Multichannel services for patient home-based care during COVID-19

At the beginning of 2020, the Worldwide Health Organization (WHO) declared a pandemic caused by the COVID-19 virus. In this sense, this article describes an experiment carried out in a Portuguese health institution during the COVID-19 pandemic between March and July 2020. The number of cases of infection increased exponentially and health facilities were forced to adapt to the circumstances. Due to the health facility limited resources they had to be innovative. A new modality of care service was introduced in which patients were admitted to home-based care to receive medical follow-up. The modality introduced focuses mainly on multichannel interaction between patients and health professionals. Two channels of interaction were made available to patients in home-based care to interact with health professionals. Also, a back-office platform was designed to support health professionals in the management of patients diagnosed with the disease and all the processes related to patient remote follow-up and their decision-making. The results of the experiments were very positive with the modality implemented both for patients and care facilities and their health professionals. The patients were able to receive medical follow-up at their houses without any major complications and they were included in their treatment process. The care facility was able to better manage and reallocate their resource according to their need. This modality proved to be a win-win situation for all the parties involved.This work has been supported by “FCT–Fundação para a Ciência e Tecnologia” within the R&D Units Project Scope: UIDB/00319/2020

Disponibilidade, desempenho e confiança em sistemas de bases de dados hospitalares - Suporte à decisão inteligente para prevenção de falhas

Tese de Doutoramento em Engenharia BiomédicaNos ambientes hospitalares, as tecnologias e os sistemas de informação suportam a atividade dos profissionais que atuam na prestação de cuidados de saúde, devendo proporcionar um acesso seguro e consistente, confidencialidade, eficiência e disponibilidade permanente. Por outro lado, devem mimetizar os processos de registo e difusão da informação mantendo um elevado grau de desempenho. Nestes contextos, os Sistemas de Gestão Bases de Dados (SGBD) assumem-se como sistemas críticos consumindo grandes quantidades de recursos de armazenamento, de processamento e de comunicação e não podendo estar sujeitos a falhas. Apesar da existência de ferramentas tecnológicas para a monitorização e a afinação das configurações dos SGDBs e do avanço tecnológico, com versões mais estáveis, mais seguras e com maior desempenho constata-se que os problemas e dificuldades continuam a surgir. Estes aspectos constituem uma oportunidade de investigação no sentido de se procurar definir modelos para a previsão de eventos, situações e formas de atuação, com alguma antecedência, tais como: • Prever a taxa de utilização de um sistema e do volume de armazenamento necessário; • Prever a ocorrência de um evento crítico que implique a paragem do SGDB; • Prever com antecedência os recursos necessários para resolver um problema. A investigação na área clínica há muito que tem produzido modelos de intervenção em situações críticas permitindo alocar recursos e atuar em conformidade (e.g. MEWS). Seguindo de perto estes avanços, este trabalho visa o estudo, modelação e implementação de um modelo de antecipação e de intervenção em SGBDs e a sua materialização no contexto de um sistema de suporte à decisão inteligente.In healthcare environments, technologies and information systems support the activities of professionals working in health care and must provide a safe and consistent access, confidentiality, efficiency and continuous availability. On the other hand, should reduce the registration process and dissemination of information while maintaining a high performance degree. In these contexts, the Database Management Systems (DMS) are assumed to be critical systems consuming large amounts of storage resources, processing and communication and can not be subject to failures. Despite the existence of technological tools for monitoring and tuning the settings of DMS and technological advances, more stable versions, safer and higher performance notes that the problems and difficulties continue to arise. These constitute a research opportunity in order to seek to define models for the prediction of events, situations and ways of action, such as: • Predict the utilization rate of a system and the required storage volume; • Provide for the occurrence of a critical event that causes the stop of DMS; • Plan in advance the resources needed to solve a problem. Research in the clinical area has long produced models of intervention in critical situations allowing allocate resources and act accordingly (e.g. MEWS). Following these developments, this work aims to study, modeling and implementation of a model of anticipation and intervention in DBMS and its materialization in the context of a support system for intelligent decision

