Diss. (sammanfattning) Linköping : Linköpings universitet, 2009. / Härtill 5 uppsatser.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-03-22T20:42:18Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) hellen_lilliane_cruz.pdf: 1979684 bytes, checksum: aeec38f943d5d28b666426a307585456 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-03-29T14:04:17Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) hellen_lilliane_cruz.pdf: 1979684 bytes, checksum: aeec38f943d5d28b666426a307585456 (MD5) / Made available in DSpace on 2018-03-29T14:04:17Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) hellen_lilliane_cruz.pdf: 1979684 bytes, checksum: aeec38f943d5d28b666426a307585456 (MD5) Previous issue date: 2017 / A maioria das doen?as cr?nicas s?o consideradas problemas de sa?de p?blica, e s?o conhecidas mundialmente como as principais causas de ?bitos e interna??es hospitalares. A hipertens?o arterial sist?mica e o diabetes mellitus est?o inclu?dos neste grupo, representando as principais causas de morte em todo o Brasil. Considerando seus m?ltiplos fatores, ? necess?rio repensar os modelos assistenciais. Para isso estrat?gias para promover acesso ao cuidado prim?rio, t?m sido desenvolvidas, com o objetivo de garantir a seguran?a do paciente, no uso do medicamento. Portanto, o objetivo deste estudo foi identificar as caracter?sticas dos sistemas de informa??es de sa?de e prontu?rios m?dicos, para analisar os sinais de seguran?a do pacientes com doen?a cr?nica na aten??o prim?ria de Diamantina, Minas Gerais. A pesquisa consistiu em um estudo transversal, descritivo observacional de associa??o e explorat?rio. A an?lise de dados mostra uma cobertura populacional de 94,1%; m?dia consulta m?dica de 0,76 consultas/ano; dentre os atendimentos, 23,1% foram destinados aos usu?rios hipertensos e 7,30% aos diab?ticos; no sistema hospitalar foi registrada 12,2% das interna??es por condi??es sens?veis a aten??o prim?ria sendo a angina respons?vel por 18,9% das interna??es. Nos prontu?rios m?dicos, a m?dia de idade do paciente foi de 62,1 ? 14,3 anos. O n?mero de cuidados b?sicos de enfermagem (95,5%) prevaleceu e as consultas m?dicas foram de 82,6%. A polifarm?cia foi registrada em 54,0% da amostra e a revis?o das listas de medicamentos revelou que 67,0% dos medicamentos inclu?am pelo menos um risco. Os riscos mais comuns foram: intera??o medicamentosa (57,8%), risco renal (29,8%), risco de queda (12,9%) e duplicidade terap?utica (11,9%). Os fatores associados ? hist?ria de erros de medicamentos foram doen?as cr?nicas e polifarm?cia, que persistiram em an?lises multivariadas, com doen?as cr?nicas RP ajustadas, diabetes RP 1.55 (95% IC 1.04-1.94), diabetes / hipertens?o RP 1.6 (95% IC 1.09-1.23) e polifarm?cia RP 1,61 (95% IC 1,41-1,85), respectivamente. Os resultados indicam que a aten??o prim?ria como coordenadora da rede de aten??o ? sa?de de Diamantina, para doen?as cr?nicas, ? complexa e precisa ser reestruturada. Para isso ? necess?rio sincronizar os servi?os de sa?de por meio da transfer?ncia e processamento de informa??es, para alcan?ar o objetivo comum fornecer cuidado continuo e centrado no paciente. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ci?ncias Farmac?uticas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / Most chronic diseases are some of the main public health problems, and they have been known worldwide to be the main causes for deaths and hospital admissions. Systemic arterial hypertension and diabetes mellitus are included in this group, accounting for the main death causes all over Brazil. Considering their multiple risk factor, it is necessary to rethink the assist models. For this, strategies to promote access to primary care have been developed with objective of ensuring patient safety in the use of the drug. Therefore, the purpose of this study was to identify and determine characteristics of health information systems and medical records, to analyze safety signs of patients with chronic disease in the primary care of Diamantina, Minas Gerais. The research consisted of a cross-sectional study, observational descriptive of association and exploratory. Data analysis shows that a population coverage was 94.1%; the average medical consultation was 0.76 consultations/year; among the visits, 23.1% were for hypertensive and 7.30% for diabetics; in the hospital system, 12.2% of hospitalizations were registered to conditions that were sensitive to primary care, and angina was responsible for 18.9% of admissions. In the medical records, the patients the mean age of patient was 62.1 ? 