bluuebunny/crossref_metadata_2025 huggingface dataset:
Undergraduate Nurses' Preferred Use of Mobile Devices in Healthcare Settings
Authors: Mather Carey  , Cummings Elizabeth  , Allen Penny
Published: February 2025

The growth of digital technology has created challenges for appropriate and safe use of mobile or portable devices in healthcare environments. There is perceived risk that the use of mobile technology for learning may distract from provision of patient care if used by undergraduate students during work-integrated learning. This paper reports on a study that aimed to identify differences in preferred behavior of student nurses in their use of mobile technology during and away from the clinical practice environment. A previously validated online survey was administered to students during a period of work integrated learning in a range of healthcare settings in two Australian states. Respondents agreed that mobile devices could be beneficial to patient care. Overall, students proposed they would use mobile devices for accessing information, during work integrated learning, less than when away from the workplace. The development of policy to guide the use of mobile devices, in situ, is important to the provision of safe and competent care and improved health outcomes for patients.
Optimizing the Efficacy of Multimedia Consumer Health Information
Authors: Monkman Helen  , Kushniruk Andre W.
Published: February 2025

Using two or more communication methods (e.g., text, narration, pictures, animation, video) is known as multimedia. Multimedia has been used in a broad range of domains. Not surprisingly, multimedia is gaining popularity in the field of consumer health information as its benefits are being recognized. However, there is a large body of evidence in the cognitive literature that could be used to inform and optimize multimedia presentation of consumer health information. This paper outlines the Cognitive Theory of Multimedia Learning (CTML) and presents the application of this model for consumer health informatics. The CTML is a valuable resource for the development and revision of consumer health information to optimize its efficacy. Current research on multimedia and consumer health information is described. Finally, the outstanding opportunities to leverage the CTML for consumer health information are discussed.
Information System Hazard Analysis: A Method for Identifying Technology-induced Latent Errors for Safety
Authors: Weber Jens H.  , Mason-Blakley Fieran  , Price Morgan
Published: February 2025

Many health information and communication technologies (ICT) are safety-critical; moreover, reports of technology-induced adverse events related to them are plentiful in the literature. Despite repeated criticism and calls to action, recent data collected by the Institute of Medicine (IOM) and other organization do not indicate significant improvements with respect to the safety of health ICT systems. A large part of the industry still operates on a reactive “break & patch” model; the application of pro-active, systematic hazard analysis methods for engineering ICT that produce “safe by design” products is sparse. This paper applies one such method: Information System Hazard Analysis (ISHA). ISHA adapts and combines hazard analysis techniques from other safety-critical domains and customizes them for ICT. We provide an overview of the steps involved in ISHA and describe.
Structured Data Capture from Multiple EMRs: Towards an Architecture for Clinical Research
Authors: Zaveree Zaib  , Keshavjee Karim
Published: February 2025

EMR adoption by primary care physicians in Canada has increased dramatically in recent years. This provides an excellent opportunity for researchers to collaborate with primary care providers to capture structured data at the point of care. This paper describes the feasibility of converting a popular well-baby checklist form into an electronic version for research data collection. Usability and scalability of the instrument to large numbers of physicians was assessed. We developed and tested a standardized, electronic version of the Rourke Baby Record (eRourke) that was embedded into two different EMRs at four primary care clinics in Southern Ontario over a 6-month period. We utilized qualitative and quantitative research techniques, including on-site observation, key informant interviews and administration of pre- and post-questionnaires. Implementation of the eRourke improved the quality of data for research and reporting significantly. Providers also reported a subjective sense of having collected better quality data. Enhancing the usability of the form in 3 specific areas would likely increase the receptivity to the form to larger numbers of providers. Overall, providers were satisfied with the eRourke and felt that it captured higher quality information than previous versions (55% Agree before vs 88% Agree after).
Development of a Flexible and Extensible Computer-based Simulation Platform for Healthcare Students
Authors: Bindoff Ivan  , Cummings Elizabeth  , Ling Tristan  , Chalmers Leanne  , Bereznicki Luke
Published: February 2025

Accessing appropriate clinical placement positions for all health profession students can be expensive and challenging. Increasingly simulation, in a range of modes, is being used to enhance student learning and prepare them for clinical placement. Commonly these simulations are focused on the use of simulated patient mannequins which typically presented as single-event scenarios, difficult to organise, and usually scenarios include only a single healthcare profession. Computer based simulation is relatively under-researched and under-utilised but is beginning to demonstrate potential benefits. This paper describes the development and trialling of an entirely virtual 3D simulated environment for inter-professional student education.
The Experiences of Patients Undertaking a ‘Virtual’ Cardiac Rehabilitation Program
Authors: Banner Davina  , Lear Scott  , Kandola Daman  , Singer Joel  , Horvat Dan  , Bates Joanna  , Ignaszewski Andrew
Published: February 2025

