O registro eletrônico do paciente (REP) está sendo gradativamente implantado no meio médico hospitalar. Grande parte das informações essenciais do REP está armazenada na forma de texto narrativo livre, dificultando operações de procura, análise e comparação de dados. O processamento de linguagem natural (PLN) refere-se a um conjunto de técnicas computacionais, cujo objetivo é a análise de texto através de conhecimentos léxicos, gramaticais e semânticos. O presente projeto propõe a criação de uma ferramenta computacional de investigação clínicoepidemiológica aplicada a textos narrativos médicos. Como metodologia propomos a utilização do processador de linguagem natural especializado em medicina MEDLEE desenvolvido para textos em Inglês. Para que seu uso seja possível textos médicos em Português são traduzidos ao Inglês automaticamente. A tradução automatizada (TA) é realizada utilizando o aplicativo baseado em regras SYSTRAN especialmente configurado para processar textos médicos através da incorporação de terminologias especializadas. O resultado desta seqüência de TA e PLN são informações conceituais que serão investigadas à procura de achados clínicos pré-definidos, atrvés de inferência lógica sobre uma ontologia. O objetivo experimental desta tese foi conduzir um estudo de recuperação de informações em um conjunto de 12.869 relatórios de radiografias torácicas à procura de vinte e dois achados clínicos e radiológicas. A sensibilidade e especificidade médias obtidas em comparação com referência formada pela opinião de três médicos radiologistas foram de 0,91 e 0,99 respectivamente. Os resultados obtidos indicam a viabilidade da procura de achados clínicos em relatórios de radiografias torácicas através desta metodologia de acoplamento da TA e PLN. Conseqüentemente em trabalhos futuros poderá ser ampliado o número de achados investigados, estendida a metodologia para textos de outras modalidades, bem como de outros idiomas / The Electronic Medical Record (EMR) is gradually replacing paper storage on clinical care settings. Most of essential information contained on EMR is stored as free narrative text, imposing several difficulties on automated data extraction and retrieval. Natural language processing (NLP) refers to computational linguistics tools, whose main objective is text analysis using lexical, grammatical and semantic knowledge. This project describes the creation of a computational tool for clinical and epidemiologic queries on narrative medical texts. The proposed methodology uses the specialized natural language processor MEDLEE developed for English language. To use this processor on Portuguese medical texts chest x-ray reports were Machine Translated into English. The machine translation (MT) was performed by SYSTRAN software, a rule based system customized with a specialized lexicon developed for this project. The result of serial coupling of MT an NLP is tagged text which needs further investigation for extracting clinical findings, whish was done by logical inference upon an ontolgy. The experimental objective of this thesis project was to investigate twenty-two clinical and radiological findings on 12.869 chest x-rays reports. Estimated sensitivity and specificity were 0.91 and 0.99 respectively. The gold standard reference was formed by the opinion of three radiologists. The obtained results indicate the viability of extracting clinical findings from chest x-ray reports using the proposed methodology through coupling MT and NLP. Consequently on future works the number of investigated conditions could be expanded. It is also possible to use this methodology on other medical texts, and on texts of other languages

The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors as prescribers, focusing on responsibility for and factors of importance in achieving appropriate prescribing. To provide insights into the prescriber’s perspective the study designs were qualitative. In the first studies secondary care doctors’ perceptions of appropriate prescribing and influences in prescribing were investigated in interviews. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions. In the subsequent studies the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between health care levels, doctors’ views of responsibility in prescribing and exchange of information are of concern. The doctors expressed how they assume information to be in the e-PMR and active information transfer has decreased. On the other hand, they experienced an information overload in the e-PMR system. There is a need for improved and structured communication between health-care givers. Taking responsibility to review all the patient’s medications was perceived as important, but described as still not done. Lack of responsibility taken was often due to acts of omission, i.e. that doctors did not make needed changes to the list of medications due to different barriers. The barriers rested both with individual doctors and the system, but to ensure solutions that are realisable in practise, perspectives of the doctors need to be taken into consideration when overcoming those barriers.

