Hospital Information System Research Articles

Access to and use of Data for better Healthcare: A Plea for a cooperative data and Research Infrastructure of Statutory and Private Health Insurers and the Network University Medicine (NUM)

With the Network of University Medicine (NUM) and the Medical Informatics Initiative (MII), the BMBF is funding two pioneering, structure-building research measures that are now being merged. The data integration centers (DIZ) of the MII are to be consolidated in the NUM. The aim is to establish a standardized research infrastructure within which the existing data from the clinical routine care of the 36 German university hospitals, from clinical cohorts and clinical-epidemiological studies can be used for various research questions upon request and via coordinated processes. The legal basis for this was the MII's "Informed Broad Consent", which had been agreed upon with ethics committees and data protection authorities and implemented in all NUM locations, with a so-called "health insurance module" that allows the collection and linking of routine medical data from statutory health insurance funds (GKV) and private health insurers (PKV) as a category of care-related data (VeDa). Linking this routine data with data from hospital information systems offers particularly high potential, as no single data source provides a complete picture of medical care and the two data sources complement each other optimally. The aim now is to integrate this routine data into the NUM's secure, transparent and participatory research infrastructure in a strategic partnership with statutory health insurance funds and private health insurance companies. This promotes Germany in its role as a research location and makes a decisive contribution to improving the quality and safety of healthcare in Germany in an evidence-based manner.

Orchestrating Digital Resilience: A Clinical IS Study of an Everything-as-a-Service Technology Strategy

ABSTRACT Organisations must build digital resilience to effectively safeguard their business operations against environmental, economic, or socio-political disruptions. One approach involves adaptation – using Information Technology (IT) to design business operations that can withstand and recover from such disruptions. A second approach involves mitigation – using IT to advance environmental, social, or economic objectives that reduce the root causes and likelihood of future disruptions. However, both approaches to building digital resilience are challenging to implement. Our clinical Information Systems (IS) research article examines and reflects on how Beta Bank, an Australian fintech firm, developed an Everything-as-a-Service (EaaS) technology strategy and achieved digital resilience throughout its business operations. We explain how Beta Bank strategically leveraged EaaS to adapt to the significant disruptions caused by the Australian wildfire disaster and the global COVID pandemic of 2019–2021. We then unpack how Beta Bank further leveraged EaaS to enhance its digital resilience via a mitigation approach. Our work delineates a typology of four EaaS pathways for pursuing digital resilience, discusses the scholarly implications of EaaS as a future IS research area, and provides actionable managerial guidance through an EaaS roadmap, a strategic planning tool for those aiming to implement and benefit from this technology strategy.

A randomized double-blind noninferiority clinical multicenter trial on oral moxifloxacin versus placebo in the outpatient treatment of uncomplicated acute appendicitis: APPAC IV study protocol.

Antibiotic therapy is currently considered a safe and effective treatment alternative for computed tomography (CT)-confirmed uncomplicated acute appendicitis with recent studies reporting good results on both oral antibiotics only and outpatient management. Furthermore, there are promising pilot results on uncomplicated acute appendicitis management with symptomatic treatment (placebo). This trial aims to assess whether both antibiotics and hospitalization can be safely omitted from the treatment of uncomplicated acute appendicitis. The APPAC IV (APPendicitis Acuta IV) trial is a randomized, double-blind, multicenter noninferiority clinical trial comparing oral moxifloxacin with oral placebo in an outpatient setting with a discharge directly from the emergency room (ER). Adult patients (18-60 years) with CT-confirmed uncomplicated acute appendicitis (absence of appendicolith, abscess, perforation, tumor, appendiceal diameter ⩾15 mm on CT, or body temperature >38 °C) will be enrolled in nine Finnish hospitals. Primary outcome is treatment success at 30 days, that is, the resolution of acute appendicitis resulting in discharge from the hospital without appendectomy during the 30-day follow-up evaluated using a noninferiority design with a noninferiority margin of 6 percentage points. Noninferiority will be evaluated using one-sided 95% confidence interval of proportion difference between groups. Secondary endpoints include postintervention complications, recurrent appendicitis after the 30-day follow-up, duration of hospital stay, admission to hospital and reason for admission, readmissions to emergency department or hospitalization, VAS pain scores, quality of life, sick leave, and treatment costs. The follow-up after discharge from the ER includes a phone call at day 1, and at 3-4 days, 30 days, and 1, 3, 5, 10, and 20 years. Those eligible patients, who decline to undergo randomization, will be invited to participate in a concurrent observational cohort study with follow-up at 30 days, and 1 and 5 years. To our knowledge, APPAC IV trial is the first large randomized, double-blind, noninferiority multicenter clinical trial aiming to compare oral antibiotics and placebo for CT-diagnosed uncomplicated acute appendicitis in an outpatient setting. The study aims to bridge the major knowledge gap on whether antibiotics and hospitalization or both can be omitted in the treatment of uncomplicated acute appendicitis. The study protocol has been approved by the Clinical Trials Information System (CTIS) of the European Medicines Agency (EMA), study number: 2023-506213-21-00 and the trial has been registered in ClinicalTrials.gov, NCT06210269.

