Heimar de Fátima Marin

Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages

OBJECTIVE To assess whether a warning system based on mobile SMS messages increases the adherence of HIV-infected Brazilian women to antiretroviral drug-based treatment regimens and their impressions and satisfaction with respect to incoming messages. DESIGN A randomized controlled trial was conducted from May 2009 to April 2010 with HIV-infected Brazilian women. All participants (n=21) had a monthly multidisciplinary attendance; each participant was followed over a 4-month period, when adherence measures were obtained. Participants in the intervention group (n=8) received SMS messages 30 min before their last scheduled time for a dose of medicine during the day. The messages were sent every Saturday and Sunday and on alternate days during the working week. Participants in the control group (n=13) did not receive messages. MEASUREMENTS Self-reported adherence, pill counting, microelectronic monitors (MEMS) and an interview about the impressions and satisfaction with respect to incoming messages. RESULTS The HIV Alert System (HIVAS) was developed over 7 months during 2008 and 2009. After the study period, self-reported adherence indicated that 11 participants (84.62%) remained compliant in the control group (adherence exceeding 95%), whereas all 8 participants in the intervention group (100.00%) remained compliant. In contrast, the counting pills method indicated that the number of compliant participants was 5 (38.46%) for the control group and 4 (50.00%) for the intervention group. Microelectronic monitoring indicated that 6 participants in the control group (46.15%) were adherent during the entire 4-month period compared to 6 participants in the intervention group (75.00%). According to the feedback of the 8 participants who completed the research in the intervention group, along with the feedback of 3 patients who received SMS for less than 4 months, that is, did not complete the study, 9 (81.81%) believed that the SMS messages aided them in treatment adherence, and 10 (90.90%) responded that they would like to continue receiving SMS messages. CONCLUSION SMS messaging can help Brazilian women living with HIV/AIDS to adhere to antiretroviral therapy for a period of at least 4 months. In general, the results are encouraging because the SMS messages stimulated more participants in the intervention group to be adherent to their treatment, and the patients were satisfied with the messages received, which were seen as reminders, incentives and signs of affection by the health clinic for a marginalized population.

Perspectivas atuais da Informática em Enfermagem

Nursing Informatics is the area of knowledge that studies the application of technological resources in teaching, in practice, in care, and in the management of care. Resources such as voice recognition, knowledge base, genoma project and even Internet have offered to Nursing a gama of possibilities for a better professional performance and better nursing care to the patient/client. This text reports and exemplifies how these resources are impacting and presenting new oportunities for teaching, research and specially for nursing care, still warns for the importance of humanized care in a high-tech scenario.Nursing Informatics is the area of knowledge that studies the application of technological resources in teaching, in practice, in care, and in the management of care. Resources such as voice recognition, knowledge base, genoma project and even Internet have offered to Nursing a gama of possibilities for a better professional performance and better nursing care to the patient/client. This text reports and exemplifies how these resources are impacting and presenting new oportunities for teaching, research and specially for nursing care, still warns for the importance of humanized care in a high-tech scenario. Descriptors: Informatics; Nursing informatics; Knowledge bases.

Collaborative Efforts for Representing Nursing Concepts in Computer- based Systems: International Perspectives

Current nursing terminology efforts have converged toward meeting the demand for a reference terminology for nursing concepts by building on the foundation of existing interface and administrative terminologies and by collaborating with terminology efforts across the spectrum of health care. In this article, the authors illustrate how collaboration is promoting convergence toward a reference terminology for nursing by briefly summarizing a wide range of exemplary activities. These include: 1) the International Classification of Nursing Practice (ICNP) activities of the International Council of Nurses (ICN), 2) work in Brazil and Korea that has contributed to, and been stimulated by, ICNP developments, 3) efforts in the United States to improve understanding of the different types of terminologies needed in nursing and to promote harmonization and linking among them, and 4) current nursing participation in major multi-disciplinary standards initiatives. Although early nursing terminology work occurred primarily in isolation and resulted in some duplicative efforts, the activities summarized in this article demonstrate a tremendous level of collaboration and convergence not only in the discipline of nursing but in multi-disciplinary standards initiatives. These efforts are an important prerequisite for ensuring that nursing concepts are represented in computer-based systems in a manner that facilitates multi-purpose use at local, national, regional, and international levels.

