH/SUS)]; 11,742 (MMG)]; compared to MMG, SIH/SUS had a lower proportion of hospitalizations due to “complications during pregnancy” (9.7% versus 16.5%) as well as under-recording of all diagnoses and procedures assessed, except “ectopic pregnancy”. Conclusion Better recording of diagnoses and procedures on SIH/SUS is essential for its use in maternal morbidity surveillance.

Background: Trauma can lead to significant complications and mortality for victims of accidents.Objectives: The present study was conducted to determine the mortality caused by trauma and its related factors.Methods: The present study was conducted using the data available in the Isfahan Trauma Registration System (ITR) and Hospital Information Systems (HIS). The number of 1266 deceased trauma patients who were registered in this system over 18 months (between September 2020 and March 2022) were included in the study and analyzed.Results: Out of 1266 patients who died from trauma, 604 (47.7%) patients experienced early death, 427 (33.7%) delayed mortality, and 235 (18.6%) late mortality. The mechanism and type of trauma, and the pre-impact conditions were significantly different between the three death categories (P

OBJECTIVE: There is a need to increase patient and clinician awareness on the effectiveness of pneumococcal vaccination in at-risk groups. The aim of the study was to evaluate the effect of reminders for physicians and patients using the vaccination tracking system created in the hospital information management system (HIMS) on the vaccination rate, and the effect of pneumococcal vaccination on pneumonia-related hospitalization and mortality over a 12-month period. MATERIAL AND METHODS: This prospective observational cohort study was undertaken during a 2-year period in 3 tertiary care centers. Patients were followed up for 12 months following vaccination, and hospital admissions and mortality were recorded via HIMS. During the campaign, HIMS transmitted pneumococcal immunization reminder messages in accordance with guideline recommendations to physicians' computers and patients' mobile phones. Educational posters on pneumococcal vaccination were posted in outpatient clinics. Regular seminars on the evidence for pneumococcal vaccination were organized. All patients who were hospitalized during the follow-up period for chronic obstructive pulmonary disease (COPD), asthma, lung cancer, or pneumonia were analyzed in relation to their vaccination history regarding clinical outcomes. RESULTS: A total of 29 530 patients were included in the study. During the study period, the annual vaccination rate increased by 74.4% and reached 4.8% in 3 hospitals (P = .001). The rates were 3.9% in patients older than 65 years without comorbidities and 5.2% in those with COPD and asthma (P = .002). In pneumococcal vaccine recipients, pneumonia-related hospital mortality was lower (relative risk (RR) = 0.19, CI 0.09-0.35, P < .001). CONCLUSION: It is possible to raise the rate of pneumococcal vaccination through awareness campaigns. Individuals with COPD and asthma are more willing to receive pneumococcal vaccination. Among patients hospitalized for pneumonia, prior pneumococcal vaccination is associated with lower mortality. [ABSTRACT FROM AUTHOR]

Objective: Hospital information systems (HIS) are meant to manage complex work processes across healthcare organizations. We describe limitations of HIS to address local information requirements and how they are circumvented at different organizational levels. Results can be used to better support collaboration in socio-technical systems. Background: Workarounds describe a mismatch between a technology's purpose and its actual use, whereas shadow systems are unofficial IT systems circumventing limitations of official systems to support workflows. Boundary infrastructures are conceptualized as the entirety of all (in)formal digital and analog systems connecting different communities of practice in a socio-technical system. Methods: An ethnographic study with observations and semi-structured interviews was conducted and analyzed through categorization and iterative coding. Results: Several digital-analog workarounds are employed for documentation and a shared server functions as a shadow system to support workflows in ways the HIS cannot. For collaborative documentation, all (official and informal) information sources were used simultaneously as part of an interconnected boundary infrastructure. Conclusion: Formal and informal IT systems are interconnected across different organizational levels and provide insights into unmet information requirements, effective and problematic work practices, and how to address them to improve system functioning. An integrated perspective on boundary infrastructures, workarounds, and shadow systems may advance system analysis, providing a more comprehensive picture of IT requirements than any concept alone. Application: Workarounds and shadow systems highlight that HIS should support systemic and local needs. Customized interfaces in HIS to support search, access, and exchange of relevant data might help to mitigate current shortcomings. [ABSTRACT FROM AUTHOR]

Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Patient medical records are records relating to the patient's identity, diagnosis, action, and to the treatment that has been given to the patient. Thus, medical records must be protected from damage, but damage to medical records is still found in every hospital. Purpose: This study attempts to investigate the causes of damage to hospital medical record materials. Methods: this is literature review, and the research was obtained from google scholar and the portal garuda, using full text articles. The measured results were factors that cause damage to medical record documents. Results: The main factor were still officers with a low level of education, namely high school graduates. This has an impact on filing officers to be not disciplined in maintaining medical record documents, and the absence of implementation of training related to management and storage management in the filing section. The machine factor was that there was no medical record rack available in accordance with the number of medical record documents. The method factor was that there was no SOP for maintaining medical records. The material factor was the raw material for the map using thin paper. The media factor, namely the storage space, has not been avoided from the dangers of water, fire, and biological damage. Conclusion: Based on 5M factors, the factors that have the highest influence on damage to medical record documents are the elements of people, machine, and material. While the factor that causes the least damage to medical record documents is the method. [ABSTRACT FROM AUTHOR]

Background. Climatic and geomorphological characteristics of a region are vital factors in the regional spread of diseases. Geographic Information System (GIS) is a useful tool for studying cancer epidemiology. This study was conducted with the aim of investigating the prevalence of childhood leukemia in Khuzestan based on 10-year GIS data of temperature, wind speed and dust level. Methods. The medical characteristics of all cases of leukemia in children admitted to Bagai 2 Ahvaz Hospital, which were diagnosed with leukemia for the first time. We collected what was diagnosed. Results. Five hundred and twelve children had acute lymphoblastic leukemia (ALL) and 100 children had acute myeloblastic leukemia (AML). The year 2015 had the highest and the year 2018 the lowest ALL rate. The peak of AML was in 2013 and the lowest was in 2018. Central cities had the highest mean particulate matter, temperature, wind speed, and the highest rate of leukemia. Conclusion. The results show that dust, temperature and wind speed are related to the prevalence of childhood leukemia in Khuzestan, Iran. Practical Implications. A wide range of environmental and genetic factors can play a role in the occurrence of cancer, so additional studies are needed to confirm the effect of particles and environmental factors such as temperature and dust on the occurrence of cancer. [ABSTRACT FROM AUTHOR]

Background: Human communities suffered a vast socioeconomic burden in dealing with the pandemic of coronavirus disease 2019 (COVID-19) globally. Real-word data about these burdens can inform governments about evidence-based resource allocation and prioritization. The aim of this scoping review was to map the cost-of-illness (CoI) studies associated with COVID-19. Methods: This scoping review was conducted from January 2019 to December 2021. We searched cost-of-illness papers published in English within Web of Sciences, PubMed, Google Scholar, Scopus, Science Direct and ProQuest. For each eligible study, extracted data included country, publication year, study period, study design, epidemiological approach, costing method, cost type, cost identification, sensitivity analysis, estimated unit cost and national burden. All of the analyses were applied in Excel software. Results: 2352 records were found after the search strategy application, finally 28 articles met the inclusion criteria and were included in the review. Most of the studies were done in the United States, Turkey, and China. The prevalence-based approach was the most common in the studies, and most of studies also used Hospital Information System data (HIS). There were noticeable differences in the costing methods and the cost identification. The average cost of hospitalization per patient per day ranged from 101$ in Turkey to 2,364$ in the United States. Among the studies, 82.1% estimated particularly direct medical costs, 3.6% only indirect costs, and 14.3% both direct and indirect costs. Conclusion: The economic burden of COVID-19 varies from country to country. The majority of CoI studies estimated direct medical costs associated with COVID-19 and there is a paucity of evidence for direct non-medical, indirect, and intangible costs, which we recommend for future studies. To create homogeneity in CoI studies, we suggest researchers follow a conceptual framework and critical appraisal checklist of cost-of-illness (CoI) studies. [ABSTRACT FROM AUTHOR]

