Electronical Health Record's Systems. Interoperability

Understanding the importance that the electronic medical health records system has, with its various structural types and grades, has led to the elaboration of a series of standards and quality control methods, meant to control its functioning. In time, the electronic health records system has evolved along with the medical data's change of structure. Romania has not yet managed to fully clarify this concept, various definitions still being encountered, such as "Patient's electronic chart", "Electronic health file". A slow change from functional interoperability (OSI level 6) to semantic interoperability (level 7) is being aimed at the moment. This current article will try to present the main electronic files models, from a functional interoperability system's possibility to be created perspective. \ud \u

Cervical Cancer – A Serious Chronic Problem – Statistical Data from the Western Region of Romania

Introduction: In Romania, every year, there are 4,343 new cases of cervical cancer and 1,909 deaths caused by this disease. The screening program for early detection of cervical cancer has been running since 2012, but unfortunately not with the same impact on the population. When it reveals characteristic changes in cervical cells, HPV testing is further indicated. Material and method: This retrospective study, in the period 2013-2022 includes the screening Babes Papanicolau smear in all women aged 25-64 years. Through the descriptive statistics of the collected data, we analyzed the dynamics of the phenomenon of occurrence and spread of cervical cancer depending on the environment of origin. We observed a higher incidence in urban areas than in rural areas, registering several new cases: 496 (57% urban), 375 (43% rural), in total 871 (100%) of cases, respectively cases remaining: 5,843 (55% urban), 4,858 (45% rural), in total 10,701 from an eligible population of ~ 400,000, of which only 30% tested Babes Papanicolau test. Results: Thus, in 2019, less than 30% of Romanian women said they had done a Babes Papanicolau test in the last three years, the proportion being half the European average. The participation rate – calculated based on statements – was 45% among women with high incomes, compared to 13%, women with low incomes and 51% for women with a high level of education, versus 11% for women of low level of training.  The study of the distribution of cervical cancer in the Northwest Region shows that over 30% of cases are diagnosed in advanced stages (III and IV). Conclusions: Unfortunately, Romania, due to the incidence of cervical cancer cases occupies the first place in Europe, both in incidence and mortality; the mortality rate is four times higher than the European Union average

Immunoinformatics-Driven Design of an HPV-16 and -18 Synthetic Long Peptide Vaccine

Background and Aim: Human papillomavirus types 16 and 18 cause most cervical cancers worldwide. Existing VLP-based vaccines are unable to eliminate ongoing highly oncogenic infections. This study suggests an SLP-based vaccine for already infected patients, even with precancerous lesions. Methods: HPV16/18 E6 and E7 proteins' potent HLA class I and class II-restricted epitopes were extracted from IEDB or predicted by ANNs (IC50 90% of the residues in the most favorable regions reflect good quality 3D structures. Molecular docking studies provided a ΔG of −13.20±1.42 kcal/mol, and an average Kd of 3.5×10−9 M. MD simulations reflect favorable thermodynamic properties, based on mild RMSD ([0.1;0.87] nm), RMSF, SASA (49.37±1.54 nm2) and Rgyr ([1.15;1.34]) fluctuations over the 100-ns simulations. Conclusions: 25 in silico-designed SLPs stimulate both innate and adaptive immunity, with little to no toxic or allergenic effects. The presented vaccination platform could exert both a therapeutic (by tumor cell clearance) and a prophylactic effect (by eradicating E6 and E7+ premalignant cells)

Recent Developments in Breast Cancer Imaging

Purpose: Breast cancer stands as a primary contributor to cancer-related fatalities among women globally, underscoring the significance of early detection for better prognosis. Innovative imaging methods and biochemical indicators have emerged to augment the diagnosis of breast cancer; however, a systematic assessment of their clinical effectiveness and performance is imperative. Materials and Methods: It was conducted a comprehensive literature review by systematically searching PubMed and Scopus databases. Was included pertinent publications from the period spanning 2010 to 2022. The search terms employed were "breast cancer," "diagnosis," "imaging modalities," and "biomarkers”. Results: Emerging imaging methods such as contrast-enhanced spectral mammography (CESM), diffusion-weighted magnetic resonance imaging (DW-MRI), and positron emission tomography-computed tomography (PET-CT) have exhibited promising outcomes in the realm of breast cancer diagnosis. CESM amalgamates the benefits of mammography and contrast-enhanced MRI, delivering heightened sensitivity and specificity. DW-MRI is a non-intrusive approach adept at identifying alterations in the diffusion characteristics of malignant tissues. PET-CT furnishes valuable functional insights into tumor metabolism and angiogenesis. Regarding biochemical markers, including carbohydrate antigen 15-3 (CA 15-3), carcinoembryonic antigen (CEA), and cancer antigen 125 (CA 125), these have been extensively scrutinized in the context of breast cancer diagnosis. Nevertheless, their diagnostic efficacy remains constrained due to their relatively low sensitivity and specificity, and they are predominantly employed for monitoring disease progression and gauging treatment response. Conclusions: Innovative imaging methods like CESM, DW-MRI, and PET-CT have displayed encouraging outcomes in the diagnosis of breast cancer. However, it is imperative to conduct more in-depth assessments to ascertain their clinical applicability and cost-effectiveness. The potential synergy of integrating imaging techniques with biochemical markers holds promise for augmenting diagnostic precision and mitigating the occurrence of false-positive and false-negative results

