Background: Shared decision-making (SDM) counseling for lung cancer screening is recommended by multiple professional societies and mandated by the Center for Medicare and Medicaid Services since lung cancer screening has both benefits and risks. However, uptake of SDM counseling as well as lung cancer screening itself remain low. We sought to develop educational text messages about lung cancer screening as an innovative implementation intervention tool to promote patient-provider discussion about lung cancer screening. Methods: After the study team drafted educational text messages about lung cancer screening, informed by existing decision aids, participants who had had lung cancer screening were recruited and asked to review and edit text messages. After that, participants eligible for lung cancer screening without the previous screening experience were recruited and were asked to select the messages to be included in this text message intervention. The final set of 14 text messages were delivered to the participants both with and without the previous lung cancer screening over a period of 14 days. Participants completed a telephone survey assessing their reactions to the messages after receiving the last message. Results: We successfully involved twelve participants with lung cancer screening experience and eleven lung cancer screening eligible participants without previous screening experience in the development of educational text messages about lung cancer screening. After one participant withdrew, 22 participants received text messages and completed the survey regarding the messages. Most participants (18 of 22) reported reading all 14 text messages, however most recommended sending fewer messages (median recommended number of messages = 10). Participants found the educational text messages informative. Only four participants reported the text messages triggered anxiety and two reported text messages disrupted their daily activities. Participants perceived the text messages would empower patients to discuss lung cancer screening with their providers. Conclusion: Participants generally supported the use of educational text messages about lung cancer screening to increase patients’ awareness and promote patient-provider discussion. Engaging patients in the development and evaluation of text messages elicited helpful feedback that will inform the content of the messages to be delivered via this lung cancer screening text messages intervention.

<p>  </p> <p>Although community pharmacists have further reduced medication errors and improved care with access to patient data through unidirectional health information exchange (HIE), access to routine patient data has not been sustained. Several barriers to sustaining use and access of HIE in community pharmacies have been noted, such as lack of implementation supports and technological restrictions. Further, pharmacists and pharmacy technicians have not been involved in the development of HIE systems for their use previously. My research aims to optimize HIE access for community pharmacists through our co-developed HIE interface prototype specifically for use by community pharmacy teams in collaboration with PioneerRx, a pharmacy dispensing software system and our state HIE, the Indiana Health Information Exchange (IHIE), and provide supports for the sustainability of community pharmacist access to HIE.</p> <p>Therefore, the objectives of my research are to 1) conduct a formative usability evaluation of the HIE interface prototype with community pharmacists and pharmacy technicians to inform strategies to improve the HIE interface design for future implementation in community pharmacies (“<em>Study One”</em>) and 2) identify the potential barriers, facilitators, and recommendations for HIE implementation in community pharmacies through semi-structured interviews to create a curated list of resources to address identified implementation needs to assist with the future implementation of HIE (“<em>Study Two”</em>).</p> <p>The findings from Study One demonstrate the HIE interface prototype was viewed favorably by pharmacists and pharmacy technicians, with the average System Usability Scale (SUS) score 69 (scale 0 – 100, where 100 is the best). Pharmacists reported higher satisfaction than technicians on average (74 vs. 65, respectively). Key problems identified included accessibility of HIE links and placement in the existing workflow and application label name clarifications. The same eight pharmacists and eight pharmacy technicians, with the addition of seven patients, completed interviews in Study Two. Five barriers, four facilitators, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE, guidance on workflow and team roles, and provider and patient facing resources for discussing HIE. Curated draft implementation resource items that are responsive to all four key implementation needs are in development. The combination of findings from Study One and Study Two create the blueprint for pharmacy-team informed implementation of HIE in community pharmacies.</p>

There is an international increase of patients’ access to medical information through digital patient portals. This has provided access to test results from different laboratories, including clinical pathology. Patients have reported several benefits with access to test results but there are concerns from clinicians over their ability to interpret and understand pathology reports independently. Research that has explored the perspectives of laboratory personnel in clinical pathology in this accessis lacking, who can provide further insights and potential risks and effects for the patients. The aim of this study is to examine the perspectives of pathologists and biomedical scientists in clinical pathology in relation to patients’ digital access to pathology reports through patient portals. Using a qualitative design twelve interviews were conducted with six pathologists and six biomedical scientists. The results was coded and analyzed using the qualitive computer analysis program Dedoose and a thematic analysis. The results showed a generally more negative attitude from pathologists and biomedical scientists towards patients’ access to pathology reports through patient portals. They believed patients needed further resources and support to interpret the pathology reports. Future research and implementation of this digital access should consider including laboratory personnel in clinical pathology as they can provide valuable insights for the resources needed for the interpretation of pathology reports.