Cardiac rehabilitation programs (CRP) are medically supervised, multidisciplinary programs that provide secondary prevention aimed at addressing risk factors and improving lifestyle behaviours for patients following an acute cardiac event. CRPs have been demonstrated to be a cost-effective and evidence-based mechanism to improve patient outcomes, but despite the known benefits of these programs, uptake remains poor. Poor attendance has been linked to many factors, but geographical accessibility is a key concern, since many CRPs are limited to hospitals in urban areas. The widespread availability of the Internet has made it possible to provide virtual health services to populations that may have previously been hard to access. This paper examines the qualitative findings from a 16-month mixed methods randomized controlled trial examining the impact of a virtual CRP (vCRP). The vCRP was revealed to be an accessible, appropriate, convenient and effective way to deliver cardiac rehabilitation services, with patients experiencing both clinical improvements and a high level of satisfaction. To understand the experience of patients undertaking the vCRP, semi-structured interviews were undertaken with a purposive sample of 22 participants. An analysis of the qualitative interviews revealed that the vCRP improved participants' access to healthcare professionals, supported them to make healthy choices, and enhanced feelings of accountability due to greater surveillance. Barriers to participation, such as computer literacy, and general perceptions of a vCRP were also examined. Further investigation into the use and long-term effectiveness of virtual programs across a broader range of healthcare settings is warranted, particularly in those with multiple chronic diseases and those located in rural and remote communities.
Clinical Decision Support using a Terminology Server to improve Patient Safety
Authors: Garcia-Jimenez Alba  , Moreno-Conde Alberto  , Martínez-García Alicia  , Marín-León Ignacio  , Medrano-Ortega Francisco Javier  , Parra-Calderón Carlos L.
Published: February 2025

Clinical Decision Support Systems (CDSS) are software applications that support clinicians in making healthcare decisions providing relevant information for individual patients about their specific conditions. The lack of integration between CDSS and Electronic Health Record (EHR) has been identified as a significant barrier to CDSS development and adoption. Andalusia Healthcare Public System (AHPS) provides an interoperable health information infrastructure based on a Service Oriented Architecture (SOA) that eases CDSS implementation. This paper details the deployment of a CDSS jointly with the deployment of a Terminology Server (TS) within the AHPS infrastructure. It also explains a case study about the application of decision support to thromboembolism patients and its potential impact on improving patient safety. We will apply the inSPECt tool proposal to evaluate the appropriateness of alerts in this scenario.
Version Changes in Medical Software: Proposing Minimal Requirements for Release Notes and a Version Number Convention – An Operators' Point of View
Authors: Ahlbrandt Janko  , Bott Constantin  , Moll Peter  , Naziyok Tolga  , Majeed Raphael W.  , Röhrig Rainer
Published: February 2025

Medical software – like any other software - is susceptible to errors. To avoid false system behaviour or attenuate its consequences, system operators need to know about changes in the software. The goal of this proposal is to define terms and minimum requirements regarding documentation for a version change from the operator's point of view, especially in the domain of medical software or software as a medical device (SaMD). The results are a classification of version changes (Upgrade: breaks support for a rollback to a prior version, Major Update: either substantial configuration or user education needed, Minor Update: minor configuration or user information needed, Patch: collection of (small) changes that require neither configuration nor user information.). Additionally, minimal requirements for release notes are determined and a document structure recommended.
Filling the Gap Between Guideline Development and Formalization Process - A Requirement Analysis
Authors: Khodambashi Soudabeh  , Nytrø Øystein
Published: February 2025

Clinical guidelines are made to aid diagnosis, management and treatment of patients. Authoring, publishing, updating and maintaining clinical guidelines are time-consuming, labour-intensive and complex. Unfortunately, it is time-consuming to search and retrieve patient-specific recommendations in free-text documents. Literature is rich with methods proposed to support encoding of clinical guidelines into computer-interpretable formats (CIG). However, there is a lack of studies covering the actual guideline development and authoring. So, the objective of this research is to explore gap between tools and methods for authoring guideline content and for designing and implementing computer-interpretable guidelines. Towards this objective, we have performed a user requirements analysis to arrive at a set of design recommendations. The resulting functionality framework can be used to design and develop authoring tools for the entire life-cycle of the computerized clinical guideline.
Exploring User Experience of a Telehealth System for the Danish TeleCare North Trial
Authors: Lilholt Pernille Heyckendorff  , Hæsum Lisa Korsbakke Emtekær  , Hejlesen Ole Kristian
Published: February 2025