14.3 years. The number of basic nursing care (95.5%) prevailed and physician consultations were 82.6%. Polypharmacy was recorded in 54.0% of sample, and review of the medication lists by a pharmacist revealed that 67.0% drug included at least one risk. The most common risks were: drug-drug interaction (57.8%), renal risk (29.8%), risk of falling (12.9%) and duplicate therapies (11.9%). Factors associated with medications errors history were chronic diseases and polypharmacy, that persisted in multivariate analysis, with adjusted RP chronic diseases, diabetes RP 1.55 (95%IC 1.04-1.94), diabetes/hypertension RP 1.6 (95%CI 1.09-1.23) and polypharmacy RP 1.61 (95%IC 1.41-1.85), respectively. The results of this study indicate that primary care as the coordinator of health care network of Diamantina, for chronic diseases, is complex and needs to be restructured. For this is necessary to synchronize health services by transferring and processing information, for to achieve the common objective of providing continuous and patient-centered care.

Submitted by Valdinei Souza (neisouza@hotmail.com) on 2016-10-03T21:09:37Z No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / Approved for entry into archive by Urania Araujo (urania@ufba.br) on 2016-10-04T20:07:55Z (GMT) No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / Made available in DSpace on 2016-10-04T20:07:55Z (GMT). No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / A pesquisa apresentada nesta dissertação de mestrado teve como objetivo a investigação do uso e importância do prontuário do paciente em instituições de saúde, através da publicação de atos ou informações nos sítios eletrônicos oficiais destas. Esse trabalho foi desenvolvido metodologicamente utilizando uma abordagem qualitativa, tendo por base a pesquisa descritiva na forma documental, utilizando a técnica de observação direta para a coleta de dados. A pesquisa fez uma investigação da publicidade das ações relacionadas aos prontuários e arquivos, nos sítios eletrônicos de doze instituições de saúde previamente escolhidas, respondendo objetivamente a dezoito questões formuladas, conhecendo assim a realidade de cada uma, e do conjunto destas no que tange a relação prontuário e arquivo da instituição de saúde com os respectivos sítios eletrônicos. Essa investigação revelou que nenhuma instituição apresentou em seu sítio eletrônico a totalidade de respostas positivas. A instituição que chegou mais próximo do resultado alcançou doze das dezoito respostas, que representa 66,67%, revelando assim a necessidade dos sítios eletrônicos serem melhorados para a garantia do acesso a informação dos clientes ou pacientes. O trabalho apresentou ainda o panorama atual da legislação sobre prontuário, as correlações com a prática e a identificação de ações quanto a soluções para inserção dessa espécie documental como instrumento relevante de registro de informação para a eficácia de um atendimento de qualidade e com segurança jurídica ao paciente. / ABSTRACT The research presented in this Master’s thesis investigated the use and importance of patients’ medical records at health institutions, by publishing actions or information on their official websites. This study was developed methodologically using a qualitative approach, having descriptive research in documentary form as a base, and utilizing the technique of direct observation for data collection. The research analyzed the disclosure of actions related to medical records and archives on the websites of 12 previously selected health institutions, objectively responding to 18 formulated questions. The reality of each institution and the group as a whole with regards to the health institutions’ medical records and files’ relation with their websites was discovered in this way. The analysis revealed that none of the institutions presented totally positive replies on their websites. The institution which came closest to the outcome attained 12 of the 18 responses, representing 66.67%. Therefore, this revealed the need for improvements to the websites, in order to guarantee access to information on clients or patients. This study also presents an overview of legislation on medical records, correlations with practice and identifying actions for solutions to insert a patient’s medical records as a relevant instrument to record information for an effective, high quality service and legal certainty for patients.

