The aim of this work was to bring the issue of mandatory confidentiality of health workers and the exceptions to this concept in the context of criminal law. In the first part of the thesis is generally defined by the Institute of mandatory confidentiality in health care, sources of legal regulation of this institute and its development in the Czech legal order. The work also deals with medical records and privacy of sensitive data in connection with the obligation of confidentiality of medical professionals. The next section is defined by breaking the confidentiality required the consent of the patient and also cases where the patient's consent to obtain information about his state of health is not required. The work also deals with criminal liability for breach of confidentiality and lists the offenses that can be committed in violation of this obligation. In the conclusion the work presents a brief comparison of the regulation of the Slovak Republic and in the Federal Republic of Germany.

Background Established in 1999, the Swedish Maternal Health Care Register (MHCR), collects data on pregnant women and their offspring. Since 2013, the MHCR has been a part of the Swedish Pregnancy Register (SPR). Data are entered manually into the MHCR by midwives in antenatal care (ANC). ANC is primarily organised within public primary health care in Sweden. Midwives are the primary providers of health care during pregnancy, and they are responsible for providing information about prenatal diagnosis to expecting parents. Aims This thesis investigated internal validity of MHCR data, and user’s experiences of the MHCR. Prenatal diagnosis was explored in regard to local guidelines and to background characteristics and pregnancy outcomes. Factors affecting the work situation for midwives in ANC, as well as their experiences on informing expecting parents about prenatal diagnosis were investigated. Methods Study I, II and III were cross-sectional studies. Study I included data from MHCR and medical records on 878 pregnancies during 2011. Study III analysed data from MHCR/SPR, in total 284,789 pregnancies for 2011 to 2013. Study II was a questionnaire study with a quantitative and a qualitative component, including 989 participants. Study IV was a qualitative study applying qualitative content analysis. Fifteen midwives participated in individual, telephone interviews. Main findings Overall, the degree of coverage of variables was high in the MHCR as well as in the medical records. For 17 of the 27 variables, agreement of data in both data sources reached 95% or more. Possible systematic errors were identified for two variables (Paper I). Midwives valued MHCR generally positively, although manual registration of data into the MHCR was perceived burdensome. Foremost midwives engaged in supervision regularly accessed data on pregnant women at their own ANC clinic (Paper II). Offers on prenatal diagnosis varied considerably between the 21 Swedish counties during 2011 to 2013. Maternal age and educational level demonstrated strong associations with uptake of prenatal diagnosis (Paper III). Midwives in ANC reported their work load as manageable. Clinical guidelines, continuing education, and collaboration in the chain of care of pregnant women, were supportive factors for midwives work situation in antenatal care. Administrative work load was perceived as strenuous and informing expecting parents about prenatal diagnosis was challenging (Paper IV). Conclusions Data in the MHCR demonstrated sufficient internal validity. MHCR was an underutilised source in operational planning of ANC. Offers and uptake on prenatal diagnosis was unequally distributed in Sweden. Midwives enjoyed their work in ANC. Administrative