Identification of the Phosphorylated Residues in TveIF5A by Mass Spectrometry

AbstractThe initiation factor eIF5A in Trichomonas vaginalis (TveIF5A) is previously shown to undergo hypusination, phosphorylation and glycosylation. Three different pI isoforms of TveIF5A have been reported. The most acidic isoform (pI 5.2) corresponds to the precursor TveIF5A, whereas the mature TveIF5A appears to be the most basic isoform (pI 5.5). In addition, the intermediary isoform (pI 5.3) is found only under polyamine-depleted conditions and restored with exogenous putrescine. We propose that differences in PI are due to phosphorylation of the TveIF5A isoforms. Here, we have identified phosphorylation sites using mass spectrometry. The mature TveIF5A contains four phosphorylated residues (S3, T55, T78 and T82). Phosphorylation at S3 and T82 is also identified in the intermediary TveIF5A, while no phosphorylated residues are found in the precursor TveIF5A. It has been demonstrated that eIF5A proteins from plants and yeast are phosphorylated by a casein kinase 2 (CK2). Interestingly, a gene encoding a protein highly similar to CK2 (TvCK2) is found in T. vaginalis, which might be involved in the phosphorylation of TveIF5A in T. vaginalis

Interoperability in health care

With the advancement of technology, patient information has been being computerized in order to facilitate the work of healthcare professionals and improve the quality of healthcare delivery. However, there are many heterogeneous information systems that need to communicate, sharing information and making it available when and where it is needed. To respond to this requirement the Agency for Integration, Diffusion, and Archiving of medical information (AIDA) was created, a multi-agent and service-based platform that ensures interoperability among healthcare information systems. In order to improve the performance of the platform, beyond the SWOT analysis performed, a system to prevent failures that may occur in the platform database and also in machines where the agents are executed was created. The system has been implemented in the Centro Hospitalar do Porto (one of the major Portuguese hospitals), and it is now possible to define critical workload periods of AIDA, improving high availability and load balancing. This is explored in this chapter.(undefined

Knowledge acquisition process for intelligent decision support in critical health care

An efficient triage system is a good way to avoid some future problems and, how much quicker it is, more the patient can benefit. However, a limitation still exists, the triage system are general and not specific to each case. Manchester Triage System is a reliable known system and is focused in the emergency department of a hospital. When applied to specific patients’ conditions, such the pregnancy has several limitations. To overcome those limitations, an alternative triage system, integrated into an intelligent decision support system, was developed. The system classifies patients according to the severity of their clinical condition, establishing clinical priorities and not diagnosis. According to the woman urgency of attendance or problem type, it suggests one of the three possible categories of the triage. This paper presents the overall knowledge acquisition cycle associated to the workflow of patient arrival and the inherent decision making process. Results showed that this new approach enhances the efficiency and the safety through the appropriate use of resources and by assisting the right patient in the right place, reducing the waiting triage time and the number of women in general urgency.Fundação para a Ciência e a Tecnologia (FCT

Business intelligence and nosocomial infection decision making

Nosocomial infection prevention in healthcare units it is very important to improve patient’s well-being and safety. This prevention can be done by manipulating and analysing real data to identify critical processes and areas inside the healthcare unit, and monitoring indicators generated from data. The main goal of this paper is to evaluate the applicability of the Business Intelligence tools and concepts to healthcare and their performance as a Clinical Decision Support System, analyzing the evolution of nosocomial infection in the Centro Hospitalar do Porto, by defining a set of indicators that can help the nosocomial infection management and inducing Data Mining models to predict the occurrence of nosocomial infections (sensitivity of 91%). A Business Intelligence system composed by the presentation of a set of indicators and a Data Mining part capable of predict the occurrence of infection can provide important information to support healthcare professionals in their decisions.(undefined

Asthma, much more than a respiratory disease: influence of depression and anxiety