The aim was to explore user experiences of using a telehealth system (Telekit) designed for the Danish TeleCare North trial. Telekit is designed for patients diagnosed with chronic obstructive pulmonary disease (COPD) in order to manage the disease and support patient empowerment. This article sums up COPD-participants' user experiences in terms of increased sense of freedom, of security, of control, and greater awareness of COPD symptoms. A consecutive sample of sixty participants (27 women, 33 men) were recruited from the TeleCare North trial. At home the participants completed a non-standardised questionnaire while a researcher was present. The questionnaire identified their health status, their use of specific technologies, and their user experiences with the telehealth system. Results from the questionnaire indicate that the majority of participants (88%) considered the Telekit system as easy to use. 43 (72%) participants felt increased sense of security, and 37 (62%) participants felt increased sense of control by using the system. 30 (50%) participants felt greater awareness of their COPD symptoms, but only 16 (27%) participants felt increased freedom. The study has provided a general picture of COPD participants' user experiences which is important to emphasise as it has a bearing on whether a given implementation will be successful or not.
Mobile Technology Support for Clinical Decision in Diabetic Keto-Acidosis Emergency
Authors: Frandes Mirela  , Timar Bogdan  , Tole Alexandra  , Holban Stefan  , Lungeanu Diana
Published: February 2025

The main challenge of effectively managing emergencies in diabetic ketoacidosis (DKA) is the fine tuning of the treatment in order to re-establish the normal metabolic homeostasis. We propose a mobile application for clinical decision support in DKA emergencies (mDKA), running under Android on smart phones and tablet PCs. mDKA provides decision support for treatment concerning the main components (i.e. choice and dose of re-hydration agent, insulin, potassium or bicarbonate) for up to 12 hours after the diagnosis. The application underwent a preliminary scanty evaluation aimed at assessing its perceived usability. The results sustained the informal hints that mDKA's accuracy in deciding the treatment path was acceptable in terms of general variability of medical decision in DKA and brought evidence of positive attitude towards the application itself.
Automatic Landmarks Detection in Breast Reconstruction Aesthetic Assessment
Authors: Núñez-Benjumea Francisco J.  , Serrano Carmen  , Acha Begoña
Published: February 2025

This paper addresses a fully automatic landmarks detection method for breast reconstruction aesthetic assessment. The set of landmarks detected are the supraesternal notch (SSN), armpits, nipples, and inframammary fold (IMF). These landmarks are commonly used in order to perform anthropometric measurements for aesthetic assessment. The methodological approach is based on both illumination and morphological analysis. The proposed method has been tested with 21 images. A good overall performance is observed, although several improvements must be achieved in order to refine the detection of nipples and SSNs.
Using ICT to Support Individual Guidance in Health Promotion Programs for Increased Physical Activity
Authors: Tute Erik  , Engelke Bernward  , Haase Ingo  , Kupka Thomas  , Marschollek Michael  , Schneider Gerald  , Stein Lothar  , Tegtbur Uwe
Published: February 2025

Introduction: We report on experiences in implementing a system to support the individual guidance of training in health promotion programs aiming to increase participants' regular level of physical activity.
Automatic extraction of numerical values from unstructured data in EHRs
Authors: Bigeard Elise  , Jouhet Vianney  , Mougin Fleur  , Thiessard Frantz  , Grabar Natalia
Published: February 2025

Clinical data recorded in modern EHRs are very rich, although their secondary use research and medical decision may be complicated (eg, missing and incorrect data, data spread over several clinical databases, information available only within unstructured narrative documents). We propose to address the issue related to the processing of narrative documents in order to detect and extract numerical values and to associate them with the corresponding concepts (or themes) and units. We propose to use a CRF supervised categorisation for the detection of segments (themes, numerical sequences and units) and a rules-based system for the association of these segments among them in order to build semantically meaningful sequences. The average results obtained are competitive (0.96 precision, 0.78 recall, and 0.86 F-measure) and we plan to use the system with larger clinical data.
Problem Solving for Volatilizing Situation in Nursing: Developing Thinking Process Supporting System using NursingNAVI
Authors: Tsuru Satoko  , Wako Fumiko  , Omori Miho  , Sudo Kumiko
Published: February 2025

We have identified three foci of the nursing observation and nursing action respectively. Using these frameworks, we have developed the structured knowledge model for a number of diseases and medical interventions. We developed this structure based NursingNAVI®contents collaborated with some quality centered hospitals. Authors analysed the nursing care documentations of post-gastrectomy patients in light of the standardized nursing care plan in the “NursingNAVI®” developed by ourselves and revealed the “failure to observe” and “failure to document”, which leaded to the volatility of the patients' data, conditions and some situation. This phenomenon should have been avoided if nurses had employed a standardized nursing care plan. So, we developed thinking process support system for planning, delivering, recording and evaluating in daily nursing using NursingNAVI®contents. A hospital decided to use NursingNAVI®contents in HIS. It was suggested that the system has availability for nursing OJT and time reduction of planning and recording without volatilizing situation.
User experience integrated life-style cloud-based medical application
Authors: Serban Alexandru  , Lupşe Oana Sorina  , Stoicu-Tivadar Lăcrămioara
Published: February 2025