Background: This study aimed to construct an enteral nutrition evaluation system for critically ill patients using the Delphi method to direct the formulation of enteral nutrition support strategies and reduce interruption to enteral feeding. Methods: We used domestic and foreign databases to obtain and analyze the literature and form "The Whole-Proceeding Enteral Nutrition Evaluation System for Critically Ill Patients." The Delphi method was used to conduct two rounds of expert opinion consultation, combined with the suggestions from the research group to finalize the nutrition evaluation content of the system. Results: After two rounds of expert consultation, a nutrition evaluation system was formed around three dimensions: before the start, during, and after the end of nutritional support. The effective recovery rates of the two rounds of expert consultation were 90.0% (18/20) and 100.0% (18/18), respectively. Authority coefficients were 0.865 and 0.908, while Kendall coordination coefficients were 0.108 (P < 0.05) and 0.115 (P < 0.001), respectively. Finally, the full enteral nutrition evaluation system for critically ill patients was constructed based on the Delphi method, including three primary items and seven secondary and 28 tertiary indicators. Conclusion: The established "Whole-Proceeding Enteral Nutrition Evaluation System for Critically Ill Patients" has high consistency from expert opinions and reliability, which can provide a practical evaluation tool for the process of enteral nutrition for severe patients. [ABSTRACT FROM AUTHOR]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ahi Evran Medical Journal is the property of Ahi Evran University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hospital information system, as an integrated system consists of complex, diverse, and heterogeneous information systems, which supports all clinical, administrative, and financial activities of patients; therefore, it faces interoperability problems, which is a critical feature of data sharing and integration. In this regard, a reference architecture will be presented for the integration of different systems in the hospital which comprises system, information and software architecture. This architecture emphasizes interoperability with eight layers of user interface and application, services, data collection and storage, integration, external application systems, communication and information infrastructure, management, and security/privacy, based on service orientation. It will be evaluated by ATAM method, based on ten scenarios. It shows the presented architecture will satisfy all functional and non-functional requirements such as interoperability between different information systems, reduction of information redundancy and development cost and time, scalability and accessibility. [ABSTRACT FROM AUTHOR]

Background: Trauma can lead to significant complications and mortality for victims of accidents. Objectives: The present study was conducted to determine the mortality caused by trauma and its related factors. Methods: The present study was conducted using the data available in the Isfahan Trauma Registration System (ITR) and Hospital Information Systems (HIS). The number of 1266 deceased trauma patients who were registered in this system over 18 months (between September 2020 and March 2022) were included in the study and analyzed. Results: Out of 1266 patients who died from trauma, 604 (47.7%) patients experienced early death, 427 (33.7%) delayed mortality, and 235 (18.6%) late mortality. The mechanism and type of trauma, and the pre-impact conditions were significantly different between the three death categories (P<0.05). There was a significant difference in oxygen level (SpO2), heart rate, and respiratory rate at the time of admission and at the time of death between the three categories of mortality (P<0.05). Glasgow Coma Scale (GCS) was a predictor of early, delayed, and late mortality. Injury Severity Score (ISS) was a predictor of delayed mortality and age was also a predictor of late mortality. Conclusion: The present study's results indicate that ISS and GCS are significant prognostic indicators of mortality in trauma patients, warranting greater attention during admission. The combination of GCS and ISS appears to improve the accuracy of outcome prediction, thereby enabling the creation of a novel predictive model. [ABSTRACT FROM AUTHOR]

Healthcare professionals must provide their patients with the best possible service and be well-informed and expert at carrying out complex surgical procedures to fulfill this responsibility. The aim of the medical treatments is fewer complications, shorter hospital stays, and a better patient experience. Through continuous learning and training, medical practitioners trained in up-to-date and state-of-the-art surgical techniques and technologies make productive and effective healthcare systems possible. Healthcare systems often report on problems with surgical processes, skipped procedures, unusual activities during operations, and lengthy transition times. This event log data allows implementing process mining methods to deliver medical professionals with simple and understandable findings using Petri nets for process analysis and enhancement. This study identifies the parallels and discrepancies between the pre-and post-stages and their respective frequency on each typical Central Venous Catheter (CVC) installation activity. The Process Mining for Python (PM4Py) frameworks used four major mining algorithms to view the event log (i.e., alpha miner, directly-follows graph (DFG), heuristic miner, and inductive miner). This study's findings indicate that medical residents are more susceptible to error during pre-operative procedures.

Abstract Background Adverse drug reactions (ADR), both preventable and non-preventable, are frequent and pose a significant burden. This study aimed to produce up-to-date estimates for ADR rates in hospitals, in Portugal, from 2010 to 2018. In addition, it explores possible pitfalls when crosswalking between ICD-9-CM and ICD-10-CM code sets for ADR identification. Methods The Portuguese Hospital Morbidity Database was used to identify hospital episodes (outpatient or inpatient) with at least one ICD code of ADR. Since the study period spanned from 2010 to 2018, both ICD-9-CM and ICD-10-CM codes based on previously published studies were used to define episodes. This was an exploratory study, and descriptive statistics were used to provide ADR rates and summarise episode features for the full period (2010–2018) as well as for the ICD-9-CM (2010–2016) and ICD -10-CM (2017–2018) eras. Results Between 2010 and 2018, ADR occurred in 162,985 hospital episodes, corresponding to 1.00% of the total number of episodes during the same period. Higher rates were seen in the oldest age groups. In the same period, the mean annual rate of episodes related to ADR was 174.2/100,000 population. The episode rate (per 100,000 population) was generally higher in males, except in young adults (aged '15–20', '25–30' and '30–35' years), although the overall frequency of ADR in hospital episodes was higher in females. Conclusions Despite the ICD-10-CM transition, administrative health data in Portugal remain a feasible source for producing up-to-date estimates on ADR in hospitals. There is a need for future research to identify target recipients for preventive interventions and improve medication safety practices in Portugal.