Several factors are driving the transition from paper-based health records to electronic health record systems. In the United States, the adoption rate of electronic health record systems significantly increased after "Meaningful Use" incentive program was started in 2009. While increased use of electronic health record systems could improve the efficiency and quality of healthcare services, it can also lead to a number of security and privacy issues, such as identity theft and healthcare fraud. Such incidents could have negative impact on trustworthiness of electronic health record technology itself and thereby could limit its benefits. In this dissertation, we tackle three challenges that we believe are important to improve the security and privacy in electronic health record systems. Our approach is based on an analysis of real-world incidents, namely theft and misuse of patient identity, unauthorized usage and update of electronic health records, and threats from insiders in healthcare organizations. Our contributions include design and development of a user-centric monitoring agent system that works on behalf of a patient (i.e., an end user) and securely monitors usage of the patient's identity credentials as well as access to her electronic health records. Such a monitoring agent can enhance patient's awareness and control and improve accountability for health records even in a distributed, multi-domain environment, which is typical in an e-healthcare setting. This will reduce the risk and loss caused by misuse of stolen data. In addition to the solution from a patient's perspective, we also propose a secure system architecture that can be used in healthcare organizations to enable robust auditing and management over client devices. This helps us further enhance patients' confidence in secure use of their health data.

Introduction: The epidemic of overweight and obesity both worldwide and in Canada is indicative of the need for proper growth monitoring beginning at birth. This study evaluated Family Physician’s (FP) Level of Use (LoU) of the recommended 2006 and 2007 World Health Organization (WHO) Growth Charts for monitoring their paediatric patients’ growth. It explored factors influencing LoU, utilizing the Diffusion of Innovations (DOI) theory and Ecological Framework for Effective Implementation (EFEI) as guiding models. FPs’ awareness of resources to support paediatric weight management was also assessed. Methods: A survey was distributed to FP in British Columbia (BC), Canada (N = 2853). The survey addressed provider and innovation characteristics, prevention delivery and support system factors, and barriers and facilitators to chart use. Correlations and multiple linear regression were used to determine correlates and predictors of LoU. Results: Sixty-two surveys were returned (2.2%). WHO Growth Chart LoU was 80.4%. Six variables significantly predicted LoU, including age (β = -.28, t = -3.15, p < .05), practicing in Fraser Health Authority region (β = -.24, t = -2.67, p < .05), assessing head circumference of birth to two year olds (β = .23, t = 2.45, p < .05), perceived growth chart accessibility (β = .39, t = 4.22, p < .05) and compatibility (β = .47, t = 5.27, p < .05), and innovativeness (β = -.37, t = -4.11, p < .05). These variables accounted for 69% of the variance in LoU. The most commonly identified barrier and facilitator to chart use was related to the Electronic Medical Record (EMR) system. FPs’ awareness of resources to support overweight paediatric patients was low. Conclusion: The majority of FP in BC in this sample had adopted the WHO Growth Charts. The results showed partial support for DOI theory and EFEI derived factors. Despite a small sample size, the findings highlighted the importance of installing the charts in the EMR systems, and can provide a foundation for future public health dissemination efforts and research on medical guideline implementation. / Graduate / 0573 / 0769 / erand@uvic.ca

This thesis explores the field of context-aware information systems (CAIS). We present an approach called Compose, Learn, and Discover (CLD) to incorporate CAIS into the user daily workflow. The CLD approach is self-adjusting. It enables users to personalise the information views for different situations. The CAIS learns about the usage of the information views and recalls the right view in the right situation. We illustrate the CLD approach through an application in the health care field using the Clinical Document Architecture (CDA). In order to realise the CLD approach, we introduce Semantic Composition as a new paradigm to personalise information views. Semantic Composition leverages the type information in the domain model to simplify the user-interface composition process. We also introduce a pattern discovery mechanism that leverages data-mining algorithms to discover correlations between user information needs and different situations.