work was strenuous and informing expecting parents about prenatal diagnosis was challenging. The register can further develop its report systems to be used in a higher extent in evaluation and planning of Swedish maternal health care services. Expecting couples in Sweden should be offered the same opportunities on prenatal diagnosis. Pedagogical tools may facilitate midwives mission to inform expecting parents with varying pre-understanding about prenatal diagnosis / Bakgrund Det svenska Mödrahälsovårdsregistret är ett nationellt kvalitetsregister som används inom mödrahälsovården för uppföljning av verksamheten, i förbättringsarbete och som underlag för forskning. Mödrahälsovårdsregistret startade 1999 och samlar in data på gravida kvinnor, förlossningar och nyfödda barn. Sedan 2013 är Mödrahälsovårdsregistret en del av Graviditetsregistret, som består av tre delregister; Mödrahälsovårdsregistret, Fosterdiagnostikregistret och det Obstetriska registret. Barnmorskor inom svensk mödrahälsovård registrerar data manuellt vid två tillfällen i registret, dels i anslutning till inskrivningsbesöket, och dels efter avslutad graviditet, senast 16 veckor efter förlossningen. Barnmorskor inom svensk mödrahälsovård har skyldighet att erbjuda blivande föräldrar information om fosterdiagnostik. Däremot utförs de fosterdiagnostiska undersökningarna på särskilda mottagningar, vanligen inom ramen för Sveriges kvinnokliniker. Med tidig fosterdiagnostik avses rutinultraljud i graviditetsvecka 17 till 20, kombinerat ultraljud och biokemiskt test (KUB), samt de invasiva undersökningarna fostervattenprov (AC) och korionvillibiopsi (CVS). Nästan alla gravida kvinnor kontrolleras inom mödrahälsovården. Majoriteten av mödrahälsovårdsmottagningarna bedrivs inom den offentliga primärvården. Barnmorskan arbetar självständigt och är ansvarig för kvinnor med okomplicerade graviditeter. Övriga uppdrag för barnmorskor inom svensk mödrahälsovård är, föräldrastödsverksamhet, rådgivning och förskrivning av preventivmedel, screening för livmoderhalscancer, samt utåtriktat arbete. I barnmorskans arbete ingår därutöver olika patientadministrativa uppgifter. Syfte Det övergripande syftet med avhandlingen var att undersöka det svenska Mödrahälsovårdsregistret ur följande aspekter: intern validitet i registerdata, användarnas erfarenheter, synpunkter och användning av registret samt registerutfall. Ytterligare syften var att undersöka stödjande och belastande faktorer för barnmorskans arbetssituation inom svensk mödrahälsovård och barnmorskors erfarenheter och synpunkter av att informera blivande föräldrar om fosterdiagnostik. vii Metod Studie I, II och III var tvärsnittsstudier. I Studie I jämfördes data i den medicinska journalen med motsvarande uppgifter i Mödrahälsovårdsregistret över 879 gravida kvinnor med ett förlossningsdatum under maj till juni 2011. Studie II var en enkätundersökning som riktade sig till samtliga barnmorskor inom svensk mödrahälsovård (N=989). Undersökningen genomfördes januari till mars 2012. I Studie III analyserades data på totalt 284,789 gravida kvinnor och deras nyfödda barn under perioden 2011 till 2013. Statistiska analyser som användes i Studie I, II och III var Cohen’s Kappa, Pearson’s Chi-två test, sensitivitet och specificitet, samt univariat och multivariat logistisk regressionsanalys. Studie IV var en kvalitativ studie där data insamlades vid individuella telefonintervjuer med totalt 15 barnmorskor verksamma vid olika mödrahälsovårdsmottagningar. Materialet analyserades med kvalitativ innehållsanalys. Resultat Variablerna uppvisade överlag en hög täckningsgrad i både Mödrahälsovårdsregistret och den medicinska journalen. Variabler gällande fosterdiagnostik uppvisade en något lägre