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Introduction: Health information systems play a crucial role in the delivery of efficient and effective healthcare. Poor usability is one of the reasons for their lack of acceptance and low usage by users. The aim of this study was to identify the usability problems of a national comprehensive health information system using the concurrent think-aloud method in the recording of childcare data. Methods: A descriptive cross-sectional study was conducted in the health centers of Kashan University of Medical Sciences, Iran, in 2020. Ten healthcare providers as system's users were purposively selected to evaluate the system. To identify problems, a concurrent think-aloud evaluation was conducted. Two administrators of the system designed scenarios for ten childcare data recording tasks. By analysing the recorded files, usability problems were identified. The severity of the problems was then determined with the help of the users and problems were assigned to usability attributes based on their impact on the user. Results: A total of 68 unique problems were identified in the system, of which 47.1% were rated as catastrophic problems. The participants assigned 47 problems (69%) to the user satisfaction attribute and 45 problems (66%) to the efficiency attribute; they also did not assign any problems to the effectiveness attribute. Conclusion: The problems identified in the national comprehensive health information system using the think-aloud method were rated as major and catastrophic, which indicates poor usability of this system. Therefore, resolving the system problems will help increase user satisfaction and system efficiency, allowing more time to be spent on patient care and parent's education as well as improving overall quality of care. [ABSTRACT FROM AUTHOR]

Purpose Due to the low specificity of drug-drug interaction (DDI) warnings, hospitals and healthcare systems would benefit from the ability to customize alerts, thereby reducing the burden of alerts while simultaneously preventing harm. We developed a tool, called the Drug Interaction Customization Editor (DICE), as a prototype to identify features and functionality that could assist healthcare organizations in customizing DDI alerts. Methods A team of pharmacists, physicians, and DDI experts identified attributes expected to be useful for filtering DDI warnings. A survey was sent to pharmacists with informatics responsibilities and other medication safety committee members to obtain their opinions about the tool. The survey asked participants to evaluate the 4 sections of the DICE tool (General, Medication, Patient, and Visit) on a scale ranging from 0 (not useful) to 100 (very useful). The survey provided an opportunity for participants to express their opinions on the overall usefulness of the DICE tool and to provide other comments. Results The 50 survey respondents were mainly pharmacists (n = 47, 94%) with almost half (n = 23, 47%) having health information technology/informatics training. Most respondents (n = 33, 80%) were employed by organizations with over 350 beds. Respondents indicated the most useful features of the DICE tool were the ability to filter DDI warnings based on routes of administrations (mean [SD] rating scale score, 86.5 [21.6]), primary drug properties (85.7 [20.5]), patient attributes (85.6 [16.7]) and laboratory attributes (88.8 [18.0]). The overall impression of the DICE tool was rated at 82.8 (19.0), and when asked about the potential to reduce DDI alerts, respondents rated the tool at 83.7 (21.8). Conclusion The ability to customize DDI alerts using data elements currently within the electronic health records (EHRs) has the potential to decrease alert fatigue and override rates. This prototype DICE tool could be used by end users and vendors as a template for developing a more advanced DDI filtering tool within EHR systems. [ABSTRACT FROM AUTHOR]

Background: Malignant ureteral obstruction (MUO) is a serious health condition in which a malignant tumor compresses the ureter. The optimal decompressive intervention in MUO remains unclear. This study was conducted to assess and compare renal function, the occurrence of ureterohydronephrosis (UHN), intraoperative, and postoperative complications among patients with MUO who underwent double J stenting (DJS) and percutaneous nephrostomy (PCN) in the Palestinian practice. Methods: This study was conducted in retrospective design in one of the main tertiary care hospitals in the West Bank of Palestine. The data were collected from the electronic health information system of the hospital for the patients with MUO who received either DJS or PCN as a decompressive intervention from January 2018 to January 2024. Results: In this retrospective analysis, 62 patients who had stage 2 to stage 4 cancer and suffered MUO were included. The mean age of the patients was 60.8 ± 13.6 years. Of the patients, 40 (64.5%) were male and 22 (35.5%) were female. Of the patients, 26 (41.9%) had urinary bladder cancer. Of the patients, 23 (37.1%) had flank pain and 16 (25.8%) had lower urinary tract symptoms. Of the patients, 34 (54.8%) experienced bilateral UHN and 28 (45.2%) experienced unilateral UHN. In this study, 43 patients (69.4%) received PCN, and 19 (30.6%) received DJS as a decompressive intervention. Of the patients, 36 (58.1%) suffered postoperative complications. Stent migration/slip, UTIs, and urosepsis were the most commonly reported postoperative complications. There were no statistically significant differences in the occurrence of intraoperative complications, postoperative complications, time elapsed from receiving the decompression intervention to the diagnosis of complications, ICU admission, prognosis of UHN, serum creatinine, and serum BUN between both decompressive interventions. Conclusion: Despite improvements in renal functions, creatinine and BUN levels remained abnormal even after receiving a decompressive intervention. Postoperative complications were frequently reported among patients who received DJS or PCN as decompressive interventions. Larger prospective studies are still needed to determine the optimal interventions to improve outcomes, quality of life, and survival rates of patients with DJS or PCN. [ABSTRACT FROM AUTHOR]

Background: This study seeks to investigate the contemporary use and effectiveness of fibrinolysis as a first-line option in pediatric empyema. Methods: The Pediatric Health Information System (PHIS) was queried to identify patients with empyema without fistula (2018–2023). First-line treatments were chest drainage (CD), chest drainage with fibrinolysis (CDF), and video-assisted thoracoscopic surgery/open decortication (VATS/OD). Outcomes between groups were compared using Kruskal–Wallis and Chi-Square tests. Multivariate generalized linear model was used to account for covariates. Results: 581 individuals/cases met inclusion criteria. CD accounted for 11.9% of cases, CDF for 67.6%, and VATS/OD for 20.7%. After adjusting for covariates differences in LOS were not significant (p = 0.393). Subsequent VATS/ODs were required in 6.9% of CDF cases, 8.9% of CD, and 3.3% of primary VATS/OD. Additionally, 32.5% of primary VATS/OD received adjuvant fibrinolysis. Complications were more often observed in the VATS/OD group compared to CD and CDF (11.7% vs 5.8% and 4.1% respectively; p =.008). There were no differences in 30-day readmission rate (VATS/OD:1.2%, CTD:1.5%, and CTDF:1%; p = 0.83). Conclusion: Fibrinolysis is now utilized as first-line treatment for most patients and as adjunct in other approaches. The findings justify further implementation as it is the less invasive first-line primary therapy in patients with empyema. [ABSTRACT FROM AUTHOR]

Globally, Healthcare-associated infections (HCAIs) pose a significant threat to patient safety and healthcare systems. In low- and middle-income countries (LMICs), the lack of adequate resources to manage HCAIs, as well as the weak healthcare system, further exacerbate the burden of these infections. Traditional surveillance methods that rely on laboratory tests are cost-intensive and impractical in these settings, leading to ineffective monitoring and delayed management of HCAIs. The rates of HCAIs in resource-limited settings have not been well established for most LMICs, despite their negative consequences. This is partly due to costs associated with surveillance systems. Syndromic surveillance, a part of active surveillance, focuses on clinical observations and symptoms rather than laboratory confirmation for HCAI detection. Its cost-effectiveness and efficiency make it a beneficial approach for monitoring HCAIs in LMICs. It provides for early warning capabilities, enabling timely identification and response to potential HCAI outbreaks. Syndromic surveillance is highly sensitive and this helps balance the challenge of low sensitivity of laboratory-based surveillance systems. If syndromic surveillance is used hand-in-hand with laboratory-based surveillance systems, it will greatly contribute to establishing the true burden of HAIs in resource-limited settings. Additionally, its flexibility allows for adaptation to different healthcare settings and integration into existing health information systems, facilitating data-driven decision-making and resource allocation. Such a system would augment the event-based surveillance system that is based on alerts and rumours for early detection of events of outbreak potential. If well streamlined and targeted, to monitor priority HCAIs such as surgical site infections, hospital-acquired pneumonia, diarrheal illnesses, the cost and burden of the effects from these infections could be reduced. This approach would offer early detection capabilities and could be expanded into nationwide HCAI surveillance networks with standardised data collection, healthcare worker training, real-time reporting mechanisms, stakeholder collaboration, and continuous monitoring and evaluation. Syndromic surveillance offers a promising strategy for combating HCAIs in LMICs. It provides early warning capabilities, conserves resources, and enhances patient safety. Effective implementation depends on strategic interventions, stakeholder collaboration, and ongoing monitoring and evaluation to ensure sustained effectiveness in HCAI detection and response. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described. Methods: This was a cross‐sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation‐adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$. Results: Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021). Conclusions: While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed. [ABSTRACT FROM AUTHOR]