Having a modern application capable to automatically collect and process data from users, based on information and lifestyle answers is one of current challenges for researchers and medical science. The purpose of the current study is to integrate user experience design (UXD) in a cloud-based medical application to improve patient safety, quality of care and organizational efficiency. The process consists of collecting traditional and new data from patients and users using online questionnaires. A questionnaire dynamically asks questions about the user's current diet and lifestyle. After the user will introduce the data, the application will formulate a presumptive nutritional plan and will suggest different medical recommendations regarding a healthy lifestyle, and calculates a risk factor for diseases. This software application, by design and usability will be an efficient tool dedicated for fitness, nutrition and health professionals.
Design and evaluation of a patient website to reduce crowding in emergency departments: a preliminary study
Authors: Schiro Jessica  , Marcilly Romaric  , Leroy Nicolas  , Wawrzyniak Clément  , Martinot Alain  , Pelayo Sylvia
Published: February 2025

The study aims to identify the information useful to support a patients' EDs' choice in order to design a patient Web-based system. For that purpose, a focus group and a formative user test have been performed. The results show that five types of information can be relevant. The spontaneous favored information is the “distance” to EDs. The “Wait time”, that is sanctified in literature, is only used in a second time. A larger summative evaluation should be planned to evaluate and validate the befits of this kind of tool.
Analysis of Care Pathway Variation Patterns in Patient Records
Authors: Li Xiang  , Mei Jing  , Liu Haifeng  , Yu Yiqin  , Xie Guotong  , Hu Jianying  , Wang Fei
Published: February 2025

A care/clinical pathway (CP) is a standardized care process where temporal and data constraints of clinical activities are defined to ensure quality of care. In actual care practice, various situations of compliance and non-compliance with CPs can be observed. Analysis of these CP variation patterns (CPVPs) can help improve care quality and enhance decision support. In this paper, we propose an automatic method to detect CPVPs in electronic medical records (EMR), and statistically examine their correlation with patient outcomes. From each CP constraint, we first derive a CPVP tree, where each pattern is represented using first-order linear temporal logic and translated into a Büchi automaton for pattern detection. Then we identify the CPVPs that are evidently correlated with a patient outcome by examining the odds ratios. The method has been applied to a CP for congestive heart failure and real world EMR to demonstrate the effectiveness.
Privacy-preserving Statistical Query and Processing on Distributed OpenEHR Data
Authors: Hailemichael Meskerem Asfaw  , Marco-Ruiz Luis  , Bellika Johan Gustav
Published: February 2025

Reuse of data from EHRs is essential for many purposes. The objective of the study was to explore how distributed electronic health record (EHR) data can be reused for privacy-preserving statistical query and processing. Method: We have designed and created a proof of concept prototype solution based on the OpenEHR specification to ensure interoperability and to query the EHRs. XMPP was used for communication between the distributed processing components. Results: We have created a two-phased process where a distributed virtual dataset is first created and thereafter processed using distributed privacy-preserving statistical queries. Conclusion: Health authorities in Norway are currently defining the set of archetypes for the national interoperability program. This will create a common information schema enabling reuse of EHR data for statistical query and processing in a privacy-preserving manner. One benefit of the approach is that information transformation between information models for clinical use and statistical processing can be avoided.
A “pivot” Model to set up Large Scale Rare Diseases Information Systems: Application to the Fibromuscular Dysplasia Registry
Authors: Toubiana Laurent  , Ugon Adrien  , Giavarini Alessandra  , Riquier Jérémie  , Charlet Jean  , Jeunemaitre Xavier  , Plouin Pierre-François  , Jaulent Marie-Christine
Published: February 2025

