Security Requirements for a Lifelong Electronic Health Record System: An Opinion

This article discusses the authors' views on the security requirements of a central, unique electronic health record. The requirements are based on the well-known principles of confidentiality and integrity and the less discussed principles of control and legal value. The article does not discuss any technical or legal solutions to the requirements proposed herein

How do experts recognize schizophrenia: the role of the disorganization symptom

Objective: Research on clinical reasoning has been useful in developing expert systems. These tools are based on Artificial Intelligence techniques which assist the physician in the diagnosis of complex diseases. The development of these systems is based on a cognitive model extracted through the identification of the clinical reasoning patterns applied by experts within the clinical decision-making context. This study describes the method of knowledge acquisition for the identification of the triggering symptoms used in the reasoning of three experts for the diagnosis of schizophrenia. Method: Three experts on schizophrenia, from two University centers in Sao Paulo, were interviewed and asked to identify and to represent the triggering symptoms for the diagnosis of schizophrenia according to the graph methodology. Results: Graph methodology showed a remarkable disagreement on how the three experts established their diagnosis of schizophrenia. They differed in their choice of triggering-symptoms for the diagnosis of schizophrenia: disorganization, blunted affect and thought disturbances. Conclusions: The results indicate substantial differences between the experts as to their diagnostic reasoning patterns, probably under the influence of different theoretical tendencies. The disorganization symptom was considered to be the more appropriate to represent the heterogeneity of schizophrenia and also, to further develop an expert system for the diagnosis of schizophrenia.2815

Orientação temporal e funções executivas na predição de mortalidade entre idosos: estudo Epidoso

OBJECTIVE: To analyze the predictive ability of a functional cognitive index of mortality in the elderly. METHODS: Cohort study performed with 1,667 elderly individuals aged more than 65 years and living in the city of São Paulo, Southeastern Brazil, between 1991 and 2001. Functional cognitive index was constructed from time orientation and executive functions (going shopping and taking medication), controlled by sociodemographic variables, life habits, morbidity, self-perception of health, hospitalization, edentulism and social support. Deaths occurred during this period were analyzed with family members in home interviews, notary public offices and records from the Fundação Seade (State System of Data Analysis Foundation), until 2003. Crude and adjusted relative risks were calculated with their respective 95% confidence intervals, using bivariate and multiple analysis with Poisson regression and pOBJETIVO: Analizar la capacidad predictiva del índice cognitivo funcional para mortalidad entre ancianos. MÉTODOS: Estudio de cohorte realizado con 1.667 ancianos encima de 65 años residentes en el municipio de São Paulo, Sureste de Brasil, en el período 1991-2001. El índice cognitivo funcional fue construido a partir de la orientación temporal y funciones ejecutivas (hacer compras y tomar medicamento), controlado por variables sociodemográficas, hábitos de vida, morbilidad, autopercepción de salud, internación, edentulismo y soporte social. Los óbitos ocurridos en el período fueron investigados con familiares en entrevistas domiciliares, en oficinas del notario y registros de la Fundación Seade (hasta 2003). Fueron calculados riesgos relativos brutos y ajustados con respectivos intervalos con 95% de confianza por medio de análisis bivariado y múltiple con regresión de Poisson, adoptándose pOBJETIVO: Analisar a capacidade preditiva de índice cognitivo funcional para mortalidade entre idosos. MÉTODOS: Estudo de coorte realizado com 1.667 idosos acima de 65 anos residentes no município de São Paulo, SP, no período 1991-2001. O índice cognitivo funcional foi construído a partir da orientação temporal e funções executivas (fazer compras e tomar medicação), controlado por variáveis sociodemográficas, hábitos de vida, morbidade, autopercepção de saúde, internação, edentulismo e suporte social. Os óbitos ocorridos no período foram investigados com familiares em entrevistas domiciliares, em cartórios e registros da Fundação Seade (até 2003). Foram calculados riscos relativos brutos e ajustados com respectivos intervalos com 95% de confiança por meio de análise bivariada e múltipla com regressão de Poisson, adotando-se