Artificial intelligence techniques applied to the development of a decision-support system for diagnosing celiac disease.

BACKGROUND Celiac disease (CD) is a difficult-to-diagnose condition because of its multiple clinical presentations and symptoms shared with other diseases. Gold-standard diagnostic confirmation of suspected CD is achieved by biopsying the small intestine. OBJECTIVE To develop a clinical decision-support system (CDSS) integrated with an automated classifier to recognize CD cases, by selecting from experimental models developed using intelligence artificial techniques. METHODS A web-based system was designed for constructing a retrospective database that included 178 clinical cases for training. Tests were run on 270 automated classifiers available in Weka 3.6.1 using five artificial intelligence techniques, namely decision trees, Bayesian inference, k-nearest neighbor algorithm, support vector machines and artificial neural networks. The parameters evaluated were accuracy, sensitivity, specificity and area under the ROC curve (AUC). AUC was used as a criterion for selecting the CDSS algorithm. A testing database was constructed including 38 clinical CD cases for CDSS evaluation. The diagnoses suggested by CDSS were compared with those made by physicians during patient consultations. RESULTS The most accurate method during the training phase was the averaged one-dependence estimator (AODE) algorithm (a Bayesian classifier), which showed accuracy 80.0%, sensitivity 0.78, specificity 0.80 and AUC 0.84. This classifier was integrated into the web-based decision-support system. The gold-standard validation of CDSS achieved accuracy of 84.2% and k=0.68 (p<0.0001) with good agreement. The same accuracy was achieved in the comparison between the physicians diagnostic impression and the gold standard k=0. 64 (p<0.0001). There was moderate agreement between the physicians diagnostic impression and CDSS k=0.46 (p=0.0008). CONCLUSIONS The study results suggest that CDSS could be used to help in diagnosing CD, since the algorithm tested achieved excellent accuracy in differentiating possible positive from negative CD diagnoses. This study may contribute towards developing of a computer-assisted environment to support CD diagnosis.

Desenvolvimento de um sistema de alerta para prevenção de quedas em pacientes hospitalizados

Este estudo descreve a analise de um Sistema computadorizado de avaliacao do paciente no desenvolvimento de um sistema de alerta para prevenir quedas de pacientes hospitalizados. Foi realizada a revisao de prontuarios para identificar os fatores de risco presentes no referido instrumento de avaliacao. As variaveis identificadas foram: estado funcional do paciente incluindo andar, transferir-se e toilete, sexo e habilidade de realizar auto-cuidado. Usando tais variaveis, foi desenvolvido um sistema de alerta que encontra-se disponibilizado desde Fevereiro de 1997. Em uma segunda etapa, pretende-se estudar o impacto deste sistema na qualidade do atendimento de enfermagem.The present study describes the analysis of an online patient assessment system developed to prevent inpatients falls. A chart review was performed in order to identify risk factors present in the Nursing Assessment tool. The identified variables were Functional status including walking, transferring and toilet, sex and patients self-care ability. Authors developed a system using these variables, that is available since February 1997. In a second phase of this study, authors aim to evaluate the effectiveness of this computerized intervention.

Enfermagem na WEB: o processo de criação e validação de um WEB site sobre doença arterial coronariana

A World Wide Web e uma importante fonte a pesquisa da informacao de saude. Um desafio para a area de Informatica em Enfermagem brasileira e o de usar esse potencial para promover a educacao em saude. Este artigo objetiva apresentar um modelo de criacao e validacao usado em um Web site educativo, denominado CardioSite, cujo tema e a Doenca Arterial Coronariana. Para a criacao do mesmo, foi adotado um metodo com fases de modelagem conceitual, de desenvolvimento, de implementacao e de avaliacao. Na fase de avaliacao, a validacao foi feita atraves de um painel on-line com especialistas nas areas de informatica e saude. Os resultados demonstraram que as informacoes sao confiaveis e validas. Considerando a inexistencia de sistemas nacionais oficiais com esse proposito, este modelo demonstrou-se efetivo para avaliar a qualidade do conteudo do Web site.