Identifikasi Penerapan Fitur Aplikasi Simrs Terhadap Efektivitas Pelayanan Pendaftaran Pasien Unit Rawat Jalan di RS X Kota Bandung

Hospital Management Information System (HMIS) is a communication and information technology system that processes and integrates the whole steps of hospital’s service process in the form of a coordinated network, report and administration procedure to obtain information precisely and accurately. The purpose of this study is to determine the Identification of HMIS Application’s Features Implementation on the Effectivity of Outpatient’s Registration Service in Hospital X Bandung City. This study used descriptive method with qualitative approach which was carried out at Hospital X during March until April 2024 and as many as 4.373 outpatients who have registered to all available polyclinics. The subjects of this study consisted of the head of the medical record unit, 2 registration operators and IT technicians. The results obtained from this study is that the HMIS application at Hospital X hasn’t been running effectively due to often constraint of errors on the HMIS application that being used by Hospital X which also has been connected to BPJS by bridging method till it causes constraints to medical record officers and IT technicians during the registration of the patients along with no exclusive training regarding HMIS application for new employees.

Optimising Outpatient Registration System Implementation Using Critical Path Method: A Case Study.

Today, hospital information systems (HISs) play an irreplaceable role in hospital management. At present, HIS construction projects in many hospitals have faced the setback of 'project quagmire' to varying degrees. The critical path method (CPM) mainly aims to find the critical path, thus managing project progress. To explore the importance and practical application of the CPM to the management of HIS project schedules. This study used the construction project of a hospital's outpatient registration subsystem as an example. CPM was used to determine the critical path. The time and workload required for the project were calculated using the forward and backward extrapolation methods. The earliest start time and earliest completion time as well as the latest start time and latest completion time of each task could be calculated using the forward and backward extrapolation methods. The path with the longest construction period was determined to be the critical path, and the unit speed rate of each activity was calculated on this basis. Then, the time schedule of the outpatient registration subsystem was compressed and the project schedule optimised. Path 3 [outpatient registration demand analysis (A)-basic data preparation (C)-subsystem test (F)-simulation test (G)] was determined to be the critical path according to the construction period, and the task time was compressed on this basis. Considering many factors, the time of the subsystem test task (F) was reduced from 7 weeks to 4 weeks. The total cost was saved by 1000 yuan, which not only ensured the progress ahead but also saved the overall cost. The CPM could effectively measure the completion and deviation of each stage of the registration system project, which provided an effective guarantee for the subsequent schedule compression to ensure that the project was completed as scheduled and was of sufficient quality. However, all conditions had to be considered comprehensively; doing otherwise would lead to increased risks and costs.

Evaluation of Acceptance of Hospital Information Management System Among Nurses Through Technology Acceptance Model

Background: Health Information Management System has widely been used by healthcare professionals, particularly nurses. Purpose: The purpose of the study was to develop a research model showing the factors affecting the use of HIMS. The factors including in this conceptual model were taken from Information Success Model and updated Technology Acceptance Model (TAM). Methods: Total four-hundred and one nurses participated in this cross-sectional study from both public and private hospitals in Turkey. For data analysis, SPSS 25 software package was used. This study employed the following statistical methods: descriptive statistics, correlation and path analysis as well as Structure Equation Model using AMOS. Results: System Quality has a positive and significant effect on both Perceived Ease of Use and Perceived Usefulness. Service Quality has a positive and significant effect only on Perceived Usefulness and Information Quality does not have any effect on both Perceived Usefulness and Perceived Ease of Use. The Perceived Ease of Use has a positive and significant effect on Intention to Use. Similar effect was seen with Perceived Usefulness. Conclusion: This research model identified the factors influencing the acceptance hospital information management system and how those factors can be improved to affect users’ intention in the future.