Deep learning models are increasingly used to analyze health records to model disease progression. Two characteristics of health records present challenges to developers of deep learning-based medical systems. First, the veracity of the estimation of missing health data must be evaluated to optimize the performance of deep learning models. Second, the currently most successful deep learning diagnostic models, called transformers, lack a mechanism to analyze the temporal characteristics of health records. In this thesis, these two challenges are investigated using a real-world medical dataset of longitudinal health records from 340,143 patients over ten years called MIIDD: McMaster Imaging Information and Diagnostic Dataset. To address missing data, the performance of imputation models (mean, regression, and deep learning) were evaluated on a real-world medical dataset. Next, techniques from adversarial machine learning were used to demonstrate how imputation can have a cascading negative impact on a deep learning model. Then, the strengths and limitations of evaluation metrics from the statistical literature (qualitative, predictive accuracy, and statistical distance) to evaluate deep learning-based imputation models were investigated. This research can serve as a reference to researchers evaluating the impact of imputation on their deep learning models. To analyze the temporal characteristics of health records, a new model was developed and evaluated called DTTHRE: Decoder Transformer for Temporally-Embedded Health Records Encoding. DTTHRE predicts patients' primary diagnoses by analyzing their medical histories, including the elapsed time between visits. The proposed model successfully predicted patients' primary diagnosis in their final visit with improved predictive performance (78.54 +/- 0.22%) compared to existing models in the literature. DTTHRE also increased the training examples available from limited medical datasets by predicting the primary diagnosis for each visit (79.53 +/- 0.25%) with no additional training time. This research contributes towards the goal of disease predictive modeling for clinical decision support. / Dissertation / Doctor of Philosophy (PhD) / In this thesis, two challenges using deep learning models to analyze health records are investigated using a real-world medical dataset. First, an important step in analyzing health records is to estimate missing data. We investigated how imputation can have a cascading negative impact on a deep learning model's performance. A comparative analysis was then conducted to investigate the strengths and limitations of evaluation metrics from the statistical literature to assess deep learning-based imputation models. Second, the most successful deep learning diagnostic models to date, called transformers, lack a mechanism to analyze the temporal characteristics of health records. To address this gap, we developed a new temporally-embedded transformer to analyze patients' medical histories, including the elapsed time between visits, to predict their primary diagnoses. The proposed model successfully predicted patients' primary diagnosis in their final visit with improved predictive performance (78.54 +/- 0.22%) compared to existing models in the literature.

No description available.