The SIR-FMD project is a partnership between the Department of Genetics and Reference Centre for Rare Vascular Diseases at the Georges Pompidou European Hospital in Paris and the Medical Informatics and Knowledge Engineering Laboratory of Inserm. Its aim is to use an ontological approach to implement an information system for the French Fibromuscular Dysplasia Registry. The existing data was dispersed in numerous databases, which had been created independently. These databases have different structures and contain data of diverse quality. The project aims to provide generic solutions for the management of the communication of medical data. The secondary objective is to demonstrate the applicability of these generic solutions in the field of rare diseases (RD) in an operational context. The construction of the French FMD registry was a multistep process. A secure platform has been available since the beginning of November 2013. The medical records of 471 patients from the initial dataset provided by the HEGP-Paris, France have been included, and are accessible from a secure user account. Users are organized into a collaborative group, and can access patient groups. Each electronic patient record contains more than 2,200 items. The problem of semantic interoperability has become one of the major challenges for the development of applications requiring the sharing and reuse of data. The information system component of the SIR-FMD project has a direct impact on the standardisation of coding of rare diseases and thereby contributes to the development of e-Health.
A Cloud Based Real-Time Collaborative Platform for eHealth
Authors: Ionescu Bogdan  , Gadea Cristian  , Solomon Bogdan  , Ionescu Dan  , Stoicu-Tivadar Vasile  , Trifan Mircea
Published: February 2025

For more than a decade, the eHealth initiative has been a government concern of many countries. In an Electronic Health Record (EHR) System, there is a need for sharing the data with a group of specialists simultaneously. Collaborative platforms alone are just a part of a solution, while a collaborative platform with parallel editing capabilities and with synchronized data streaming are stringently needed. In this paper, the design and implementation of a collaborative platform used in healthcare is introduced by describing the high level architecture and its implementation. A series of eHealth services are identified and usage examples in a healthcare environment are given.
Psychologist in a Pocket: Towards Depression Screening on Mobile Phones
Authors: Bitsch Jó Ágila  , Ramos Roann  , Ix Tim  , Ferrer-Cheng Paula Glenda  , Wehrle Klaus
Published: February 2025

Depression is the most prevalent clinical disorder and one of the main causes of disability. This makes early detection of depressive symptoms critical in its prevention and management. This paper presents and discusses the development of Psychologist in a Pocket (PiaP), a mental mHealth application for Android which screens and monitors for these symptoms, and–given the explicit permission of the user–alerts a trusted contact such as the mental health professional or a close friend, if it detects symptoms.
Business Model Design for a Wearable Biofeedback System
Authors: Hidefjäll Patrik  , Titkova Dina
Published: February 2025

Wearable sensor technologies used to track daily activities have become successful in the consumer market. In order for wearable sensor technology to offer added value in the more challenging areas of stress-rehab care and occupational health stress-related biofeedback parameters need to be monitored and more elaborate business models are needed. To identify probable success factors for a wearable biofeedback system (Affective Health) in the two mentioned market segments in a Swedish setting, we conducted literature studies and interviews with relevant representatives. Data were collected and used first to describe the two market segments and then to define likely feasible business model designs, according to the Business Model Canvas framework. Needs of stakeholders were identified as inputs to business model design. Value propositions, a key building block of a business model, were defined for each segment. The value proposition for occupational health was defined as “A tool that can both identify employees at risk of stress-related disorders and reinforce healthy sustainable behavior” and for healthcare as: “Providing therapists with objective data about the patient's emotional state and motivating patients to better engage in the treatment process”.
Supervised Machine Learning Algorithms to Diagnose Stress for Vehicle Drivers Based on Physiological Sensor Signals
Authors: Barua Shaibal  , Begum Shahina  , Ahmed Mobyen Uddin
Published: February 2025

Machine learning algorithms play an important role in computer science research. Recent advancement in sensor data collection in clinical sciences lead to a complex, heterogeneous data processing, and analysis for patient diagnosis and prognosis. Diagnosis and treatment of patients based on manual analysis of these sensor data are difficult and time consuming. Therefore, development of Knowledge-based systems to support clinicians in decision-making is important. However, it is necessary to perform experimental work to compare performances of different machine learning methods to help to select appropriate method for a specific characteristic of data sets. This paper compares classification performance of three popular machine learning methods i.e., case-based reasoning, neutral networks and support vector machine to diagnose stress of vehicle drivers using finger temperature and heart rate variability. The experimental results show that case-based reasoning outperforms other two methods in terms of classification accuracy. Case-based reasoning has achieved 80% and 86% accuracy to classify stress using finger temperature and heart rate variability. On contrary, both neural network and support vector machine have achieved less than 80% accuracy by using both physiological signals.
Managing Integrated Oncology Treatment in Virtual Networks
Authors: Stanicki Verena  , Becker Matthias  , Böckmann Britta
Published: February 2025