Knowledge, Attitude and Use of Evidence-Based Practice among Nurses and Midwives in Bucharest Hospitals

Background and Aim: Evidence-based practice (EBP) is considered a critical element in safe and quality health care delivery. This paper is a report of a study describing the EBP knowledge, attitudes, and use of nurses and midwives practicing in hospitals in Bucharest. Materials and Methods: The descriptive, cross-sectional research design was conducted with a random sample of 245 nurses and midwives. The study used an online version 24-item validated questionnaire (adapted from Upton and Upton, 2006) to collect the data. Each item was measured using a 7-point Likert scale. Values between 1 and 3 were considered negative, between 3 and 5 were average values, and between 5 and 7 were positive values. Data were analyzed using the SPSS Statistics 20 program. The chi-square test (p) was used to perform the comparative analysis of the scores of the three subscales (Knowledge, Attitudes, and Practices) according to socio-demographic characteristics. Results: Most of the average scores of the 24 items do not register positive values (m<5), with the exception of item “Level of knowledge in information technology” (m=5.20). The weighting of scores with high values is relatively low, for all three subscales, the lowest percentage being recorded by the Knowledge subscale (approx. 4% of respondents), and the highest percentage by the Practices subscale (almost 38%). There are no significant differences according to certain socio-demographic characteristics, the only exception being university education, which is assigned significantly higher scores for the Attitudes and Knowledge subscales. Conclusions: This study demonstrates the priority need to improve the level of knowledge and use of EBP in the evaluated medical units. Also, this study can be extended to the national level, and its results can represent the basis of the decision to develop a policy regarding the professional training of nurses and midwives in the field of EBP

Chemoinformatic Study of Benzodiazepines

Benzodiazepines are a type of psychotropic drugs with tranquilizing effect, originally used as ansiolytics. However, benzodiazepines are highly addictive, and a person who abuses them faces a host of symptoms. Moreover, the market for new psychoactive substances is growing. The aim of this study was to predict in silico chemical structures on benzodiazepine skeleton with affinity for the GABA A receptor. A set of 50 benzodiazepine-based compounds was analyzed to develop a QSAR training set with respect to published binding values to GABA receptors. To develop a mathematical model, physicochemical properties (partition coefficient, molar refractivity, molar volume) were used to correlate with biological activity (logIC50). We estimated the logIC50 and compared it with the observed values to test our model.  To create the ADMET profile, we used the ADMETlab2.0 program. The molecular target for diazepam and nitrazepam molecules was predicted using SwissTargetPrediction. The visualization of the target structure was achieved with the Chimera program. The SeamDock molecular docking program was used to study molecular target interactions with diazepam and nitrazepam drugs. The best results of univariate correlation are shown by molar volume. The best statistics were obtained for univariate correlation. Diazepam and nitrazepam are small molecules with good oral availability that cross the blood-brain barrier, affecting the nervous system. The target predicted most likely to interact with drugs is the alpha-1 subunit of the GABA A receptor. The molecular docking study showed a favorable interaction between the molecular target and the drugs diazepam and nitrazepam. This QSAR model will allow rapid prediction of the binding activity of emerging benzodiazepines in a rapid and economic way, compared with expensive in vitro/in vivo analysis. Diazepam and nitrazepam interact with GABA A receptors, potentiating their activity