Background: A summary of clinical findings and laboratory data is collected in patient summary sheets. The aim of this study was to determine the frequency of laboratory data reported in the summary sheets based on the classification of diagnoses in ICD-10. Methods: A descriptive-cross sectional study was performed on summary sheets of patients admitted to the pediatric ward from March 2015 to February 2016.The laboratory data of these sheets were extracted using a data collection form. Because of high number of data in each sheet and given that, depending on the diagnosis, the reported laboratory data were different, to simplify the presentation of the results the data were categorized based on patients’ diagnoses which were coded by ICD-10. Results: A total of 10224 laboratory data were extracted, which included 47 unique data elements. The highest number of laboratory data was related to hematology (N = 14) and the lowest number was related to urine and stool analysis (N = 6). Conclusions: Laboratory data are recorded in summary sheets in accordance with patient's diagnosis. Therefore, it is possible to process the existing summary sheets and extract the registration rules, then implement these rules in hospital information systems to generate electronic summary sheets.

Developing an anesthesia module in the operating room is one of the significant steps toward the implementation of electronic medical records (EMR) in health care centers. This study aimed to develop and evaluate the web based-anesthesia module of an electronic medical record Sciences, in the operating room of the Namazi Medical Training Center of Shiraz University of Medical Iran. This developmental and applied study was conducted in steps including determining the functional and non-functional requirements, designing and implementing the anesthesia module, and usability evaluation. 3 anesthesiologists, 3 anesthesiologist assistants, and 12 anesthetist nurses were included in the study as a research community. React.js, Node.js programming language to program this module, Mongo dB database, and Windows server for data management and USE standard questionnaire were used. In the anesthesia module, software quality features were determined as functional requirements and non-functional requirements included 286 data elements in 25 categories (demographic information, surgery information, laboratory results, patient graphs, consults, consent letter, physical examinations, medication history, family disease records, social record, past medical history, type of anesthesia, anesthesia induction method, airway management, monitoring, anesthesia chart, blood and fluids, blood gases, tourniquets and warmers, accessories, positions, neuromuscular reversal, transfer the patient from the operating room, complications of anesthesia and, seal/ signature). Also, after implementing the anesthesia module, results of the usability evaluation showed that 69.1% of the users agreed with the use of this module in the operating room and considered it user-friendly. [ABSTRACT FROM AUTHOR]

Background: In Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS. Methods: This cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS' Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it. Results: About 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021. Conclusions: COVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country. [ABSTRACT FROM AUTHOR]

Copyright of Revista Habanera de Ciencias Médicas is the property of Universidad de Ciencias Medicas de La Habana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Work‐related burns can have a destructive impact; however, knowledge of the epidemiology of work‐related burn injuries in Iran is limited. This study aimed to describe epidemiological characteristics of work‐related burn injuries in a burn centre in the north of Iran. This study was a retrospective single‐centre study of the medical records of work‐related burns between 2011 and 2020. Data collection was done using the hospital information system (HIS). The data were analysed by using descriptive statistical methods and SPSS 24.0 software. Of the 9220 cases treated in the burn centre, 429 (4.65%) had work‐related burns. There was an increasing trend of work‐related burns during the ten years. The mean age of patients was 37.53 (SD = 13.72). Most patients were male (n = 377, 87.9%), with a male‐to‐female ratio of 7.25/1. The mean total body surface area burn was 23.39% (SD = 20.03). Most work‐related burns occurred in the summer season (46.9%, n = 201), and the upper limb was the most common anatomical site of burns (n = 123, 28.7%). The most common mechanism of injury was fire & flames (266, 62.0%). Inhalation injury was observed in 52 (12.1%) patients, and mechanical ventilation was undertaken in 71 (16.6%) patients. The mean length of stay in the hospital was 10.38 (SD = 10.37) days, and the overall mortality rate was 11.2%. The most common activities associated with burns at the time of the incidents were food preparation and serving related (108, 25.2%), followed by welders (n = 71, 16.6%) and electricians (n = 61, 14.2%). This research is the basis for evaluating work‐related burns and identifying the causes of these injuries to develop education and prevention programmes, especially for young male workers. [ABSTRACT FROM AUTHOR]