Interdisciplinary and intersectoral coordinated healthcare management based on Clinical Practice Guidelines is essential to achieve high quality in oncological networks. The objective of our research project is to create a cookbook, which can be used by oncological networks as a template. The cookbook is based on guideline-compliant care processes. To develop these care processes, the three S3-guidelines breast, colon and prostate carcinoma have been formalized. The thus-obtained platform-independent process fragments were transformed into an underlying metamodel, which is based on HL7 and can be used for modeling clinical pathways. Additional, qualitative guided interviews were chosen to capitalize on the experts' (e.g. chief residents, resident specialists) wide knowledge and experience in oncological health care management. One of these use cases (tumor board scheduling) is developed for a healthcare management platform which is linked to a national electronic case record. The projected result of our approach is a cookbook which shows, how the treatment can be controlled by interdisciplinary and intersectoral care processes in an oncological network.
A Systematic Review of Mobile Health Technology Use in Developing Countries
Authors: Alghamdi Manal  , Gashgari Horeya  , Househ Mowafa
Published: February 2025

In developing countries, patients are now more informed about their healthcare options as a result of their use of mobile health (mHealth) technologies. The purpose of this paper is to describe the opportunities and challenges in using mHealth technologies for developing countries. In April 2015, Google Scholar and PubMed were searched to identify articles discussing the types, advantages and disadvantages, effectiveness, evaluation of mHealth technologies, and examples of mHealth implementation in developing countries. A total number of 3,803 articles were retrieved from both databases. Articles reporting the benefits and risks, effectiveness, and evaluation of mHealth were included. Articles that were written in English and from developing countries were also included. We excluded papers that were published before 2005, not written in English, and that were technical in nature. After screening the articles using the inclusion and exclusion criteria, 27 articles were selected for inclusion in the study. Of the 27 papers included in the review, eight described opportunities and challenges relating to mHealth, four focused on smoking cessation, three focused on weight loss, and four papers focused on chronic diseases. We also identified four articles discussing mHealth evaluation and four discussing the use of mHealth as a health promotion tool. We conclude that mHealth can improve healthcare delivery for developing countries. Some of the advantages of mHealth include: patient education, health promotion, disease self-management, decrease in healthcare costs, and remote monitoring of patients. However, there are several limitations in using mHealth technologies for developing countries, which include: interoperability, lack of evaluation standards, and lack of a technology infrastructure.
Resilient Systemics to Telehealth Support for Clinical Psychiatry and Psychology
Authors: Fiorini Rodolfo A.  , De Giacomo Piero  , L'Abate Luciano
Published: February 2025

Reliably expanding our clinical practice and lowering our overhead with telepsychiatry, telepsychology, distance counseling and online therapy, requires resilient and antifragile system and tools. When utilized appropriately these technologies may provide greater access to needed services to include more reliable treatment, consultation, supervision, and training. The wise and proper use of technology is fundamental to create and boost outstanding social results. We present, as an example, the main steps to achieve application resilience and antifragility at system level, for diagnostic and therapeutic telepractice and telehealth support, devoted to psychiatry and psychology application. This article presents a number of innovations that can take psychotherapy treatment, supervision, training, and research forward, towards increased effectiveness application.
Clinical Decision Support Knowledge Management: Strategies for Success
Authors: Khalifa Mohamed  , Alswailem Osama
Published: February 2025

Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital.
Use of Smartphones to Estimate Carbohydrates in Foods for Diabetes Management
Authors: Huang Jurong  , Ding Hang  , McBride Simon  , Ireland David  , Karunanithi Mohan
Published: February 2025

Over 380 million adults worldwide are currently living with diabetes and the number has been projected to reach 590 million by 2035. Uncontrolled diabetes often lead to complications, disability, and early death. In the management of diabetes, dietary intervention to control carbohydrate intake is essential to help manage daily blood glucose level within a recommended range. The intervention traditionally relies on a self-report to estimate carbohydrate intake through a paper based diary. The traditional approach is known to be inaccurate, inconvenient, and resource intensive. Additionally, patients often require a long term of learning or training to achieve a certain level of accuracy and reliability. To address these issues, we propose a design of a smartphone application that automatically estimates carbohydrate intake from food images. The application uses imaging processing techniques to classify food type, estimate food volume, and accordingly calculate the amount of carbohydrates. To examine the proof of concept, a small fruit database was created to train a classification algorithm implemented in the application. Consequently, a set of fruit photos (n=6) from a real smartphone were applied to evaluate the accuracy of the carbohydrate estimation. This study demonstrates the potential to use smartphones to improve dietary intervention, although further studies are needed to improve the accuracy, and extend the capability of the smartphone application to analyse broader food contents.
Considering Governance for Patient Access to E-Medical Records
Authors: Day Karen  , Wells Susan
Published: February 2025