Designing Healthcare Organisations For Excellence: Improving Bed Management Process And Strategies To Reduce The Turn Around Time

Background Bed management in a hospital is the process of ensuring that every bed is used optimally, while also providing quality care and efficient treatment. It involves allocating beds, tracking bed availability, managing patient flow, improving patient care and improving clinical staff efficiency. The process by which patients are admitted against any hospital bed, and when they are discharged and the bills are cleared, the bed is cleaned and allotted to the next patient in line is called bed management. Objectives ➢To understand the process flow of bed management in the hospital ➢To conduct a Time Motion Study for the patients getting discharged ➢To locate the problem areas in the process and give suitable solutions Methods Observation at various levels of the process of bed management (Pharmacy, Billing, TPA, Floors, Front office) Study Frame • Patients getting discharged • HIS (Hospital Information System) • Stakeholders of the system Findings It was observed that incorrect time management and inefficient system usage including communication gaps and delays, manual system updates and housekeeping protocols were the main problem areas in the bed management process. Conclusion Strict Vigilance of the work at the nerve cell and floors is required. The stakeholders were suggested to put ceilings on the number of beds that can be blocked for a day as well as on the time for which these beds are blocked. In addition to these, the stakeholders were also advised to replace manual system updation with some smart solutions

Prevalence and demographic distribution of anaemia among those visiting a teaching hospital located in tribal predominant block of Jharkhand: Retrospective record based analysis

ABSTRACT Background: Anaemia is a major public health concern in developing countries, with cases increasing rapidly among women, young girls, and children under age 5. Aims: This study aimed to estimate the prevalence of anaemia and to identify the age and gender distribution of anaemia among those attending IPD/OPD of a teaching hospital located in the tribal block. Methodology: The study was conducted at a multispecialty tertiary care hospital in tribal predominant area, Jharkhand, India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the Department of Laboratory Medicine and the electronic hospital information system of the institute were reviewed between January 1, 2021, and January 31, 2024. Result: A total of 15004 reports were screened for detecting anaemia, of them 7095 (47.3%) were males and 7909 (52.7%) were females. The overall prevalence of any grade of anaemia was found in 6579 (43.8%; 95% CI: 43.1–44.6). Univariate logistic regression analysis to predict status of anaemia among study participants showed the odds of being anaemic was 1.5 times (95% CI: 1.2–2.1) higher among those with age >60 years compared to those who were in the age group of 1–4 years. Females had 2.3 times (95% CI: 2.2–2.5) higher odds of having anaemia than males. Conclusion: This study shows that half of the patients attending hospital are anaemic and the burden increases as the age increases and highest among elderly >60 years. The results of our secondary data analysis should contribute to better screening and identifying the cases among people attending the hospital and also could aid planning services at the primary care level.

Analysis of the Implementation of Zi Care Indonesia's Hospital Information System (HIS) using the Technology Readiness Index Method at Emanuel Hospital

Objective: This research aims to assess the readiness of staff and doctors at Emanuel Hospital for the implementation of the Zi.Care hospital information system (HIS) using the Technology Readiness Index (TRI) method. Design/Methods/Approach: The study involved 441 staff and doctors from Emanuel Hospital. Data collection utilized a questionnaire covering demographics, psychographics, and aspects of HIS implementation readiness. The TRI method was applied for quantitative analysis to categorize readiness levels in terms of optimism, innovativeness, discomfort, and insecurity. Findings: Initial findings indicate varying levels of readiness among staff and doctors regarding the Zi.Care HIS implementation. Optimism and innovativeness were generally high, while discomfort and insecurity were more nuanced. Respondents foresee benefits such as improved information accessibility, increased productivity, enhanced efficiency, reduced paper costs, minimized errors, improved patient safety, and higher patient satisfaction. Originality/Value: This study contributes to existing literature by applying the TRI method specifically to assess readiness for implementing HIS in a healthcare setting in Indonesia. It adds insights into the psychological and organizational factors affecting readiness, thus enhancing understanding in healthcare IT adoption. Practical/Policy implication: Managers should address discomfort and insecurity to ensure smooth HIS implementation, leveraging training and support programs to boost staff confidence and reduce resistance. Aligning technology adoption with regulatory mandates is crucial for enhancing healthcare delivery and patient outcomes.