täckningsgrad på cirka 90 %. Andelen identiska data i de båda datakällorna varierade från 73,9 % till 99,7 %. För 17 av de 27 undersökta variablerna var överensstämmelsen mellan de båda datakällorna, 95 % eller högre. Variabler relaterade till förlossningen (”enkelbörd/flerbörd”, ”levande fött barn”, och ”barnets kön”) var de variabler som uppvisade högst andel identiska uppgifter i de båda datakällorna. Systematiska fel identifierades för två variabler, ”andra trimester serum screening”, och ”antal barnmorskebesök”. Barnmorskor var överlag positiva till Mödrahälsovårdsregistrets webbapplikation, däremot upplevde en majoritet (70,7 %) av barnmorskorna med enbart patientarbete att den manuella registreringen var en betungande arbetsuppgift. Mödrahälsovårdsregistrets ingående variabler uppfattades som relevanta. I fritext frågorna kommenterades att en del variabler var onödiga, till exempel frågor om fosterdiagnostik medan andra variabler saknades i registret, exempelvis frågor om sjukdomar och medicinska komplikationer under graviditet och förlossning. Barnmorskor med arbetsledande uppgifter rapporterade i jämförelse med de barnmorskor som enbart hade patientarbete att de i högre utsträckning regelbundet extraherade data från registret avseende den egna mottagningen (p<0,001; OR=11,79 CI 95 % 7,43-18,69), och de uppvisade en minskad sannolikhet att ifrågasätta nyttan med registret (p<0,001; OR=0,29 CI 95 % 0,16-0,49). Erbjudande om fosterdiagnostik till blivande föräldrar varierade betydligt mellan de 21 landstingen under åren 2011-2013. Sex landsting erbjöd KUB till alla gravida viii kvinnor, nio landsting erbjöd KUB på indikation och fem landsting erbjöd inte KUB till gravida kvinnor. Ett landsting hade inga skrivna riktlinjer. Under samma tidsperiod var andelen kvinnor som genomgick ultraljud i graviditetsvecka 17-20, 97,6 %, KUB 33,0 %, AC 2,6 % och CVS 1,1 %. Moderns ålder uppvisade störst inverkan på genom-gången fosterdiagnostik. Utbildningsnivå universitet i jämförelse med lägre utbildningsnivå var associerad med en ökad sannolikhet att genomgå KUB (OR 2,30, 95 % CI 2,26-2,35), AC (OR 1,54, 95 % CI 1,46-1,63) och CVS (OR 2,68, 95 % CI 2,44-2,93). Barnmorskor inom svensk mödrahälsovård ansåg att arbetsbelastningen var hanterbar även om den var hög. Kliniska riktlinjer, regelbunden fortbildning, och samarbetet med kollegor och läkare i vårdkedjan för den gravida kvinnan beskrevs som stödjande faktorer i arbete. Den administrativa arbetsbelastningen upplevdes som krävande och att informera blivande föräldrar om fosterdiagnostik som utmanande. Slutsats Data i Mödrahälsovårdsregistret uppvisade god till mycket god täckningsgrad, överensstämmelse och intern validitet för de flesta variablerna i registret. Barnmorskor var överlag positiva till Mödrahälsovårdsregistret, även om arbetsuppgiften att föra in uppgifter manuellt i registret upplevdes som betungande. Erbjudande om fosterdiagnostik varierade avsevärt mellan olika landsting. Moderns ålder och utbildningsnivå var de faktorer som uppvisade störst inverkan på genomgången fosterdiagnostik. Barnmorskor uppskattade sitt arbete inom mödrahälsovården, men det administrativa arbetet upplevdes som krävande. Att informera blivande föräldrar om fosterdiagnostik upplevdes som utmanande. Mödrahälsovårdsregistret har en utvecklingspotential vad gäller dess rapportfunktioner och registerdata skulle i högre grad kunna användas i planering och förbättring av innehållet i svensk mödrahälsovård. Erbjudande om fosterdiagnostik till blivande föräldrar borde vara likvärdiga i samtliga landsting i Sverige. Pedagogiska hjälpmedel skulle kunna underlätta för barnmorskor att informera blivande föräldrar med olika kunskapsnivå vad gäller fosterdiagnostik.