People having access to their medical records could have a transformative improvement effect on healthcare delivery and use. Our research aimed to explore the concerns and attitudes of giving people electronic access to their medical records through patient portals. We conducted 28 semi-structured interviews with 30 people, asking questions about portal design, organisational implications and governance. We report the findings of the governance considerations raised during the interviews. These revealed that (1) there is uncertainty about the possible design and extent of giving people access to their medical records to view/use, (2) existing policies about patient authentication, proxy, and privacy require modification, and (3) existing governance structures and functions require further examination and adjustment. Future research should include more input from patients and health informaticians.
Current Status for Teaching Nursing Informatics in Denmark, Canada, and Australia
Authors: Madsen Inge  , Cummings Elizabeth  , Borycki Elizabeth M.
Published: February 2025

Nursing schools in Denmark, Canada, and Australia are all currently involved in integrating nursing informatics in the nursing bachelor programme. This paper gives a brief update on the current situation of nursing informatics education for bachelor level nurses in each of the three countries. Whilst there are differences in the curriculum in each county, it is important to share knowledge about undergraduate nursing informatics worldwide to ensure consistency.
Clinical Trial Feasibility Study Questionnaire Analysis
Authors: Soto-Rey Iñaki  , Dugas Martin  , Fritz Fleur
Published: February 2025

With the growing complexity and cost of clinical trials (CTs) over the past few decades, Protocol Feasibility (PF) studies have become one of the most critical CT steps in order to avoid costly protocol amendments and ensure the success of CTs. The PF process includes interaction with clinicians located at targeted clinical sites, which results in slow and cumbersome process steps. These process steps are normally supported by information systems that allow users to create, share and collect responses to feasibility questionnaires. This investigation analyzes the systems and questionnaires utilized at several clinical research companies for PF. In addition, it provides recommendations that could eventually improve current methods and systems in place.
An HL7-FHIR-based Object Model for a Home-Centered Data Warehouse for Ambient Assisted Living Environments
Authors: Schwartze Jonas  , Jansen Lars  , Schrom Harald  , Wolf Klaus-Hendrik  , Haux Reinhold  , Marschollek Michael
Published: February 2025

Current AAL environments focus on assisting a single person with seperated technologies. There is no interoperability between sub-domains in home environments, like building energy management or housing industry services. BASIS (Building Automation by a Scalable and Intelligent System) aims to integrate all sensors and actuators into a single, efficient home bus. First step is to create a semtically enriched data warehouse object model. We choose FHIR and built an object model mainly based on the Observation, Device and Location resources with minor extensions needed by AAL-foreign sub domains. FHIR turned out to be very flexible and complete for other home related sub-domains. The object model is implemented in a separated software-partition storing all structural and procedural data of BASIS.
Restricted Versus Unrestricted Search Space: Experience from Mining a Large Japanese Database
Authors: Nienhoff Hendrik  , Huebner Ursula  , Frey Andreas  , Przysucha Mareike  , Kimura Michio
Published: February 2025

The aim of this study was to investigate whether standard Big Data mining methods lead to clinically useful results. An association analysis was performed using the apriori algorithm to discover associations among co-morbidities of diabetes patients. Selected data were further analyzed by using k-means clustering with age, long-term blood sugar and cholesterol values. The association analysis led to a multitude of trivial rules. Cluster analysis detected clusters of well and badly managed diabetes patients both belonging to different age groups. The study suggests the usage of cluster analysis on a restricted space to come to meaningful results.
Design of a Graph-Based System for Similar Case Retrieval of Pulmonary Nodules
Authors: Raniery Ferreira Junior José  , Costa Oliveira Marcelo  , Mazzoncini de Azevedo-Marques Paulo
Published: February 2025

Due to difficulty of diagnosing lung cancer, it is important to integrate computational tools in the imaging interpretation process. Content-Based Image Retrieval (CBIR) can provide decision support to specialists by allowing them to find nodules from a database that are similar to a reference one. However, CBIR systems still face problems visualizing multidimensional images. This paper presents the design of a graph-based system for the retrieval of similar temporal computed tomography (CT) scans of pulmonary nodules, in order to optimize the visualization of multidimensional images in a CBIR system. Temporal Image Registration has been used to compare reference and retrieved previously segmented nodules. A rooted tree graph is employed to visualize retrieved cases, and it is deployed in a web system for portability and usability purposes.
Audit Trail Management System in Community Health Care Information Network
Authors: Nakamura Naoki  , Nakayama Masaharu  , Nakaya Jun  , Tominaga Teiji  , Suganuma Takuo  , Shiratori Norio
Published: February 2025

After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.
Is it Possible to Make Everyone Talk in the Same Language?
Authors: Lau Maggie  , Fung Vicky  , Cheung N.T.  , Wong Austen  , Tam Edward  , Wai Andy
Published: February 2025