Introdução: No Brasil, a maioria dos nascimentos é por cirurgia cesárea (CC), sendo amplamente utilizada no setor privado, mesmo com pesquisas indicando que quando as taxas de CC ultrapassam10-15%, os riscos adicionais superam os benefícios. A informação sobre benefícios e riscos das intervenções é fundamental para uma assistência segura e efetiva. É considerável o aumento de busca na web durante a gestação, no entanto, a qualidade das informações é questionável. Objetivo: avaliar a qualidade e abrangência das informações disponíveis sobre cesariana para leigos, em português, após um conjunto de políticas públicas para regular esta prática (2014/2015), na internet em geral e no site da Federação Brasileira de Associações de Ginecologia e Obstetrícia (FEBRASGO). Métodos: Trata-se de estudo documental observacional, transversal e analítico. A palavra \"cesárea\" e 25 sinônimos foram submetidos no campo de procura do site da FEBRASGO e em cinco motores de pesquisa para avaliar a preferência dos termos de busca. Os links catalogados foram analisados por dois pesquisadores independentes utilizando dois checklists: o DISCERN e um checklist específico para conteúdo. Adicionalmente, apresentou-se um debate sobre o sentido do nascimento, o ciberativismo e as políticas público no Brasil. Optou-se pela apresentação da tese no formato de três publicações, sendo duas já submetidas. Resultados: A palavra \"cesaria\" é a forma mais frequente, seguida de \"cesarea\". Na análise do conteúdo geral da internet, a produção de dado proveniente do Google.com.br representou apenas 45,5% (n = 235, 2018), sendo que este buscador tem a preferência de 94,5% dos brasileiros. Um terço do conteúdo esteve associado com informações relativas à recuperação da CC, resultado similar ao apontado pelo Google Trends com termos preferencias de busca na internet. As páginas Web foram melhor avaliadas em 2018 que em 2013, principalmente no critério de confiabilidade. O número páginas Web obtídos em 2018 foi 33% maior que em 2013, sendo que 93% eram inéditas. No site da FEBRASGO, foram observadas três fases distintas: 1) sem informação para leigos sobre CC, até 2014; 2) momento defensivo, onde os conteúdos estavam associados às medidas de redução de CC; 3) informativo, melhor redigido e autoral em 2018, porém, sem debater indicações, riscos e seu uso abusivo, no qual a CC é apenas citada dentro de outros temas. O debate sobre os ritos, mitos e as narrativas utilizadas no nascimento institucionalizado do Brasil traçou um paralelo teórico dos estudos entre o interacionismo simbólico de Mead e Blumer, com Davis Floyd e Diniz. Conclusões: Comparando os períodos de 2013 e 2018, nota-se melhora na confiabilidade da informação, porém, com uma queda do número de indicações e danos potenciais, e mais informação sobre recuperação. A cesárea é tratada frequentemente como fato consumado, tema que as gestantes estão mais interessadas. As associações médicas profissionais não tem promovido a devida informação sobre gravidez e parto, em linguagem apropriada para leigos, a Febrasgo poderia ocupar um lugar de referência na apomediação da relação médico-paciente, através de uma área dedicada a pacientes. O questionamento à epidemia de cesáreas se beneficiou da participação de iniciativas coletivas que representam narrativas independentes, como de grupos organizados de usuárias. Para a oferta de informações úteis à promoção de melhores resultados maternos e infantis, é necessária a mobilização em todas esferas sociais, públicas e privadas, e entre movimentos sociais, para a produção de conteúdo sobre CS com bases científicas, e uma orientação aos profissionais de saúde em recomendar páginas Web de qualidade às gestantes / Introduction: In Brazil, the majority of births are due to cesarean surgery (CC), being widely used in the private sector, even with research indicating that when CC rates exceed 10-15%, the additional risks outweigh the benefits. Information on benefits and risks of interventions is critical to safe and effective care. There is a growing trend for web research during pregnancy; however, the quality of information found is questionable. Objectives: This research aims to evaluate the quality and comprehensiveness of available information on CC for laypeople in Portuguese, following implementation of a set of public policies aimed at regulating this practice (2014/2015), on the internet in general and on the website of the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO). Methods: An observational, transversal, analytical documentary research. The word \"cesarean\" and 25 synonyms were submitted in the search field of the FEBRASGO website and in five search engines to evaluate the preference of search terms.Two independent researchers using checklists to analyze the cataloged links: the DISCERN and a specific checklist for content.In addition, a debate was presented on the meaning of birth, cyberpolitics and public policies in Brazil.The thesis is presented in the article format, of the three publications, two already submitted.Results:The preliminary results on Internet search shows that the word \"cesaria\" is the most frequent form of the internet, followed by \"cesarea\". In the analysis of the general content of the internet, the production of data from Google.com.br represented only 45.5% (n = 235, 2018), and this search engine has the preference of 94.5% of Brazilians.One-third of the content was associated with CC recovery, a similar result to the one pointed out by Google Trends as preferences for internet search terms.The webpage (WP) number collected in 2018 was 33% higher than in 2013, and 93% of the previous were unpublished before. In 2018, WP were better endorsed than 2013 ones, particularly concerning the reliability criterion. On the FEBRASGO\'s website, analysis went through three phases: 1) no information for lay people about CC in 2014; 2) defensive texts associated with the CC reduction measures, in 2016; 3) a more informative, better written and authorial content in 2018, but with no debate on indications and abusive use of CC, only mentioned in other topic CC. The debate about the rites, myths and narratives used in the institutionalized birth of Brazil drew a theoretical parallel between the symbolic interactionism by Mead and Blumer and those by Davis Floyd and Diniz. Conclusions: When comparing the two periods, there is an improvement in the quality of information on CS, but with a decrease in the number of texts on indications and potential damages, as well as a rise on information about recovery from the surgery - often treated as a fait accompli - which is also a theme of great interest to pregnant women. Medical corporations have not promoted adequate information on pregnancy and childbirth in language appropriate for laypeople and need to be a reference in apomediation the physician-patient relationship through an area dedicated to patients. The questioning of the CS epidemy has benefited from the participation of collective initiatives that represent independent narratives, such as organized groups of healthcare consumers. To provide useful information that will improve the lives of mothers and infants, it\'s necessary to act in all social spheres, such as the public and the private, and across different social movements, producing CS related content based on scientific evidence, and guide healthcare professionals to recommending quality PW to pregnant women.