Introduction Approximately 9 million veterans receive health care at the Veterans Health Administration, many of whom have psychiatric illnesses. The military continues to have higher rates of psychiatric illness compared to the civilian population. Having a diagnosis such as posttraumatic stress disorder or depression may create challenges in using health care services, such as surgery. The aim of this study was to evaluate eye surgery cancellation, risk factors for cancellation, and areas for intervention within the VA. Materials and Methods This was a single-center retrospective cohort study. The Veteran Health Information Systems and Technology Architecture were queried to identify all surgical requests at the West Los Angeles VA in 2019. Data collection included sociodemographic information and comorbid medical conditions, including psychiatric illness. Exploratory analyses using univariate logistic regression were used to evaluate factors associated with surgery cancellation. Results A total of 1,115 surgical requests were identified with a cancellation rate of 23.7% (n  = 270). Sociodemographic factors were similar between those with completed and cancelled surgery. However, having a psychiatric diagnosis correlated with surgery cancellation. For all subspecialties, patients with schizophrenia were more likely to have cancellation (odds ratio [OR], 2.53, P =  .04). For retina surgery, patients with posttraumatic stress disorder were more likely to have cancellation (OR, 4.23, P =  .01). Glaucoma patients with anxiety (OR, 5.78, P =  .05) and depression (OR, 4.05, P =  .04) were more likely to have cancellation. Conclusions There was a significant amount of eye surgery cancellations in veterans with variation by subspecialty and comorbid conditions. Having a psychiatric illness was correlated with increased rates of surgery cancellation amongst veterans. Areas to improve surgical utilization include risk stratification and increased support of vulnerable patients before surgery. [ABSTRACT FROM AUTHOR]

Kidney diseases have become a global epidemic with significant public health impact. Chronic kidney disease (CKD) is set to become the fifth largest cause of death by 2040, with major impacts on low-resource countries. This review is based on a recent report of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) which uncovered gaps in key vehicles of kidney care delivery assessed using World Health Organization building blocks for health systems (financing, services delivery, workforce, access to essential medicines, health information systems and leadership/governance). High-income countries had more centres for kidney replacement therapies (KRT), higher KRT access, higher allocation of public funds to KRT, larger workforces, more health information systems, and higher government recognition of CKD and KRT as health priorities than low-income nations. Evidence identified from the current ISN-GKHA initiative should serve as template for generating and advancing policies and partnerships to address the global burden of kidney disease. The results provide opportunities for kidney health policymakers, nephrology leaders and organizations to initiate consultations to identify strategies for improving care delivery and access in equitable, resource-sensitive manners. Policies to increase use of public funding for kidney care, lower the cost of KRT and increase workforces should be a high priority in low-resource nations, while strategies that expand access to kidney care and maintain current status of care should be prioritized in high-income countries. In all countries, the perspectives of people with CKD should be exhaustively explored to identify core kidney care priorities. [ABSTRACT FROM AUTHOR]

Objective: Vitamin K (VK) is commonly prescribed for pediatric sepsis-induced coagulopathy without trial-derived evidence to support its use for this indication. The purpose of this study was to characterize national prescribing trends for VK in this population. Patients and Methods: This is a multicenter retrospective cohort study using the Pediatric Health Information System registry including children 0 to 17 years of age hospitalized for sepsis in the pediatric intensive care unit from January 2016 through December 2022. The primary outcome was overall, annual, and center-specific VK prescribing rates. Descriptive data included demographics, length of stay, and rates of VK deficiency, hepatic insufficiency, red blood cell (RBC) transfusion, venous thromboembolism (VTE), and mortality. VK prescribing trends were assessed using Joinpoint regression. Descriptive statistics employed included Wilcoxon rank-sum, student's t, and chi-square tests. Results: Of the 31 221 encounters studied, 4539 (14.6%) were prescribed VK (median center-specific rate: 14.2%; interquartile range [IQR]: 8.8-21%) with a linear annual trend decreasing from 17.3% in 2016 to 13.3% in 2022 (−0.6%/year, r 2 =.661). Those prescribed VK had greater rates of hepatic dysfunction (20.5% vs 3.1%), RBC transfusion (26.5% vs 11.2%), VTE (12.5% vs 4.6%), mortality (17.1% vs 4.4%), and median length of stay (16 [IQR: 8-33] vs 8 [4-15] days) (all P <.001). VK deficiency was diagnosed in 0.2% of encounters. Conclusions: In this multicenter retrospective cohort, VK prescribing was common among critically ill children diagnosed with sepsis. Phased trials are needed to demonstrate clinical efficacy and safety for VK in this population. [ABSTRACT FROM AUTHOR]

In the dynamic field of healthcare, clinical coding plays a key role in providing accurate and comprehensive information about patients' illnesses and their treatment as part of a comprehensive medical service. Coding systems are now part of health information systems across Europe. Much of what is known about the extent of prevalence, causes and consequences of human disease and mortality worldwide is based on the use of data coded according to the International Classification of Diseases (ICD). The ICD is the world's standard methodology for collecting mortality and morbidity data. The analysis of the available literature on the selected issues outlines the multidimensional role of coding systems in health care, which has a huge impact on decisionmaking in the process of providing medical services. In Bulgaria, despite the abundance of literary sources in the native medical literature, there is still a lack of a comprehensive analysis dedicated specifically to the importance of clinical coding. Regardless of what coding system in a country is used, it is important that medical institutions are trained and know how to record full and precise information about diagnoses and procedures. In this regard, a survey and analysis was conducted in various medical institutions within 6 months in 2023 among staff dealing with clinical coding in medical institutions: doctors, health care professionals, coders and others. The study focused on organization and training in clinical coding, with the aim of highlighting the key elements that contribute to the high degree of accuracy and efficiency in this important medical process. By analyzing the various aspects related to professionalism, training, and internal structures of medical institutions, the study seeks to reveal the inevitable relationship between well-organized and trained coding and increased quality of health care [ABSTRACT FROM AUTHOR]

Although health information systems (HIS) play an important role in elevating health standards, a comprehensive understanding of how to effectively implement HIS in rural areas is lacking. This issue becomes more significant when considering that globally a majority of the approximately 1.5 million deaths of children under the age of five in 2019 that were attributable to vaccine‐preventable diseases occurred in rural areas. Accordingly, we ask two questions. How does rurality influence the implementation of information and communication technology for development (ICT4D) projects? How do organisations navigate challenges associated with rurality during the implementation of these projects? Our findings, derived from an in‐depth case study of a social enterprise in rural India, reveal two paradoxes that pose challenges to the effective implementation of HIS in rural settings: the localisation paradox and the cultural embedding paradox. We found that contextually balanced engagement was comprised of four organisational responses—prioritising; localising; cultural adjustment; and engaging stakeholders—that help navigate the challenges posed by the localisation and cultural embedding paradoxes. Synthesising these findings, we develop a process model that shows how the implementation of HIS in rural areas is shaped by the descriptive and sociocultural characteristics of rurality. Further, organisations require a dynamic approach, engaging in multiple responses over time to navigate the paradoxes inherent in HIS implementation. We suggest that organisational responses to paradoxical tensions stemming from the descriptive and sociocultural characteristics of rurality lead to the development of HIS enabled for rurality. Our findings contribute the understanding of ICT4D projects implementation. [ABSTRACT FROM AUTHOR]