[Abstract] OBJECTIVE: The goals of this study are to compare self-reported depression and anxiety in subjects diagnosed of asthma and healthy controls. METHODS: We designed a case-control study. Subjects were recruited using a consecutive sampling method from a single institution. Two groups were created: Asthma and healthy controls. Data of medical history and demographic background were collected from the medical record. Self-reported depression level was assessed using Beck's depression inventory (BDI). Self-reported anxiety was measured with the “State-trait anxiety inventory” (STAI). RESULTS: Fifty-one subjects with asthma, and fifty healthy patients were included in this study. BDI scores (p<0.001) were higher for asthma (10.22±7.3) than in the control group (5.2±6.56). STAI state (p<0.001) was higher in asthma (42.61±11.5) than in controls (34.88±9.25). STAI trait (p<0.001) showed higher scores in asthma (43.14±10.89) than in controls (34.62±9.19). CONCLUSIONS: These study findings showed that BDI, and STAI trait and state scores are significantly higher in subjects who suffer from asthma than healthy controls

Angina de Ludwig em paciente portador de esquizofrenia: relato de caso

Introdução: Angina de Ludwig é um processo de celulite severa, quase sempre de origem odontogênica, que envolve bilateralmente os espaços perimandibulares. Objetivo: Discutir o manejo da Angina de Ludwig em paciente comprometido sistemicamente em uma situação de urgência. Relato de caso: Paciente L.H.S.A., 36 anos, portador de esquizofrenia, apresentou-se à emergência do Hospital Geral do Estado, cursando com disfagia, dispneia e aumento de volume endurecido e aquecido à palpação em região submandibular bilateral, sublingual e submentoniana. Foi iniciado regime de antibioticoterapia venosa e encaminhamento ao centro cirúrgico para remoção do foco causal, incisão e dissecação romba profunda, bem como inserção de drenos rígidos sob anestesia geral. Resultados: Aproximadamente um mês após a intervenção inicial, o paciente apresentou remissão da infecção e segue sem recidivas. Conclusão: A Angina de Ludwig é uma infecção agressiva, de rápida evolução. A Angina implica em diversas morbidades e suas complicações podem ser fatais, a intervenção imediata é mandatória

Step towards fault forecasting in hospital information systems

Nowadays, many organizations consider databases indispensable tools for their daily tasks. Particularly in healthcare units, databases have a vital role, since they archive very important information about patients’ clinical status, therefore, it is crucial that databases are available twenty-four hours a day, seven days per week. Healthcare units have already implemented fault tolerant systems, which intended to ensure the availability, reliability and disaster recovery of data. However, these mechanisms do not allow to take preventive actions in order to avoid the occurrence of faults. In this context, the necessity of the development of faults prevention and prediction systems is emerging. These systems can predict faults with some time in advance and provide taking early action to solve problems. The objectives of this paper are: monitor database performance and adapt a forecasting model used in medicine (Modified Early Warning Score - MEWS) to database reality.(undefined

Caracterización de la población de caninos de raza Pastor Alemán con displasia de cadera en el municipio de Florencia - Caquetá

Durante el año 2012 se realizó un estudio de caracterización de población de caninos con displasia de cadera en el municipio de Florencia Caquetá a través del cual se realizaron visitas a propiedades de las cuales se tenía información sobre la presencia de caninos de raza Pastor Alemán para obtener información sobre características del hábitat, tipo de al imentación, tipo de servicio que presta el animal y determinar la presencia de displasia de cadera en cada uno de ellos. Se obtuvo que de la población identificada el 70% de los animales corresponde a machos y el 30 % a hembras. A partir de esta distribución porcentual fue posible determinar que para el caso de los machos el 28.57% presento displasia. La población de hembras estudiadas no presento dicha patología. Por otra parte se logró determinar que la mayor cantidad de caninos de raza Pastor Alemán pertenecen a un núcleo familiar de estrato I lo que indica que puede haber una relación directa entre el estrato social y la tendencia a la presentación de displasia de cadera, debido a aspectos de selección y manejo