Pedro Vieira-Marques

Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

BackgroundThe integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS.MethodsThe literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing.ResultsOf 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters.ConclusionIt is clear that Information Systems are evolving to meet peoples needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability.

Secure Integration of Distributed Medical Data Using Mobile Agents

Healthcare is information driven and knowledge driven. Good healthcare depends on making decisions at the right time and place, using the right patient data and applicable knowledge. Communication is of utmost relevance in todays healthcare settings, in that delivery of care, research, and management all depend on sharing information. The proposed system can securely gather, integrate, and display distributed medical information using mobile-agent technology and agent-driven security

Periodontal inflammation in renal transplant recipients receiving Everolimus or Tacrolimus – preliminary results

OBJECTIVE To compare oral health status between renal transplant recipients (RTRs) receiving tacrolimus (Tac) or everolimus (ERL) as immunosuppressive therapy. DESIGN This study is a cross-sectional study. METHODS Thirty-six RTRs receiving Tac and 22 RTRs receiving ERL were included in the study. Age, gender, time since transplant and pharmacological data were recorded for both groups. Oral health status was assessed through the evaluation of teeth, periodontal parameters as well as saliva flow rate and pH. RESULTS RTRs receiving ERL were older than those receiving Tac. No differences were found between groups concerning oral hygiene habits, oral symptoms, smoking habits, unstimulated and stimulated saliva flow rate and pH, clinical attachment level or the number of decayed, missing and filled teeth. However, RTRs receiving ERL presented lower visible plaque index and lower values for bleeding on probing when compared to RTRs receiving Tac. In addition, RTRs receiving ERL presented a gingival index varying from normal to moderate inflammation whereas RTRs receiving Tac presented a gingival index varying from mild to severe inflammation. CONCLUSIONS RTRs receiving ERL have lower periodontal inflammation when compared to RTRs receiving Tac.

Simulation environment for the optimization of the data retrieval capabilities of an agent based system in a healthcare setting

A Virtual Electronic Patient Record (VEPR) has been deployed at Hospital de S. Joao since 2005, that retrieves and integrates clinical record data. One of its modules is a Multi-Agent system for Integration of Data (MAID) that provides automatic report retrieval from departmental systems. The currently deployed MAID uses a static interval for the retrieval of report references. As each department differs in report production rate throughout the day there was a need to optimize and adapt the report reference retrieval to each departmental system. As this optimization could not be done with the deployed system, a simulation environment was developed that enables the testing and comparison of different optimization options using real past report data as reference. The use of the simulation environment has proven to be essential for the development of the optimization solution as it allows the comparison of variables related to the optimization process.

Relevant Lifelong Nutrition Information for the Prevention and Treatment of Childhood Obesity - Design and Creation of New openEHR Archetype Set

Introduction: The worldwide prevalence of obesity had a drastic increase in childhood/ adolescents. In 2014, it was estimated that 41 million children in all world, under the age of 5 were overweight or obese. Despite all the efforts, the number of overweight and obese children/adolescents is rising in almost all countries. Meanwhile, some points impaired the healthcare professionals to follow obesity guideline clinical practice (CPG). Information systems have an important role to play in the maintaining of this reality. Aim: To propose a set of archetypes for the integration of CPG recommendations for treatment and prevention of obesity in children and adolescents in an openEHR based Electronic Health Record (EHR). Methods: We assessed obesity guidelines as National Heart, Lung and Blood Institute (NHLBI), American Academic of Paediatrics (AAP), Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), World Health Organization (WHO) and Dietary Reference Intake (DRI) and selected the most representative variables in nutrition parameters (anthropometry, body composition, nutrients intake, etc.) in order to create/ find archetypes in Clinical Knowledge Manager (CKM) repository, and, finally, compose a template in openEHR. Results: 38 variables were identified in guidelines. However, only 22 archetypes were necessary to represent all of them. Of these 22 archetypes, 8 are already available in CKM, while 14 clinical statements had no archetype representation and they had to be created. Conclusion: Based on the created archetypes, an openEHR template can be created for the representation of clinical statements regarding the most important clinical guidelines in obesity. This template can be used by nutritionists and others health professionals to manage data relevant to obesity care.