Burkina Faso has implemented a nationwide free healthcare policy (gratuité) for pregnant and lactating women and children under 5 years since April 2016. Studies have shown that free healthcare policies can increase healthcare service use. However, the emerging coronavirus disease 2019 pandemic, escalating insecurity and the political situation in recent years might have affected the implementation of such policies. No studies have looked at whether the gratuité maintained high service use under such changing circumstances. Our study aimed to assess the effects of gratuité on the utilization of facility-based delivery and curative care of children under 5 years in light of this changing context. We employed a controlled interrupted time series analysis using data from the Health Management Information System and annual statistical reports of 2560 primary health facilities from January 2013 to December 2021. We focused on facility-based deliveries and curative care for children under 5 years, with antenatal care and curative care for children over 5 years as non-equivalent controls. We employed segmented regression with the generalized least square model, accounting for autocorrelation and monthly seasonality. The monthly utilization rate among children under 5 years compared to those above 5 years (controls) immediately increased by 111.19 visits per 1000 children (95% CI: 91.12, 131.26) due to the gratuité. This immediate effect declined afterwards with a monthly change of 0.93 per 1000 children (95% CI: −1.57, −0.29). We found no significant effects, both immediate and long-term, on the use of maternal care services attributable to the gratuité. Our findings suggest that free healthcare policies can be instrumental in improving healthcare, yet more comprehensive strategies are needed to maintain healthcare utilization. Our findings reflect the overall situation in the country, while localized research is needed to understand the effect of insecurity and the pandemic at the local level and the effects of gratuité across geographies and socioeconomic statuses. [ABSTRACT FROM AUTHOR]

Purpose: Integrated care is the leading approach to developing health and social care services in Finland. After the national health and social care reform, the importance of assessing integration has been emphasized. The aim of this study was to pilot the SCIROCCO tool, which assesses integration maturity, in Finland. The SCIROCCO tool was translated and adapted to the Finnish health and social care context. The feasibility and utility of this tool for assessing the maturity for integration across health and social care in Finland were evaluated using empirical pilot data collected among employees of selected well-being service counties. The study also provided baseline information on the maturity of integration after the national health and social care reform. Design/methodology/approach: Employees (n = 111) of different personnel groups in health and social care services in four well-being service counties assessed the maturity of integration using a web-based survey. A pilot study design was used. Findings: The SCIROCCO tool was found to be useful for assessing the maturity of integration in health and social care within the well-being service counties. However, the tool requires further development to be fully adapted to the Finnish health and social care system and to assess integration across sectors. The results emphasize the need to understand the perspectives of different personnel groups on integration and to consider them in the development work. Originality/value: This was the first study conducted in Finland that provided valuable insights into the assessment of integration across the health and social care sectors. This study establishes the foundation for future research and development in the field of integration assessment. [ABSTRACT FROM AUTHOR]

The main factors related to the lack of coverage in Health Information Systems are concentrated in the scarce and incipient training of health professionals regarding the collection and typing of data, as well as the importance of using information. The aim of this study was to analyze the perceptions of primary health care professionals from Brazil about the functioning of the Food and Nutritional Monitoring System (SISVAN). Multicentric qualitative study, carried out with 38 health professionals in Basic Health Units (BHU) in five regions around the country. Data collection took place through interviews, which were submitted to content analysis, using the thematic modality. The treatment of the results and interpretation of the themes were carried out using the theoretical framework of the philosopher Michel Foucault. Four themes emerged: (Lack of) knowledge of SISVAN; SISVAN and the conditional income transfer program; Difficulties in the execution and use of SISVAN information; and Strengths. Some of the interviewees recognized the purpose of SISVAN's functioning. The collection of anthropometric data was related to the conditions of the Bolsa Família Program. Ignorance of the system and/or limited perception emerged as obstacles in the operability, use and quality of the data. The participants recognize that professional training is necessary to optimize the strengths of the system. [ABSTRACT FROM AUTHOR]

Background: Congenital heart disease (CHD) care has evolved during the past decades. Advances in care have contributed to improved survival among CHD patients. Children with CHD are requiring interventions for non-CHD related medical issues that occur in the general pediatric population. Methods: A retrospective review of the Pediatric Health Information System (PHIS) database from January 1, 2004, to July 31, 2023. Discharges of patients with an admitting/principal diagnosis of appendicitis were evaluated and categorized as CHD or non-CHD. Results: A total of 319,228 patients were identified with 1,25,858(39.4%) female, 1,38,966(43.5%) white, and median age of 11[IQR:8–14] years. 708(0.2%) had CHD with 85(12%) of them having a diagnosis consistent with single-ventricle CHD (SV-CHD). In univariate analysis, CHD patients were more likely to undergo conservative treatment (n = 172(24.2%)vs n = 59,358(18.6%)) and less likely to undergo laparoscopic appendectomy (n = 483(68.2%) vs n = 2,35,324(73.8%))(p < 0.001) compared to non-CHD. After adjustment, CHD patients had increased odds of undergoing open appendectomy compared to non-CHD. CHD patients were more likely to have an ICU admission (OR:8.36(95%CI 6.35–10.00),p < 0.001) and had a 77.6%(95%CI 40.89–123.93) increase in length of stay (LOS) (p < 0.001). Conclusion: CHD patients are more likely to have an open appendectomy than non-CHD patients. These findings suggest a distinctive pattern in the care of CHD patients compared to non-CHD. Overall, CHD patients had a more intense level of care with longer LOS and increased ICU admissions. Further work is needed to evaluate drivers of management decisions, the role of conservative treatment with antibiotics alone in the CHD population, and the potential impacts and safety of a laparoscopic approach. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Design Setting Participants Main Outcome Measures Results Conclusions To determine the current practice, safety and efficacy of interventions used in the management of recurrent respiratory papillomatosis (RRP) in the UK NHS.Prospective registry (recruitment between 1st April 2018 and 31st August 2022, retrospective data from 1st January 2015 permitted with consent). Sub‐group data‐linked to Hospital Episode Statistics for additional follow‐up (until 31st July 2022).UK NHS hospitals treating RRP patients.Children and adults diagnosed with RRP and managed in an NHS hospital.Disease severity (Derkay, voice handicap and GRBAS scores), management (type and frequency of surgical and adjuvant intervention) and complications (cancer, death).Three hundred and thirty patients were entered into the registry; 304 (including 65 children) were eligible for analysis. Children had more severe disease than adults (median Derkay score 10 vs. 5). Microdebrider was the most common surgical intervention, particularly in children (86% of children, 49% of adults). Additionally, lasers (CO2, KTP and pulsed dye) were used in 34% of adults. Gardasil was the most common adjuvant therapy (21 children, 23 adults). Procedural complications were rare (10.8% children, 5.9% adults). Five patients developed laryngeal malignancy; there were six deaths during follow‐up period.This is the largest UK RRP study to date. RRP is more aggressive in children than adults, and treatment choice differs between age groups. Overall, management was safe with minimal complications reported, and generally effective in maintaining a safe airway. Standardised reporting is required to objectively monitor disease progression and safety over time.Trial Registration: NCT03465280, ISRCTN36100560 [ABSTRACT FROM AUTHOR]

Purpose: This scoping review aims to explore the current applications of ChatGPT in the retina field, highlighting its potential, challenges, and limitations. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, MEDLINE, and Embase, to identify relevant articles published from 2022 onwards. The inclusion criteria focused on studies evaluating the use of ChatGPT in retinal healthcare. Data were extracted and synthesized to map the scope of ChatGPT's applications in retinal care, categorizing articles into various practical application areas such as academic research, charting, coding, diagnosis, disease management, and patient counseling. Results: A total of 68 articles were included in the review, distributed across several categories: 8 related to academics and research, 5 to charting, 1 to coding and billing, 44 to diagnosis, 49 to disease management, 2 to literature consulting, 23 to medical education, and 33 to patient counseling. Many articles were classified into multiple categories due to overlapping topics. The findings indicate that while ChatGPT shows significant promise in areas such as medical education and diagnostic support, concerns regarding accuracy, reliability, and the potential for misinformation remain prevalent. Conclusion: ChatGPT offers substantial potential in advancing retinal healthcare by supporting clinical decision-making, enhancing patient education, and automating administrative tasks. However, its current limitations, particularly in clinical accuracy and the risk of generating misinformation, necessitate cautious integration into practice, with continuous oversight from healthcare professionals. Future developments should focus on improving accuracy, incorporating up-to-date medical guidelines, and minimizing the risks associated with AI-driven healthcare tools. [ABSTRACT FROM AUTHOR]

