Luciana Tricai Cavalini’s research while affiliated with Fluminense Federal University and other places

Revisão Sistemática com metanálise, até dezembro de 2020. Objetivo comparar incidência de erros de prescrição antes e após introdução de Sistemas de Prescrição Eletrônica associados ou não a Sistemas de Apoio à Decisão em diferentes settings pediátricos. Em dez estudos em UTI a redução em erros de dosagem (um tipo de erro de prescrição) variou de 15% a 30%. Dois estudos com supressão total de erros. Em enfermaria as reduções foram de 36%, 45%, 67% e 74%. A redução foi de 7,4 de erros gerais de prescrição. Evidenciou-se redução de risco de erros de dosagem em pediatria com o uso de sistemas de prescrição eletrônica para UTI, enfermaria e ambulatório.

Background Potentially harmful errors occur in pediatric patients at a rate three times higher than in adults, mainly due to dosage calculations. Objective. To evaluate the effect of Computerized Prescription Order Entry (CPOE) and Decision Support Systems (DSS) on Adverse Drug Events (ADE) in pediatrics. Method. Systematic review updated up to December 2019 in the PubMed, Scopus, Web of Science and Embase, Lilacs and cross-references, recorded in Prospero CRD 42019126590. Observational and pre- and post-implementation CPOE studies were included. in any language. A scale was used for methodological evaluation of the studies. Relative risk (RR), attributable risk (AR) or number needed to treat (NNT) with 95% CIs were computed for comparing the incidence of total, actual, preventable and potentially harmful ADE. Results Starting with 203 retrieved abstracts, 12 articles were included - eight interventional and four observational studies. Five articles evaluated CPOE and seven CPOE plus DSS. Settings for eleven studies were hospitals and one an outpatient facility. Sample sizes ranged from 514 to 45,615 totaling 112,187 patients. The number of prescriptions ranged from 724 to 92,398, totaling 182,803. A reduction in total ADE was observed in two studies. The risk reduction of preventable ADE ranged from 24% RR 0.76 (0.59 - 0.97) to 47% RR 0.53 (0.29-0.91) in four articles. Potentially harmful ADE (ADE ph) in five studies were reduced from 76% RR = 0.24 (0.09-0.68) to 44% (RR 0.56 (0.46 - 0.70), with an AR variyng from 1.8 to 0.9%. One of the articles stated that 64 (95% CI 25-100) patients would need to be using CPOE in order to avoid one potentially harmful ADE. Studies identified reductions in ADE in various settings- two in wards, one in wards and Pediatric Intensive Care Unit (PICU), the others in PICU and Neonatal Intensive Care Units. Conclusions Implementation of CPOE plus DSS reduces EADs in pediatric settings. Key messages Accumulated evidence favors implementation of CPOE plus DSS as important for prevention of ADE in pediatric settings. Potentially harmful and preventable errors can be avoided by implementing electronic prescribing systems in pediatrics. Its use should be encouraged in countries in low-income countries.

Objectives: To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care. Methods: This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics into an HL7v2 message as an eXtensible Markup Language (XML) file, which was validated against an XML schema that defines constraints on a common reference model. This message was exchanged with a second prototype application, developed on the Mirth middleware, which was also used to parse and validate both the original and the hybrid messages. Results: Both versions of the data instance (one pure XML, one embedded in the HL7v2 message) were equally validated and the RDF-based semantics recovered by the receiving side of the prototype from the shared XML schema. Conclusions: This study demonstrated the semantic enrichment of HL7v2 messages for intensive-software telemedicine systems for trauma care, by validating components of extracts generated in various computing environments. The adoption of the method proposed in this study ensures the compliance of the HL7v2 standard in Semantic Web technologies.

Background: The host immune response is an important indicator of the outcome of hepatitis C virus (HCV) infection and disease progression. The aim of this study was to explore cytokine gene polymorphisms as a candidate for susceptibility to persistent HCV infection or HCV spontaneous clearance in a population from Rio de Janeiro, Brazil. Methods: Genetic polymorphisms in the cytokines, tumor necrosis factor-alpha (-308), transforming growth factor-beta 1 (codons 10 and 25), interleukin-10 (IL-10; -1082 and -592), IL-6 (-174), and interferon-gamma (+874) were analyzed by polymerase chain reaction sequence-specific primers in 245 patients with chronic hepatitis C (CHC), 41 spontaneous recovery (SR) patients, and 189 healthy volunteers. Further, polymorphisms in IL-28B (rs12979860, rs12980275, and rs8099917) were assessed by real-time polymerase chain reaction in all groups. Results: The IL-28B rs12979860 CC and rs12980275 AA genotypes were significantly associated with SR of HCV infection and response to therapy, whereas the C allele of IL-6 (-174) was associated with protection to CHC. A multivariate analysis showed that the male sex and IL-28B rs12979860 CT and TT and transforming growth factor-beta 1 (codon 10) TC genotypes were factors associated with CHC. Additionally, IL-6 (-174) C allele was increased in SR patients compared with patients with CHC. Conclusion: IL-28B polymorphisms are associated with spontaneous clearance of HCV and response to therapy in a Brazilian population. Also, IL-6 (-174) C allele is involved in SR and decreased inflammation scores.