Background Staff training in organizations is a measure for developing human capital. The pathology of this process needs to be assessed to understand the current situation and solve the challenges and limitations. Objective This study aims to assess the pathology of the training process for the incident command system (ICS) staff of hospitals in Guilan Province using the three-pronged approach. Methods This is a qualitative-quantitative study. The study population in the qualitative phase included experts in the hospital ICS. In the quantitative phase, the study population included all ICS managers and staff in the Guilan Province hospitals (n= 548). The data collection tool was a semi-structured interview in the qualitative phase and a researcher-made questionnaire in the quantitative phase. For data analysis, MAXQDA software, version 2020 was used in the qualitative phase and SPSS software, version 26 was used in the quantitative phase. Results The results in the qualitative phase showed the extraction of 55 open codes, 25 axial codes, and 6 selective codes in the form of three domains of processes, context, and structure. The results in the quantitative phase showed that among all the domains, the process domain-related factors with a percentage of variance (impact) of 0.262 were more harmful than context- and structure-related factors in the training process. Conclusion The pathology assessment based on the three-pronged model is an effective method for determining the training priorities for the hospital ICS staff. The use of this model during a crisis can be an effective step for identifying shortcomings to solve them and take appropriate measures for the ICS staff training. [ABSTRACT FROM AUTHOR]

Hospital information systems are widely used globally with an embedded role of information technology focusing on life enhancement and cost-cutting strategies, including patient care information systems and managerial information system. A very few studies focused on this topic and our study provides better insight for those willing to understand and incorporate information systems in hospital management. A survey was conducted for primary data. The results indicate the significance of this study. This opens a window for researchers with accurate data, information, and advanced research methodologies.

Background and Objectives: Burn injuries range from minor medical issues to severe, life-threatening conditions. The severity and location of the burn dictate its treatment; while minor burns might be treatable at home, severe burns necessitate medical intervention, sometimes in specialized burn centers with extended follow-up care. This study aims to leverage artificial intelligence (AI)/machine learning (ML) to forecast potential adverse effects in burn patients. Methods: This retrospective analysis considered burn patients admitted to Chi Mei Medical Center from 2010 to 2019. The study employed 14 features, comprising supplementary information like prior comorbidities and laboratory results, for building models for predicting graft surgery, a prolonged hospital stay, and overall adverse effects. Overall, 70% of the data set trained the AI models, with the remaining 30% reserved for testing. Three ML algorithms of random forest, LightGBM, and logistic regression were employed with evaluation metrics of accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Results: In this research, out of 224 patients assessed, the random forest model yielded the highest AUC for predictions related to prolonged hospital stays (>14 days) at 81.1%, followed by the XGBoost (79.9%) and LightGBM (79.5%) models. Besides, the random forest model of the need for a skin graft showed the highest AUC (78.8%), while the random forest model and XGBoost model of the occurrence of adverse complications both demonstrated the highest AUC (87.2%) as well. Based on the best models with the highest AUC values, an AI prediction system is designed and integrated into hospital information systems to assist physicians in the decision-making process. Conclusions: AI techniques showcased exceptional capabilities for predicting a prolonged hospital stay, the need for a skin graft, and the occurrence of overall adverse complications for burn patients. The insights from our study fuel optimism for the inception of a novel predictive model that can seamlessly meld with hospital information systems, enhancing clinical decisions and bolstering physician–patient dialogues. [ABSTRACT FROM AUTHOR]

Objective: The cycle threshold value was used to predict disease severity, disease progression, determine transmissibility, and differentiate active viral replication from prolonged virus shedding. In this study, we aimed to evaluate the relationship between rRT-PCR cycle threshold and clinical course, mortality and laboratory parameters in COVID-19 patients. Methods: The patients included in the study were grouped according to how they were followed; as outpatients, service and intensive care unit patients. Data of age, gender, length of hospital stay, survival status and comorbidities of the patients were obtained from the hospital information system. In addition, CRP, ferritin, albumin, lactate dehydrogenase, procalcitonin and iron values of inpatients were reviewed retrospectively. Cycle threshold values of the patients were compared with each parameter separately. Results: 1339 patients with positive SARS-CoV-2 rRT-PCR test were included in the study. Of the patients, 774 (58%) were outpatients, 548 (41%) were in the ward, and 17 (1%) were in the intensive care unit. No significant difference was found between any of the groups when the cycle threshold values of the groups were compared statistically. Fifty (3.7%) of the patients included in the study died. Cycle threshold values of deceased patients were found to be significantly lower than those who survived (p=0.019). 306 (22.8%) of the patients had comorbidities. When the cycle threshold values of patients with and without comorbid disease were compared, no significant difference was found between any of the groups (p=0.850). In addition, no significant correlation was found between the length of hospital stay, age, CRP, LDH, ferritin, procalcitonin, albumin and iron values and the cycle threshold value. Conclusion: In conclusion, we did not find a significant difference between the cycle threshold values of outpatients, ward patients and intensive care patients. No significant correlation was found between the laboratory parameters, length of hospital stay and age, and the cycle threshold: however, deceased patients were found to have lower cycle thresholds than surviving patients. [ABSTRACT FROM AUTHOR]