The Internet of Medical Things (IoMT) has revolutionized healthcare with remote patient monitoring and real-time diagnosis, but securing patient data remains a critical challenge due to sophisticated cyber threats and the sensitivity of medical information. Traditional machine learning methods struggle to capture the complex patterns in IoMT data, and conventional intrusion detection systems often fail to identify unknown attacks, leading to high false positive rates and compromised patient data security. To address these issues, we propose RCLNet, an effective Anomaly-based Intrusion Detection System (A-IDS) for IoMT. RCLNet employs a multi-faceted approach, including Random Forest (RF) for feature selection, the integration of Convolutional Neural Networks (CNN) and Long Short-Term Memory (LSTM) models to enhance pattern recognition, and a Self-Adaptive Attention Layer Mechanism (SAALM) designed specifically for the unique challenges of IoMT. Additionally, RCLNet utilizes focal loss (FL) to manage imbalanced data distributions, a common challenge in IoMT datasets. Evaluation using the WUSTL-EHMS-2020 healthcare dataset demonstrates that RCLNet outperforms recent state-of-the-art methods, achieving a remarkable accuracy of 99.78%, highlighting its potential to significantly improve the security and confidentiality of patient data in IoMT healthcare systems. [ABSTRACT FROM AUTHOR]

Background: The Avicenna unified Health Information System (HIS) was implemented by the Palestinian Ministry of Health in 2010 across government hospitals. Despite its potential, the acceptance of Avicenna HIS by healthcare providers remains unclear after 14 years of application. Understanding the factors that influence healthcare provider acceptance is essential for optimizing the system's success. We investigated factors affecting acceptance of Avicenna HIS among healthcare providers in Palestinian healthcare institutions, focusing on perceived usefulness, ease of use, human factors, technological factors, and organizational support. Materials and methods: A cross-sectional study was conducted at the Palestine Medical Complex (PMC) in Ramallah, West Bank, where the Avicenna HIS has been fully implemented since 2010. A systematic random sampling was used to select participants, resulting in 300 completed questionnaires. The study utilized a self-administered questionnaire adapted from a structured tool based on the Technology Acceptance Model (TAM). The questionnaire was validated through expert review and pilot testing, achieving a Cronbach's alpha of 0.86. Each selected healthcare provider was contacted face-to-face, and written informed consent was obtained before administering the questionnaire. Results: A total of 300 questionnaires were completed and returned. The study sample included 178 males (59.3%) and 122 females (40.7%). The majority of participants was aged 20-39 years (270 participants, 90%) and held a bachelor's degree (250 participants, 83.3%). Nurses comprised the largest professional group (153 participants, 51.0%). High levels of perceived usefulness and ease of use were reported, both with mean scores of 4.511 (S.D. = 0.295). Technological factors had a mean score of 4.004 (S.D. = 0.228), while organizational factors scored 2.858 (S.D. = 0.304). Overall acceptance of the HIS was moderately high, with a mean score of 4.218 (S.D. = 0.387). Significant differences in perceived usefulness and ease of use were noted based on gender, age, and experience. Conclusion: This study concludes that both technological and human factors significantly influence the acceptance of HIS among healthcare providers in Palestine. To improve HIS adoption, it is recommended to enhance system functionality, ensure reliable data quality, and provide comprehensive training programs for healthcare providers. [ABSTRACT FROM AUTHOR]

Robust data privacy regulations hinder the exchange of healthcare data among institutions, crucial for global insights and developing generalised clinical models. Federated learning (FL) is ideal for training global models using datasets from different institutions without compromising privacy. However, disparities in electronic healthcare records (EHRs) lead to inconsistencies in ML-ready data views, making FL challenging without extensive preprocessing and information loss. These differences arise from variations in services, care standards, and record-keeping practices. This paper addresses data view heterogeneity by introducing a knowledge abstraction and filtering-based FL framework that allows FL over heterogeneous data views without manual alignment or information loss. The knowledge abstraction and filtering mechanism maps raw input representations to a unified, semantically rich shared space for effective global model training. Experiments on three healthcare datasets demonstrate the framework's effectiveness in overcoming data view heterogeneity and facilitating information sharing in a federated setup. [ABSTRACT FROM AUTHOR]

Addressing health inequity is a central component of the Sustainable Development Goals and a priority of the World Health Organization (WHO). WHO supports countries in strengthening their health information systems in order to better collect, analyze and report health inequality data. Improving information and research about health inequality is crucial to identify and address the inequalities that lead to poorer health outcomes. Building analytical capacities of individuals, particularly in low-resource areas, empowers them to build a stronger evidence-base, leading to more informed policy and programme decision-making. However, health inequality analysis requires a unique set of skills and knowledge. This paper describes three resources developed by WHO to support the analysis of inequality data by non-statistical users using Microsoft Excel, a widely used and accessible software programme. The resources include a practical eLearning course, which trains learners in the preparation and reporting of disaggregated data using Excel, an Excel workbook that takes users step-by-step through the calculation of 21 summary measures of health inequality, and a workbook that automatically calculates these measures with the user's disaggregated dataset. The utility of the resources is demonstrated through an empirical example. [ABSTRACT FROM AUTHOR]

Background: Quality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality. Methods: This study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3–5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results. Results: The score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver. Conclusions: The proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies. [ABSTRACT FROM AUTHOR]

Objective: Early in the COVID-19 pandemic, many children with appendicitis and COVID-19 were initially treated non-operatively and later underwent interval appendectomy. Currently, children with both appendicitis and COVID-19 frequently undergo upfront appendectomy. The impact of this return to upfront surgical management on patient outcomes is unknown. This study compared outcomes of pediatric patients with and without COVID-19 infection undergoing appendectomy. Study design: A retrospective cohort study of children < 21y who underwent appendectomy from 3/19/2020 to 7/31/2022 at 50 Pediatric Health Information System children's hospitals was conducted. Children with documented COVID-19 were identified. Exclusions included preoperative ventilator or supplemental oxygen dependence, and missing data. To evaluate COVID-19 positive versus COVID-19 negative patients, we used a propensity score matched on sociodemographics, comorbidities, laparoscopy, perforation, and hospital. Chi-square and Mann–Whitney U tests identified differences between groups in length of stay, postoperative drain placement, 30-day re-admission, and mechanical ventilation requirements. Results: Overall, 51,861 children of median age 11y (IQR: 8–14) underwent appendectomy, of whom 1,440 (2.3%) had COVID-19. Most were male (60.3%), White (72.1%) and non-Hispanic (61.4%). Public insurance was the most common (47.5%). We created a matched cohort of 1,360 COVID-19 positive and 1,360 COVID-19 negative children. Children with COVID-19 had shorter hospitalizations (1d, IQR: 1–4 vs. 2d, IQR: 1–5, p = 0.03), less postoperative peritoneal drain placement (2.4% vs. 4.1%, p = 0.01), and fewer 30-day readmissions (9.0% vs. 11.4%, p = 0.04). However, no difference in incidence or duration of mechanical ventilation (p > 0.05) was detected. Conclusions: Our findings suggest that upfront appendectomy for children with appendicitis and COVID-19 has similar outcomes compared to children without COVID-19. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Provision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya's national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow. Methods: The effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO's effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data. Discussion: We hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention's integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented. Trial registration: ClinicalTrials.gov, NCT05187897. The CHV-NEO study was registered on January 12, 2022. [ABSTRACT FROM AUTHOR]

The article focuses on the evolution and adjustments made to the Here For You Librarian mobile library service after facing the U.S. Health Insurance Portability and Accountability Act (HIPAA) concerns. Topics include the shift from physical library spaces to a mobile service model, changes in hospital locations and schedules, and the challenges of balancing HIPAA compliance with the visibility and accessibility of library services.

