Designing healthcare information technology to catalyse change in clinical care

The gap between best practice and actual patient care continues to be a pervasive problem in our healthcare system. Efforts to improve on this knowledge_performance gap have included computerised disease management programs designed to improve guideline adherence. However, current computerised reminder and decision support interventions directed at changing physician behaviour have had only a limited and variable effect on clinical outcomes. Further, immediate pay-for-performance financial pressures on institutions have created an environmentwhere disease management systems are often created under duress, appended to existing clinical systems and poorly integrated into the existing workflow, potentially limiting their realworld effectiveness. The authors present a review of disease management as well as a conceptual framework to guide the development of more effective health information technology (HIT) tools for translating clinical information into clinical action

Assessing Hospital Readmission Risk Factors in Heart Failure Patients Enrolled in a Telemonitoring Program

The purpose of this study was to validate a previously developed heart failure readmission predictive algorithm based on psychosocial factors, develop a new model based on patient-reported symptoms from a telemonitoring program, and assess the impact of weight fluctuations and other factors on hospital readmission. Clinical, demographic, and telemonitoring data was collected from 100 patients enrolled in the Partners Connected Cardiac Care Program between July 2008 and November 2011. 38% of study participants were readmitted to the hospital within 30 days. Ten different heart-failure-related symptoms were reported 17,389 times, with the top three contributing approximately 50% of the volume. The psychosocial readmission model yielded an AUC of 0.67, along with sensitivity 0.87, specificity 0.32, positive predictive value 0.44, and negative predictive value 0.8 at a cutoff value of 0.30. In summary, hospital readmission models based on psychosocial characteristics, standardized changes in weight, or patient-reported symptoms can be developed and validated in heart failure patients participating in an institutional telemonitoring program. However, more robust models will need to be developed that use a comprehensive set of factors in order to have a significant impact on population health

The critical components of an electronic care plan tool for primary care: an exploratory qualitative study

Background A critical need exists for effective electronic tools that facilitate multidisciplinary care for complex patients in patient-centered medical homes.Objective To identify the essential components of a primary care (PC) based electronic care plan (ECP) tool that facilitates coordination of care for complex patients.Methods Three focus groups and nine semi-structured interviews were conducted at an academic PC practice in order to identify the ideal components of an ECP.Results Critical components of an ECP identified included: 1) patient background information, including patient demographics, care team member designation and key patient contacts, 2) user- and patient-centric task management functionalities, 3) a summary of a patient’s care needs linked to the responsible member of the care team and 4) integration with the electronic medical record. We then designed an ECP mockup incorporating these components.Conclusion Our investigation identified key principles that healthcare software developers can integrate into PC and patient-centered ECP tools

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

Can mHealth Technology Help Mitigate the Effects of the COVID-19 Pandemic?

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ICF DataSet from ClinicalTrials.gov.xlsx

Transparency Matters: A Review of Readability in Clinical Trial Informed Consent FormsBackground: Clinical research trials rely on informed consent forms (ICFs) to explain all aspects of the study to potential participants. Despite efforts to ensure the readability of ICFs, concerns about their complexity and participant understanding persist. There is a noted gap between Institutional Review Board (IRB) standards and the actual readability levels of ICFs, which often exceed the recommended 8th-grade reading level. This study evaluates the readability of over five thousand ICFs from ClinicalTrials.gov in the United States to assess their literacy levels.Methods: We analyzed 5,239 U.S.-based ICFs from ClinicalTrials.gov using readability metrics such as the Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning Fog Index, and the percentage of difficult words. We examined trends in readability levels across studies initiated from 2005 to 2024.Results: Most ICFs exceeded the recommended 8th-grade reading level, with an average Flesch-Kincaid Grade Level of 10.99. While 91% of the ICFs were written above the 8th-grade level, there was an observable improvement in readability, with fewer studies exceeding a 10th-grade reading level in recent years.Conclusions: The study reveals a discrepancy between the recommended readability levels and actual ICFs, highlighting a need for simplification. Despite a trend toward improvement at higher grade levels, ongoing efforts are necessary to ensure ICFs are comprehensible to participants of varied educational backgrounds, reinforcing the ethical integrity of the consent process.</p

Evoluția fenomenului fiscal

This paperwork is trying to present the evolution of the revenue system beginning with ancient times and is focusing on Romanian Internal Revenue System before and after 1989. Lately, the main characteristic of the Romanian Internal Revenue System is the shift in terms of indirect taxes growth versus direct taxation. Subsequently, this shift came out as the incidence of several factors, such as: the general immaturity of the system, an incoherent fiscal policy, as well as due to the personnel shortcomings and lack of adjustment to the best practices in the field. Thus, we may conclude that the revenue phenomenon in countries passing through a transition period is similar to the beginnings of the system when the state power made its way to various abuses. The fact that countries in transition persisted in making the same mistakes as other developed states prolonged this negative phenomenon.</p

Considerații privind îndatorarea comunității locale

The current article is trying to present aspects regarding local crediting, reforms dealing local crediting, concerning the fact that the needs of local communities are growing each year. It also presents the changes in local finance trough Ordinance of Local Finances no. 45/2003 and law no.313/2004. Financing local budget through credit represents an important resource for achieving the objectives of local public authorities in the interest of the whole community.</p