Phishing Through Time: A Ten Year Story based on Abstracts.

For a researcher interested in phishing, it would be useful to access an overview of phishing evolution through time, where a set of methods, tools, solutions, user studies, type of attacks, countermeasures and so on, could be acquired from a single story. This story is essential for the security community to improve on existing research as well as build new effective countermeasures to face phishing attacks. However, no systematic review exists in the literature providing a wide overview of all phishing topics. Available reviews usually focus on one or two at a time. In fact, since there is widely available and varied literature on phishing, making a comprehensive review can take a long time and be cumbersome. This paper describes a method to perform a review on abstracts of 605 scientific papers selected from major online research databases, between 2006 and 2016. The study uses a qualitative categorization software to, for the first time, achieve a story of phishing trends in its existing research strands for that period. According to obtained results, no single solution for the phishing threat could yet be found and most research is turning now into more integrated socio-technical and human related solutions.

Evaluation of skills acquisition using a new low-cost tool for CPR self-training

Background: High-quality cardiopulmonary resuscitation (CPR) remains essential to improve the outcome of patients in sudden cardiorespiratory arrest. Feedback on performance is a crucial component of the learning processes associated with simulation and has been shown to improve CPR quality during simulated cardiac arrest on mannequins. This study aims to evaluate skills acquisition using a new low-cost feedback device for CPR self-training when compared to standard training methods. Methods: Thirty-nine pregraduated medical and biomedical engineering students were recruited for a longitudinal double-blinded randomized control study. For training Basic Life Support skills, the control group used a standard task-trainer and received feedback from an instructor. The intervention group used the same standard task-trainer, instrumented with the CPR Personal Trainer that provided automated performance feedback (with no instructor) on compression-related parameters. Students’ knowledge and skills were assessed before and after training, through a theoretical knowledge test and 2 minutes of CPR practical performance. Results: The theoretical tests showed an improvement both in the intervention and in the control group. For each compression-related parameters (hands position, recoil, rate, and depth), significant increase in scores is observed, between the pre- and the post-test, in both groups. The intervention and control groups presented identical mean differences for the total score (0.72 vs 0.72), with no statistical difference (P = 0.754). Conclusions: The proposed tool proved to be effective in the acquisition of compression-related skills, with similar outcomes as the traditional instructor-based method, corroborating the hypothesis that a low-cost tool with feedback for CPR self-training can provide an alternative or a complementary extension to traditional training methods. The system can also be considered cost-efficient as it reduces the permanent presence of an instructor for the chest compressions training, promoting regular training outside formal training courses.

Do students from public schools fare better in medical school than their colleagues from private schools? If so, what can we learn from this?

BackgroundInternal grade inflation is a documented practice in secondary schools (mostly in private schools) that jeopardises fairness with regard to access to medical school. However, it is frequently assumed that the higher internal grades are in fact justifiable, as they correspond to better preparation of students in private schools in areas that national exams do not cover but nevertheless are important. Consequently, it is expected that students from private schools will succeed better in medical school than their colleagues, or at least not perform worse. We aimed to study whether students from private schools do fare better in medical school than their colleagues from public schools, even after adjusting for internal grade inflation.MethodsWe analysed all students that entered into a medical course from 2007 to 2014. A linear regression was performed using mean grades for the 1st-year curse units (CU) of the medical school curriculum as a dependent variable and student gender, the nature of students’ secondary school (public/private), and whether their secondary school highly inflated grades as independent variables.A logistic regression was also performed, modelling whether or not students failed at least one CU exam during the 1st year of medical school as a function of the aforementioned independent variables.ResultsOf the 1709 students analysed, 55% came from public secondary schools. Private (vs. public) secondary school (β = − 0.459, p < 0.001) and whether secondary schools highly inflated grades (β = − 0.246, p = 0.003) were independent factors that significantly influenced grades during the first year of medical school. Having attended a private secondary school also significantly increased the odds of a student having failed at least one CU exam during the 1st year of medical school (OR = 1.33), even after adjusting for whether or not the secondary school used highly inflated grades.ConclusionsIt is important to further discuss what we can learn from the fact that students from public secondary schools seem to be better prepared for medical school teaching methodologies than their colleagues from private ones and the implications for the selection process.