Aim: Today, Youtube, which is also used as a source of health information, is one of the most visited social platforms. The aim of this study was to evaluate the content and reliability of videos on undescended testicular operations for surgeons and parents. Materials and Methods: On 25/9/2023, the keywords "undescended testicle operation," "orchiopexy," and "children" were searched on the YouTube search engine. The selected videos were divided into two groups: useful and misleading. In addition to the descriptive characteristics of the videos, the reliability, quality and content of the videos were analysed using the global quality score (GQS), modified DISCERN (mDISCERN), and video power index (VPI) score. Results: Of the 62 videos evaluated in our study, 69.4% (n=43) were of high quality, 14.5% (n=9) were of medium quality and 16.1% (n=4) were of low quality. GQS and mDISCERN scores were higher in the useful group (p=0.002, p=0.001, respectively). While 91.1% (n=51) of the videos in the useful group were addressed to healthcare professionals (p=0.024), 78.6% (n=44) of these videos were uploaded by physicians. A positive correlation was observed between GQS and mDISCERN scores (p<0.001). Conclusion: Videos uploaded by academicians, surgeons and addressed to health professionals were found to be reliable and of high quality. Undescended testicular operations videos uploaded to social platforms should be prepared by a committee with health professionals and checked for compliance with scientific standards. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed the relationship between Childhood Opportunity Index (COI) 2.0 and LVC in children's hospitals. METHODS: We applied the Pediatric Health Information System LVC Calculator to emergency and inpatient encounters from July 2021 through June 2022. Proportions with LVC in highest (greatest opportunity) and lowest COI quintiles were compared. Generalized estimating equation logistic regression models were used to analyze LVC trends across COI quintiles. RESULTS: 842 463 encounters were eligible for 20 LVC measures. Across all measures, odds of LVC increased across increasing COI quintiles (adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.08). For 12 measures, LVC was proportionally more common in highest versus lowest COI quintile, whereas the reverse was true for 4. Regression modeling revealed increasing LVC as COI increased across all quintiles for 10 measures; gastric acid suppression for infants had the strongest association (OR 1.22, 95% CI 1.17-1.27). Three measures revealed decreasing LVC across increasing COI quintiles; Group A streptococcal testing among children <3 years revealed the lowest OR (0.85, 95% CI 0.73-0.99). The absolute volume of LVC delivered was greatest among low COI quintiles for most measures. CONCLUSIONS: Likelihood of LVC increased across COI quintiles for 10 of 20 measures, whereas 3 measures revealed reverse trends. High volumes of LVC across quintiles support a need for broad de-implementation efforts; measures with greater impact on children with lower opportunity warrant prioritized efforts. [ABSTRACT FROM AUTHOR]

Lumpy skin disease (LSD) poses a significant threat to animal welfare and leads to economic losses in affected countries. LSD outbreaks may also impact trade and regional relationships. South and Southeast Asia, with its dense livestock population and intricate trade networks, are susceptible to LSD outbreaks. Indonesia confirmed its first LSD cases in March 2022, leading to substantial livestock losses by August 2023. Australia, an important player in the global beef industry, faced trade disruptions due to LSD concerns raised by Indonesia and Malaysia, claims that were refuted by Australian authorities. The dispute highlights the need for good surveillance. EPIWATCH®, employing artificial intelligence, provides real‐time outbreak signals, and spatial analysis can identify LSD hotspots, leading to timely interventions. This study uses data collected by the EPIWATCH® open‐source disease surveillance system at the University of New South Wales in 2022 and 2023 and compares it for timeliness and completeness with data available on the World Animal Health Information System (WAHIS). We found more timely reports of LSD outbreaks in EPIWATCH® compared to WAHIS. In conclusion, open‐source surveillance tools like EPIWATCH® can provide timely alerts of disease emergence, such as LSD outbreaks in South and Southeast Asia, which can supplement formal reporting systems. [ABSTRACT FROM AUTHOR]

Over the last decade, there have been widespread efforts to reduce non-evidence-based therapies for viral bronchiolitis. We question whether this change in practice has inadvertently impacted the diagnosis and management of other pediatric lower-respiratory-tract illnesses. We used the Pediatric Health Information System (PHIS) and logistic regression to describe trends in relative diagnosis frequency of bronchiolitis, viral pneumonia, and reactive airway disease (RAD)/asthma as well as systemic corticosteroid use among children of the age range 1 to 4 years over a 10-year period. Among 169,207 children, the relative frequency of asthma/RAD diagnoses declined over a 10-year period, while bronchiolitis and viral pneumonia diagnoses increased among children of the age range 1 to 3 years and 2 to 4 years, respectively. Frequency of systemic corticosteroid use declined. We question whether the observed shift in diagnosis from asthma/RAD to bronchiolitis or viral pneumonia is reflective of true disease pathophysiology or if it represents an unintended consequence of campaigns surrounding bronchiolitis. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To study the impact of social determinants of health (SDoH) on pediatric extracorporeal membrane oxygenation (ECMO) outcomes. DESIGN, SETTING, AND PATIENTS: Retrospective study of children (< 18 yr) supported on ECMO (October 1, 2015 to March 1, 2021) using Pediatric Health Information System (44 U.S. children's hospitals). Patients were divided into five diagnostic categories: neonatal cardiac, pediatric cardiac, neonatal respiratory, pediatric respiratory, and sepsis. SDoH included the Child Opportunity Index (COI; higher indicates social advantage), race, ethnicity, payer, and U.S. region. Children without COI were excluded. Diagnostic category-specific clinical variables related to baseline health and illness severity were collected. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Children supported on ECMO experienced a 33% in-hospital mortality (2863/8710). Overall, children with lower COI, "other" race, Hispanic ethnicity, public insurance and from South or West regions had greater mortality. Associations between SDoH and ECMO outcomes differed between diagnostic cohorts. Bivariate analyses found that only pediatric cardiac patients had an association between COI or race and mortality. Multivariable logistic regression analyses examined relationships between SDoH, clinical variables and mortality within diagnostic categories. Pediatric cardiac patients had 5% increased odds of death (95% CI, 1.01-1.09) for every 10-point decrement in COI, while Hispanic ethnicity was associated with higher survival (adjusted odds ratio [aOR] 0.72 [0.57-0.89]). Children with heart disease from the highest COI quintile had less cardiac-surgical complexity and earlier cannulation. Independent associations with mortality were observed in sepsis for Black race (aOR 1.62 [1.06-2.47]) and other payer in pediatric respiratory patients (aOR 1.94 [1.23-3.06]). CONCLUSIONS: SDoH are statistically associated with pediatric ECMO outcomes; however, associations differ between diagnostic categories. Influence of COI was observed only in cardiac patients while payer, race, and ethnicity results varied. Further research should investigate differences between diagnostic cohorts and age groups to understand drivers of inequitable outcomes. [ABSTRACT FROM AUTHOR]

The management and exchange of electronic health records (EHRs) remain critical challenges in healthcare, with fragmented systems, varied standards, and security concerns hindering seamless interoperability. These challenges compromise patient care and operational efficiency. This paper proposes a novel solution to address these issues by leveraging distributed ledger technology (DLT), including blockchain, to enhance data security, integrity, and transparency in healthcare systems. The decentralized and immutable nature of DLT enables more efficient and secure information exchange across platforms, improving decision-making and coordination of care. This paper outlines a strategic implementation approach, detailing timelines, resource requirements, and stakeholder involvement while addressing crucial privacy and security concerns like encryption and access control. In addition, it explores standards and protocols necessary for achieving interoperability, offering case studies that demonstrate the framework's effectiveness. This work contributes by introducing a DLT-based solution to the persistent issue of EHR interoperability, providing a novel pathway to secure and efficient health data exchanges. It also identifies the standards and protocols essential for integrating DLT with existing health information systems, thereby facilitating a smoother transition toward enhanced interoperability. [ABSTRACT FROM AUTHOR]

