nÃo hà / A farmacovigilÃncia à a ciÃncia relativa à detecÃÃo, avaliaÃÃo, compreensÃo e prevenÃÃo de reaÃÃes adversas ou quaisquer outros possÃveis problemas relacionados a medicamentos. No Brasil, a farmacovigilÃncia encontra-se em desenvolvimento. Ainda nÃo està completamente disseminada a cultura da notificaÃÃo espontÃnea, principalmente na oncologia, onde a ocorrÃncia de reaÃÃo adversa passa muitas vezes despercebida por ser considerada como um evento esperado, e, portanto, sem importÃncia significativa. Este estudo avaliou as aÃÃes de farmacovigilÃncia desenvolvidas numa instituiÃÃo hospitalar da cidade de Teresina-PI, atravÃs da monitorizaÃÃo de pacientes portadores de cÃncer de mama submetidos à terapia antineoplÃsica com o regime de combinaÃÃo FEC. Para isso, foi realizada uma investigaÃÃo baseada em uma revisÃo dos prontuÃrios desses pacientes para detectar o registro: de reaÃÃes adversas decorrentes da quimioterapia antineoplÃsica vigente e da distinÃÃo das mesmas, segundo os graus de severidade estabelecidos pelo National Cancer Institute (NCI); de intercorrÃncias clÃnicas devido à RAM ocorridas durante a terapia e de possÃveis alteraÃÃes no plano do tratamento protocolado (atrasos na realizaÃÃo dos ciclos de quimioterapia ou suspensÃo temporÃria da terapia, reduÃÃes das doses preconizadas) relacionadas com reaÃÃes adversas. De todas as reaÃÃes adversas observadas durante a investigaÃÃo, 2,07% foram registradas em nÃo conformidade com a terminologia qualitativa adotada pelo NCI e 15,06% nÃo foram graduadas quanto à severidade; alÃm disso, 100% das RAMs nÃo foram notificadas à autoridade sanitÃria competente (ANVISA) e nÃo existe um banco de dados institucional com essas reaÃÃes adversas. Foram ainda identificadas 17 (70,83%) intervenÃÃes clÃnicas devido à RAM realizadas em nÃvel ambulatorial e 7 (29,17%) intervenÃÃes clÃnicas devido à RAM que exigiram a hospitalizaÃÃo do paciente; atrasos ou suspensÃo temporÃria da realizaÃÃo dos ciclos de quimioterapia, com 8,70% decorrentes de causas clÃnicas, entre estas reaÃÃes adversas; e 8 (5,84%) casos de reduÃÃo das doses protocoladas devido à presenÃa e severidade de reaÃÃes adversas. Conclui-se que as aÃÃes de farmacovigilÃncia da instituiÃÃo hospitalar ainda sÃo incipientes, com falhas organizacionais que diminuem a confiabilidade das informaÃÃes registradas; alÃm disso, houve a comprovaÃÃo da importÃncia da farmacovigilÃncia em oncologia, onde a toxicidade dos fÃrmacos utilizados pode ser considerada fator limitante primÃrio para uma prÃtica terapÃutica ideal. / Pharmacovigilance is the science concerning the detection, assessment, understanding and prevention of adverse reactions or any other possible drug-related problems. In Brazil, pharmacovigilance is in the developmental stage. The culture of spontaneous reporting not yet fully spread, especially in oncology, where the occurrence of adverse reaction is often unnoticed because it is considered as an expected event, and therefore immaterial. This study evaluated the pharmacovigilance actions carried out at a hospital in the city of Teresina, PI, through the monitoring of patients with breast cancer undergoing anticancer therapy with the FEC protocol. An investigation was undertaken based on a review of the medical records of these patients to detect the registry: of adverse reactions resulting from cancer chemotherapy and the distinction of them according to the degrees of severity established by the National Cancer Institute (NCI); of clinical interventions due to ADR that occurred during therapy and possible changes in the plan of treatment protocol (delays in the achievement of cycles of chemotherapy or temporary suspension of therapy, reductions in the recommended doses) related with adverse reactions. Of all the adverse reactions observed during the investigation, 2,07% were not registered in accordance with the terminology adopted by NCI qualitative and 15,06% were not graded as to severity. In addition, 100% of ADRs were not reported to the recognized health authority (ANVISA) and there is not an institutional database with these adverse reactions. There were also 17 identified (70,83%) clinical interventions due to ADR performed on an outpatient basid and 7 (29,17%) clinical interventions due to ADR that required hospitalization of the patient; delays or temporary suspension of achievement of cycles of chemotherapy with 8,70% due to clinical causes among these adverse reactions; and 8 (5,84%) cases of dose reduction due to the presence and severity of adverse reactions. It is concluded that the pharmacovigilance actions of the hospital are still preliminary, with organizational flaws that reduce the reliability of the information recorded. In addition, there was evidence of the importance of pharmacovigilance in oncology, where the toxicity of drugs used may be considered a limiting factor necessary for an ideal therapeutic practice.