Orientador: Jacques Wainer / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Computação / Made available in DSpace on 2018-08-16T05:40:57Z (GMT). No. of bitstreams: 1 Billa_CleoZanella_D.pdf: 3316703 bytes, checksum: 82c6b703f196ad4980b583703c56be1f (MD5) Previous issue date: 2009 / Resumo: Atualmente, o uso da computação na medicina vem crescendo cada vez mais, e um dos temas mais discutidos é o prontuário clínico eletrônico. é consenso que a utilização de um prontuário eletrônico pode facilitar o trabalho do profissional de saúde e melhorar ainda mais a qualidade do cuidado em saúde, porém ainda existe muita discussão sobre como ele deve ser e quais ferramentas deve oferecer. Este trabalho propõe duas novas formas de visualização do prontuário. A primeira é um sumário com as informações mais relevantes do paciente. A segunda é a representação dos dados do paciente através de um diagrama, onde o profissional de saúde pode expressar o design rationale (DR) da consulta. A área de sumarização automática é um problema altamente complexo, e apesar de terem sido usados procedimentos muito simples, o experimento realizado mostrou que o processo foi suficiente para construir um sumário com o mínimo de informações necessárias para que o quadro clínico do paciente pudesse ser entendido. Alguns estudos apontam que a falta de informação sobre o processo de diagnóstico e sobre o planejamento do tratamento é uma das principais falhas de um sistema de prontuário eletrônico. Por isso, foi sugerida uma representação que utiliza diagramas para armazenar e visualizar, além dos dados do paciente, o raciocínio do profissional de saúde durante uma consulta. Essa técnica é conhecida como design rationale, e é usada, principalmente, na área de engenharia de software. Além de propor essas duas novas formas de visualização do prontuário clínico, foi realizado um experimento formal com o objetivo de testar o sumário e o diagrama com DR na prática. O experimento ocorreu em um ambulatório de clínica geral da Unifesp, onde alunos do curso de medicina recebiam o sumário, ou o diagrama com DR, ou o prontuário clínico tradicional e respondiam questões sobre um determinado caso. Os resultados do experimento mostram que o sumário continha informações suficientes para avaliar o quadro clínico do paciente; porém, eles também mostram que o diagrama com DR provavelmente não apresentou nenhuma vantagem em relação ao prontuário tradicional / Abstract: Collaboration between computer science and medicine is growing day by day, and one of the most controversial topics is the electronic patient record (EPR). Despite all scientists agree that the EPR can improve health care quality, how it should behave, or what tools it should provide are still open questions. This work suggests two ways to visualize the EPR. The first is through a summary, with the most important information of the patient. And, the second, is a diagram where the physician is able to express his design rationale. Summarization is a complex problem, and despite very simple procedures were used, the experimental evaluation shows that the summary contains as much information as the traditional EPR. The idea of diagrams to visualize the EPR was originated in a technique called design rationale (DR), used, mostly, in Software Engineering. Its major goal is to reproduce the rationale during a project design. Some researches pointed out that one of the major limitations of EPR is the lack of information about diagnosis processes, and treatment planning. To evaluate these new ways of visualization of the EPR, an experimental evaluation was performed to test the summary and the diagram in real practice. The experiment was conduct in a outpatient care clinic at Unifesp, where medical students use the summary, or the diagram, or the traditional EPR to answer questions about specific patients. The results of the experiment show that the summary was equivalent to the traditional EPR, and that the diagram no not show any leverage to the traditional EPR / Doutorado / Informática Médica / Doutor em Ciência da Computação