Aims: Recently, nerve-sparing (NS) techniques have been incorporated in surgeries for deep infiltrating endometriosis (DIE) to prevent urinary complications. Our aim was to perform a systematic review and meta-analysis to assess the risk of urinary retention after NS surgery for DIE compared with classical (non-NS) techniques. Methods: Following the MOOSE guidelines for systematic reviews of observational studies, data were collected from published research articles that compared NS techniques with non-NS techniques in DIE surgery, with regard to post-operative urinary complications. Inclusion criteria: randomized clinical trials, intervention or observational (cohort and case-control) studies assessing women who underwent surgery for painful DIE. Exclusion criteria: cancer surgery and women submitted to bladder or ureteral resections. The respective relative risks (RR) and 95% confidence intervals (CI) were extracted and a forest plot was generated to show individual and combined estimates. Results: Preliminarily, 1,270 potentially relevant studies were identified from which four studies were selected. A meta-analysis was performed to assess the risk of urinary retention at discharge and 90 days after surgery. We found a common RR of 0.19 [95%CI: 0.03-1.17; (I(2 ) = 50.20%; P = 0.09)] for need of self-catheterization at discharge in the NS group in relation to the conventional technique. Based on two studies, common RR for persistent urinary retention (after 90 days) was 0.16 [95%CI: 0.03-0.84]. Conclusions: Our results suggest significant advantages of the NS technique when considering the RR of persistent urinary retention. Controlled studies evaluating the best approach to manage the urinary tract after complex surgery for DIE are needed. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

To the Editor Dr Hussey and colleagues1 reported that the majority of orders for advanced diagnostic imaging before (63.3%) and after (66.5%) implementation of clinical decision support (CDS) systems could not be matched to appropriateness criteria. This suggests a serious deficiency in the usefulness of CDS systems.Our hypothesis is that this was not a problem with the guidelines or the quality of the CDS system software itself, but rather an issue with the underlying data submitted to the CDS systems for analysis. For a CDS system to be able to suggest appropriate treatment, it must have access not only to the order itself but to the entire patient record in a computable format.2

OBJETIVO: avaliar a acurácia do sintoma tosse como um critério diagnóstico de tuberculose pulmonar (TBP) em pacientes internados em um hospital universitário. MÉTODOS: foi conduzida uma avaliação de teste diagnóstico em pacientes com idade ≥15 anos internados em hospital geral de Niterói-RJ, Brasil, em 2011 e 2012. RESULTADOS: foram incluídos 3.677 pacientes, dos quais 608 apresentaram tosse e 15 foram diagnosticados com TBP; entre 184 pacientes sintomáticos respiratórios, 10 foram diagnosticados com TBP; a acurácia do sintoma tosse para a identificação de pacientes com TB foi de 83,4%; a ausência de tosse revelou-se um bom indicador para o descarte do diagnóstico (valor preditivo negativo de 99,7%); todavia, o valor preditivo positivo foi baixo (0,99). CONCLUSÃO: a tosse produtiva apresentou boa acurácia, embora, isoladamente, não seja um bom sintoma de rastreio da TBP em ambientes hospitalares; torna-se necessário identificar outros sintomas e sinais para rastreio e diagnóstico precoce em hospitais.

The Fast Healthcare Interoperability Resources (FHIR) is an open suite of specifications and software implementations of the Health Level 7 version 3 (HL7v3) standard. It has been proposed to provide a consistent API for the HL7v3 CDA. However, the core issues of HL7v3 are not solved at the API level. The community around the project are proposing the adoption of RDF technologies to overcome the current challenges in interoperating with linked data. However, RDF triples nor ontologies provide semantic interoperability by themselves, a more robust information infrastructure, such as the Multilevel Model-Driven (MMD) approach, is required. An XML implementation of the MMD was used to model the FHIR Schemas as Domain Models (DMs) against a generic Reference Model (RM) to provide syntactic validation. RDF triples were included in the domain models to provide missing semantics. The XML data instances were validated against their Domain Models. The DMs do not create any new types, they only express constraints of the RM types, this provides consistent query and data analysis capability across all DMs. RDF triples were extracted from the DMs and added to a triple store graph with the RM ontology. The XML data is also expressed as Literals in the graph. This study shows the feasibility of using MMD solutions to provide full operational semantic interoperability for the FHIR ecosystem.

Controlled vocabularies such as terminologies and ontologies are regarded as a solution to the achievement of semantic interoperability across healthcare applications. This is yet to be attained. The semantics of current healthcare applications are directly in the source code and database structure and therefore cannot be readily shared. The multilevel model-driven approach is a method to produce semantically interoperable healthcare applications by providing sharable concept models. At this point, the methodology is proven, but implementations are still required. This study presents the fundamentals of knowledge modeling of controlled vocabularies for a XML-based multilevel model specification. The term subset 'Tuberculosis' of the 10th Revision of the International Classification of Diseases (ICD-10) is modeled as constraints to the XML Schema that defines the Reference Model. The Brazilian Mortality and Hospital Information Systems provided sample data for demonstration. The demonstration of the semantic validation of the XML data instances that include the ICD-10 'Tuberculosis' term set, converted to the multilevel model generated, is presented.