Nutrigenomic Information in the openEHR Data Set

BACKGROUND The traditional concept of personalized nutrition is based on adapting diets according to individual needs and preferences. Discussions about personalized nutrition have been on since the Human Genome Project, which has sequenced the human genome. Thenceforth, topics such as nutrigenomics have been assessed to help in better understanding the genetic variation influence on the dietary response and association between nutrients and gene expression. Hence, some challenges impaired the understanding about the nowadays important clinical data and about clinical data assumed to be important in the future. OBJECTIVE Finding the main clinical statements in the personalized nutrition field (nutrigenomics) to create the future-proof health information system to the openEHR server based on archetypes, as well as a specific nutrigenomic template. METHODS A systematic literature search was conducted in electronic databases such as PubMed. The aim of this systemic review was to list the chief clinical statements and create archetype and templates for openEHR modeling tools, namely, Ocean Archetype Editor and Ocean Template Design. RESULTS The literature search led to 51 articles; however, just 26 articles were analyzed after all the herein adopted inclusion criteria were assessed. Of these total, 117 clinical statements were identified, as well as 27 archetype-friendly concepts. Our group modeled four new archetypes (waist-to-height ratio, genetic test results, genetic summary, and diet plan) and finally created the specific nutrigenomic template for nutrition care. CONCLUSION The archetypes and the specific openEHR template developed in this study gave dieticians and other health professionals an important tool to their nutrigenomic clinical practices, besides a set of nutrigenomic data to clinical research.

Proceedings of the 23rd Annual Meeting of the Society in Europe for Simulation Applied to Medicine

Introduction & Aims Medical simulation is an important technique to provide education as well as clinical evaluation with physical examination. Simulation is now regarded as a strategy to improve safety of learning (to patient and student) and quality in real medical practice. The aim of this study was to evaluate students’ confidence levels in detection of heart and respiratory murmurs with Harvey the Cardiopulmonary Patient Simulator compared to real patients with cardiopulmonary disorders. Methods Three hundred and eighty 3 year medical students underwent prestudy multiple-choice question test (MCQ) to assess their confidence of cardiopulmonary examination and to detect cardiopulmonary murmurs. Three hundred and eleven students successfully passed (>51% test score). They were divided in two groups: G1 (n=155) firstly examine patients with cardiopulmonary disorders pneumonia with crackles (CR), bronchial asthma with wheezes (WZ), typical mitral stenosis (MS) and aortic stenosis (AS) and then participate in the Harvey simulation (the same scenarios). G2 (n=156) firstly participate in the Harvey simulation and then examine real patients. At the end, all the students completed the post-study MCQ to assess their confidence in detecting murmurs. Statistical analysis was performed using Statistica 10.0. Data was presented as M±SD. For comparison of frequency we used x2-criterion. Mann-Whitney and multiple logistic regression analysis were performed. P <0.05 was considered statistically significant. Results & Discussion 311 students completed all surveys. There was no difference in mean pre-study score between groups (58% vs 63%, p>0.05). After completing the first activity there were no differences in detecting CR and WZ between groups (74% vs 72%, 80 vs 78%, p>0.05 respectively), but there was significantly higher confidence in detecting MS and AS in G2 (50 vs 72%, x2= 15,1, p<0.001 and 82% vs 94%, x2= 11,2, p<0.001). After completing second activity, significant increase of confidence level in detection of MS, especially in G1 was observed (for detail information see Table 1). The mean score of post-study MCQ increase in both groups, but was higher in G2 (82 vs 90%, x2= 3,9, p<0.05).