Participatory design for drug-drug interaction alerts

The utilization of decision support systems, in the point of care, to alert drug-drug interactions has been shown to improve quality of care. Still, the use of these systems has not been as expected, it is believed, because of the difficulties in their knowledge databases; errors in the generation of the alerts and the lack of a suitable design. This study expands on the development of alerts using participatory design techniques based on user centered design process. This work was undertaken in three stages (inquiry, participatory design and usability testing) it showed that the use of these techniques improves satisfaction, effectiveness and efficiency in an alert system for drug-drug interactions, a fact that was evident in specific situations such as the decrease of errors to meet the specified task, the time, the workload optimization and users overall satisfaction in the system.Fil: Luna, Daniel Roberto. Instituto Tecnologico de Buenos Aires. Departamento de Investigacion y Doctorado.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Otero, Carlos Martin. Instituto Tecnológico de Buenos Aires; Argentina. Hospital Italiano. Departamento de Informática En Salud.; ArgentinaFil: Almerares, Alfredo. Hospital Italiano. Departamento de Informática En Salud.; Argentina. University of Oregon; Estados UnidosFil: Stanziola, Enrique Luis. Hospital Italiano. Departamento de Informática En Salud.; ArgentinaFil: Risk, Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Oregon Health And Science University; . Instituto Tecnologico de Buenos Aires. Departamento de Investigacion y Doctorado.; ArgentinaFil: González Bernaldo De Quirós, Fernán. Hospital Italiano. Departamento de Informática En Salud.; Argentin

Incidence of hospital-acquired venous thromboembolic disease.

Background: There is limited knowledge of the incidence of venous thromboembolic disease (VTE) during hospitalization, since most of these are community-based data.Purpose: To estimate the incidence rate (IR) of VTE developed during hospitalization.Methods: Prospective cohort of all inpatients admitted in a university tertiary hospital, in Argentina. The inclusion criteria were defined as: adult patients consecutively admitted from July/2006 to August/2013, for any cause. Patients admitted for VTE were excluded; all patients at the time of admission were free of event. Each person was followed contributing time at risk, from admission to event, discharge or death. VTE incident cases were captured from the Institutional Registry of Thromboembolic Disease (ClinicalTrials.gov Identifier NCT01372514). Incidence rate was calculated with 95% confidence intervals.Results: The crude incidence rate of VTE for clinical patients was 0.49 (95%CI 0.45-0.55) per 1,000 cases person-days, and IR adjusted for WHO was 0.23 (95%CI 0.19-0.26). The crude IR of VTE for surgical patients was 0.25 (95%CI 0.23-0.27), and IR adjusted for WHO was 0.13 (95%CI 0.10-0.17). The incidence rate ratio (IRR) for VTE shows that surgical admission reduces the IRR and age categories increases the thrombosis rate risk, after adjustment for age category, sex and surgical admission.Conclusions: This study suggests that there is a high risk of VTE in hospitalized patients and is still a frequent problem.</p

Cost-effectiveness of a hypertension management programme in an elderly population: a Markov model

<p>Abstract</p> <p>Background</p> <p>Mounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer.</p> <p>Methods</p> <p>We built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payer's perspective. Incremental cost-effectiveness ratio (ICER) was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA) to explore variable uncertainty.</p> <p>Results</p> <p>The ICER for the base-case of the "Hypertension Programme" versus the "Usual care" approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly) and, overall, 95% chance of being cost-effective.</p> <p>Discussion</p> <p>Results showed that "Hypertension Programme" had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis.</p> <p>Conclusions</p> <p>The comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where hypertension treatment for elderly patients is a standard practice.</p

Immunogenicity induced by the use of alternative vaccine platforms to deal with vaccine shortages in a low- to middle-income country: Results of two randomized clinical trials