Terminologia de referência em enfermagem: a Norma ISO 18104

This article describes the ISO 18104 standard, published in 2003 by the International Organization for Standardization Technical Committee 215 (ISO/TC). The standard consists of reference terminology model for nursing diagnoses and interventions. The reference terminology is an instrument that facilitates the mapping of several available terminologies, which promotes the integration of the healthcare information systems and electronic medical records.

Proposta de um instrumento de avaliação da saúde do idoso institucionalizado baseado no conceito do Conjunto de Dados Essenciais em Enfermagem

Este artigo tem como objetivo apresentar o instrumento de avaliacao de saude do idoso institucionalizado desenvolvido com a utilizacao do conceito de Conjunto de Elementos Essenciais de Enfermagem dividido em duas secoes: identificacao e avaliacao de saude. Trata-se de uma pesquisa metodologica sobre o desenvolvimento de um instrumento de coleta de dados. O instrumento constitui-se de duas secoes: Secao A com as informacoes de identificacao na admissao, e a Secao B e o Formulario de Avaliacao Total, contendo dados dos padroes cognitivos, de comunicacao, audicao, visao, humor e comportamento e condicoes fisiologicas e nutricionais. Conclui-se que este instrumento e uma ferramenta capaz de agregar os dados mais importantes para subsidiar a assistencia de enfermagem na atencao ao idoso institucionalizado.This article aims at presenting a health evaluation tool for the institutionalized aged developed under the concepts of the Nursing Minimum Data Set (NMDS) divided in two sections: identification and health evaluation. It is a methodological research about the development of a data collection tool. The tool is constituted of two sections: Section A contains identification data in the admission, and Section B is the Total Assessment Form, containing data of cognitive, communication, hearing, vision, mood and behavior patterns, and physiological and nutritional conditions. It was concluded that this tool is capable of aggregating the most important data to subside nursing assistance in the care of the institutionalized aged.

Conjunto de Dados Mínimos de Enfermagem: construindo um modelo em sáude ocupacional

PURPOSE: to review the concept of the Nursing Minimum Data Set, its current usage, and explore its potential use in Occupational Health. METHODS: systematic review of the literature. RESULTS: the Nursing Minimum Data Set can be applied to occupational health because it documents essential data from individuals and organizations. In addition, it allows nurses to organize Occupational Health services, collect and analyze data, and generate new useful information. CONCLUSION: the Nursing Minimum Data Set may be a useful tool in Occupational health clinical practice.OBJETIVOS: presentar el concepto del Conjunto de Datos Minimos de Enfermeria, incluyendo una vision global de los trabajos desarrollados, y construir un concepto de interes del Conjunto de Datos Esenciales de Enfermeria en Salud Ocupacional. METODOS: revision bibliografica. RESULTADOS: el Conjunto de Datos Minimos de Enfermeria aplicado a la Salud Ocupacional, con una estructura capaz de captar los dados esenciales de los individuos y de las organizaciones, en la determinacion del proceso trabajo-salud-enfermedad, puede permitir que el enfermero conquiste un espacio en los servicios de salud ocupacional, en la medida que la recoleccion y analisis de estos datos sean transformados en informacion. CONCLUSIONES: como herramienta de soporte para la practica profesional, este estudio en desarrollo tiene la finalidad de construir un modelo de conjunto de datos en enfermeria en la salud ocupacional.

Diagnósticos de enfermagem em mulheres que freqüentam serviço de planejamento familiar

The purpose of this study was to identify nursing diagnoses in women enrolled in a family planning program. An instrument of data collection was elaborated according to the Functional Health Patterns. The sample consisted of 100 adult women. Forty-nine nursing diagnoses, of which 9 with a frequency equal or higher to 45.0% were identified. Further studies are still needed in institutions that offer assistance in the area of family planning in order to examine if the nursing diagnoses found in these women can be generalized to the population.