The technology exists for the migration of healthcare data from its archaic paper-based system to an electronic one and once in digital form, to be transported anywhere in the world in a matter of seconds. The advent of universally accessible healthcare data benefits all participants, but one of the outstanding problems that must be addressed is how to uniquely identify and link a patient to his or her specific medical data. To date, a few solutions to this problem have been proposed that are limited in their effectiveness. We propose the use of biometric technology within our FIRD framework in solving the unique association of a patient to his or her medical data distinctively. This would allow a patient to have real time access to all of his or her recorded healthcare information electronically whenever it is necessary, securely with minimal effort, greater effectiveness, and ease.

This paper presents the results of a survey of 30 adults aged 55 and older, who had taken multiple prescription medications in the past two years. The purpose of the study was to determine how older adults manage their medication information currently, what information they save and share, and how they wish to manage medication information in an electronic environment, such as a personal health record. Adults in the survey shared information most frequently with their doctors, and with friends and family. They usually shared basic information about a medication, including its name, dose, and the frequency with which it is taken. Nearly half used an artifact, such as a list, to keep track of and share their information. Nearly a third of participants desired to keep an electronic record, suggesting that a percentage of the older adult population would be open to using electronic records to manage medication information.

Abbreviations are common in clinical documentation, as this type of text is written under time-pressure and serves mostly for internal communication. This study attempts to apply and extend existing rule-based algorithms that have been developed for English and Swedish abbreviation detection, in order to create an abbreviation detection algorithm for Swedish clinical texts that can identify and suggest definitions for abbreviations and acronyms. This can be used as a pre-processing step for further information extraction and text mining models, as well as for readability solutions. Through a literature review, a number of heuristics were defined for automatic abbreviation detection. These were used in the construction of the Swedish Clinical Abbreviation Normalizer (SCAN). The heuristics were: a) freely available external resources: a dictionary of general Swedish, a dictionary of medical terms and a dictionary of known Swedish medical abbreviations, b) maximum word lengths (from three to eight characters), and c) heuristics for handling common patterns such as hyphenation. For each token in the text, the algorithm checks whether it is a known word in one of the lexicons, and whether it fulfills the criteria for word length and the created heuristics. The final algorithm was evaluated on a set of 300 Swedish clinical notes from an emergency department at the Karolinska University Hospital, Stockholm. These notes were annotated for abbreviations, a total of 2,050 tokens. This set was annotated by a physician accustomed to reading and writing medical records. The algorithm was tested in different variants, where the word lists were modified, heuristics adapted to characteristics found in the texts, and different combinations of word lengths. The best performing version of the algorithm achieved an F-Measure score of 79%, with 76% recall and 81% precision, which is a considerable improvement over the baseline where each token was only matched against the word lists (51% F-measure, 87% recall, 36% precision). Not surprisingly, precision results are higher when the maximum word length is set to the lowest (three), and recall results higher when it is set to the highest (eight). Algorithms for rule-based systems, mainly developed for English, can be successfully adapted for abbreviation detection in Swedish medical records. System performance relies heavily on the quality of the external resources, as well as on the created heuristics. In order to improve results, part-of-speech information and/or local context is needed for disambiguation. In the case of Swedish, compounding also needs to be handled.

Although end-user support is an important aspect of EMR implementation, it is not known in what ways it affects EMR success. To investigate this topic, a case study of end-user support for an open-source EMR was conducted in an Ontario Family Health Organization using 7 semistructured interviews based on the DeLone and McLean Model of Information System Success. Second, documentation for an open-source and proprietary EMR was analyzed using Carroll’s Minimalism as a theoretical framework. Finally, themes from this thesis were compared and contrasted with a multiple case study that examined support for a commercial EMR in 4 Ontario family health teams. Main findings include the role of informal support, which was important for ensuring that data are documented consistently, which in turn enabled information retrieval for providing better preventive care services. Also, formal support was important for mitigating problems of system quality, which had potential implications for patient safety.

Although end-user support is an important aspect of EMR implementation, it is not known in what ways it affects EMR success. To investigate this topic, a case study of end-user support for an open-source EMR was conducted in an Ontario Family Health Organization using 7 semistructured interviews based on the DeLone and McLean Model of Information System Success. Second, documentation for an open-source and proprietary EMR was analyzed using Carroll’s Minimalism as a theoretical framework. Finally, themes from this thesis were compared and contrasted with a multiple case study that examined support for a commercial EMR in 4 Ontario family health teams. Main findings include the role of informal support, which was important for ensuring that data are documented consistently, which in turn enabled information retrieval for providing better preventive care services. Also, formal support was important for mitigating problems of system quality, which had potential implications for patient safety.

Thesis (Ph. D. in Biomedical Informatics)--Vanderbilt University, Dec. 2009. / Title from title screen. Includes bibliographical references.

Thesis (MCur (Nursing Science))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

Thesis (M.A.)--Northern Kentucky University, 2009. / Made available through ProQuest. Publication number: AAT 1470022. ProQuest document ID: 1905525191. Includes bibliographical references (p. 52-54.)

Dissertation (Ph.D.)--Auburn University, 2009. / Abstract. Includes bibliographic references (p.164-184).