The Future of Critical Care: Innovations in Patient-Centered Technology

In the landscape of modern healthcare, the evolution of critical care has been marked by the integration of innovative technologies and the emergence of patient-centered approaches. This study aimed to explore the potential of Artificial Intelligence (AI) in shaping the future of critical care, using data collected from Centricity High Acuity data warehouse from the Anesthesia and Intensive Care Clinic and the operating theater from Emergency County Clinical Hospital "Pius Brînzeu" Timişoara. The existing healthcare landscape is characterized by the complex balance between technological advances and patient-centered care. The advent of AI presents an opportunity to revolutionize critical care, offering real-time insights and personalized interventions. This research seeks to harness the capabilities of AI to enhance patient outcomes in critical care scenarios. The study was conducted at a tertiary care hospital, using a mixed-methods approach that involved retrospective analysis of patient data from Centricity. The AI algorithms were trained on historical data to predict patient deterioration patterns, enabling timely interventions and proactive management. Results demonstrated that the integration of AI-driven insights from Centricity High Acuity data warehouse significantly improves patient outcomes. AI-assisted interventions led to reduced instances of adverse events, shorter lengths of stay, and improved resource utilization. The AI algorithms demonstrated high accuracy in predicting patient deterioration, enabling early interventions and preventing complications. In conclusion, the integration of AI technology using data from Centricity High Acuity data warehouse holds immense promise for the future of patient-centered critical care. The results indicate that AI-driven interventions can enhance patient outcomes, reduce healthcare costs, and improve resource utilization. As healthcare continues to embrace AI, the potential for transformative advancements in critical care is evident, paving the way for a new era of innovative and personalized patient-centered care

Assessment Study of Nurses' Attitudes Regarding the Safety of Care in Surgical Patients

Background and Aim: The modern surgical environment is complex and has a high potential risk of medical errors. In this context, the attitudes of healthcare professionals regarding patient safety represent an important component of organizational safety culture. Materials and Methods: We conducted a study in which we used the "Safety Attitudes Questionnaire", a standardized questionnaire with six scales: Teamwork Climate, Safety Climate, Job Satisfaction, Stress Recognition, Perception of Management and Work Conditions. The scores ≥75 signified positive attitudes of the respondents. Statistical data analysis was performed with the SPSS Statistics 20 program. Results: We included in the study 70 nurses, 46% from Anesthesia and Intensive Care Units (AICU) and 54% from surgical wards, most with secondary education (81%) and female gender (88%). The average age was 42.2±7.6 years and the average professional experience was 14.05±8.7 years. The lowest percentage of respondents with a positive attitude was identified for the Management Perception scale (53%), followed by the Stress Recognition scale (57%) and the Work Conditions scale (63%). On the other hand, the highest percentage of respondents with a positive attitude was associated with the Job Satisfaction scale (91%), followed by the Safety Climate scale (74%) and the Teamwork Climate scale (73%). The comparison of the average scores of the six scales for nurses from the two types of departments showed that there are significant differences in two scales: Stress Recognition, with higher scores in AICU, and Work Conditions, with lower scores in AICU. Conclusions: The low percentages of nurses with positive attitudes regarding the institutional management, stress recognition and work conditions highlight the need to implement effective strategies to improve organizational safety culture in hospitals, especially in AICU. The results are consistent with the literature and argue for the development of institutional educational programs and voluntary error reporting systems to achieve proactive professional safety attitudes

The endothelial cell markers von Willebrand Factor (vWF), CD31 and CD34 are lost in glomerulonephritis and no longer correlate with the morphological indices of glomerular sclerosis, interstitial fibrosis, activity and chronicity.

Endothelial cells (ECs) are active participants of an inflammatory process in glomeruli. EC damage has been shown to play an important role in the progression of glomerulonephritis (GN). The degree of glomerular and peritubular capillary loss in models of progressive renal disease correlates with the severity of glomerulosclerosis and interstitial fibrosis. The aim of our study was to analyze the association of vWF, CD31 and CD34 immunoreactivity with the morphological indices of glomerular sclerosis, interstitial fibrosis, activity and chronicity in GN. A cross-sectional study of 22 patients with GN was conducted. Conventional stains (hematoxylin-eosin, periodic acid Schiff and Trichrome GĂśmĂśri stains) and immunohistochemistry (vWF, CD31 and CD34) were employed on kidney biopsies. Activity and chronicity of GN, as well as glomerular segmental sclerosis and interstitial fibrosis, were evaluated according to a scoring system initially used for lupus nephritis and antineutrophil-cytoplasmic-antibody-associated vasculitis. Immunohistochemistry was assessed using a semi-quantitative score. Statistical analysis was performed using EpiInfo 6.04. The mean patient age was 46.68+/-14.09; 14 patients were male, and eight were female. Performing Spearman's rank correlation test, no correlation was found between each marker and glomerular segmental sclerosis, interstitial fibrosis, activity and chronicity, which suggests a loss of these markers and microvasculature involvement