Digitalisering och införandet av hälsoinformationssystem som digitala journalsystem har inneburit många fördelar inom sjukvårdssektorn jämfört med de äldre pappersjournalsystemen, exempelvis genom en ökad möjlighet både dela och spara patientinformation. Dock så har även en hel del problem uppkommit med deras införande, varav en av de större är att de digitala journalsystem som finns inte är anpassade efter klinisk sjukvård och vårdpersonalens arbetssätt. Sjuksköterskor är en av de största användargrupperna av dessa digitala journalsystem och de är även den arbetsgrupp som har hand om patienterna på vårdavdelning dygnet runt. Därmed är deras arbete även starkt knutet till patienternas säkerhet. Denna studie har undersökt vilka patientsäkerhetsrisker som användning av digitala journalsystem medför vid sjuksköterskearbete på vårdavdelning. Det gjordes med hjälp av en kvalitativ ansats där en litteraturstudie, intervjuer och deltagande observationer genomfördes. Studiens resultat har bidragit till en ökad förstående för de patientsäkerhetsrisker som användning av digitala journalsystem vid sjuksköterskearbete medför samt en ökad förståelse för den kontext som digitala journalsystem används i. / Digitalization and the introduction of health information systems (such as the electronic health records) has contributed to many advantages within the healthcare industry, especially compared to the old paper-based system. For instance, an electronic health record makes it easier to archive and share patient information, but the advances these systems contribute is also accompanied by its fair share of problems. One of the main problems being that there is a mismatch between the electronic health records in use and the way the healthcare personnel work. Nurses are one of the biggest user groups of the electronic health records and they are also providing healthcare to the patients admitted to hospital wards 24/7. That means that their work is tightly intertwined with patient safety. This study has examined risks for patient safety connected to the use of electronic health records during nursing practice at hospital wards. The study was conducted using a qualitative approach with a literature study, interviews and participatory observations. The result of the study has contributed to increased knowledge and insights regarding patient risks connected to the use of electronic health records during nursing practice at hospital wards as well as an increased understanding for the context in which the electronic health records are used.