A Dissertation in fulfillment of the requirements for the Degree of Master of Commerce by Research in Information Systems / Electronic Medical Records (EMR) systems aim to provide an integrated solution to a number of hospital processes, including supporting administrative functions such as patient billing, providing clinical guidelines, and allowing clinicians to order and view lab reports. Yet with all these possible benefits, like many other types of information systems and technologies, their impact on hospital performance has been a key area of interest and a source of debate. This study examines the extent to which EMR systems are available across South African hospitals as well as how well they have been integrated into the processes of the said hospitals. The diffusion of EMR systems means they are available in the relevant clinical units whilst their infusion suggests they are comprehensively embedded into the processes that they are meant to support. The most important question answered in this study was whether the diffusion and infusion of these systems had any impact on the performance of hospitals. Answering this question would aid decision makers on whether more effort is indeed needed to ensure their availability across units and their embedding into hospital processes. The study collected data from a number of hospitals in the private and public sector with multiple informants providing data on diffusion and infusion of these systems as well as on hospital performance. Performance measures included the hospitals’ economic efficiency, their clinical effectiveness, patient safety, and patient satisfaction. Key findings were that while there are performance benefits in the diffusion of EMR systems across units, the impacts are not always positive for some hospitals. Large hospitals were less likely to benefit from the diffusion of these systems. However the comprehensive use of these systems provided benefits for all types of hospitals, suggesting that while availability may be important, it is the comprehensive embedding of the EMR system into the hospital’s processes that is more beneficial to all types of hospitals. These results present further opportunity for research into why the impact of EMR systems is not always positive for some hospitals. / MT2017

"It was the purpose of this study to examine the case records of sixty-six patients referred for history resources to the Social Service Department at the Florida State Hospital, from July 1, 1958 through June 30, 1959"--Introduction. / Typescript. / "June, 1960." / "Submitted to the Graduate School of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: James H. Williams, Professor Directing Study. / Includes bibliographical references.

"It was the purpose of this study to determine if the background information contained in the medical records of patients committed from the criminal courts was sufficient for the needs of the state hospital staff for purposes of efficient examination, treatment planning, and disposition of such patients; if the state hospitals outside of Florida encounter problems of gathering background information of patients admitted under criminal commitments: and if the criminal courts of Florida have facilities and resources for assisting the state hospitals in gathering identifying data and background information on offenders committed from their courts"--Introduction. / Typescript. / "June, 1959." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Vernon Fox, Professor Directing Study. / Includes bibliographical references.

In order to improve the quality of care, there is urgent need to involve patients in their own healthcare. So to make patient centered health care system Personal Health Records are proposed as viable solution. This research discusses the importance of a Patient Centric Health Record system. Such systems can empower patients to participate in improving health care quality. It would also provide an economically viable solution to the need for better healthcare without escalating costs by avoiding duplication. The proposed system is Web-based; therefore it has high accessibility and availability. The cloud computing based architecture is used which will allow consumers to address the challenge of sharing medical data. PHR would provide a complete and accurate summary of the health and medical history of an individual by gathering data from many sources. This would make information accessible online to anyone who has the necessary electronic credentials to view the information. / by Vishesh Ved. / Thesis (M.S.C.S.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