O Acidente Vascular Cerebral (AVC) é uma doença prevalente e incapacitante, cujo atendimento no Brasil é insuficiente e concentrado em poucos centros de alta complexidade. A telemedicina possibilita assistência à saúde através do uso de tecnologias de comunicação entre dois ou mais profissionais, ou entre o profissional e o paciente, que estejam em locais distintos, permitindo aumento do acesso a tratamentos especializados, podendo ser útil na assistência do AVC agudo. Os objetivos deste estudo foram avaliar a viabilidade de uma rede de telemedicina para o AVC no Sistema Único de Saúde na região de Ribeirão Preto e desenvolver um sistema de telemedicina para o AVC. Para a análise da viabilidade, foram realizados o levantamento de indicadores demográficos e epidemiológicos da população de municípios que constituem o Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) e uma análise técnica e econômica relacionada à estrutura necessária. O sistema de registro eletrônico e videoconferência foi desenvolvido por equipe multiprofissional, baseado em diretrizes nacionais para sistemas de informação em saúde e protocolos padronizados para o atendimento do AVC agudo. Concluiu-se que uma rede de telemedicina entre o Hospital das Clínicas de Ribeirão Preto e os outros hospitais que possuem os pré-requisitos para cadastramento como Unidade de AVC no DRS XIII será estratégica para a expansão do atendimento qualificado do AVC na região, e sua viabilidade depende do cadastro destes serviços junto ao Ministério da Saúde, financiamento dos equipamentos e treinamento das equipes assistenciais. O sistema de telemedicina desenvolvido possibilitará o registro seguro dos atendimentos, a educação permanente das equipes e base de dados para pesquisas clínicas, contribuindo para a concretização desta e de outras redes de telemedicina brasileiras. / Stroke is a prevalent and disabling disease, whith insufficient treatment in Brazil, where is concentrated in a few high complexity centers. Telemedicine enables health care through communication technology between two or more professionals, or between the professionals and patients, in different locations, allowing increased access to specialized treatments, therefore useful in acute stroke treatment. This study objectives were to evaluate the feasibility of a public stroke telemedicine network at Ribeirão Preto region and to develop a stroke telemedicine eletronic system. For feasibility study, populational demographic and epidemiological indicators were compiled for the cities that constitute the Regional Health Department of Ribeirão Preto (DRS XIII) and a technical and economic analysis related to the necessary structure was performed. The electronical record and videoconference system was developed by a multiprofessional team, based on national guidelines for health information systems and standardized protocols for acute stroke care. A telemedicine network between the Hospital das Clínicas of Ribeirão Preto and the other hospitals that meet criteria for enrollment as Stroke Units in DRS XIII will be strategic for the expansion of regional qualified stroke care. Its viability depends on the registration of these services at the Health Ministry, equipment financing and assistance teams training. The developed telestroke system will enable the secure record of calls, the permanent education of the teams and a database for clinical research, contributing to the realization of this and other telemedicine networks.

