The Re-Heart Registry: A Prospective, Interoperable, Standardised Clinical Registry of Outpatients With Heart Failure

Purpose: To describe the creation and implementation of the RE-Heart Registry, a prospective, interoperable, highly scalable and standardised clinical registry of outpatients with heart failure (HF). Methods and Results: We carried out the steps, as follows: (1) data standardisation in accordance with national and international data elements. Dataset included all applicable standardised data elements published by the American Heart Association (AHA), American College of Cardiology (ACC) with the National Cardiovascular Data Registry (NCDR)and the Brazilian Cardiovascular Registries, as a reference the BREATHE (I Brazilian Registry of Heart Failure) and PINNACLE (heart failure and atrial fibrillation); (2) development of an initial data collection and clinical research workflow; (3) development of electronic case reports using REDCap and in accordance with the HIPAA privacy rule; (4) pilot test and validation of the data collection and clinical research workflows and CRFs; (5) development of automated data quality reporting using REDCap. Data collection occurs at the outpatient department at the moment of inclusion and every 6 months (phone calls and visits to the outpatients department). Conclusions: The RE-Heart Registry represents a comprehensive database capable to represent real clinical practice favouring clinical research, technology assessment, services management and health policies

Implementation of a Management Registry for Storing Clinical Data in a Research Centre

In clinical research, there is great concern about the storage and veracity of electronic data to ensure the accuracy of information. Objective: To implement a management registry for storing study data in the cardiovascular area, conducted in a clinical research centre. Methods: This is a retrospective registry and prospective joint study. An electronic database was developed using REDCap software. Data elements were standardised in accordance with the American College of Cardiology Foundation and American Heart Association. Data were extracted from research participants from the clinical studies conducted in our Institution with records of cardiovascular diagnosis that were monitored by the health team from 2009 to 2015. Results: The registry was composed of eight sections: demographic variables, diagnostic tests, laboratory tests, cardiovascular risk factors (CV), comorbidities and pharmacological treatment used, and outcome of patients. Each session consisted of sub-items, totalling 113 variables. Phase III (57.8%) and phase IV (36.8%) studies with mean follow-up of 2+4 years were predominant. We used data from 490 participants randomised to 25 studies, 63 percent men, aged 63 ą 10 years, hypertensive (81.4%), with dyslipidaemia (56.5%), and diabetes 48 (36.3%). Most had previous myocardial infarction (72.7%) and underwent coronary angioplasty (87.2%). Conclusion: The implementation of an electronic database of research on participants with cardiovascular disease was applicable and reproducible in clinical practice, being a low cost and very useful tool to store and share data from multicentre studies of medium and large scale

Prospective Clinical Registry to Evaluate Clinical Outcomes of Hypertension Patients in a Multidisciplinary Clinic

Introduction: clinical registries are necessary to define public policies for treatment and prevention, by providing highly accurate and interoperable data. Objective: to describe the implementation of a prospective, computerised, interoperable and multidisciplinary clinical registry to evaluate the clinical practice and outcomes of hypertensive patients. Methods: prospective observational study designed as a clinical registry carried out in a multidisciplinary hypertension clinic, in Brazil. A multi-professional team attends the patients. The database included patients with primary hypertension, above 18 years of age. Patients who had undergone surgery, a stroke, myocardial infarction, or renal failure were excluded. Variables were defined in accordance with national and international variables to allow interoperability. Results: the RE-HYPER registry was implemented by following the steps: (1) Data standardisation. The dataset included all applicable standardised data elements published by the American Heart Association / American College of Cardiology, and Brazilian national datasets standards; (2) Development of an initial data collection and clinical research workflow; (3) Development of electronic case reports (CRF) using REDCap (Research Electronic Data Capture) and in accordance with the HIPAA (Health Insurance Portability and Accountability Act) privacy rule; (4) Pilot testing and validation of the data collection and clinical research workflows and CRFs, and (5) Development of automated data quality report using REDCap. Discussion: Due to the magnitude of this disease in the world, this study becomes relevant to clinical practice. Conclusion:  The study showed reproducible standards and solutions that can be applied in the implementation of health records, allowing data integration between health and research services

Pronto Fácil: A software for Patient Data and Health Service Management for Clinical Psychologists

