A data infrastructure for the assessment of health care performance: Lessons from the BRIDGE-health project

The integration of different administrative data sources from a number of European countries has been shown useful in the assessment of unwarranted variations in health care performance. This essay describes the procedures used to set up a data infrastructure (e.g., data access and exchange, definition of the minimum common wealth of data required, and the development of the relational logic data model) and, the methods to produce trustworthy healthcare performance measurements (e.g., ontologies standardisation and quality assurance analysis). The paper ends providing some hints on how to use these lessons in an eventual European infrastructure on public health research and monitoring. Although the relational data infrastructure developed has been proven accurate, effective to compare health system performance across different countries, and efficient enough to deal with hundred of millions of episodes, the logic data model might not be responsive if the European infrastructure aims at including electronic health records and carrying out multi-cohort multi-intervention comparative effectiveness research. The deployment of a distributed infrastructure based on semantic interoperability, where individual data remain in-country and open-access scripts for data management and analysis travel around the hubs composing the infrastructure, might be a sensible way forward

Construction of Empirical Care Pathways Process Models from Multiple Real-World Datasets

Care pathways (CPWs) are "multidisciplinary care plans that detail essential care steps for patients with specific clinical problems." While CPWs impact on health or cost outcomes is vastly studied, an in-depth analysis of the real-world implementation of the CPWs is an area that still remains underexplored. The present work describes how to apply an existing process mining methodology to construct the empirical CPW process models. These process models are a unique piece of information for health services research: for example to evaluate their conformance against the theoretical CPW described on clinical guidelines or to evaluate the impact of the process in health outcomes. To this purpose, this work relies on the design and implementation of a solution that a) synthesizes the expert knowledge on how health care is delivered within and across providers as an activity log, and b) constructs the CPW process model from that activity log using process mining techniques. Unlike previous research based on ad hoc data captures, current approach is built on the linkage of various heterogeneous real-world data (RWD) sets that share a minimum semantic linkage. RWD, defined as secondary use of routinely collected data as opposite to ad hoc data extractions, is a unique source of information for the CPW analysis due to its coverage of the caregiving activities and its wide availability. The viability of the solution is demonstrated by constructing the CPW process model of Code Stroke (Acute Stroke CPW) in the Aragon region (Spain)

AXA: a computer program for the management of the Canary Goat Group milking control programs

A computer program, developed in Clipper, for the management of the genealogical and productive information from the Canary Goat Group, is described. The two first sections of this program are planned for the males and females genealogical data arrangement. Third section is devised for the productive data storage. Fourth section is constructed for the emission of reports and finally, fifth section is a miscellaneous of utilities, where the connection with other programs must be highlighted. Also an exit control is enclosed. The basic purposes of this program aim the emission of official production reports for the Administration and farmers, and the information processing for its analysis in programs of genetic selection.Se describe un programa de ordenador, desarrollado en Clipper, para la gestión de la información genealógica y productiva de la Agrupación Caprina Canaria. Sus dos primeras secciones se ocupan de la organización de la información genealógica de machos y de hembras; la tercera de la información productiva; la cuarta de la elaboración de informes y la quinta es una miscelánea de utilidades y un control de salida, con conexión con otros programas. Las misiones básicas del programa se centran en la emisión de informes productivos oficiales, destinados a la administración y a los ganaderos, y la preparación de la información para su análisis en programas de selección genética