Alguns estudos têm proposto que os acidente ofídicos em crianças estão associados a maior gravidade e ao maior risco de desenvolvimento de complicações comparados aos acidentes em adultos. Este estudo retrospectivo descreve as características de acidentes causados por serpentes do gênero Bothrops admitidos no Hospital Vital Brazil/Instituto Butantan/SP (HVB/IB) e compara a gravidade, e necessidade de soroterapia antiveneno e o risco para o desenvolvimento de complicações entre crianças (menores de 13 anos) e adultos. Trata-se de uma coorte histórica que utilizou dados de prontuários do arquivo do HVB/IB de dezembro de 1999 a junho de 2003. Foram incluídos no estudo pacientes que trouxeram a serpente ou apresentavam manifestações clínicas ou laboratoriais compatíveis com envenenamento botrópico. Não foi observada diferença estatisticamente significante na freqüência da gravidade dos envenenamentos, no número de ampolas administradas e na freqüência de complicações entre os dois grupos estudados. O estudo sugere que os acidentes ofídicos causados por serpentes do gênero Bothrops apresentam gravidade semelhante na avaliação admissional e evolução com a mesma proporção de complicações em crianças quando comparados aos acidentes em adultos / Some studies propose that the level of severity of the accidents caused by snakes in children can be associated with a stronger envenoming and a higher risk of later complication if compared to the same accidents in adults. This retrospective study aim to describe the caracteristics of snakebites acidents of the genus Bothrops, and compare their severities, necessity of antivenom, and the risk of developing later complications between children (less than 13 years) and adults, all the accidents where admitted at Hospital Vital Brazil/Instituto Butantan/SP, Brazil (HVB). This retrospective cohort study was carried out by using HVB\'s records of snakebite victims, from December 1999 to June 2003. Patients included were those who brought the snake and/or have the clinical or laboratorial presence of abnormalities compatible with Bothrops envenoming. No statistic differences were found between the two groups of this study concerning the severity of envenoming, number of antivenom vials and the frequency of complications. This study suggests that snakebite accidents are similar between adults and children. Age is not supposed to be a predictor of complication in such accidents

This thesis is focused on the detection of the effectiveness of the established information system that is used by the Emergency Medical Service of the Vysočina Region to keep medical records; in case of the Emergency Medical Assistance there are used intervention records. The aim of this thesis is to determine the effectiveness of information system implementation used for the administration of medical records on the basis of selected indicators. This research will confirm or refute hypotheses whether keeping of medical records in electronic form is effective for the organization in terms of potential time savings, or from the perspective of the administration of medical records. This thesis is to introduce a comprehensive view on the matters of computerization of medical records, namely in a specific environment of the Emergency Medical Service. The introduction describes terms that are used in this thesis. There is defined the environment of the Emergency Medical Service, specified the documentation and forms of the medical records administration which is used by the Emergency Medical Service. There is also introduced the information system that serves the medical records administration and the theory of cost effectiveness. The practical part is focused on the analysis of the information system, and on confirmation and refutation of set hypotheses supported by quantitative research. The summary and recommendation are based on obtained and analyzed results of this research.

Alguns estudos têm proposto que os acidente ofídicos em crianças estão associados a maior gravidade e ao maior risco de desenvolvimento de complicações comparados aos acidentes em adultos. Este estudo retrospectivo descreve as características de acidentes causados por serpentes do gênero Bothrops admitidos no Hospital Vital Brazil/Instituto Butantan/SP (HVB/IB) e compara a gravidade, e necessidade de soroterapia antiveneno e o risco para o desenvolvimento de complicações entre crianças (menores de 13 anos) e adultos. Trata-se de uma coorte histórica que utilizou dados de prontuários do arquivo do HVB/IB de dezembro de 1999 a junho de 2003. Foram incluídos no estudo pacientes que trouxeram a serpente ou apresentavam manifestações clínicas ou laboratoriais compatíveis com envenenamento botrópico. Não foi observada diferença estatisticamente significante na freqüência da gravidade dos envenenamentos, no número de ampolas administradas e na freqüência de complicações entre os dois grupos estudados. O estudo sugere que os acidentes ofídicos causados por serpentes do gênero Bothrops apresentam gravidade semelhante na avaliação admissional e evolução com a mesma proporção de complicações em crianças quando comparados aos acidentes em adultos / Some studies propose that the level of severity of the accidents caused by snakes in children can be associated with a stronger envenoming and a higher risk of later complication if compared to the same accidents in adults. This retrospective study aim to describe the caracteristics of snakebites acidents of the genus Bothrops, and compare their severities, necessity of antivenom, and the risk of developing later complications between children (less than 13 years) and adults, all the accidents where admitted at Hospital Vital Brazil/Instituto Butantan/SP, Brazil (HVB). This retrospective cohort study was carried out by using HVB\'s records of snakebite victims, from December 1999 to June 2003. Patients included were those who brought the snake and/or have the clinical or laboratorial presence of abnormalities compatible with Bothrops envenoming. No statistic differences were found between the two groups of this study concerning the severity of envenoming, number of antivenom vials and the frequency of complications. This study suggests that snakebite accidents are similar between adults and children. Age is not supposed to be a predictor of complication in such accidents