Background: With the global rise in the elderly population, ensuring geriatric-friendly healthcare services is paramount. This study aimed to assess the current readiness of health facilities in Kampala City, Uganda, to provide geriatric-friendly care services. Methods: We conducted a cross-sectional study in 35 health facilities (HF) including Private for-profit (PFP), Private not-for-profit, and public (government-run) facilities at different levels i.e., Health Centre III, Health Centre IV, and Hospitals, within Kampala City, Uganda. Data was collected using a self-administered health facility assessment tool. Facilities scoring 80–100 were classified as fully ready to offer geriatric-friendly care, 51–79 indicated moderate readiness, and 0–50 indicated low readiness. Results: The overall readiness index (RI) across all facilities was low, 44.09 (SD ± 14.18). The National Referral Hospital (NRH), PFPs, and HFs in Kampala Central had the highest RI of 55.34. 47.63 and 51.09 respectively. The low readiness of HF to provide geriatric-friendly care was due to the low scores in leadership and governance (13.49), financing (19.29), human resource (42.66), and Health Management Information System (47.99) WHO building blocks. HCIVs had a higher readiness index than the other HF levels (Coefficient: 17.40, 95% CI: 4.16 to 30.64, p = 0.012). HFs in Kawempe had a significantly lower RI than those in Makindye and Kampala Central (Coefficient: -13.80, 95% CI: -24.48 to -3.11, p = 0.013). Conclusion: The findings of our study indicate that public and private health facilities in Kampala City are not ready enough to provide geriatric-friendly care services. [ABSTRACT FROM AUTHOR]

Background: Despite major primary health care (PHC) reforms in China with the 2009 launch of the National Essential Public Health Service Package, the country experiences many challenges in improving the management of non-communicable diseases in PHC facilities. "EMERALD" is a multifaceted implementation strategy to strengthen the management of hypertension and type-2 diabetes mellitus (T2DM) in PHC facilities. The study aims to: (1) examine the effectiveness of EMERALD in improving hypertension and T2DM management; (2) evaluate the implementation of the interventions; and (3) use the study findings to model the long-term health economic impact of the interventions. Methods: The EMERALD intervention components include: (1) empowerment for PHC providers through training and capacity building; (2) empowerment for patient communities through multi-media health education; and (3) empowerment for local health administrators through health data monitoring and strengthening governance of local PHC programs. An interrupted time series design will be used to determine the effectiveness of the interventions based on routinely collected health data extracted from local health information systems. The primary effectiveness outcome is the guideline-recommended treatment rates for people with hypertension and T2DM. Secondary effectiveness outcomes include hypertension and T2DM diagnosis and control rates, and enrolment and adherence rates to the recommended care processes in the National Essential Public Health Service Package. A mixed-methods process evaluation will be conducted to evaluate the implementation of the interventions, including the reach of the target population, adequacy of adoption, level of implementation fidelity, and maintenance. Qualitative interviews with policy makers, health administrators, PHC providers, and patients with hypertension and/or T2DM will be conducted to further identify factors influencing the implementation. In addition, health economic modelling will be performed to explore the long-term incremental costs and benefits of the interventions. Discussion: This study is expected to generate important evidence on the effectiveness, implementation, and health economic impact of complex PHC interventions to strengthen the primary care sector's contribution to addressing the growing burden of non-communicable diseases in China. Trial registration: The study has been registered on Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Registration number ChiCTR2400082036, on March 19th 2024). [ABSTRACT FROM AUTHOR]

Background: The Brazilian Ministry of Health has developed and provided the Citizen's Electronic Health Record (PEC e-SUS APS), a health information system freely available for utilization by all municipalities. Given the substantial financial investment being made to enhance the quality of health services in the country, it is crucial to understand how users evaluate this product. Consequently, this scoping review aims to map studies that have evaluated the PEC e-SUS APS. Methods: This scoping review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) framework, as well as by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist extension for scoping reviews (PRISMA-ScR). The research question was framed based on the "CoCoPop" mnemonic (Condition, Context, Population). The final question posed is, "How has the Citizen's Electronic Health Record (PEC e-SUS APS) been evaluated?" The search strategy will be executed across various databases (LILACS, PubMed/MEDLINE, Scopus, Web of Science, ACM Digital Library, and IEEE Digital Library), along with gray literature from ProQuest Dissertation and Theses Global and Google Scholar, with assistance from a professional healthcare librarian skilled in supporting systematic reviews. The database search will encompass the period from 2013 to 2024. Articles included will be selected by three independent reviewers in two stages, and the findings will undergo a descriptive analysis and synthesis following a "narrative review" approach. Independent reviewers will chart the data as outlined in the literature. Discussion: The implementation process for the PEC e-SUS APS can be influenced by the varying characteristics of the over 5500 Brazilian municipalities. These factors and other challenges encountered by health professionals and managers may prove pivotal for a municipality's adoption of the PEC e-SUS APS system. With the literature mapping to be obtained from this review, vital insights into how users have evaluated the PEC will be obtained. Systematic review registration: The protocol has been registered prospectively at the Open Science Framework platform under the number 10.17605/OSF.IO/NPKRU. [ABSTRACT FROM AUTHOR]

Introduction Design Methods Results Conclusion Clinical Relevance The rapid evolution of artificial intelligence (AI) technology has revolutionized healthcare, particularly through the integration of AI into health information systems. This transformation has significantly impacted the roles of nurses and nurse practitioners, prompting extensive research to assess the effectiveness of AI‐integrated systems. This scoping review focuses on machine learning (ML) used in nursing, specifically investigating ML algorithms, model evaluation methods, areas of focus related to nursing, and the most effective ML algorithms.The scoping review followed the Preferred Reporting Items for Systematic Review and Meta‐Analysis Extension for Scoping Reviews (PRISMA‐ScR) guidelines.A structured search was performed across seven databases according to PRISMA‐ScR: PubMed, EMBASE, CINAHL, Web of Science, OVID, PsycINFO, and ProQuest. The quality of the final reviewed studies was assessed using the Medical Education Research Study Quality Instrument (MERSQI).Twenty‐six articles published between 2019 and 2023 met the inclusion and exclusion criteria, and 46% of studies were conducted in the US. The average MERSQI score was 12.2, indicative of moderate‐ to high‐quality studies. The most used ML algorithm was Random Forest. The four second‐most used were logistic regression, least absolute shrinkage and selection operator, decision tree, and support vector machine. Most ML models were evaluated by calculating sensitivity (recall)/specificity, accuracy, receiver operating characteristic (ROC), area under the ROC (AUROC), and positive/negative prediction value (precision). Half of the studies focused on nursing staff or students and hospital readmission or emergency department visits. Only 11 articles reported the most effective ML algorithm(s).The scoping review provides insights into the current status of ML research in nursing and recognition of its significance in nursing research, confirming the benefits of ML in healthcare. Recommendations include incorporating experimental designs in research studies to optimize the use of ML models across various nursing domains.The scoping review demonstrates substantial clinical relevance of ML applications for nurses, nurse practitioners, administrators, and researchers. The integration of ML into healthcare systems and its impact on nursing practices have important implications for patient care, resource management, and the evolution of nursing research. [ABSTRACT FROM AUTHOR]