EVALUATION OF THE RELATIONSHIP BETWEEN IRON LOAD, AGE, AND CARDIAC FUNCTION IN CHILDREN AND YOUNG ADULTS WITH THALASSEMIA MAJOR: A PULSED-WAVE DOPPLER AND TISSUE DOPPLER IMAGING STUDY

Objective: To determine the structural and functional cardiac differences in children and young adults with thalassemia major (TM) compared to healthy subjects using pulsed-wave Doppler and tissue Doppler imaging methods and determine the relationship between iron overload and these differences. Materials and Methods: We analyzed the data of pediatric and young adult TM patients (n = 44) aged 4–22 years and an age- and gender-matched control group (n = 40) in our hospital data system between Oct.01.2023 and Oct.01.2024. Height, weight, body mass index (BMI), systolic–diastolic blood pressure measurements, complete blood count, ferritin, cardiac T2* magnetic resonance imaging (MRI) values, and echocardiography results were recorded. In addition to comparisons between the two groups, correlation analysis was performed between ferritin–cardiac T2* MRI results and echocardiographic parameters and age in TM patients. Results: Our study showed growth retardation (low height standard deviation score (SDS), low weight SDS and low BMI SDS), dilatation of the left cavities (high left ventricular internal diameter end diastole (LVIDd)), increased left ventricular muscle mass (high left ventricular mass index (LVMI)), cardiac distinctive diastolic (restrictive pattern: left ventricular (LV) peak early diastolic flow (E)/peak late diastolic flow (A) and E/early diastolic myocardial peak flow (E') high), and subclinical systolic (LV peak systolic flow low and LV Tei index high) dysfunction. In addition, iron load (ferritin and cardiac T2* MRI) was correlated with LVMI, and cardiac diastolic and systolic function indicators. As age increased, ferritin value did not change, but cardiac T2* MRI value decreased and diastolic–systolic parameters worsened. Conclusion: Periodic cardiac T2* MRI and Doppler echocardiography examinations of patients with TM may detect subclinical myocardial dysfunction at an early stage, thus providing a window of opportunity for intervention.

PENINGKATAN MUTU DAN EFISIENSI PELAYANAN KESEHATAN MELALUI IMPLEMENTASI REKAM MEDIS ELEKTRONIK DI RUMAH SAKIT HASTA HUSADA

Implementation of electronic medical records (RME) in hospitals has become an important step in improving the quality and efficiency of health services. Hasta Husada Hospital has adopted this system, but still faces various challenges. This study aims to analyze and evaluate improving the quality and efficiency of health services through the implementation of electronic medical records (RME) at Hasta Husada Hospital. This research uses a qualitative approach. The research results show that RME provides significant benefits, including fast and accurate access to patient data, increased work efficiency, and reduced medical errors. Although most users feel comfortable using RME after training, there are still complaints about the system interface needing to be simplified. User attitudes were generally positive towards RME after seeing real benefits, despite initial resistance. Implementation of the Hospital Management Information System (SIMRS) has shown mixed results, with some units having fully transitioned to RME and others still in the transition stage.

Clinical and Serological Findings of Patients with Antiphospholipid Syndrome in Mashhad, Iran, from 2008 to 2018: A Retrospective, Descriptive, Cross-sectional Study.

