Personal Medical Record Research Articles

Вопросы организации «умного поезда милосердия»

The article is devoted to the problem of digitalization of sanitary trains, which ensure the stage of medical evacuation of victims in emergency situations. In order to improve the quality of medical and diagnostic measures along the route, and the use of existing digital medical services, it is necessary to create a “smart mercy train” (UPM) equipped with modern information and telecommunications facilities. Relevance: At the stage of the digital transformation of Russian Railways, ensuring the timeliness and efficiency of medical evacuation of victims is possible by creating a “smart mercy train” using existing solutions for objects of an intelligent transport system. The choice of equipment for an intelligent transport system is determined by the volume and type of information of a medical and administrative nature. Objective: To assess the projected information flows and functional needs of a “smart” means of medical evacuation by rail in emergency situations. Methods: Methods of expert survey, system analysis and theory of operations research were used. Results: An analysis of existing solutions for the creation of a “smart” means of medical evacuation by rail is presented. The internal and external information flows received by the head of the mercy train, which need special technical support (means of communication), are ranked. The place of the integrated personal electronic medical record at the stages of medical evacuation within the framework of the Unified Military Medical Information System has been determined. The results of the creation of a digital “smart mercy train” are determined. Practical significance: Taking into account the assessment of projected information flows and functional needs of communication users in the UPM made it possible to determine the required types of communication and the speed of information transfer for the implementation of the functions of communication users, which will further calculate the average subscriber load on the UPM communication network.

Toward the issues of knee injuries in athletes

According to World Health Organization (WHO) statistics, injuries are one of the leading causes of health problems in modern society. Despite the fact that physical training and health are very closely related, it is almost impossible to avoid injury during a sports career in almost any sport. There are many different factors of knee joint injury, among them it is customary to distinguish external and internal. External factors do not depend directly on the athlete (improper training organization, unsatisfactory condition of the equipment, non-compliance with diet, etc.), internal, on the contrary, depend directly on the person himself. Prevention of injuries in sports is based on the implementation of both general preventive measures to ensure health safety and those specific to a particular sport. However, it should not be forgotten that no one can be fully insured against sports injuries.Keywords: digital healthcare, telemedicine, medical information systems, digital clinic, electronic medical record, integrated electronic medical record, electronic personal medical record.

Hungarian general practice paediatricians’ antibiotic prescribing behaviour for suspected respiratory tract infections: a qualitative study

ObjectivesInappropriate antibiotic prescribing is a major cause of antimicrobial resistance (AMR). The aim of this study was to explore paediatric general practitioners’ (GP Peds) antibiotic prescription practice in suspected respiratory...

A Smart and User-Friendly Interface for Storing and Retrieving Personal Medical Records

A Smart and User-Friendly Interface for Storing and Retrieving Personal Medical Records

Clinical pharmacists' scope of knowledge for medication therapy management in chronic kidney disease patients

Medication therapy management (MTM) was first implemented and introduced for chronically ill patients and those taking multiple prescription drugs. The MTM has five steps, namely medication therapy review (MTR), personal medication record (PMR), medication-related action plan (MAP), intervention or referral, and finally, documentation. After receiving MTM services, patients will gain knowledge on medicines, which may decrease non-adherence to treatment and increase its efficacy. Studies have shown the positive impact of MTM on geriatric, pediatric, and chronically ill patients and those on polypharmacy. MTM services may improve medication adherence, decrease healthcare costs, and improve the quality of life (QoL) of patients with chronic kidney disease (CKD) by addressing various issues like anaemia, metabolic acidosis, protein management, fluid management, electrolyte management, dosage adjustment based on eGFR, vaccination, and medication-related problems and intervening with the education about the disease, drugs, and lifestyle modifications.