The implementation of electronic medical record (EMR) systems is a complex process that is receiving more focus in developing countries to support understaffed and overcrowded health facilities deal with the HIV/AIDS epidemic. This thesis research uses exploratory-grounded theory to study clinician perceived benefits of EMRs in antiretroviral therapy (ART) clinics at four hospitals in Ethiopia. The study is designed to understand the process, technology, social and organizational challenges associated with EMR implementation in resource-limited areas. The research found the attitude of ART clinicians towards the implementation of EMR systems to be overwhelmingly positive. The data showed that perceived benefits of EMRs are improved continuity of care, timely access to complete medical record, patient care efficiency, reduced medication errors, improved patient confidentiality, improved communication among clinicians, integration of various HIV programs, timely decision support and overall job motivation. Conversely, drawbacks to EMR implementation include productivity loss and negative impact on the interaction and relationship between clinicians and their patients. The study proposes a conceptual framework classifying key components for successful EMR implementation in Ethiopia.

Introduction: The epidemic of overweight and obesity both worldwide and in Canada is indicative of the need for proper growth monitoring beginning at birth. This study evaluated Family Physician’s (FP) Level of Use (LoU) of the recommended 2006 and 2007 World Health Organization (WHO) Growth Charts for monitoring their paediatric patients’ growth. It explored factors influencing LoU, utilizing the Diffusion of Innovations (DOI) theory and Ecological Framework for Effective Implementation (EFEI) as guiding models. FPs’ awareness of resources to support paediatric weight management was also assessed. Methods: A survey was distributed to FP in British Columbia (BC), Canada (N = 2853). The survey addressed provider and innovation characteristics, prevention delivery and support system factors, and barriers and facilitators to chart use. Correlations and multiple linear regression were used to determine correlates and predictors of LoU. Results: Sixty-two surveys were returned (2.2%). WHO Growth Chart LoU was 80.4%. Six variables significantly predicted LoU, including age (β = -.28, t = -3.15, p < .05), practicing in Fraser Health Authority region (β = -.24, t = -2.67, p < .05), assessing head circumference of birth to two year olds (β = .23, t = 2.45, p < .05), perceived growth chart accessibility (β = .39, t = 4.22, p < .05) and compatibility (β = .47, t = 5.27, p < .05), and innovativeness (β = -.37, t = -4.11, p < .05). These variables accounted for 69% of the variance in LoU. The most commonly identified barrier and facilitator to chart use was related to the Electronic Medical Record (EMR) system. FPs’ awareness of resources to support overweight paediatric patients was low. Conclusion: The majority of FP in BC in this sample had adopted the WHO Growth Charts. The results showed partial support for DOI theory and EFEI derived factors. Despite a small sample size, the findings highlighted the importance of installing the charts in the EMR systems, and can provide a foundation for future public health dissemination efforts and research on medical guideline implementation. / Graduate / 0573 / 0769 / erand@uvic.ca