OBJETIVO. O objetivo deste estudo foi verificar a variação entre observadores, com diferentes graus de treinamento em RM das mamas, na aplicação dos critérios morfológicos e cinéticos propostos pelo BI-RADS® para descrever os realces na RM. Também, buscou-se avaliar a importância desta variação sobre a categorização final e a conduta sugerida, antes e após o conhecimento dos dados clínicos e dos demais exames de imagem pertinentes a cada caso. MÉTODOS. 109 realces, sendo 36 malignos, em 96 mulheres, foram interpretados por quatro radiologistas, divididos em duas duplas de acordo com a experiência em RM das mamas. Cada realce foi descrito seguindo os critérios de interpretação propostos pelo BI-RADS® para RM, sendo posteriormente informada a categoria final e a recomendação sugerida para cada caso. Tanto a categoria final quanto a conduta sugerida foram informadas duas vezes por cada observador, uma vez antes do conhecimento dos dados clínicos e dos demais exames de imagem e outra vez após o conhecimento dos mesmos. A concordância entre os membros de cada uma das duplas quanto à aplicação dos critérios de descrição morfológicos e dinâmicos utilizados na caracterização dos realces foi medida, seguida pela mensuração da concordância quanto à classificação final e a conduta recomendada, tanto antes quanto após o conhecimento dos dados clínicos. O teste kappa foi usado para estimar a concordância entre os observadores além daquela esperada pelo acaso. Visando determinar se as taxas de concordância de uma dupla de observadores eram superiores a da outra dupla, tanto para os critérios de descrição quanto para as categorias finais e condutas sugeridas, o teste de Wilcoxon foi utilizado. RESULTADOS. A concordância entre observadores experientes foi substancial (0,64) para categoria final após o conhecimento dos dados clínicos, moderada para forma dos nódulos (0,44), realce interno dos nódulos (0,41) e recomendação sugerida após o conhecimento dos dados clínicos (0,52). Concordância razoável foi obtida para todos os critérios entre os observadores não experientes, assim como para os demais critérios para os observadores experientes. Os observadores com maior experiência apresentaram maiores taxas de concordância entre si na aplicação dos critérios de descrição morfológicos e dinâmicos propostos pelo BI-RADS®, assim como para categoria final e conduta sugerida. CONCLUSÃO. Experiência prévia em RM das mamas aumenta a concordância entre observadores na aplicação dos critérios propostos pelo BI-RADS® para RM. Conhecimento dos dados clínicos e dos demais exames de imagem também aumenta a concordância para a categoria final e recomendação sugerida, especialmente entre os observadores experientes. / OBJECTIVE. The purpose of this study was to assess the variability among observers with different degree of breast MR expertise in the use of the Breast Imaging Reporting and Data System (BI-RADS®) standardized MR lexicon and to evaluate if the variability in lesion description has any implication over lesion final category and management recommendation before and after the knowledge of clinical and other imaging modalities information. MATERIALS AND METHODS. In 96 women, 109 enhancements, including 36 malignant, were interpreted independently by four radiologists divided in pairs according to their experience in breast MR. Each lesion was described using morphologic and dynamic features from the MR BI-RADS® lexicon. A final category and an overall impression were suggested in two occasions, one before and the other after the information about other breast imaging modalities and clinical examination. The agreement between the two members of each pair was measured concerning the description of the enhancement and both final category and recommendation. Kappa statistics were calculated as measures of agreement beyond chance. In order to determine if the rates of agreement in a group were superior then in the other group, the Wilcoxon statistics were used. RESULTS. The experienced interobserver agreement was substantial (0.64) for BI-RADS® final category after the knowledge of clinical information, moderate for mass shape (0.44), mass enhancement (0.41) and management recommendation after clinical knowledge (0.52). Fair agreement was observed for all descriptors among the observer with less experience and for the other descriptors among the experienced ones. The observers with more experience agreed more between themselves for image descriptors and final assessment and recommendation than did the observers with less experience in breast MR. CONCLUSION. Prior experience in breast MRI decreases variability between observers in the application of the criteria proposed by the BI-RADS for MR. Knowledge of relevant information about clinical and other imaging modalities also increased agreement for final category and management recommendation, especially among the experienced radiologists.