Prevalence and predictors of inadequate patient medication knowledge

© 2016 John Wiley & Sons, Ltd. Objectives: To assess medication knowledge in adult patients and to explore its determinants. Method: Cross-sectional study. Medication knowledge was the primary outcome and was assessed using a previously validated questionnaire. A multivariate logistic regression analysis was performed to explore the association between medication knowledge and the factors included in the model. Results: Seven thousand two hundred seventy-eight patients participated in the study. 71.9% (n = 5234) (95% CI: 70.9%–73.0%) of the surveyed patients had an inadequate knowledge of the medication they were taking. The dimensions obtaining the highest level of knowledge were the ‘medication use process’ and ‘therapeutic objective of medication’. The items ‘frequency’ (75.4%), ‘dosage’ (74.5%) and ‘indication’ (70.5%) had the highest percentage of knowledge. Conversely, ‘medication safety’ represented the dimension with the lowest scores, ranging from 12.6% in the item “contraindications” to 15.3% in the item ‘side effects’. The odds ratio (OR) of having an inadequate medication knowledge increased for unskilled workers (OR: 1.33; 85% CI:1.00–1.78; P = 0.050), caregivers (OR:1.46; 95% CI:1.18–1.81; P < 0.001), patients using more than one medication (OR: 1.14; 95% CI: 1.00–1.31; P = 0.050) and patients who did not know the name of the medication they were taking (OR: 2.14, 95% CI: 1.71–2.68 P < 0.001). Conclusion: Nearly three quarters of the analysed patients had inadequate knowledge regarding the medicines they were taking. Unskilled workers and caregivers were at a higher risk of lacking of medication knowledge. Other factors that correlated with inadequate medication knowledge were the use of more than one drug and not knowing the name of the medication dispensed

Control and operation of a three-phase local energy router for prosumers in a smart community

UID/EEA/00066/2019From the electrical energy point of view, the smart community (SC) concept is meant to be as a sustainable and environmentally friendly alternative to the classical configuration. The SC includes small-scale renewable energy sources (RES) and small-scale energy storage system (ESS). The SC energy management system acts as an aggregator, aiming to assure benefits for community stakeholders. These trends led to the energy routers (ERs) concept. This study proposes and describes the control strategies for these ERs to contribute to the SC goals. The approach of these strategies increases the RES adjustability, contributing to maintain the ESS state of health. The ER is able to operate simultaneously with active and reactive power control, besides compensating SC grid voltage imbalances, and providing ancillary services to the SC. The proposed control strategies are validated by simulations and experiments.publishersversionpublishe

A Comparative Study of Handwriting and Computer Typing in Note-taking by University Students = Análisis comparativo entre escritura manual y electrónica en la toma de apuntes de estudiantes universitarios

Taking notes is a common strategy among higher education students, and has been found to affect their academic performance. Nowadays, however, the use of computers is replacing the traditional pencil-and-paper methodology. The present study aims to identify the advantages and disadvantages associated with the use of computer (typing) and pencil-and-paper (handwriting) for taking notes by college students. A total of 251 social and health science students participated in the study. Two experimental conditions were chosen: taking notes by hand (n=211), and taking notes by computer (n=40). Those that used computer-written notes performed better on tasks based on reproducing the alphabet, writing sentences, and recognizing words (p<.05). However, those using handwritten notes performed better on free recall tasks (p<.05). Differences between the two conditions were statistically significant rejecting the hypothesis of equality between groups (X2=60.98; p<.0001). In addition, the discriminant analysis confirmed that 77.3% of students were correctly classified by the experimental conditions. Although the computer allowed for greater velocity when taking notes, handwriting enhanced students’ grades when performing memory tasks

Transparency, openness, and reproducible research practices are frequently underused in health economic evaluations

Objectives: To investigate the extent to which articles of economic evaluations of healthcare interventions indexed in MEDLINE incorporate research practices that promote transparency, openness, and reproducibility. Study design and setting: We evaluated a random sample of health economic evaluations indexed in MEDLINE during 2019. We included articles written in English reporting an incremental cost-effectiveness ratio in terms of costs per life years gained, quality-adjusted life years, and/or disability-adjusted life years. Reproducible research practices, openness, and transparency in each article were extracted in duplicate. We explored whether reproducible research practices were associated with self-report use of a guideline. Results: We included 200 studies published in 147 journals. Almost half were published as open access articles (n = 93; 47%). Most studies (n = 150; 75%) were model-based economic evaluations. In 109 (55%) studies, authors self-reported use a guideline (e.g., for study conduct or reporting). Few studies (n = 31; 16%) reported working from a protocol. In 112 (56%) studies, authors reported the data needed to recreate the incremental cost-effectiveness ratio for the base case analysis. This percentage was higher in studies using a guideline than studies not using a guideline (72/109 [66%] with guideline vs. 40/91 [44%] without guideline; risk ratio 1.50, 95% confidence interval 1.15-1.97). Only 10 (5%) studies mentioned access to raw data and analytic code for reanalyses. Conclusion: Transparency, openness, and reproducible research practices are frequently underused in health economic evaluations. This study provides baseline data to compare future progress in the field.F.C-L. is supported by the Institute of Health Carlos III/CIBERSAM. D.M. is supported by a University Research Chair, University of Ottawa. The funders were not involved in the design of the study or de cision to submit the manuscript for publication, nor they were involved in aspect of the study conduct. The views expressed in this manuscript are those of the authors and may not be understood or quoted as being made on behalf of, or reflection of the position of, the funder(s) or any institution.S