Antiphospholipid syndrome (APS) is among the autoimmune disorders caused by antiphospholipid antibodies, which provoke blood clots (thrombosis) in arteries and veins. It can also cause such complications as severe preeclampsia, miscarriage, premature birth, and stillbirth in pregnant women. We investigated the clinical and serological characteristics of antiphospholipid syndrome patients. This retrospective cross-sectional study was performed on those with persistently positive antiphospholipid syndrome. Data were extracted from medical records from the hospital information system(HIS) of rheumatology, neurology, cardiology, gynecology, general, and hematology wards of Ghaem Hospital and private rheumatology clinics of Mashhad, which were surveyed for 10 years (2008-2018). Of the 284 patients, 85.6% were female. The most common adverse outcome of pregnancy was miscarriage (68.1%). Non-criteria manifestations, including arthralgia and arthritis, were observed in 37.7% and 33.1% of the patients, respectively. Moreover, deep vein thrombosis (DVT) and cerebrovascular accident (CVA) (13%), organ gangrene (7.4%), and pulmonary thromboendarterectomy (PTE) and transient ischemic attack (TIA) (4.6%) were the most common thrombotic events in antiphospholipid syndrome patients. Deep vein thrombosis was seen in 70.3% of females (P=.005), and subclavian thrombosis was seen in 66.7% of males (P < .001). The risk of DVT in the presence of anti-cardiolipin Ab IgG positive was increased 2.7 times (CI: 95%, 1.2-5.7; P=.007), and it was increased 2.4 times in the presence of anti-β-2 glycoprotein 1 Ab IgG positive (CI: 95%, 1-5.8; P=.033) and 4.2 times in the presence of lupus anticoagulant Ab positive (CI: 95%, 1.9-9.1; P < .001). In patients with anti-β-2 glycoprotein 1 Ab IgG positive, the risk of placental dysfunction increased 4.3 times (CI: 95%, 0.9-20.3; P=.04). This study's results found that this APS syndrome is mainly seen in women with a mean age of 38, and the most common symptoms associated with it are DVT, CVA, and abortion. Anti-β-2 Glycoprotein 1 Ab IgM and Anti-Cardiolipin Ab IgM were the most common positive antibodies in the patients.

Evaluation of C-Reactive Protein and Procalcitonin as a Mortality Indicator in Febrile Neutropenic Patients

Introduction: Febrile neutropenia (FN) develops as a side effect of chemotherapeutics in cancer patients. It causes complications, increased cost, and mortality. Microbiological agents can be detected in 30-50% of FN. Therefore, specific, highly effective, and rapid markers that can indicate infection are needed. Various biomarkers are under investigation and are still in use today. In this study, it was aimed to evaluate their effectiveness in early detection of infection and mortality by comparing quantitative C-reactive protein (CRP) and procalcitonin values at the beginning of FN and during treatment. Methodology This research is a retrospective, case-control study. The study included 572 FN patients who were followed up in the Hematology Clinic, Bone Marrow Transplantation Unit and Medical Oncology Clinic between 3 September 2018 and 25 May 2022. 748 FN attacks developed in these patients. The hospital information management system was analysed, and the data of the patients were recorded in the pre-prepared form. Data were analysed using ‘The Package for Social Sciences 26.0’ statistical program. Results: 49.1% of FN cases were female and 50.9% male. Hematological malignancy was detected in 60.8% of the patients. Mortality developed in 118 (20.6%) patients. The rate of bacteremia in FN attacks was 36.5%. The most common causative microorganism was Escherichia coli. Pseudomonas aeruginosa and Acinetobacter baumannii were more common in patients with mortality. CRP and procalcitonin values in the first five days of treatment were higher in patients with bacteremia and mortality. Prolonged neutropenia and bloodstream infection were found to be risk factors for mortality. Conclusion: It has been observed that CRP and procalcitonin values can be used both prognostically and diagnostically. It was found that resistant Gram-negative bacteria growth was higher in blood cultures of patients with mortality. More studies are needed to develop new treatment algorithms.

Digitalization and standardization oncology drug therapy plans with the Onkopti database for online publication and import into software.

Background Oncological therapy is based on multidimensional therapy protocols. The requirements for standardized protocols and digitation are high. These protocols are created through several complex development stages to ensure standardized recording. The process involves analyzing original publications published in international journals and extracting key content. Standardized supportive therapy is then added, and compatibility with current guidelines and quality controls is checked. Summary The Onkopti® website is based on the WordPress content management system and provides protocols in a variety of formats, generated through the use of a relational SQL database (www.onkopti.de, www.onkopti.com, www.oncopti.com). It is continuously updated to include new therapeutic developments or changes to standard therapy. The protocols are stored in a relational database and can be exported to various application systems via a standardized XML format or other formats. The website and protocols are available in both German and English. As of August, 2024, there are over 2600 protocols for parenteral and oral therapies for all oncological specialties.. Key Messages The digitalization of protocol selection, prescription, pharmacy preparation, hospital or practice information system documentation, billing, and prescription creation can accelerate, standardize, and streamline these processes. This optimization can significantly reduce personnel costs, resulting in cost savings and improved quality.