Efficient and Secure Cross-Domain Sharing of Blockchain Electronic Medical Records Based on Edge Computing

In this article, we analysed the problems of electronic medical records (EMRs) and found that the EMRs generated by different hospitals for the same patient are mutually independent and duplication and data sharing are difficult among hospitals. In order to solve this problem, this paper proposes an efficient and secure cross-domain sharing scheme of EMRs based on edge computing. The program allows the doctor to access the personal history EMRs through the patient’s authorization so that the doctor can understand the patient’s history of illness and, on this basis, generate a new medical record for the patient. Then, the doctor sends the EMRs to the edge server, and the server calculates the ciphertext and adds it to the patient’s personal medical record to complete the case update. Analysis shows that this solution can effectively prevent data tampering and forgery through blockchain and avoid privacy leakage problems in plaintext sharing by using searchable encryption and by relying on edge servers to solve nearby computing tasks and divert the computing capacity of cloud servers to improve efficiency. The security proof shows that the scheme satisfies the complex problem of the BDH assumption. Performance analysis shows that the scheme is feasible and efficient.

Van basisarts tot public health: verschillende wegen om naar Rome te reizen

From medical doctor to public health: different ways to travel to Rome Public health aims at health promotion through an organized societal effort. The Alma Ata declaration laid the broad conceptual foundation for public health and primary care in developing countries (the South) and industrialized countries (the North). Family medicine evolved to a professional practice where a community focus is also important. The introduction of the ‘personal medical record’ and the design of primary care areas in Flanders are anchor points for the development of public health in our country. In developing countries and more specifically in Africa, a structured population approach to health care is since long more evident, amongst others through the development of health districts. The evolution of the post-war period that the authors experienced and describe, makes it clear that public health must be a combination of care for the population and the individual: an ‘and-and’ story, in situations where contexts may strongly differ but where basic objectives remain similar. Thereby, the North can learn from the district experiences in the South, and the South from the power of primary care and general practice in the North.

The effectiveness of an independent anti-neoplastic medication therapy management system in ambulatory cancer patients.

BackgroundCancer has always been a serious health threat for human. Patients with cancer are at high risk of drug-related problems (DRPs) due to multi-morbidity associated polypharmacy. However, data is lacking in identifying and addressing potential DRPs in cancer patients in China. This study aims to investigate the prevalence of DRPs and evaluate the effectiveness of an independent anti-neoplastic medication therapy management (MTM) system in ambulatory cancer patients.MethodsThis is a retrospective study. An independent anti-neoplastic MTM system in Shanghai Jiao Tong University affiliated sixth People's Hospital was established in 2018 with the collaboration of oncologists, clinical pharmacists and software engineers. The system contains an independent clinic of pharmacy and MTM software. The software consisted of six modules to help clinical pharmacists serve the tumor patients. The six modules include medication therapy review, intervention plan, personal medication record, medication-related action plan, intervention and/or referral, and documentation and follow-up.ResultsA total of 173 eligible tumor patients visited the anti-neoplastic pharmaceutical clinic and were recorded in the independent anti-neoplastic MTM system from Jun 2018 to May 2019. The average clinic visits were 2.4 times of the study participants. Two thirds patients (117/173) had one or more identified DRPs in medication therapy review. Adverse drug reaction, potential drug interaction and non-adherence were the leading DRPs. 85.8% of DRPs could be resolved (cured or improved) in four weeks. Tumor patients showed medication adherence reached 84–100% after three or four times of follow-up and intervention.ConclusionsThe participation of clinical pharmacists in managing polypharmacy tumor patients, with the independent anti-neoplastic MTM system, facilitated the identifying and solving DRPs, especially improving medication adherence of patients, and thus enhancing the effectiveness, safety and rational use of medication.

Assessment of the clinical utility of pharmacogenetic guidance in a comprehensive medication management service.