Objective To explore the excess hospitalization and structural change in hospitalization costs of acute respiratory infections (novel coronavirus infection excluded) in Yantian, Shenzhen, as the changing epidemiological patterns of respiratory infections. To provide information for the development of evidence-based public health policies and the burden of disease control measures. Methods Adjusted Serfling regression models were used to estimate the excess hospitalization and degree of structural change and grey correlation analysis was employed to analyze the change in structure of hospitalization costs and the association of items, based on the data from the regional health information platform in Yantian District from 2020 to 2023. Results In 2023, there were 1 698 excess hospitalization cases of acute respiratory infection, with an excess rate of 170.82%, accounting for 63.08% of the total number of hospitalizations. An increase in the number of viral and mycoplasma infections may be the reason for the excess hospitalization. There was a change in the structure of hospitalization costs, with the diagnostic category having the greatest value, contribution, and association with the structural change in costs. Conclusion There was a high excess hospitalization for acute respiratory infections and structural change in hospitalization costs was observed in 2023. Surveillance systems should be continuously improved to capture abnormal epidemics or excess hospitalizations to provide evidence for medical resource preparation and allocation. Clinical pathway management should be continuously strengthened to reduce the medical cost of patients. [ABSTRACT FROM AUTHOR]

Background: Despite global efforts to reduce and eventually interrupt malaria transmission, the disease remains a pressing public health problem, especially in sub-Saharan Africa. This study presents a detailed spatio-temporal analysis of malaria transmission in Rwanda from 2012 to 2022. The main objective was to gain insights into the evolving patterns of malaria and to inform and tailor effective public health strategies. Methods: The study used yearly aggregated data of malaria cases from the Rwanda health management information system. We employed a multifaceted analytical approach, including descriptive statistics and spatio-temporal analysis across three demographic groups: children under the age of 5 years, and males and females above 5 years. Bayesian spatially explicit models and spatio scan statistics were utilised to examine geographic and temporal patterns of relative risks and to identify clusters of malaria transmission. Results: We observed a significant increase in malaria cases from 2014 to 2018, peaking in 2016 for males and females aged above 5 years with counts of 98,645 and 116,627, respectively and in 2018 for under 5-year-old children with 84,440 cases with notable geographic disparities. Districts like Kamonyi (Southern Province), Ngoma, Kayonza and Bugesera (Eastern Province) exhibited high burdens, possibly influenced by factors such as climate, vector control practices, and cross-border dynamics. Bayesian spatially explicit modeling revealed elevated relative risks in numerous districts, underscoring the heterogeneity of malaria transmission in these districts, and thus contributing to an overall rising trend in malaria cases until 2018, followed by a subsequent decline. Our findings emphasize that the heterogeneity of malaria transmission is potentially driven by ecologic, socioeconomic, and behavioural factors. Conclusions: The study underscores the complexity of malaria transmission in Rwanda and calls for climate adaptive, gender-, age- and district-specific strategies in the national malaria control program. The emergence of both artemisinin and pyrethoids resistance and persistent high transmission in some districts necessitates continuous monitoring and innovative, data-driven approaches for effective and sustainable malaria control. [ABSTRACT FROM AUTHOR]

This study aimed to explore and evaluate the development trends and differential changes in the prevalence of mental and behavioral disorders among the earthquake survivors in exposure groups (highly hard-hit areas) and control groups (general disaster areas) from 2015 to 2019, as well as to investigate the potential influencing factors. Data was obtained from the Sichuan Health Information System and the Sichuan Health Yearbook, the prevalence of the exposure group and the control group were calculated, the difference between the two groups was evaluated using the prevalence rate ratio, and a fixed effect model was developed to investigate the potential influencing factors of the prevalence. The prevalence by gender and age in the exposure group was always greater than those in the control group (RR>1), although the disparity between the two proceeded to diminish with time. The urbanization rate (β = 0.0448, P < 0.05) and disaster area levels (β = 0.0104, P < 0.05) were risk factors for the prevalence of mental and behavioral disorders. The study only collected data at the group level following the Wenchuan earthquake. Consequently, the findings are only applicable at the group level. Furthermore, diagnostic criteria for various types of mental and behavioral disorders diseases were not provided. The earthquake has a significant long-term impact on mental health. It is necessary to continuously monitor the mental health of Wenchuan earthquake survivors and take appropriate post-disaster intervention measures. • Studying mental health in regional adult survivors post-Wenchuan, 2015-2019, through bio-social lens. • Mental and behavioral disorder prevalence gap between exposure and control groups narrows annually. • The urbanization rate is the risk factor of the prevalence rate of mental and behavioral disorders. [ABSTRACT FROM AUTHOR]

Background Data monitoring and surveillance systems are the cornerstone for governance and regulation, planning, and policy development for chronic disease care. Our study aims to evaluate health systems capacity for data monitoring and surveillance for kidney care. Methods We leveraged data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), an international survey of stakeholders (clinicians, policymakers and patient advocates) from 167 countries conducted between July and September 2022. ISN-GKHA contains data on availability and types of kidney registries, the spectrum of their coverage, as well as data on national policies for kidney disease identification. Results Overall, 167 countries responded to the survey, representing 97.4% of the global population. Information systems in forms of registries for dialysis care were available in 63% (n  = 102/162) of countries, followed by kidney transplant registries (58%; n  = 94/162), and registries for non-dialysis chronic kidney disease (19%; n  = 31/162) and acute kidney injury (9%; n  = 14/162). Participation in dialysis registries was mandatory in 57% (n  = 58) of countries; however, in more than half of countries in Africa (58%; n  = 7), Eastern and Central Europe (67%; n  = 10), and South Asia (100%; n  = 2), participation was voluntary. The least-reported performance measures in dialysis registries were hospitalization (36%; n  = 37) and quality of life (24%; n  = 24). Conclusions The variability of health information systems and early identification systems for kidney disease across countries and world regions warrants a global framework for prioritizing the development of these systems. [ABSTRACT FROM AUTHOR]

Background: Data quality in health information systems has a complex structure and consists of several dimensions. This research conducted for identify Common data quality elements for health information systems. Methods: A literature review was conducted and search strategies run in Web of Knowledge, Science Direct, Emerald, PubMed, Scopus and Google Scholar search engine as an additional source for tracing references. We found 760 papers, excluded 314 duplicates, 339 on abstract review and 167 on full-text review; leaving 58 papers for critical appraisal. Results: Current review shown that 14 criteria are categorized as the main dimensions for data quality for health information system include: Accuracy, Consistency, Security, Timeliness, Completeness, Reliability, Accessibility, Objectivity, Relevancy, Understandability, Navigation, Reputation, Efficiency and Value- added. Accuracy, Completeness, and Timeliness, were the three most-used dimensions in literature. Conclusions: At present, there is a lack of uniformity and potential applicability in the dimensions employed to evaluate the data quality of health information system. Typically, different approaches (qualitative, quantitative and mixed methods) were utilized to evaluate data quality for health information system in the publications that were reviewed. Consequently, due to the inconsistency in defining dimensions and assessing methods, it became imperative to categorize the dimensions of data quality into a limited set of primary dimensions. [ABSTRACT FROM AUTHOR]

Background: The Decade of Healthy Aging (2021–2030) emerges as a 10 years strategy to improve the lives of older adults, their families, and the communities in which they live. One of the actions defined in this framework is related to improving the measurement, monitoring, and understanding of characteristics, factors, and needs related to aging and health. The aim was to analyze and assess the process of construction and development of the Strategic Information System on Health, Funcional Dependence and Aging (SIESDE, for its acronym in Spanish). SIESDE will provide strategic information in Mexico at the municipal, state, and national levels that support the public policies on healthy aging. Methods: The system processes and analyzes the data sources of the Health Information Systems and the National System of Statistical and Geographical Information. SIESDE comprises three components: (1) Design, construction, and evaluation of the indicators; (2) storage, management, and visualization, and (3) diffusion and translation of information. Results: A total of 135 indicators were built on seven themes: (1) demographic, socioeconomic, and aging conditions, (2) health, (3) functional dependence, (4) healthy aging, (5) health services, (6) social and physical environments, and (7) complex indicators. Conclusions: SIESDE is an effective system for providing an overall view of health, aging, and functional dependence. [ABSTRACT FROM AUTHOR]