Hurdles at work: perceptions of hospital food handlers

<p>Abstract</p> <p>Background</p> <p>Food handlers have a very important role in preventing food contamination during its preparation and distribution. This responsibility is even greater in hospitals, since a large number of patients have low immunity and consequently food contamination by pathogenic bacteria could be particularly harmful. Therefore, a good working environment and periodic training should be provided to food handlers by upper management.</p> <p>Methods</p> <p>This study is qualitative research by means of focus group and thematic content analysis methodologies to examine, in detail, the statements by food handlers working in the milk and specific-diet kitchens in a hospital to understand the problems they face in the workplace.</p> <p>Results</p> <p>We found that food handlers are aware of the role they play in restoring patients' health; they consider it important to offer a good-quality diet. However, according to their perceptions, a number of difficulties prevent them from reaching this aim. These include: upper management not prioritizing human and material resources to the dietetic services when making resource allocation decisions; a perception that upper management considers their work to be of lesser importance; delayed overtime payments; lack of periodic training; managers lacking administrative skills; insufficient dietitian staff assistants, leading to overwork, at the same time as there is an excess of dietitians; unhealthy environmental working conditions – high temperature, high humidity, loud and constant noise level, poor ventilation; lack of food, and kitchen utensils and equipment; and relationship conflicts with chief dieticians and co-workers.</p> <p>Conclusion</p> <p>From these findings, improvement in staff motivation could be achieved by considering non-financial incentives, such as improvement in working conditions and showing appreciation and respect through supervision, training and performance appraisal. Management action, such as investments in intermediary management so that managers have the capacity to provide supportive supervision, as well as better use of performance appraisal and access to training, may help overcome the identified problems.</p

Electronic health records in outpatient clinics: Perspectives of third year medical students

Abstract Background United States academic medical centers are increasingly incorporating electronic health records (EHR) into teaching settings. We report third year medical students' attitudes towards clinical learning using the electronic health record in ambulatory primary care clinics. Methods In academic year 2005&#8211;06, 60 third year students were invited to complete a questionnaire after finishing the required Ambulatory Medicine/Family Medicine clerkship. The authors elicited themes for the questionnaire by asking a focus group of third year students how using the EHR had impacted their learning. Five themes emerged: organization of information, access to online resources, prompts from the EHR, personal performance (charting and presenting), and communication with patients and preceptors. The authors added a sixth theme: impact on student and patient follow-up. The authors created a 21-item questionnaire, based on these themes that used a 5-point Likert scale from "Strongly Agree" to "Strongly Disagree". The authors emailed an electronic survey link to each consenting student immediately following their clerkship experience in Ambulatory Medicine/Family Medicine. Results 33 of 53 consenting students (62%) returned completed questionnaires. Most students liked the EHR's ability to organize information, with 70% of students responding that essential information was easier to find electronically. Only 36% and 33% of students reported accessing online patient information or clinical guidelines more often when using the EHR than when using paper charts. Most students (72%) reported asking more history questions due to EHR prompts, and 39% ordered more clinical preventive services. Most students (69%) reported that the EHR improved their documentation. 39% of students responded that they received more feedback on their EHR notes compared to paper chart notes. Only 64% of students were satisfied with the doctor-patient communication with the EHR, and 48% stated they spent less time looking at the patient. Conclusion Third year medical students reported generally positive attitudes towards using the EHR in the ambulatory setting. They reported receiving more feedback on their electronic charts than on paper charts. However, students reported significant concerns about the potential impact of the EHR on their ability to conduct the doctor-patient encounter.Peer Reviewe

Anthropometry and body composition in ethnic Japanese and Caucasian adolescent girls: Considerations on ethnicity and menarche

Objective: This study aimed to compare the various anthropometric and body composition parameters based on the ethnicity and the absence or presence of menarche.Design: A cross-sectional study with incomplete sampling, using the subject as the evaluation unit.Subjects: the final sample of 550 subjects was composed of 122 Japanese and 179 Caucasian premenarcheal adolescents, and 72 Japanese and 177 Caucasian postmenarcheal adolescents.Methods: the variables of body composition were measured through the following methods: bioelectrical impedance analysis, near-infrared interactance (NIR), Slaughter cutaneous skinfold equations and body mass index. Weight, height and sitting height were also evaluated.Results: the Japanese pre- and postmenarcheal girls presented lower weight and height values when compared with the Caucasian girls. in general, the Japanese premenarcheal girls presented less fat and fat-free mass than the premenarcheal Caucasian girls. This fact was demonstrated through NIR results. Conversely, the Japanese postmenarcheal adolescents accumulated more fat than their Caucasian counterparts. However, significant differences were solely encountered in the values of cutaneous skinfold percent body fat. With regard to menarche, it was verified that, regardless of ethnicity, all the anthropometric and body composition variables reached higher values among postmenarcheal adolescents when compared with premenarcheal adolescents.Conclusion: Different results of weight and height between the ethnic groups may bring back the discussion concerning separate growth curves for different ethnic groups. the results of the body composition analysis indicated high adiposity levels among postmenarcheal adolescents.Universidade Federal de São Paulo, Escola Paulista Med, Dept Postgrad Nutr, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Prevent Med, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Postgrad Nutr, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Prevent Med, São Paulo, BrazilWeb of Scienc