Pharmacists are poised to be the health care professionals best suited to provide medication-related consults and services based on a patient's genetics. Despite its potential benefits, the implementation of pharmacogenetic (PGx) testing into primary clinical settings has been slow among medically underserved populations. To our knowledge, this is the first time that PGx-driven recommendations have been incorporated into a Comprehensive Medication Management (CMM) service in a Hispanic population. The aim of this study is to evaluate the clinical utility of adding PGx guidance into pharmacist-driven CMM. This is a pre- and post-interventional design study. Patients were recruited from a psychologist's clinic. A total of 24 patients had a face-to-face interview with a pharmacist to complete a CMM, Personal Medication Record, and Medication-Related Action Plan (MAP) blind to PGx findings. Collected buccal DNA samples were genotyped using drug-metabolizing enzymes and transporters (DMET) Plus Array. The pharmacist generated new MAPs for each patient based on PGx results. Genetic variants that could potentially affect the safety and effectiveness of at least one drug in the pharmacotherapy were identified in 96% of patients, for whom the pharmacist changed the initial recommendations. Polymorphisms in genes encoding for isoenzymes CYP2D6, CYP2C19, and CYP2C9 were identified in 83%, 52%, and 41% of patients, respectively. Pharmacists performing CMM identified 22 additional medication problems after PGx determinations. Moreover, they agreed with the clinical utility of PGx in the studied sample based on perceived value of adding PGx to traditional CMM and its utility in the decision-making process of pharmacists. The study confirmed the critical role to be played by pharmacists in facilitating the clinical usage of relevant genetic information to optimize drug therapy decisions as well as their involvement on many levels of these multidisciplinary implementation efforts, including championing and leading PGx-guided CMM services.

The Perceptions of and Factors Associated With the Adoption of the Electronic Health Record Sharing System Among Patients and Physicians: Cross-Sectional Survey.

BackgroundThe electronic health record sharing system (eHRSS) was implemented as a new health care delivery platform to facilitate two-way communication between the public and private sectors in Hong Kong.ObjectiveThis study aimed to investigate the perceptions of and factors associated with the adoption of eHRSS among patients, the general public, and private physicians.MethodsTelephone interviews were conducted in 2018 by using a simple random sampling strategy from a list of patients who had enrolled in the eHRSS and a territory-wide telephone directory for nonenrolled residents. We completed 2000 surveys (1000 each for enrolled and nonenrolled individuals). Private physicians completed self-administered questionnaires, including 762 valid questionnaires from 454 enrolled physicians and 308 nonenrolled physicians.ResultsMost participants (707/1000, 70.70%) were satisfied with the overall performance of the eHRSS. Regarding registration status, most nonenrolled patients (647/1000, 64.70%) reported that “no recommendation from their physicians and family members” was the major barrier, whereas more than half of the physicians (536/1000, 53.60%) expressed concerns on “additional workload due to use of eHRSS.” A multivariate regression analysis showed that patients were more likely to register when they reported “other service providers could view the medical records” (adjusted odds ratio [aOR] 6.09, 95% CI 4.87-7.63; P<.001) and “friends’ or family’s recommendation or assistance in registration” (aOR 3.51, 95% CI 2.04-6.03; P=.001). Physicians were more likely to register when they believed that the eHRSS could improve the quality of health care service (aOR 4.70, 95% CI 1.77-12.51; P=.002) and were aware that the eHRSS could reduce duplicated tests and treatments (aOR 4.16, 95% CI 1.73-9.97; P=.001).ConclusionsIncreasing the possibility of viewing patients' personal medical record, expanding the sharable data scope for patients, and highlighting the benefits of the system for physicians could be effective to enhance the adoption of the eHRSS.

Mental health professional perspectives on health data sharing: Mixed methods study.

This study explores behavioral health professionals’ perceptions of granular data. Semi-structured in-person interviews of 20 health professionals were conducted at two different sites. Qualitative and quantitative analysis was performed. While most health professionals agreed that patients should control who accesses their personal medical record (70%), there are certain types of health information that should never be restricted (65%). Emergent themes, including perceived reasons that patients might share or withhold certain types of health information (65%), care coordination (12%), patient comprehension (11%), stigma (5%), trust (3%), sociocultural understanding (3%), and dissatisfaction with consent processes (1%), are explored. The impact of care role (prescriber or non-prescriber) on data-sharing perception is explored as well. This study informs the discussion on developing technology that helps balance provider and patient data-sharing and access needs.