Unnecessary Medical Imaging and Determinant Factors in a District Hospital of Iran: A Cross-Sectional Study.

Due to the increasing use of imaging services, this study aimed to estimate the number of unnecessary imaging services, normal and abnormal imaging examinations, and their determinant factors. This cross-sectional study was conducted at a district hospital in East Azerbaijan, Iran. Retrospective data were collected from the electronic medical records of patients referred to the Imaging Department between March and August 2022, using the Hospital Information System (HIS). Descriptive statistics and χ 2 tests were performed, followed by hierarchical logistic regression with AOR, 95% CI, using SPSS-24 for analysis. About 28% of imaging examinations with abnormal results and 21% of the examinations with normal results were unnecessary. The probability of ultrasound abnormal imaging results was 67% lower than computed tomography (CT) scan (CT-scan) (adjusted odds ratio (AOR) = 0.33 (0.212-0.50); p < 0.001). One year increase of patient age is associated with a 1% lower likelihood of having normal imaging (AOR = 0.99 (0.98-0.99); p < 0/001). Women were 20% less likely than men to have abnormal imaging results (AOR = 0.80 (0.65-0.98); p = 0.035). The probability of necessary imaging decreases by 1% for 1 year increase in patient age (p = 0.017), on the other hand, the probability of unnecessary chest radiography was 5% higher than a brain CT-scan imaging (AOR = 2.05 (1.19-3.51); p = 0.009). Unnecessary imaging were more frequently performed on the older patients. Additionally, ultrasound was less likely than CT-scans to show abnormal findings, while chest radiography was more frequently deemed unnecessary compared to brain CT-scans. These insights highlight the need for age- and modality-specific guidelines to reduce unnecessary imaging and improve diagnostic efficiency.

Clinical characteristics and booster vaccine effectiveness of the Omicron variant

BackgroundAlthough many people received the COVID-19 vaccine, shortly after the Chinese government announced that the three-year COVID-19 restrictions were being eased, the first large number of Omicron infections appeared in Beijing. We describe epidemiological characteristics, clinical severity, and time-to-event distribution of patients infected with SARS-CoV-2 in Beijing Omicron outbreak, comparing those who received the booster vaccine with cases of full-course/partial-course vaccines.MethodsWe collected epidemiological, clinical, laboratory, and clinical management data from the hospital information system (HIS) for 1495 cases during Dec 2022-Jan 2023. We also collected illness onset time, diagnosis time, hospital admission time, and start and end times of each treatment. In addition, we collected the time of vaccination, inoculation times, and type of COVID-19 vaccination thorough the vaccination system. We described the epidemiological characteristics across vaccine inoculation doses, and estimated the risk of death, mechanical ventilation, and admission to the intensive care unit for patients admitted to hospital. We used the Kaplan–Meier method to estimate the survival rate and plot the survival curve, and the Cox proportional hazards model to assess the effect of covariates on survival time.ResultsOf the 1495 cases, 58.1% were male. The median ages in the non-vaccinated and vaccinated groups were 80 and 47 years. Elderly with underlying medical conditions and lower BMI less willing to vaccinate(p < 0.05). Both the inactivated vaccine and adenovirus vaccine could reduce clinical severity and prolong survival time, and the protective effect of booster vaccination was the best. The clinical severity increased linearly from the booster vaccinated group to the full-course vaccinated group and non-vaccinated groups, and the death risk of COVID-19 cases without vaccination was the highest.ConclusionBooster vaccines of COVID-19 can provide greater protection against severe illness and death, and continuous monitoring and regular assessment are needed to minimize the risk of a recurrence of the pandemic.