Currently, the Taiwan Electronic Medical Record Exchange Center uses the Clinical Document Architecture (CDA) framework, which is based on the international medical standard. The CDA R2 standard, defined in 2005, is used for cross-institution retrieval of electronic medical records (Ministry of Health and Welfare, Information Department, 2021). However, CDA R2 only supports the exchange of clinical documents and is limited to the XML format. Due to the lack of a standardized framework for medical data exchange in Taiwan, different standards and specifications result in different data interface methods between systems, requiring customization for each system by healthcare institutions or the government. The inconsistency in data formats requires healthcare institutions and the government to spend more time on data parsing and mapping, resulting in slow integration of medical data. In this study, we simulated healthcare institutions using Fast Healthcare Interoperability Resources (FHIR) for medical information exchange and utilized the exchanged medical information to create a dynamic dashboard to assist healthcare professionals in making medical decisions. To ensure information security, we employed Hyper Text Transfer Protocol Secure (HTTPS) for secure transmission, which encrypts the transmitted medical record data using the Transport Layer Security (TLS) protocol, preventing deliberate interception and tampering of medical record data between the two systems. Finally, to test the load and performance of static and dynamic resources and web applications, we conducted a system performance evaluation using Apache JMeter. The results of this study demonstrate that replacing the gateway of the Electronic Medical Record Exchange Center with an FHIR server effectively reduces the time and cost spent by developers on data format conversion while also mitigating the information security risks associated with the previous VPN solution. Additionally, by utilizing dynamic charts, healthcare professionals are assisted in making medical decisions. [ABSTRACT FROM AUTHOR]

The etiology and outcomes of chemical burns vary worldwide, influenced by the local population structure, industry distribution, and geographical and social environments. The aim of this study was to evaluate the epidemiology of chemical burns among patients referred to a burn centre in the north of Iran. A single‐centre, retrospective study was conducted on patients with chemical burns between 2011 and 2021. Data collection was carried out using the hospital information system (HIS), and data collected from medical records included gender, age, marital status, occupations, burn season, place of residence, intention to burn, location of the accident, percent of total body surface area (%TBSA), the primary cause of burns, the body region of the burn, length of hospital stay (days), infection, and discharge status. The data were analysed using descriptive statistical methods and SPSS 24.0 software. Of the 10 133 burn patients treated in a burn centre in the north of Iran between 2011 and 2021, 1.2% had chemical burns. The average age of patients was 34.45 (SD = 22.16) years, and most chemical burns cases were male (70.6%, n = 89). Chemical burns occurred most frequently in patients aged 20 to 49 years (69.8%, n = 107), and most of the burns were accidental (84.9%, n = 107). The home was the most common place of chemical burn injury, accounting for 49.2% (62 cases), followed by the workplace (43.7%, n = 55), respectively. Most chemical burns occurred in the summer season (36.5%, n = 46), and acid (74.6%, n = 94) was the most common cause of chemical burns. The mean TBSA was 16.41 (SD = 15.10). The most common burn area was the lower limb (34.9%, n = 44), and the overall mortality rate was 4.8%. The average length of stay in the hospital was 6.53 (SD = 5.57) days. Community education on household safety, restricting non‐specialists' access to chemical substances, and the promotion of early consultation could reduce chemical burn prevalence and improve outcomes. [ABSTRACT FROM AUTHOR]