A data-driven predictive system using Case-Based Reasoning for the configuration of device-assisted back pain therapy

ABSTRACT Lower back Pain (LBP) is pathological and occurs in about 80% of the population at least once in their life. Physiotherapists personalise manual treatments to heal or relieve pain according to the patient characteristics. The contribution of this methodological paper is the description and evaluation of the configuration software associated to a therapy machine that executes back segment mobilisations. The configuration software uses Case-Based Reasoning (CBR), a successful Machine Learning technique, based on mimicking the human decision making process by reusing previously applied configuration episodes on similar individuals. This paper demonstrates its feasibility and cost-effectiveness for the configuration of treatments as it reuses expert knowledge and maximises effectiveness by taking into account the patient’s personal medical record and similar patterns among different patients. Having a baseline of 31% success rate using a standard solution based on interpolation, the CBR engine can achieve, on average, up to 70% success rate when proposing a machine configuration to the physiotherapist. Regarding clinical results, we run a longitudinal observational study that achieves an average improvement of 31.63% using the pain Visual Analogue Scale (VAS), a 7% according to the Oswestry Disability Index (ODI), and 13% in the 36-Item Short Form Health Survey (SF-36).

PNS169 PERSONAL MEDICAL HEALTH RECORDS REGULATION IN THE UNITED STATED, EUROPEAN UNION AND ISRAEL

The extensive growth of medical information, digitalized information that is being stored in various platforms should be precision secured. This study compares health care regulation status regarding personal medical records (PMR) in Israel, United states (US) and the European union (EU). By comparing the latest GDPR regulation, HIPAA and the Israeli privacy protection regulation in order to allow for a closer examination of regulatory approaches and measures. We conducted a comprehensive PubMed (MEDLINE) search on literature concerning security of electronic health. In addition, we performed an extensive search using the general Google search engine, as many papers specifically regarding regulation are not necessarily published in academic journals but may be published through government and private publications and websites. Comparing the GDPR requirements in terms of safety and security we found that the GDPR has more strict requirements. The GDPR specifically recommends two security techniques, encryption and pseudonymization. While HIPAA requires data in transmission to be encrypted. In Israel and in EU the legislation applies to all industrial and health sectors while the HIPAA applies only to healthcare providers. In case of data breach the regulator must be informed but without a time limit in Israel, while under the GDPR the regulator must be notified within a time limit of 72 hours, and a 10 days notification in the US. In this case a penalty measures can reach a 20 million euro while in Israel no such a penalty exists. In addition, only the GDPR gives the right to the individual to require entities to erase personal data without a delay. There is a considerable variance with regards to regulation and legislative frameworks in countries around the world. These differences in regulation may results in conflicts and limitations regarding transfer of personal data across different countries.

The Perception of and Factors Associated with Adoption of the Electronic Health Record Sharing System Among Patients and Physicians

Background: The Electronic Health Record Sharing System (eHRSS) was implemented as a new healthcare delivery platform to facilitate a two-way communication between the public and private sectors in Hong Kong. We investigated the perception of and factors associated with the of eHRSS among patients, the general public and private physicians. Methods: Telephone interviews were conducted in 2018 by a simple random sampling strategy from a list of patients who have enrolled in eHRSS, and a territory-wide telephone directory for non-enrolled residents. We completed 2,000 surveys (1,000 each for enrolled and non-enrolled individuals). Self-administered questionnaires were conducted among private physicians, including 762 valid questionnaires from 454 enrolled physicians and 308 non-enrolled physicians. Findings: Most participants (70·7%, n=707) were satisfied with the overall performance of the Regarding status, most non-enrolled patients (64·7%, n=647) reported that recommendation from their physicians and family members was the major barrier, whilst more than half of the physicians (53·6%, n=536) expressed concerns on additional workload due to use of eHRSS. Multivariate regression analysis showed that patients were more likely to register when they reported other service providers could view the medical records (AOR=6·09, 95% CI=4·87-7·63, p<0·01) and friends/family recommendation/assistance in registration (AOR=3·51, 95% CI=2·04-6·03, p<0·01). Physicians were more likely to register when they believed eHRSS could improve the quality of healthcare service (AOR=4·70, 95% CI=1·77-12·51, p<0·01); and were aware that eHRSS could reduce duplicated tests and treatments (AOR=4·16, 95% CI=1·73-9·97, p<0·01). Interpretation: Increasing the possibility of viewing their personal medical record; expanding the sharable data scope for patients; and highlighting the benefits of the system for physicians could be effective to enhance the of eHRSS. Funding Statement: The Hospital Authority of Hong Kong (8110-059-888). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Approval for this study was obtained from the Survey and Behavioural Research Ethics Committee, the Chinese University of Hong Kong.