Background: Shortages of component two of Sputnik V vaccine (rAd5) are delaying the possibility of achieving full immunisation. The immunogenic response associated with the use of alternative schemes to complete the scheme was not explored. Methods: We did two non-inferiority randomized clinical trials with outcomes measures blinded to investigators on adults aged 21–65 years, vaccinated with a single dose of rAd26 ≥ 30 days before screening and no history of SARS-CoV-2. Participants were assigned (1:1:1:1:1) to receive either rAd5; ChAdOx1; rAd26; mRNA-1273 or BBIBP-CorV. The primary endpoint was the geometric mean ratio (GMR) of SARS-CoV-2 anti-spike IgG concentration at 28 days after the second dose, when comparing rAd26/rAd5 with rAd26/ChAdOx1, rAd26/rAd26, rAd26/mRNAmRNA-1273 and rAd26/BBIBP-CorV. Serum neutralizing capacity was evaluated using wild type SARS-CoV-2 reference strain 2019 B.1. The safety outcome was 28-day rate of serious adverse. The primary analysis included all participants who received ≥ 1 dose. The studies were registered with NCT04962906 and NCT05027672. Both trials were conducted in Buenos Aires, Argentina. Findings: Between July 6 and August 3, 2021, 540 individuals (age 56·7 [SD 7·3]; 243 (45%) women) were randomly assigned to received rAd5 (n=150); ChAdOx1 (n=150); rAd26 (N=87); mRNAmRNA-1273 (n=87) or BBIBP-CorV (n=65). 524 participants completed the study. As compared with rAd26/rAd5 (1·00), the GMR (95%CI) at day 28 was 0·65 (0·51–0·84) among those who received ChAdOx1; 0·47 (0·34–0·66) in rAd5; 3·53 (2·68–4·65) in mRNA-1273 and 0·23 (0·16–0·33) in BBIBP-CorV. The geometric mean (IU/ml) from baseline to day 28 within each group increased significantly with ChAdOx1 (4·08 (3·07–5·43)); rAd26 (2·69 (1·76–4·11)); mRNA-1273 (21·98 (15·45–31·08)) but not in BBIBP-CorV (1·22 (0·80–1·87)). Interpretation: Except for mRNA-1273 which proved superior, in all other alternatives non-inferiority was rejected. Antibody concentration increased in all non-replicating viral vector and RNA platforms. Funding: The trials were supported (including funding, material support in the form of vaccines and testing supplies) by the Buenos Aires City Government.Fil: Macchia, Alejandro. No especifíca;Fil: Ferrante, Daniela. No especifíca;Fil: Bouzas, María Belén. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Angeleri, Patricia. No especifíca;Fil: Biscayart, Cristián. No especifíca;Fil: Geffner, Jorge Raúl. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Mammana, Lilia. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Zapiola, Inés. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: López, Eduardo Luis. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Gentile, Angela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Varese, Augusto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Mazzitelli, Ignacio Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Di Diego García, Facundo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Sharff, Deborah. No especifíca;Fil: Lucconi, Verónica. No especifíca;Fil: Sujansky, Paula. No especifíca;Fil: Mariani, Javier. No especifíca;Fil: González Bernaldo de Quirós, Fernán. No especifíca

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

La historia clínica electrónica

Incluye bibliografí

Sistemas de información en salud: integrando datos clínicos en diferentes escenarios y usuarios