Introduction: Clinical and management data need to be stored in a manner that allows easy, safe and real time access. Objective: Develop a software for patient data and health service management for use on clinical psychologists’ smartphones, tablets and computers. Method: This research used applied technology production for software application development, and was carried out in five steps: (1) Preliminary survey; (2) Target public contact retrieval and pilot research; (3) Definition of the development’s basic aspects and questionnaire preparation for final research; (4) Initial development, beta testing and final questionnaire; (5) Development of the application’s final version. Results: (1) Low records registration and methods used by clinical psychologists. (2) Reasons for low records registration and helping factors to change this. (3) Chosen a software language which was able to be used as platform independent when developing to Windows, Android and iOS, easy-to-read text fonts for everyone, pleasant colours and intuitive user interface. (4) First software version, group of testers and final questionnaire. (5) Application is able to manage patient records and appointments, together with financial and tax registries, and tax collection formularies. Conclusion: The proposed psychological records strategy has resulted in a key factor to tackle the barriers raised against recording psychological treatment in medical records, being also a great ally for private practices’ management, as clinical psychologists, liked the versatility in handling and scope, such as appointments, registration of clinical records and financial control. The application will be freely available on Microsoft Store for Windows 10 users and in the future on Play Store (Android)

RIAM – Multicentre, Interoperable, Clinical Registry of Acute Myocardial Infarction

Introduction: Ischemic heart disease is the leading cause of death in the world. In Brazil, in 2013, acute myocardial infarction (AMI) was the main cause of mortality due to heart disease. A better identification of the patients will serve as a tool to improve the treatment of this pathology. Objective: To expand the database of patients with ST elevation myocardial infarction (STEMI) of the Cardiology Institute (Porto Alegre-RS, Brazil). Methods and Results: The following steps were taken: (1) data elements standardisation in accordance with standard variables, including all applicable standardized data elements published by the American Heart Association / American College of Cardiology, and Brazilian national datasets standards; (2) Development of electronic case reports (CRF) using REDCap (Research Electronic Data Capture) and in accordance with the HIPAA (Health Insurance Portability and Accountability Act) privacy rule ; And (3) expansion of registration to other referral centers. The participating institutions are distributed in the regions of Santa Maria, Passo Fundo, Caxias do Sul all of Rio Grande do Sul, as well as the regions of Santa Catarina and the Distrito Federal in Brasília. The data collected will be stored according to the Health Insurance Portability and Accountability Act. Conclusion: The enhancement and expansion of the RIAM Registry to other referral centers is generating data directly into the REDCap CRF, is a tool with results the treatment of AMI in our environment, which contributes to clinical practice, health services management and policies

Fuentes de información sobre salud mental : revisión sistemática de la literatura

O objetivo deste estudo foi identificar na literatura as fontes de informação sobre saúde mental (FISM) utilizadas pelas pessoas, bem como discutir as vantagens e desvantagens associadas a fontes específicas a fim de compreender as preferências e suas justificativas. Foi realizada uma revisão sistemática de literatura em cinco bases de dados nacionais e internacionais (PubMed, Pepsic, IndexPsi, Scielo e Lilacs) com a combinação entre dois descritores “fontes de informação” e “saúde mental” em Português, Inglês e Espanhol. No total, foram encontrados 46 trabalhos completos, mas apenas 12 foram selecionados para análise. As informações foram organizadas em duas categorias definidas a priori, com base nos objetivos do estudo: FISM utilizadas por grupos específicos e implicações dos resultados dos estudos analisados na prática. Verificou-se que a Internet e os profissionais da saúde foram as FISM de maior preferência das diferentes amostras analisadas. Contudo, é necessário que os profissionais indiquem aos pacientes FISM confiáveis e expliquem as possíveis limitações sobre cada uma. Conclui-se que, embora a Internet tenha aumentado o acesso a informações sobre saúde mental, o papel dos profissionais continua sendo fundamental na produção de conteúdo confiável.The aim of this study was to identify the sources of information on mental health (SIMH) used by people in the literature,as well as to discuss the advantages and disadvantages associated with specific sources in order to understand the preferences and their explanations. A systematic literature review was carried out in five national and international databases (PubMed, Pepsic, IndexPsi, Scielo, and Lilacs) with the combination of two descriptors "information sources" and "mental health" in Portuguese, English, and Spanish. In total, 46 complete papers were found, but only 12 were selected for analysis. The information was organized in two categories defined a priori, based on the objectives of the study: SIMH used by specific groups and implications of the results of the studies analyzed in practice. We verified that the Internet and the health professional(s) were the most favored SIMH of the different samples analyzed. However, it is necessary for practitioners to point out reliable SIMH for patients and to explain possible limitations of each of these. We concluded that, although the Internet as increased access to mental health information, the role of professionals remains crucial in the production of reliable content.El objetivo de este estudio fue identificar en la literatura las fuentes de información sobre salud mental (FISM) utilizadas por las personas, así como discutir las ventajas y desventajas asociadas a fuentes específicas a fin de comprender las preferencias y sus justificaciones. Se realizó una revisión sistemática de literatura en cinco bases de datos nacionales e internacionales (PubMed, Pepsic, IndexPsi, Scielo y Lilacs) con la combinación entre dos descriptores "fuentes de información" y "salud mental" en Portugués, Inglés y Español. En total, se encontraron 46 trabajos completos, pero sólo 12 fueron seleccionados para análisis. Las informaciones fueron organizadas en dos categorías definidas a priori, conbase en los objetivos del estudio: FISM utilizados por grupos específicos e implicaciones de los resultados de los estudios analizados en la práctica. Se verificó que la Internet y el profesional de la salud fueron las FISM de mayor preferencia de las diferentes muestras analizadas. Sin embargo, es necesario que los profesionales indiquen a los pacientes FISM confiables y expliquen las posibles limitaciones sobre cada una. Se concluye que, aunque Internet ha aumentado el acceso a información sobre salud mental, la función de los profesionales sigue siendo fundamental en la producción de contenido confiable