A Review on Drug Therapy Problems

Drug therapy problems are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying drug therapy problem help patients to achieve their goals of therapy and understand the best possible outcome from drug therapy. Drug therapy problem represent the foremost responsibility of pharmaceutical care practitioner. Medication Therapy Management is medical care provided by the pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. It is medical care provided by the pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. Medication Therapy Management includes five core components: A medication therapy review [MTR], Personal medication record [PMR], Medication rela Documentation Ted action plan [MAP] Intervention and or referral, and Documentation and follow up. These proposed methods were successfully applied for simultaneous maintenance of the patient pharmacist relationship[1]

Medical experience in the paralympic games in Rio 2016

When paralympic means «beside» the Olympic games and the International Paralympic Committee's catchword is: «Spirit In Motion»; we wanted to report how the paralympic movement has increased during the last game. The medical team wanted therefore to present how the paralympic games in Rio were completed on their part. There were 5 sport federations united in the French team composed of 126 athletes (42 women and 84 men). They competed in 17 sports. The medical team was made up of 3 PRM doctors whose one was able to do ultrasounds and two others were sports physicians. There was also one adapted sport physician and 3 nurses. 14 Physiotherapists were split between the sports team. The medical team needed to answer all transport issues between France and Brasil depending on the impairment. They also had to bring many specific materials and organise an health space adapted to all athletes’ needs. They collected all possibly data during the games concerning each athlete. There were 35 orthopedic impairments, 48 neurologic impairments, 6 visual impairments and 5 cognitive impairments among the athletes. All athletes had a personal medical record reviewed by the physicians and all therapeutic use exemptions had been required. There was a daily medical and paramedical meeting. There was a medical room with a drugstore and a moblie ultrasonography apparatus, a physical therapy room with many specific equipment and a cryotherapy bath. There were mainly ENT and digestive illnesses, followed by skins disorders and urinary infections. Sports injuries were tendinopathy and musculoskeletal disorders (50 ultrasounds and one punction). They had to order 3 medical rapatriations due to acute psychiatric disorders. All data collected bring up in-depth discussions about injury prevention and athlete's follow-up.

Use of pharmacy technicians in elements of medication therapy management delivery: A systematic review.

Documented barriers to Medication Therapy Management (MTM) delivery, such as limited time and inefficient workflow may be overcome by utilizing support staff for administrative services. However, it is unknown how pharmacy technicians have been historically utilized to assist pharmacists in MTM-delivery. To characterize literature describing pharmacy technicians' participation in actions commonly undertaken in the provision of MTM services. In August 2016, a PubMed (MEDLINE) and Journal of Pharmacy Technology search was conducted using the term "pharmacy technician" with services outlined within the MTM Core Elements Version 2.0, and with terms related to administrative actions in the provision of MTM. References were searched using identified studies. Eligible articles described pharmacy technicians' performance and/or assistance in at least one MTM Core Element or related administrative action to the provision of MTM. Data was independently extracted by two researchers; any variation in extraction was reconciled via with discussion until consensus reached. A standardized data extraction template was used. Forty-four manuscripts were included. Manuscripts were most likely to describe pharmacy technicians' assistance with medication reconciliation (70%), documentation (41%) and medication therapy review (30%). Actions least likely to be described included personal medication record development (5%), physical assessment (5%), follow-up (2%), and medication action plan development (0%). Most articles were written in the United States (73%), or Europe (16%), while the remaining articles were Canadian (11%); no articles were found originating from Asia, Africa, Australia or the Middle East. Pharmacy technicians are utilized most often to support MTM through assistance in medication reconciliation. Standardized training for pharmacy technicians that delineates administrative support from pharmacists' role of clinical decision making could help pharmacists obtain greater efficiency in MTM delivery.