Total gestational weight gain (GWG) is identified as a strong and potentially controllable predictor of long-term health outcomes in women with gestational diabetes mellitus (GDM) and infants. When the total GWG of women with excess weight/obesity and GDM does not exceed the Institute of Medicine (IOM) suggested range, neonatal birthweight outcomes may be favorable, but the evidence is limited. Therefore, the objective of this study was to evaluate the dose-response relationship between increased total GWG and the risk of neonatal birthweight in Chinese women with excess weight/obesity and GDM. This study obtained electronic medical records (EMR) from the hospital information system (HIS) of the Chongqing Health Center for Women and Children between July 2017, and June 2020. A retrospective study analyzed the effect of the total GWG of women with excess weight/obesity and GDM on neonatal birthweight. The dose-response relationship between total GWG and neonatal birthweight was studied using a generalized linear model and embedded restricted cubic splines (RCS). The average age of all women with GDM was 31.99 ± 4.47 years, and 27.61% were advanced maternal age (≥35 years). The total GWG among women with excess weight and obesity and GDM greater than the IOM recommendations were found in 42.96% and 58.62% of cases, respectively. Total GWG in women with excess weight and excessing the IOM recommended range is a risk factor for large gestational age (LGA) [adjusted odds ratio (aOR) 0.1.47, 1.08–2.01] and macrosomia (aOR 1.55, 1.04–2.31). In the obesity above group, excessive weight gain increased the risk of LGA (aOR 2.92, 1.33–6.41) and macrosomia (aOR 2.83, 1.03–7.72). We used an RCS to examine pregnant women with excess weight and GDM and discovered a linear dose-response relationship between total GWG and LGA/macrosomia. In women with excess weight and obesity, increases in total GWG above the lowest end of the IOM recommendations range (7 kg and 5 kg) were associated with an increased risk of LGA and macrosomia. Therefore, research is urgently needed to support maternal and newborn health to provide recommendations for the ideal weight increase in women with excess weight/obesity and GDM. [ABSTRACT FROM AUTHOR]

Patient-centered care is recognized as a key element in recent healthcare management strategies. However, the integrated collection of patient feedback capturing the entire journey of patients with complex medical conditions remains understudied. Herein, we aimed to describe the development of an instrument prototype for the collection of PROMs and PREMs that would encompass a whole patient journey at a single time point. We further describe the process of its integration into a hospital's information system (HIS) and the results of a pilot feasibility study in adult patients with kidney and hematological diseases. We developed an instrument consisting of original PREM and generic EQ-5D-5L questionnaires. E-questionnaires were handled with REDCap software (version 12.5.14) and integrated into the HIS. Patients refusing to use e-questionnaires (48%) were offered paper administration and were older (64 vs. 50 years). The overall response rate for e-questionnaires was 57.1% with a median completion time of 2.0 and 3.7 min for PROM and PREM, respectively. Psychological and social services and primary care setting (diagnosis establishment and involvement in continuous care) were identified as most problematic. The majority of PREM dimensions encompassing different levels of care significantly correlated with PROM responses. Our data indicate the feasibility and potential relevance of the proposed approach, although wider-scale studies in diverse settings are needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: One of the complications of chronic transfusions in thalassemia is the development of red cell alloimmunization. AIMS: The aim of the study was to determine the frequency, specificity of red cell alloantibodies, and factors influencing alloimmunization in multiply transfused thalassemia patients. MATERIALS AND METHODS: The study was carried out prospectively on beta-thalassemia patients over 10 months. Plasma samples were used for antibody screening and identification using the column agglutination technique. Patients' clinical, laboratory, and transfusion details were obtained from hospital information system and patient files. STATISTICAL ANALYSIS: Continuous variables were reported as median and quartile, whereas categorical variables were provided as numbers and proportions. P < 0.05 was considered statistically significant. RESULTS: Out of 255 patients, 17 (6.6%) patients developed alloantibodies. Alloimmunized patients had significantly higher median ages at their first transfusions (1 year vs. 0.5 years; P = 0.042) than nonalloimmunized patients. Alloimmunized patients had significantly higher conjugated bilirubin (P = 0.016) and serum ferritin (P = 0.007). The majority of alloantibodies had specificity toward K antigen, followed by E, C, D, JKa, and JKb antigens. Alloimmunized patients received more units per year than nonalloimmunized patients (median, 30 vs. 24 units; P < 0.001). The average transfusion interval time between two successive transfusions showed a significant difference (P < 0.001). CONCLUSIONS: The prevalence of alloimmunization in thalassemia patients in North India is relatively low. Since most of the alloantibodies belong to Rh and Kell blood group system, extended phenotype-matched blood for Rh and Kell will be helpful in further preventing or decreasing the development of alloantibodies in multiply transfused thalassemia patients. [ABSTRACT FROM AUTHOR]