Effect of the faique (Acacia macracantha) on the nutritional value of guinea grass (Panicum maximum Jacq.) in a silvopastoral system

Universidad Nacional Agraria La Molina. Escuela de Posgrado. Maestría en Producción AnimalEl objetivo del estudio fue determinar la tasa de crecimiento y calidad nutricional del pasto Guinea (Panicum maximum Jacq) bajo un sistema silvopastoril con el árbol faique (Acacia macracantha). Se evaluaron dos épocas (lluviosa y seca) y tres tratamientos: (1) bajo la copa del árbol joven, (2) bajo la copa del árbol mediano y (3) fuera de la copa del árbol. Los árboles se clasificaron según el diámetro a la altura al pecho. El crecimiento y calidad del pasto se midió por el método de corte y separación y posterior análisis de laboratorio. La tasa de crecimiento osciló de 71.09 a 51.15 kg MS/ha/d, fuera y dentro de la copa de los árboles, respectivamente, en la época lluviosa. La proteína cruda varió de 10.58, 12.79 y 13.88% (época lluviosa) y 8.93, 10.26 y 11.99% (época seca) fuera de la copa del árbol, bajo la copa del árbol joven y bajo la copa del árbol mediano, respectivamente (p<0.05). El contenido de calcio en el pasto fue estadísticamente (p<0.05) superior bajo la copa del árbol mediano (0.23%) que fuera de la copa del árbol (0.20%) en la época lluviosa. El fósforo en el pasto varió significativamente (p<0.05) entre 0.72, 0.83 y 0.91% (época lluviosa) y 0.73, 0.87 y 1.06% (época seca), fuera de la copa de los árboles, bajo la copa del árbol joven y bajo la copa del árbol mediano, respectivamente. El estudio reveló que la presencia de árboles leguminosos (Acacia macracantha) dentro de los potreros mejora la calidad nutricional de la pastura Panicum maximum Jacq.The aim of this study was to determine the growth rate and nutritional quality of Guinea grass (Panicum maximum Jacq) under a silvopastoral system with the faique tree (Acacia macracantha). The evaluation included two seasons (rainy and dry) and three treatments: (1) under the canopy of the young tree, (2) under the canopy of the mediumsize tree, and (3) outside the canopy of the tree. The trees were classified according to the diameter at chest height. The growth and quality of the grass were measured by the method of cutting and separation and subsequent laboratory analysis. The growth rate ranged from 71.09 to 51.15 kg DM/ha/d, outside and inside the tree canopy, respectively, in the rainy season. Crude protein varied from 10.58, 12.79 and 13.88% (rainy season) and 8.93, 10.26 and 11.99% (dry season) outside the tree canopy, under the young tree canopy and under the middle tree canopy respectively (p<0.05). The calcium content in the grass was statistically (p<0.05) higher under the middle tree canopy (0.23%) than outside the tree canopy (0.20%) in the rainy season. The phosphorus in the grass varied significantly (p<0.05) between 0.72, 0.83 and 0.91% (rainy season) and 0.73, 0.87 and 1.06% (dry season), outside the tree canopy, under the canopy of the young tree and under the canopy of the medium tree, respectively. The study revealed that the presence of leguminous trees (Acacia macracantha) within the paddocks improves the nutritional quality of the Panicum maximum Jacq pasture