Submitted by Carvalho Cristiane (crisedangelo@yahoo.com.br) on 2012-05-30T12:17:49Z No. of bitstreams: 1 Marcos Nakamura Pereira.pdf: 2337168 bytes, checksum: 8ed5a86601d971398b0db84852aa3df7 (MD5) / Made available in DSpace on 2012-05-30T12:17:49Z (GMT). No. of bitstreams: 1 Marcos Nakamura Pereira.pdf: 2337168 bytes, checksum: 8ed5a86601d971398b0db84852aa3df7 (MD5) / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / Este estudo tem por objetivo avaliar o desempenho do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) na identificação dos casos de near miss materno ocorridos, em um hospital terciário da cidade do Rio de Janeiro, no ano de 2008. A identificação dos casos se deu pela avaliação dos prontuários médicos das mulheres que apresentaram condições potencialmente ameaçadoras à vida, selecionados a partir da revisão dos sumários de alta hospitalar, sendo este processo considerado o padrão-ouro. A segunda etapa do estudo consistiu no escrutínio das informações contidas no SIH-SUS, através da busca nominal dos casos de near miss materno identificados pela revisão dos prontuários e da seleção das AIHs cujos campos “Diagnóstico Principal”, “Diagnóstico Secundário” e/ou “Procedimento Realizado” apresentassem codificações compatíveis com este agravo, realizando-se então a avaliação das propriedades diagnósticas do SIH-SUS. Após avaliação de 1.170 sumários de internação hospitalar, foram selecionados 228 casos para a revisão dos prontuários. Após revisão das informações contidas nos registros médicos, foram identificados 165 casos de morbidade materna grave, dentre as quais 8 evoluíram com óbito materno, 130 cursaram com situações de morbidade grave não caracterizadas como near miss materno e 27 efetivamente apresentaram-se como casos de near miss materno. Na avaliação inicial do desempenho do SIH-SUS, através da busca nominal das mulheres identificadas com near miss, constatou-se que apenas 16 (59,2%) casos estavam no banco de dados. Acerca da ausência dos outros 11 casos (40.7%) restantes no sistema, foi possível detectar que ao menos 4 (36,3%) deles decorreram pelo não faturamento AIH por haver excedido o limite percentual de cesarianas do hospital. Analisando as propriedades diagnósticas do SIH-SUS, obteve-se sensibilidade de 18,5% (IC95% = 6,3-38,1), valor preditivo positivo de 7,14% (IC95% = 2,36-13,9), especificidade de 94,3 (IC95% = 92,8-95,6) e área sob a curva ROC de 0,56 (IC95% = 0,48-0,63). Considerando os resultados obtidos, em princípio, o SIH-SUS não parece ser boa ferramenta para vigilância do near miss materno. / The aim of this study is to evaluate the performance of the Hospital Information System (SIH) of Brazilian National Health Service in identifying cases of maternal near miss in a tertiary hospital in the city of Rio de Janeiro, during the year of 2008. The identification of such cases was done through evaluation of the medical records of patients who presented with potential life-threatening conditions. The cases were selected after revision of the discharge summaries of those patients; this process is considered gold-standard. The second phase of the study consisted in the scrutiny of the information in the SIH-SUS, through a nominal search of the maternal near miss cases identified from the revision of medical records and selection of the Hospital Admittance Forms (AIH) which the fields “primary diagnosis”, “secondary diagnosis” and/or “performed procedure” presented data compatible with such grievance, thus evaluating the diagnostic properties of the SIH. After evaluation of 1.170 hospital chart summaries, 228 cases were selected for a full chart revision. After revision of the information in the medical charts 165 cases of severe maternal morbidity were identified, among which 8 resulted in maternal death, 130 were cases of severe maternal morbidity not classified as near miss, and 27 were effectively considered maternal near miss cases. In the initial evaluation of the SIH performance through the nominal search of women identified as near miss, it was detected that only 16 (59. 2%) cases were in the database. Regarding the absence of the other 11 (40.7%) remaining cases, it was detected that at least 4 (36.3%) of them resulted from the non-billing of the procedures because the hospital’s cesarean-section percentage limit had been exceeded. An analysis of the diagnostic properties of the SIH showed a 18,5% sensibility (95%CI = 6.3 – 38.1), 7.14% positive predictive value (95%IC = 2.36-15.9), 94.3% specificity (95%CI = 92.8 – 95.6) and area under the ROC curve of 0.56 (95%CI = 0.48 – 0.63). At a first look, considering the results obtained,the SIH does not seem to be a good tool for surveillance of maternal near miss.

Le cancer du foie est le 6ème cancer le plus fréquent et le 2ème plus meurtrier dans le monde. Au Cambodge, en raison du contexte historique et économique, les données précises concernant cette pathologie manquent. A l'aide d'outils épidémiologiques, nous avons décrit les caractéristiques de 553 patients atteints de cancer du foie à l'hôpital Calmette à Phnom Penh, et ainsi mis en évidence l'importance de l'infection par les virus des hépatites B et C chez les sujets étudiés. Puis, nous avons documenté les connaissances de 42 de ces patients vis-à-vis de leur maladie. Nous avons détaillé leurs itinéraires thérapeutiques, mis en évidences des pratiques à risques (forte utilisation d'injections thérapeutiques et de techniques de dermabrasion), et le recours fréquent à des médecines dites traditionnelles. Nous avons ensuite tenté de comprendre les stratégies de prise en charge des patients souffrant de maladies hépatiques par les médecins traditionnels, et mis en évidence la variété des remèdes utilisés et l'importance de la perception khmère des propriétés des plantes. Enfin, à l'aide d'un modèle in vitro de culture de cellules cancéreuses hépatiques couplé à des outils d'analyse métabolomique, nous avons évalué 10 espèces médicinales, sélectionnées sur des critères bibliographiques et de terrain, et tenté d'identifier les composés potentiellement responsables de l'activité antiproliférative observée. / Liver cancer is the 6th most common and 2nd most lethal cancer in the world. In Cambodia, due to the historical and economic context, there is a lack of accurate data on this pathology. Using epidemiological tools, we described the characteristics of 553 patients with liver cancer at the Calmette Hospital in Phnom Penh, and thus highlighted the importance of infection with hepatitis B and C viruses in the subjects studied. Then we documented the knowledge of 42 of these patients about their disease. We have detailed their therapeutic itineraries, highlighted risky practices (high use of therapeutic injections and dermabrasion techniques) and the use of traditional medicines. We then attempted to understand strategies for the management of patients with liver diseases by traditional healers, and highlighted the variety of remedies used and the importance of Khmer perception of plant properties. Finally, using an in vitro model of liver cancer cell culture coupled with metabolic analysis tools, we evaluated 10 medicinal species, selected on the basis of bibliographic and field criteria, and attempted to identify the compounds potentially responsible for the antiproliferative activity observed.