Introdução: A Atenção Básica do Sistema Único de Saúde SUS é definida pelo Ministério da Saúde como um conjunto de ações e serviços de saúde no âmbito individual e coletivo, desenvolvidos com práticas gerenciais, sanitárias e sociais participativas, através de ações complexas nos cuidados e atenção à saúde da população do seu território e fundamentada nos princípios da universalidade, integralidade e da eqüidade. Os sistemas de informática em saúde da atenção básica são tecnologias estratégicas na gestão e governança sobre a situação de saúde da população em cada nível de responsabilidade sanitária. O cerne de funcionamento dos sistemas de informática é o software. A literatura pesquisada relata que os softwares dos sistemas de informática em saúde apresentam vários aspectos: inflexibilidade para mudanças, altos custos, baixa eficácia, são frágeis em relação à segurança e a privacidade, não adotam padrões tecnológicos e de saúde, apresentam dificuldades na escalabilidade, são refratários a adaptações às culturas e línguas locais e induzem ao aprisionamento tecnológico dos sistemas de informação em saúde. Neste contexto, o objetivo deste estudo foi o de identificar e analisar quais são as contribuições e limitações do software livre para os sistemas de informática e informação na atenção básica do SUS. Metodologia: Estudo de caso exploratório e qualitativo, comparando dois municípios que utilizam software livre e software privativo nos sistemas de atenção básica do SUS, a partir de critérios obtidos na literatura pesquisada. Resultados: A utilização de software livre nos sistemas de atenção básica do SUS de Campinas e São Paulo apresentou limites nos seguintes tópicos, utilizados como critérios de análise: educação, segurança, privacidade e padrões abertos. A utilização do software livre demonstrou vantagens para os municípios estudados nos seguintes tópicos: custos, escalabilidade, autonomia tecnológica, adaptação do software ao idioma e à cultura local, estabilidade e impacto na qualidade dos serviços de saúde. Conclusão: O software livre é uma alternativa tecnológica viável, robusta e flexível e oferece novas perspectivas para a construção de sistemas de informática e informação da Atenção Básica em saúde / The Primary Health Care of the Brazilian Unified National Health System (SUS) is defined by the Health Ministry as a set of actions and services in the individual and collective scopes developed through managerial sanitary and social participative practices by means of complex actions in the attention and care of thee health of the population within their territory based on the principles of universality, integrality and equity . The health informatics system of the basic attention are strategic tools of management and managery of the health status of the population at each level of sanitary responsibility. The core of operation of the informatics system is the software .The researched literature reports the health and informatics system software to present inflexibility for change, high cost and low efficacy, fragility concerning privacy and safety, lack of technological and health patterns and difficulties in scalability . The software is also depicted as being refractory to local languages and cultures, and to induce technological trap of the health informatics systems. Within this context the aim of the study was the identification and analysis of the contributions and limitations of free software for the informatics and information systems of the primary health of SUS. METODOLOGY: Exploratory qualitative study comparing two municipalities making use of free software and private software in their SUS primary health system based on the criteria obtained from the literary review. RESULTS: The use of free software in the basic attention of the SUS of Campinas and São Paulo presents limitations in the following topics used as analysis criteria: education, safety, privacy and open patterns. The use of free software proved advantageous for the surveyed municipalities in the following topics: costs, scalability, technologic autonomy, stability, adaptation of the software to the local language and culture and impact on the quality of health services. CONCLUSION: Free software is a viable, robust and flexible technological alternative that offers new perspectives for th construction of information and informatics systems of the primary health care.

Em 2005, a Agência Nacional de Saúde Suplementar (ANS) estabelece o padrão TISS (Troca de Informação na Saúde Suplementar), intercâmbio eletrônico obrigatório entre as operadoras de planos de saúde (cerca de 1500 registradas na ANS) e prestadores de serviços (cerca de 200 mil) sobre os eventos de assistência prestados aos beneficiários. O padrão TISS foi desenvolvido seguindo a estrutura do Comitê ISO/TC215 de padrões para informática em saúde e se divide em quatro partes: conteúdo e estrutura, que compreende a estrutura das guias em papel; representação de conceitos em saúde, que se refere às tabelas de domínio e vocabulários em saúde; comunicação, que contempla as mensagens eletrônicas; e segurança e privacidade, seguindo recomendação do Conselho Federal de Medicina (CFM). Para aprimorar sua metodologia de evolução, essa presente tese analisou o grau de interoperabilidade do padrão TISS segundo a norma ISO 20514 (ISO 20514, 2005) e a luz do modelo dual da Fundação openEHR, que propõe padrões abertos para arquitetura e estrutura do Registro Eletrônico de Saúde (RES). O modelo dual da Fundação openEHR é composto, no