Speaking the same language is a vital pre-requisite in verbal communication. The same applies in sharing health information among medical professionals in rendering care to patients. The Hospital Authority of Hong Kong developed its own clinical vocabulary table (HACVT) for clinicians to document diagnoses and procedures directly in the Clinical Management System (CMS) since 1996. HACVT is referenced to international classifications and reference terminologies, with local terms added and is built according to the principles of terminology management [1]. This poster describes the process of data standardisation within the organisation in the past years to achieve data interoperability through different adoption methods of HACVT.
Linked Health Data: how linked data can help provide better health decisions
Authors: Farinelli Fernanda  , Barcellos de Almeida Maurício  , Linhares de Souza Yóris
Published: February 2025

This paper provides a brief survey about the use of linked data in healthcare to foster better health decisions and increase health knowledge. We present real cases from the Brazilian experience and emphasize some issues in research. This paper is not intending to be fully comprehensive, we discuss some open issues and research challenges in linked data and the technologies involved. We conclude that even though linked data has been adopted in many countries, some challenges have to be overcome, for example, interoperability between different standards. A defined solution able to foster the semantic interoperability between different standards must be developed. Benefits contributed through linked health data involve better decision making on diagnostics, assertive treatments, knowledge acquisition, improvements in quality healthcare service to citizens.
E-Patient Reputation in Health Forums
Authors: Abdaoui Amine  , Azé Jérôme  , Bringay Sandra  , Poncelet Pascal
Published: February 2025

Online health forums are increasingly used by patients to get information and help related to their health. However, information reliability in these forums is unfortunately not always guaranteed. Obviously, consequences of self-diagnosis may be severe on the patient's health if measures are taken without consulting a doctor. Many works on trust issues related to social media have been proposed, but most of them mainly focus only on the structure part of the social network (number of posts, number of likes, etc.). In the case of online health forums, a lot of trust and distrust is expressed inside the posted messages and cannot be inferred by only considering the structure. In this study, we rather suggest inferring the user's trustworthiness from the replies he receives in the forum. The proposed method is divided into three main steps: First, the recipient(s) of each post must be identified. Next, the trust or distrust expressed in these posts is evaluated. Finally, the user's reputation is computed by aggregating all the posts he received. Conducted experiments using a manually annotated corpus are encouraging.
High Override Rate for Opioid Drug-allergy Interaction Alerts: Current Trends and Recommendations for Future
Authors: Topaz Maxim  , Seger Diane L.  , Lai Kenneth  , Wickner Paige G.  , Goss Foster  , Dhopeshwarkar Neil  , Chang Frank  , Bates David W.  , Zhou Li
Published: February 2025

This study examined trends in drug-allergy interaction (DAI) alert overrides for opioid medications – the most commonly triggered alerts in the computerized provider order entry (CPOE). We conducted an observational analysis of the DAI opioid alerts triggered over the last decade (2004-2013, n=342,338) in two large academic hospitals in Boston (United States). We found an increasing rate of DAI alert overrides culminating in 89.7% in 2013. Allergic reactions included a high proportion (38.2%) of non-immune mediated opioid reactions (e.g. gastrointestinal upset). The DAI alert override rate was high for immune mediated (88.6%) and life threatening reactions (87.8%). Exact allergy-medication matches were overridden less frequently (about 70%) compared to non-exact matches within allergy groups (over 90%). About one-third of the alert override reasons pointed to irrelevant alerts (i.e.“Patient has tolerated the medication before”) and 44.9% were unknown. Those findings warrant further investigation into providers' reasons for high override rate. User interfaces should evolve to enable less interruptive and more accurate alerts to decrease alert fatigue.
Online Continuing Medical Education for the Latin American Nephrology Community
Authors: Margolis Alvaro  , Gonzalez-Martinez Francisco  , Noboa Oscar  , Abbud-Filho Mario  , Lorier Leticia  , Nin Marcelo  , Silvariño Ricardo  , García Sofía  , Pefaur Jacqueline  , Greloni Gustavo C.  , Noronha Irene L.  , Lopez Antonio  , Ribeiro-Alves María A.  , Tanús Roberto  , Fernández-Cean Juan
Published: February 2025

A continuing medical education (CME) course was implemented for Latin American nephrologists in 2013. The topic was Immunopathology in native and transplanted kidneys. The course was given in Spanish and Portuguese. The activities included a distance education seven-week asynchronous online modality with multiple educational strategies. Thirty hours of study workload were estimated to complete the course.
Big Data Clinical Research: Validity, Ethics, and Regulation
Authors: Balas E. Andrew  , Vernon Marlo  , Magrabi Farah  , Gordon Lynne Thomas  , Sexton Joanne
Published: February 2025

Electronic Health Records (EHR) promise improvement for patient care and also offer great value for biomedical research including clinical, public health, and health services research. Unfortunately, the full potential of EHR big data research has remained largely unrealized.