Elaboração de Cartilha Psicoeducativa on-line sobre TDAH em estudantes universitários

A psicoeducação pode ser aplicada de formas distintas. Quando a ela assume o formato de intervenção independente, corresponde a um processo de alfabetização psicológica, isto é, serve como uma primeira fonte de informação sobre saúde mental para população não clínica. O objetivo deste estudo é relatar a experiência da construção de uma cartilha psicoeducativa on-line sobre o Transtorno de Déficit de Atenção/Hiperatividade (TDAH) em estudantes universitários. O processo de elaboração ocorreu em cinco etapas: a) identificação das informações relevantes sobre a psicoeducação do TDAH na literatura científica, b) avaliação da primeira versão do texto por seis especialistas, c) diagramação do texto por um designer, d) teste piloto com sete universitários, e) teste de efetividade com 241 adultos. Verificou-se que a cartilha não só aumentou o conhecimento sobre o TDAH da amostra estudada, mas também motivou os participantes a compartilharem o material com quem apresenta os sintomas citados, a compreenderem as dificuldades alheias e a utilizarem-na nos atendimentos realizados. Conclui-se que procedimentos adotados na construção de instrumentos psicológicos podem ser úteis para a elaboração de materiais psicoeducativos

Orthodontic and orthopaedic treatment for anterior open bite in children (Review)

Background: Anterior open bite occurs when there is a lack of vertical overlap of the upper and lower incisors. The aetiology is multifactorial including: oral habits, unfavourable growth patterns, enlarged lymphatic tissue with mouth breathing. Several treatments have been proposed to correct this malocclusion, but interventions are not supported by strong scientific evidence. Objectives: The aim of this systematic review was to evaluate orthodontic and orthopaedic treatments to correct anterior open bite in children. Search methods: The following databases were searched: the Cochrane Oral Health Group's Trials Register (to 14 February 2014); the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library 2014, Issue 1); MEDLINE via OVID (1946 to 14 February 2014); EMBASE via OVID (1980 to 14 February 2014); LILACS via BIREME Virtual Health Library (1982 to 14 February 2014); BBO via BIREME Virtual Health Library (1980 to 14 February 2014); and SciELO (1997 to 14 February 2014). We searched for ongoing trials via ClinicalTrials.gov (to 14 February 2014). Chinese journals were handsearched and the bibliographies of papers were retrieved. Selection criteria: All randomised or quasi-randomised controlled trials of orthodontic or orthopaedic treatments or both to correct anterior open bite in children. Data collection and analysis: Two review authors independently assessed the eligibility of all reports identified. Risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated for dichotomous data. The continuous data were expressed as described by the author. Main results: Three randomised controlled trials were included comparing: effects of Frankel's function regulator-4 (FR-4) with lip-seal training versus no treatment; repelling-magnet splints versus bite-blocks; and palatal crib associated with high-pull chincup versus no treatment.The study comparing repelling-magnet splints versus bite-blocks could not be analysed because the authors interrupted the treatment earlier than planned due to side effects in four of ten patients.FR-4 associated with lip-seal training (RR = 0.02 (95% CI 0.00 to 0.38)) and removable palatal crib associated with high-pull chincup (RR = 0.23 (95% CI 0.11 to 0.48)) were able to correct anterior open bite.No study described: randomisation process, sample size calculation, there was not blinding in the cephalometric analysis and the two studies evaluated two interventions at the same time. These results should be therefore viewed with caution. Authors' conclusions: There is weak evidence that the interventions FR-4 with lip-seal training and palatal crib associated with high-pull chincup are able to correct anterior open bite. Given that the trials included have potential bias, these results must be viewed with caution. Recommendations for clinical practice cannot be made based only on the results of these trials. More randomised controlled trials are needed to elucidate the interventions for treating anterior open bite