Despite the technological advances of recent decades and the many documented benefits, the implementation of information and communication technologies (ICT) in health remains a major challenge for healthcare organizations. Looking to contribute to the analysis of multiple variables involved at the time of achieving successful implementation, we apply a sociotechnical model to analyze the experience of computerization of the clinical layer in the Italian Hospital of Buenos Aires. The conceptual framework applied consists of eight interconnected dimensions that allow the review of different aspects to consider at the time of design, development, implementation, use and evaluation of the application of ICT. Considering the evolution of our project, we divided it into three stages, so that each of the dimensions is analyzed in each of the stages. The socio-technical model applied resulted in an appropriate tool for assessing our implementation of ICT in health, allowing us the analysis of the eight dimensions, including retrospectively. Applying this analysis to each of the stages of the evolution of our institutional project we were able to show that by taking into account all aspects together, its execution was facilitated and allowed us to identify areas for improvement.Pese al avance tecnológico de las últimas décadas y a los múltiples beneficios documentados, la implementación de tecnologías de información y comunicación (TIC) en salud continúa siendo un importante desafío para las organizaciones de salud. Buscando contribuir al análisis de las múltiples variables involucradas a la hora de lograr implementaciones exitosas, aplicamos un modelo sociotécnico para analizar la experiencia de informatización de la capa clínica en el Hospital Italiano de Buenos Aires (HIBA). El marco conceptual aplicado consta de ocho dimensiones interconectadas que permiten revisar diferentes aspectos a tener en cuenta a la hora de diseñar, desarrollar, implementar, usar y evaluar la aplicación de TIC. Teniendo en cuenta la evolución de nuestro proyecto, lo dividimos en tres etapas, de forma tal que cada una de las dimensiones es analizada en cada una de las etapas. El modelo sociotécnico aplicado resultó en una adecuada herramienta de evaluación de nuestra implementación de TIC en salud, permitiéndonos el análisis de las ocho dimensiones, incluso de forma retrospectiva. Aplicando este análisis a cada una de las etapas de la evolución de nuestro proyecto institucional pudimos evidenciar que al tener en cuenta todos los aspectos en conjunto se facilitó la ejecución del mismo y nos permitió identificar aspectos por mejorar

Sistemas de Información en Salud: Integrando datos clínicos en diferentes escenarios y usuarios

Pese al avance tecnológico de las últimas décadas y a los múltiples beneficios documentados, la implementación de tecnologías de información y comunicación (TIC) en salud continúa siendo un importante desafío para las organizaciones de salud. Buscando contribuir al análisis de las múltiples variables involucradas a la hora de lograr implementaciones exitosas, aplicamos un modelo sociotécnico para analizar la experiencia de informatización de la capa clínica en el Hospital Italiano de Buenos Aires (HIBA). El marco conceptual aplicado consta de ocho dimensiones interconectadas que permiten revisar diferentes aspectos a tener en cuenta a la hora de diseñar, desarrollar, implementar, usar y evaluar la aplicación de TIC. Teniendo en cuenta la evolución de nuestro proyecto, lo dividimos en tres etapas, de forma tal que cada una de las dimensiones es analizada en cada una de las etapas. El modelo sociotécnico aplicado resultó en una adecuada herramienta de evaluación de nuestra implementación de TIC en salud, permitiéndonos el análisis de las ocho dimensiones, incluso de forma retrospectiva. Aplicando este análisis a cada una de las etapas de la evolución de nuestro proyecto institucional pudimos evidenciar que al tener en cuenta todos los aspectos en conjunto se facilitó la ejecución del mismo y nos permitió identificar aspectos por mejora

Sistemas de Información en Salud: Integrando datos clínicos en diferentes escenarios y usuarios

Pese al avance tecnológico de las últimas décadas y a los múltiples beneficios documentados, la implementación de tecnologías de información y comunicación (TIC) en salud continúa siendo un importante desafío para las organizaciones de salud. Buscando contribuir al análisis de las múltiples variables involucradas a la hora de lograr implementaciones exitosas, aplicamos un modelo sociotécnico para analizar la experiencia de informatización de la capa clínica en el Hospital Italiano de Buenos Aires (HIBA). El marco conceptual aplicado consta de ocho dimensiones interconectadas que permiten revisar diferentes aspectos a tener en cuenta a la hora de diseñar, desarrollar, implementar, usar y evaluar la aplicación de TIC. Teniendo en cuenta la evolución de nuestro proyecto, lo dividimos en tres etapas, de forma tal que cada una de las dimensiones es analizada en cada una de las etapas. El modelo sociotécnico aplicado resultó en una adecuada herramienta de evaluación de nuestra implementación de TIC en salud, permitiéndonos el análisis de las ocho dimensiones, incluso de forma retrospectiva. Aplicando este análisis a cada una de las etapas de la evolución de nuestro proyecto institucional pudimos evidenciar que al tener en cuenta todos los aspectos en conjunto se facilitó la ejecución del mismo y nos permitió identificar aspectos por mejora