Characteristics and Treatment of Penile Paraffinoma in Makassar, Indonesia

Introduction and objective: Penile paraffinoma or an old term is sclerosing lipogranuloma of male genitalia, are injected mineral oils, like paraffin, or other materials have been used more often in Eastern Europe and Asia, to increase the circumferential of the penis. This study aims to know the distribution and management of the Penile paraffinoma. Materials and methods: This is a single center retrospective descriptive study from January 2009 to December 2016. The data was collected from the personal interview and medical record of the patients who treated in our institution in Makassar. We collect the age of patients, a reason to injected foreign bodies, the person who injected, satisfied status after injected, site of inflammation, a reason to operate, type of operation procedure, and complications after the operation. Results: a Total Fifty-seven patient who came to our institution. Age range 25-47 years old, 56% injected to enlarged the size of the penis, 86% injected by a nonmedical person. 87% not satisfied with the results after injection, 51% inflammation less than a half of shaft penis. 49% want to operate to release the pain, and 51% of the patients we treated only with partial excision and primary closure and the rest dealt with by one step radical excision and skin graft/flap or by two-step cutaneous plasty of the penile shaft with scrotal skin. Two patients need second radical excision. Conclusion: Penile paraffinoma is an entity product that occurs by injected foreign material for penile augmentation. The treatment often requires extensive penile reconstruction surgery involve complete excision of foreign bodies along with associated reaction followed by primary closure if possible.

Wearable technology in nursing

Nursing care are changing and evolving every day. Wearable technology has gained the interest of nurses. Wearable technology devices are being developed to help people live healthier lives and to know their bodies better through a complex network of interrelated tools. These devices worn on the body that can capture data such as heart rate, gait abnormalities, heart rhythms, number of calories burned, and even hours slept. Many people already have cell phones, computers, tablets, or other devices that networked together with other devices, allowing caregivers, care providers, and even friends and family to monitor functioning and have historical records on a day-to-day or minuteby-minute basis. The system’s software can use the data from these sensors to build a personalized profile of the user’s physical performance and nervous system activation throughout the entire day—providing a truly personal medical record that can revolutionize healthcare. Wearable technology allows for data capture that is reliable and easy to retrieve and uses objective measures to enhance clinical decisions. Nurses are going to be increasingly responsible for patients who use wearable technologies. Nursing should capitalize on the wearable technology phenomenon by being visionary, vocal, and proactive. Because, wearable technology is part of the future of nursing.

The patient perspective on the effects of medical record accessibility: a systematic review

Background: Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement.Objectives: To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient–physician relationship and quality of medical care.Methods: Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords ‘medical record’, ‘patient record’, ‘communication’, ‘patient participation’, ‘doctor–patient relationship’, ‘physician–patient relationship’ between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality.Results: Out of 557 papers screened, only 12 studies qualified for the systematic review. Only a minority of patients spontaneously request access to their medical file, in contrast to frequent awareness of this patient right and the fact that patients in general have a positive view on open visit notes. The majority of those who have actually consulted their file are positive about this experience. Access to personal files improves adequacy and efficiency of communication between physician and patient, in turn facilitating decision-making and self-management. Increased documentation through patient involvement and feedback on the medical file reduces medical errors, in turn increasing satisfaction and quality of care. Information improvement through personal medical file accessibility increased reassurance and a sense of involvement and responsibility.Conclusion: From the patient perspective medical record accessibility contributes to co-management of personal health care.