primeiro nível, por um modelo de referência genérico e, no segundo, por um modelo de arquétipos, onde se detalham os conceitos e atributos. Dois estudos foram realizados: o primeiro se refere a um conjunto de arquétipos demográficos elaborados como proposta de representação da informação demográfica em saúde, baseado no modelo de referência da Fundação openEHR. O segundo estudo propõe um modelo de referência genérico, como aprimoramento das especificações da Fundação openEHR, para representar o conceito de submissão de autorização e contas na saúde, assim como um conjunto de arquétipos. Por fim, uma nova arquitetura para construção do padrão TISS é proposta, tendo como base o modelo dual da Fundação openEHR e como horizonte a evolução para o RES centrado no paciente / In 2005 the Brazilian National Healthcare Agency (Agência Nacional de Saúde Suplementar (ANS), in Portuguese) published the TISS standard, a mandatory electronic exchange claims between the health insurance (approximately 1500 registered at ANS) and healthcare providers (approximately 200 000) about the healthcare events provided to the beneficiaries. The TISS standard was developed following the structure of the ISO/TC215 Committee for Health Informatics and is divided into four parts: data structure that encompasses the forms; semantic content that refers to the vocabularies and terminologies; data interchange that includes the electronic messages; and security issues in healthcare information following a recommendation of the Federal Council of Medicine (Conselho Federal de Medicina (CFM), in Portuguese). To improve the TISS standards evolution, this study analyses the levels of interoperability in accordance with ISO 20514 (ISO 20514, 2005) and the dual model of the openEHR Foundation, which proposes open standards for Electronic Health Records (EHR) architecture and healthcare information. The dual model of the openEHR Foundation specifications is composed, on the first level, by a generic reference model and on the second by an archetype model that details the concepts and attributes. Two studies were conducted in this thesis: the first one refers to a set of demographic archetypes developed as a proposal representation of the demographic information, based on the reference model of the openEHR Foundation. The second study proposes a generic reference model, as an improvement of the openEHR specifications, to represent the concept of submission of claims, as well as a set of archetypes. Finally, a new architecture for building the TISS standard is proposed based on the dual model of the openEHR Foundation and envisioning a patient-centered EHR

La utilització d'Internet com a font d'informació sanitària és molt freqüent. La qualitat d'aquesta informació és extraordinàriament variable. Els segells de qualitat presents a les webs mediques, concedits per sistemes d'acreditació, constitueixen un instrument de millora dels serveis d'informació sanitària a Internet.A la present tesi s'analitzen les propostes i recomanacions de les principals iniciatives d'acreditació, s'estudia la percepció que tenen els responsables de webs mediques respecte a la utilitat dels segells d'acreditació i la prevalença d'ús d'aquests segells en les webs de contingut sanitari.Conclusions: la gran diversitat de recomanacions d'acreditació dificulta l'estandardització, els responsables de webs sanitàries reconeixen que el segell de WMA influeix positivament en la qualitat d'aquestes webs i existeix un ús moderat dels segells de qualitat i les webs que els presenten acostumen a ser de millor qualitat que el resta. / La utilización de Internet como fuente de información sanitaria es muy frecuente. La calidad de esta información es extraordinariamente variable. Los sellos de calidad presentes en las webs médicas, otorgados mediante sistemas de acreditación, constituyen un instrumento de mejora de los servicios de información sanitaria en Internet.En la presente tesis se analizan las propuestas y recomendaciones de las principales iniciativas de acreditación, se estudia la percepción que tienen los responsables de webs médicas respecto a la utilidad de los sellos de acreditación y la prevalencia de uso de dichos sellos de calidad en las webs de contenido sanitario. Conclusiones: la gran diversidad de recomendaciones de acreditación dificulta la estandarización, los responsables de webs sanitarias reconocen que el sello de WMA influye positivamente en la calidad de dichas webs, existe un uso moderado de los sellos de calidad y las webs que los presentan acostumbran a ser de mejor calidad que el resto. / The use of Internet as a health information source is very common. The quality of this information is widely variable. The quality seals and trust marks owned by the medical websites and granted by accreditation programmes, are good tools to improve the health services on the Internet. In this dissertation the different guidelines of the main accreditation programmes are analysed. The perception of the responsible personnel in charge of medical websites on the accreditation seal usefulness is studied as well as the prevalence usage of the quality seals in these web sites. Conclusions: the standardization is very difficult considering the wide number of guidelines and quality criteria. The responsible personnel in charge of medical websites admit that the WMA seal has a positive influence in the quality of their websites and that the seals are moderately used although the webs presenting them are usually of a higher quality then the rest.