Objective To extract key lessons on primary healthcare (PHC) service delivery strategies for non-communicable diseases (NCD) from the work of researchers funded by the Global Alliance for Chronic Diseases (GACD). Design A convergent mixed methods study that extracted data using a standardised template from research projects funded by the GACD that focused on PHC. The strategies implemented in these studies were mapped onto the PHC Performance Initiative framework. Semistructured qualitative interviews were conducted with researchers from purposefully selected projects to understand the strategies and contextual factors in more depth. Setting PHC contexts from low or middle-income countries (LMIC) as well as vulnerable groups within high-income countries. Projects came from all regions of the world, particularly East Asia and Pacific, sub-Saharan Africa, South Asia, Latin America and Caribbean. Participants The study extracted data on 84 research projects and interviewed researchers from 16 research projects. Results Research projects came from all regions of the world, and mainly focused on diabetes (35.3%), hypertension (28.3%) and mental health (27.6%). Mapped onto the PHC Performance Initiative framework: 49.4% focused on high-quality PHC (particularly the comprehensiveness of NCD care, 41.2%); 41.2% on the availability of PHC services (particularly the competence of healthcare workers, 36.5%); 35.3% on population health management (particularly community-based services, 35.3%); 34.1% on facility organisation and management (particularly team-based care, 20.0%) and 31.8% on access (particularly digital technology, 23.5%). Most common strategies were task shifting and training to improve the comprehensiveness of NCD care through community-based services. Contextual factors related to inputs: infrastructure, equipment and medication, workforce (particularly community health workers), finances, health information systems and digital technology. Conclusion Key strategies and contextual factors to improve PHC service delivery for NCDs in LMICs were identified. These strategies should combine with other strategies to strengthen the PHC system as a whole, while improving care for NCDs. [ABSTRACT FROM AUTHOR]

Managing access between large numbers of distributed medical devices has become a crucial aspect of modern healthcare systems, enabling the establishment of smart hospitals and telehealth infrastructure. However, as telehealth technology continues to evolve and Internet of Things (IoT) devices become more widely used, they are also increasingly exposed to various types of vulnerabilities and medical errors. In healthcare information systems, about 90% of vulnerabilities emerge from medical error and human error. As a result, there is a need for additional research and development of security tools to prevent such attacks. This article proposes a zero-trust-based context-aware framework for managing access to the main components of the cloud ecosystem, including users, devices, and output data. The main goal and benefit of the proposed framework is to build a scoring system to prevent or alleviate medical errors while using distributed medical devices in cloud-based healthcare information systems. The framework has two main scoring criteria to maintain the chain of trust. First, it proposes a critical trust score based on cloud-native microservices for authentication, encryption, logging, and authorizations. Second, a bond trust scoring system is created to assess the real-time semantic and syntactic analysis of attributes stored in a healthcare information system. The analysis is based on a pre-trained machine learning model that generates the semantic and syntactic scores. The framework also takes into account regulatory compliance and user consent in the creation of the scoring system. The advantage of this method is that it applies to any language and adapts to all attributes, as it relies on a language model, not just a set of predefined and limited attributes. The results show a high F 1 score of 93.5%, which proves that it is valid for detecting medical errors. [ABSTRACT FROM AUTHOR]

This study aims to develop and apply multistate models to estimate, forecast, and manage hospital length of stay during the COVID-19 epidemic without using any external packages. Data from Bellvitge University Hospital in Barcelona, Spain, were analyzed, involving 2285 hospitalized COVID-19 patients with moderate to severe conditions. The implemented multistate model includes transition probabilities and risk rates calculated from transitions between defined states, such as admission, ICU transfer, discharge, and death. In addition to examining key factors like age and gender, diabetes, lymphocyte count, comorbidity burden, symptom duration, and different COVID-19 waves were analyzed. Based on the model, patients hospitalized stay an average of 11.90 days before discharge, 2.84 days before moving to the ICU, or 34.21 days before death. ICU patients remain for about 24.08 days, with subsequent stays of 124.30 days before discharge and 35.44 days before death. These results highlight hospital stays' varying durations and trajectories, providing critical insights into patient flow and healthcare resource utilization. Additionally, it can predict ICU peak loads for specific subgroups, aiding in preparedness. Future work will integrate the developed code into the hospital's Health Information System (HIS) following ISO 13606 EHR standards and implement recursive methods to enhance the model's efficiency and accuracy. [ABSTRACT FROM AUTHOR]

Stroke is the main cause of disability among adults. Decision-making in stroke rehabilitation is increasingly complex; therefore, the use of decision support systems by healthcare providers is becoming a necessity. However, there is a significant lack of software for the management of post-stroke telerehabilitation (TR). This paper presents the results of the developed software "TeleRehab" to support the decision-making of clinicians and healthcare providers in post-stroke TR. We designed a Python-based software with a graphical user interface to manage post-stroke TR. We searched Scopus, ScienceDirect, and PubMed databases to obtain research papers with results of clinical trials for post-stroke TR and to form the knowledge base of the software. The findings show that TeleRehab suggests recommendations for TR to provide practitioners with optimal and real-time support. We observed feasible outcomes of the software based on synthetic data of patients with balance problems, spatial neglect, and upper and lower extremities dysfunctions. Also, the software demonstrated excellent usability and acceptability scores among healthcare professionals. [ABSTRACT FROM AUTHOR]

With the increasing use of technology in nursing, how nurses perform practice care has changed, inevitably leading to ethical concerns that differ from original ethical norms in nursing. Studies have focused on ethical issues in health informatics from clinicians' or patients' perspectives, while nurses' perspective is needed. This paper conducts a theoretical study on ethical predicaments that arise in nursing informatics from nurses' perspectives. Why and how these predicaments emerge are elaborated. Also, this paper offers countermeasures in realistic contexts from technique, education, and leadership aspects. Collaborations between governments, administrators, educators, technicians, and nurses are needed to step out of these predicaments. [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented including the financial impacts of service lines in rural hospitals, the role of artificial intelligence in medical care and the use of dynamic capabilities to improve performance improvement in hospitals.

Background: Electronic health records (EHR) are seen as a promising endeavour, in spite of policies, designs, user rights and types of health data varying across countries. In many European countries, including Austria, EHR usage has fallen short when compared to the deployment plans. Objective: By adopting a qualitative approach, this research aimed to explore facilitators and barriers experienced by patients and physicians across the entire EHR usage process in Austria. Method: Two studies were conducted: In Study 1, discussions were held with four homogeneously composed groups of patients (N = 30). In Study 2, eight expert semi-structured interviews were conducted with physicians to gain insights into potential facilitators and barriers Austrian physicians face when utilising personal EHR. Results: A wide range of barriers and facilitators were identified along the entire EHR usage spectrum, emerging on three different levels: the micro-level (individual level), the meso-level (level of the EHR system) and the macro-level (level of the health system). EHR literacy was identified as a booster to support EHR adherence. Health providers were identified as crucial gatekeepers with regard to EHR usage. Conclusion: The implications for mutual benefits arising out of EHR usage among the triad of health policymakers, providers and patients for both theory and practice are discussed. [ABSTRACT FROM AUTHOR]

Background: The implementation of emerging technologies has resulted in an increase of data breaches in healthcare organisations, especially during the COVID-19 pandemic. Health information and cybersecurity managers need to understand if, and to what extent, breach types and locations are associated with their organisation's business type. Objective: To investigate if breach type and breach location are associated with business type, and if so, investigate how these factors affect information systems and protected health information in for-profit versus non-profit organisations. Method: The quantitative study was performed using chi-square tests for association and post-hoc comparison of column proportions analysis on an archival data set of reported healthcare data breaches from 2020 to 2022. Data from the Department of Health and Human Services website was retrieved and each organisation classified as for-profit or non-profit. Results: For-profit organisations experienced a significantly higher number of breaches due to theft, and non-profit organisations experienced a significantly higher number of breaches due to unauthorised access. Furthermore, the number of breaches that occurred on laptops and paper/films was significantly higher in for-profit organisations. Conclusion: While the threat level of hacking techniques is the same in for-profit and non-profit organisations, certain breach types are more likely to occur within specific breach locations based on the organisation's business type. To protect the privacy and security of medical information, health information and cybersecurity managers need to align with industry-leading frameworks and controls to prevent specific breach types that occur in specific locations within their environments. [ABSTRACT FROM AUTHOR]