A novel spatial heteroscedastic generalized additive distributed lag model for the spatiotemporal relation between PM2.5and cardiovascular hospitalization

Many studies have examined the impact of air pollution on cardiovascular hospitalization (CVH), but few have looked at the delayed effects of air pollution on CVH. Additionally, there has been no research on the spatial and temporal differences in how environmental pollutants affect CVH. This study seeks to identify spatial heteroscedasticity in the relation between PM2.5 and CVH by developing a Generalized Additive Distributed Lag (GADL) model. Data on hospitalization due to cardiovascular disease were collected from the Hospital Information System (HIS) of Mashhad University of Medical Science from 2017 to 2020. Air pollution data from 22 air quality monitoring (AQM) stations were obtained from the Environmental Pollution Monitoring Center of Mashhad administrates. Markov Random Field (MRF) smoother was utilized in the GADL model to account for spatial heteroscedasticity in the observations. This developed model is a Spatial Heteroscedastic Generalized Additive Distributed Lag (SHGADL) model. Our use of GADL allowed us to discover a significant relationship between PM2.5 exposures and the risk of CVH at lags 0 and 1 in all districts. Our results reveal heteroscedasticity in the Relative Risks (RR) of PM2.5 on CVH across different districts. After accounting for this spatial heteroscedasticity, we found that the RR of PM2.5 on CVH at lags 0 and 1 were 1.0102 (95% CI: 1.0034, 1.0170) and 1.0043 (95% CI: 1.0009, 1.0078) respectively. The central and southeastern districts showed higher RR for CVH. The developed SHGADL model provides evidence of a significant lagged effect of PM2.5 exposures on CVH, and identifies low- and high-risk districts for CVH in Mashhad. This finding can assist decision-makers in allocating resources and planning strategically, with a focus on local interventions to manage ambient air pollution and providing emergency care for CVH.

A comprehensive analysis of European clinical trial governance: The evolution from directive to regulation

The implementation of the new European Clinical Trial Regulation on January 31, 2022, marks a significant advancement in promoting clinical research across Europe. This article comprises three key sections aimed at elucidating the transition from the previous clinical trial directives to the new regulation and its implications. The introductory segment provides a simplified overview of the historical context and limitations of clinical trial directives, setting the stage for a deeper exploration of the subsequent clinical trial regulation-related information. Here, the basic work structure of the Clinical Trial Information System (CTIS) is outlined alongside the transition period from directives to regulation, highlighting key differences between the two. Additionally, various differentiators of the regulation are highlighted, including coordinated assessments, increased public transparency, new definitions such as “low intervention clinical trials,” stricter timelines, simplified safety reporting, and improved patient protections. Lastly, the article creatively explores the guidance document titled “Guidance for the Transition of Clinical Trials from the Clinical Trial Directive to Clinical Trial Regulation,” elucidating its contents in an easy-to-understand manner. In summary, this article offers a concise yet comprehensive overview of the clinical trial directive, clinical trial regulation, and the clinical trial information system, while highlighting key differentiators of the regulation and the transition process, guided by the directive-to-regulation transition document.

Utilizing Open Source Clinical Information Systems in European Countries: Potential and Barriers.

GNU Health, an open-source clinical information system, offers a comprehensive solution for managing health records, hospital information, and laboratory data. Despite its robust functionality and cost-effective nature, GNU Health remains underutilized in the European healthcare context. This paper explores the potential benefits of implementing GNU Health in European healthcare systems, emphasizing its capacity for customization, integration, and scalability. We also examine the barriers to its widespread adoption, including regulatory challenges, interoperability issues, and resistance to change from established proprietary systems. Through one case study and expert interviews, we provide insights into why these obstacles can hardly be overcome.

Retrospective analysis of hip arthroplasty in patients younger than 50 years in a single center.

To report on causes and treatment options of hip arthroplasty in younger population in a single center. Data was accessed retrospectively from hospital information system (HIS) and charts were reviewed. All patients younger than 50 years, who had hip arthroplasty for any indication during January 2020 to July 2023 time period at Lady Reading Hospital, Peshawar, were included in this study. We identified 61 patients, comprising of 33 male and 28 female patients. Mean age was 36.98 ± 7.792 years. Non-cemented hip arthroplasty was performed in 88.5% of patients. Avascular necrosis (49.2%) was the leading indication for hip arthroplasty in younger patients, followed by neglected fracture neck of femur (24.6%), inflammatory arthritis (3.2%), and other causes (23%). Metal on highly cross-linked polyethylene was the commonest bearing surface. Non-cemented hip arthroplasty was the commonest treatment method in younger population in this study.