Sveriges digitala vårdsituation beskrivs i rapporter från både myndigheter samt populärvetenskapliga tidskrifter som föråldrad och problematisk. I den moderna vården är digitala journalsystem avgörande för att bedriva en effektiv och patientsäker vård. För att följande IT-system skall undvika att skapa problematik för slutanvändare är det viktigt att beakta de åsikter och synpunkter som kan förbättra systemet och därmed ge ökad acceptans. Vidare presenterar tidigare forskning att tid och design av sjukvårdsteknologi spelar en stor roll för ökad acceptans. För att identifiera om vårdsituationen är så problemfylld som den framställs blir acceptans för digitala journalsystem viktigt att undersöka. Syftet med följande uppsats var att undersöka om den svenska vårdens digitala journalsystem upplevs som accepterade eller till och med omtyckta av vårdpersonal. För att besvara syftet valde författarna att undersöka vilka faktorer det är som påverkar vårdpersonalens acceptans för digitala journalsystem inom Region Kronoberg. Genom att applicera det teoretiska ramverket Technology Acceptance Model 2 (TAM2) gavs ett underlag till att analysera empiri utifrån ett användaracceptansperspektiv. Valet av att använda TAM2 i kontrast till den ursprungliga modellen (TAM) grundades på den utökning som det senare ramverket presenterar att acceptans beror på. Från att ha genomfört en kvalitativ intervjustudie på en vårdinrättning i Region Kronoberg identifierades åtta centrala ämnen med hjälp av kodning samt transkribering. Dessa ämnen avsåg områden som uppkom frekvent av de informanter som deltog i undersökningen. Analysering av resultatet utfördes genom att ställa de variabler som TAM2 presenterar i förhållande till det resultat som undersökningen gav. Analysen visade att de deltagande i intervjustudien hade en hög acceptans för deras journalsystem då en stor majoritet svarade positivt på samtliga av de variabler som TAM2 presenterar. Vidare identifierade författarna fem faktorer som påverkar acceptans för digitala journalsystem för vårdpersonal via analysering. Dessa faktorer avser tid och kultur, design och användarvänlighet, tillgänglighet, användbarhet samt enhetlighet mellan vårdgivare. Följande faktorer leder enligt undersökningen till mer omtyckta och bättre implementerade informationssystem inom vården. Genom att identifiera vilka faktorer det är som påverkar acceptans för vårdpersonal i digitala journalsystem kan således beslutsfattare och utvecklare av sjukvårdsteknologi ta det här i beaktning för kommande förändringar. / Sweden's digital healthcare situation is described in reports from both authorities and popular science journals as outdated and problematic. In modern healthcare, digital medical record systems are crucial to providing effective and patient-safe healthcare. In order for the following IT systems to avoid creating problems for end users, it is important to take into account the opinions and views they have that can improve the system and thereby increase acceptance. Furthermore, previous research presents that time and design of healthcare technology play a major role in increasing acceptance. To identify whether the healthcare situation is as problematic as it is presented, acceptance for digital medical record systems is important to investigate. The purpose of the following thesis was to investigate whether the Swedish healthcare’s digital medical record systems is perceived as accepted or perhaps even likable by healthcare professionals. To answer the purpose, the authors chose to investigate what factors there are that affect the acceptance of healthcare professionals for digital medical records systems in the Kronoberg Region. By using the theoretical framework Technology Acceptance Model 2 (TAM2), a basis was provided to analyse empirical data from a user acceptance perspective. The choice of using TAM2 in contrast to the original model (TAM) was based on the extension that the latter framework presents that acceptance depends on. From conducting a qualitative interview study at a healthcare facility in the Kronoberg Region, eight key topics were identified by using coding and transcription. These topics related to areas that were raised very often by the informants who participated in the survey. Analysis of the results was performed by comparing the variables presented by TAM2 in relation to the results of the study. The analysis showed that the participants in the interview study had a high acceptance for their digital medical record system as a large majority responded positively to all of the variables presented by TAM2. Furthermore, the authors identified five factors that affect acceptance for digital medical record systems for healthcare professionals through analysis. These factors relate to time and culture, design and ease of use, accessibility, usability and consistency between caregivers. According to the survey, the following factors lead to more popular and better implemented information systems in healthcare. Thus, by identifying the factors that affect acceptance for healthcare professionals in digital medical records, decision makers and developers of healthcare technology can take this into account for upcoming changes.