Made available in DSpace on 2014-06-11T19:26:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-09-14Bitstream added on 2014-06-13T19:55:00Z : No. of bitstreams: 1 silva_jc_me_mar.pdf: 478207 bytes, checksum: e4df2a83f1e50aac162e977815658db0 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / A Ciência da Informação desenvolve metodologias para tratamento, acesso e transferência da informação e do conhecimento, tendo em vista as necessidades e demandas dos usuários e estabelece relações com a Terminologia, pois ao considerar a função de organização da informação e do conhecimento, ambas cumprem os papéis de recuperar e disseminar a informação e atender os usuários em suas necessidades informacionais. Ressalta-se ainda, que dentre as inúmeras possibilidades de estudos interdisciplinares no campo da Ciência da Informação, a informação em saúde é de grande importância. Pois embora a informação tenha um valor essencial na sociedade contemporânea, na área da saúde, a informação técnica-científica é vital. Neste trabalho a informação em saúde referese ao estudo da terminologia da área da saúde, destacando-se que os termos técnico-científicos desse campo do saber são utilizados principalmente para a comunicação de informações e transferência de conhecimentos entre os profissionais. Todavia, a variação na terminologia utilizada na área da saúde requer a harmonização dos termos técnico-científicos, visto que estes apresentam imprecisão e ambiguidade e podem dificultar a recuperação da informação pelos profissionais. Considerando-se ser necessário o emprego de uma terminologia mais harmoniosa para uma melhor comunicação entre os profissionais de saúde surgiu a proposta de se destacar a importância da Teoria Comunicativa da Terminologia através de uma análise da representação da informação em prontuários de pacientes de hospitais universitários, especificamente na especialidade Neurologia. Observou-se, na comparação feita entre os Hospitais Universitários, a saber, o Hospital das Clínicas da Faculdade de Medicina de Marília e o Hospital das Clínicas da Faculdade de... / Information Science develops methodologies for processing, accessing and transferring information and knowledge, in view of the needs and demands of users and establish relations with the Terminology, because when considering the function of organizing information and knowledge, both fulfill the role of retrieving and disseminating information and serve users in their informational needs. It is also noteworthy that, among the many possibilities of interdisciplinary studies in the field of Information Science, information in health care is of great importance. Although information has a core value in contemporary society, in health, scientific-technical information is vital. In this work, information in health care refers to the study of health care terminology, pointing out that the technical and scientific terms in this field are mainly used for reporting information and transferring of knowledge among professionals. However, the variation in the terminology of health care requires technical and scientific terms harmonized, since they show a lot of imprecision and ambiguity and can hinder the retrieval of information by health care professionals. Taking into consideration the need to use a more harmonious terminology, for better communication among health care professionals, emerged the proposal to highlight the importance of the Communicative Theory of Terminology through an analysis of the representation of information in medical records of patients from university hospitals, specifically in the Neurology field. It was observed in the comparison made among University Hospitals, namely, the Clinical Hospital at the Faculty of Medicine of Marília and the Clinical Hospital at the Faculty of Medicine of Ribeirao Preto, University of Sao Paulo that there are more similarities than differences at filling out patient records. As to the... (Complete abstract click electronic access below)