The Internet of Things (IoT) is a concept that refers to the deployment of Internet Protocol (IP) address sensors in health care systems to monitor patients' health. It has the ability to access the Internet and collect data from sensors. Automated decisions are made after evaluating the information of illness people records. Patients' health and well-being can be monitored through IoT medical devices. It is possible to trace the origins of biological, medical equipment and processes. Human reliability is a major concern in user activity and fitness trackers in day-to-day activities. The fundamental challenge is to measure the efficiency of the human system accurately. Aim to maintain tabs on the well-being of humans; this paper recommends the use of wireless body area networks (WBANs) and artificial neural networks (ANN) to create an IoT-based healthcare framework for hospital information systems (IoT-HF-HIS). Our evaluation system uses a server to estimate how much computing power is needed for modeling, and simulations of the framework have been done using data rate and latency requirements are implementing the energy-aware technology presented in this paper. The proposed framework implements several hospital information system case studies by building a time-saving simulation environment. As the world's population ages, more and more people suffer from physical and emotional ailments. Using the recommended strategy regularly has been proven user-friendly, reliable, and cost-effective, with an overall performance of 95.2%. [ABSTRACT FROM AUTHOR]

Background: The registry systems are a tool to provide information which can be used for improvement of medical care and preventive policies over time. The efficacy of trauma registries in improving the quality of care depends on the quality of their data. Objectives: This study aimed to determine the completeness, reliability, validity, and patient coverage of the Sina Hospital Trauma Registry (SHTR). Methods: The data collected in the SHTR by May 28, 2021, were used to assess the data completeness. A random sample of 250 patients was re-registered to evaluate the reliability and validity. The intraclass correlation coefficient (ICC) and the kappa and weighted kappa statistics were used to assess the reliability of data and agreement. The coverage was determined by comparing the list of trauma patients obtained from the trauma registry and the one from the hospital information system. Results: The overall average completeness for all variables was 97.9%. The inter-rater agreement on important variables including Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), and final outcomes was, respectively, perfect (kappa= 0.90) optimal (ICC = 0.72), and substantial (kappa= 0.71). The patient coverage was 79.6%. Conclusion: The results confirm that the data quality and patient coverage were high. In addition, although the reliability of most variables was acceptable, the agreement between NTRI's data and the medical record for AIS codes and ISS was moderate. [ABSTRACT FROM AUTHOR]

In this study, we discussed our contribution to building a data analytic framework that supports clinical statistics and analysis by leveraging a scalable standards-based data model named Fast Healthcare Interoperability Resource (FHIR). We developed an intelligent algorithm that is used to facilitate the clinical data analytics process on FHIR-based data. We designed several workflows for patient clinical data used in two hospital information systems, namely patient registration and laboratory information systems. These workflows exploit various FHIR Application programming interface (APIs) to facilitate patient-centered and cohort-based interactive analyses. We developed an FHIR database implementation that utilizes FHIR APIs and a range of operations to facilitate descriptive data analytics (DDA) and patient cohort selection. A prototype user interface for DDA was developed with support for visualizing healthcare data analysis results in various forms. Healthcare professionals and researchers would use the developed framework to perform analytics on clinical data used in healthcare settings. Our experimental results demonstrate the proposed framework's ability to generate various analytics from clinical data represented in the FHIR resources. [ABSTRACT FROM AUTHOR]

Background: Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors. Methods: This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters. Results: Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality. Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO = 1.07), access rate to EMS (PO = 0.78), arrival time (evening shift vs. day shift, PO = 0.09), and sequelae variables (PO = 9.20) had a significant association with the odds of in-hospital stroke mortality (P < 0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas. Conclusion: Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule. [ABSTRACT FROM AUTHOR]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Aim: Iranian hospitals are provided with hospital information systems (HISs) from different vendors, which make it hardly possible to summarize laboratory data in an consistent manner. Therefore, there is a need to design a minimum data set of laboratory data that will define standard criteria and reduce potential medical errors. The purpose of this study was to design a minimum data set (MDS) of laboratory data for an electronic summary sheet to be used in the pediatric ward of Iranian hospitals. Methods: This study consists of three phases. In the first phase, out of 3997 medical records from the pediatric ward, 604 summary sheets were chosen as sample. The laboratory data of these sheets were examined and the recorded tests were categorized. In the second phase, based on the types of diagnosis we developed a list of tests. Then we asked the physicians of the ward to select which ones should be documented for each patient's diagnosis. In the third phase, the tests that were reported in 21%–80% of the records, and were verified by the same percentage of physicians, were evaluated by the experts' panel. Results: In the first phase, 10,224 laboratory data were extracted. Of these, 144 data elements reported in more than 80% of the records, and more than 80% of experts approved them to be included in the MDS for patients' summary sheet. After data elements were investigated in the experts' panel, 292 items were chosen for the final list of the data set. Conclusions: This MDS was designed such that, if implemented in hospital information systems, it could automatically enable registering data in the summary sheet when patient's diagnosis is registered. [ABSTRACT FROM AUTHOR]