El Perú posee un sistema de salud fragmentado, compuesta por seis instituciones, entre ellas el Ministerio de Salud (MINSA), el cual en el marco de la Ley N° 30024, Ley que crea el Registro Nacional de Implementación de Historias Clínicas Electrónicas y la Ley de Gobierno Digital, desarrolla el Plan Nacional de Implementación el Sistema de Información de Historias Clínicas Electrónicas SIHCE e-Qhali para las IPRESS del Primer Nivel de Atención 2019-2021, con la finalidad de contribuir a mejorar la calidad de la atención de salud a los usuarios de los servicios de salud a través del mencionado sistema; sin embargo, durante dicho proceso se han presentado diversas limitaciones que han impedido el avance de dicha implementación. En ese sentido, la presente investigación toma como caso de estudio una IPRESS de Lima Norte con el objetivo de diagnosticar la situación de la Implementación del Sistema de Información de Historias Clínicas Electrónicas (SIHCE) e-Qhali en el Centro Materno Infantil El Progreso, durante el periodo del 2019 al 2020, a través del análisis de las fases de Preparación, Planificación, Ejecución, Seguimiento y Control considerados en el precitado plan de implementación; así como la utilidad de dicho sistema en el CMI El Progreso. / Peru has a fragmented health system, made up of six institutions, including the Ministry of Health (MINSA), which within the framework of Law N°. 30024, Law that creates the National Registry for the Implementation of Electronic Medical Records and the Digital Government Law, develops the National Plan for the Implementation of the Electronic Medical Records Information System - SIHCE e-Qhali for the IPRESS of the First Level of Care 2019-2021, in order to contribute to improving the quality of health care to the users of health services through the aforementioned system; however, during said process, various limitations have arisen that have impeded the advancement of said implementation. In this sense, the present research takes as a case study an IPRESS of North Lima with the objective of diagnosing the situation of the Implementation of the Electronic Medical Records Information System (SIHCE) e-Qhali in the El Progreso Maternal and Child Center, during the period from 2019 to 2020, through the analysis of the preparation, planning, execution, monitoring and control phases considered in the aforementioned implementation plan; as well as the usefulness of said system in the CMI El Progreso. / Trabajo de investigación

Slow adoption of electronic medical records (EMR) by primary care physicians in medical office practices has not facilitated the EMR adoption process. The problem is the slow pace of EMR adoption by primary care physicians in the Atlanta, Georgia area has become a public health concern. Research regarding the lived experiences of these physicians with EMR implementation and utilization may identify reasons for the slow adoption. The purpose of this phenomenological study was to explore the lived experiences of primary care physicians, who practice in the Atlanta area, regarding their perception, successes, barriers, and urgency of adoption of EMR in their healthcare practice. Lewin's change management model of health services served as the framework for the study. Data was collected during face-to-face interviews with 19 primary care physicians at Grady's Ponce de Leon Clinic and Grady's East Point Clinic in Atlanta, Georgia. Participants were physicians or residents and not those in authority to make decisions about the EMR at the two clinics. NVivo 10 and automatic coding was used for data analysis to develop themes from the interviews. The findings revealed that the adoption of EMR has enabled primary care physicians to spend more time with their patients, but the barriers such as a lack of interoperability and lack of training, has fostered a feeling of disinterestedness towards EMR adoption. This study supports positive social change that EMR adoption aids in improving patient safety and outcome.

No description available.

С ростом популярности смартфонов, они не только делают жизнь людей более удобной, но и помогают им управлять информацией о своем физическом здоровье с помощью приложений. Основной задачей данной работы является разработка и внедрение мини-программы для здоровья, которая может помочь пользователям управлять своими медицинскими записями. Проектирование и внедрение продукта будет основано на перспективе пользовательского опыта, анкетном опросе, основанном на модели Кано и анализе AHP, а также исследовании и анализе теорий, связанных с интерфейсом мини-программы здоровья WeChat, в сочетании с проектными кейсами для выяснения поведения и потребностей пользователей в процессе эксплуатации и опыта. / With the popularity of smartphones, it not only makes people's lives more convenient but also helps them manage their physical health information through applications. The main task of this work is to design and implement a health mini-program that can help users manage their medical records. The design and implementation of the product will be based on the perspective of user experience, a questionnaire survey based on the Kano model and AHP analysis, as well as research and analysis of theories related to the interface of the health WeChat mini-program, combined with design cases to clarify the behavior and needs of users in the process of operation and experience.