Objective To assess whether a warning system based on mobile SMS messages increases the adherence of HIV-infected Brazilian women to antiretroviral drug-based treatment regimens and their impressions and satisfaction with respect to incoming messages. Design A randomized controlled trial was conducted from May 2009 to April 2010 with HIV-infected Brazilian women. All participants (n = 21) had a monthly multidisciplinary attendance; each participant was followed over a 4-month period, when adherence measures were obtained. Participants in the intervention group (n = 8) received SMS messages 30 min before their last scheduled time for a dose of medicine during the day. The messages were sent every Saturday and Sunday and on alternate days during the working week. Participants in the control group (n = 13) did not receive messages. Measurements Self-reported adherence, pill counting, microelectronic monitors (MEMS) and an interview about the impressions and satisfaction with respect to incoming messages. Results The HIV Alert System (HIVAS) was developed over 7 months during 2008 and 2009. After the study period, self-reported adherence indicated that 11 participants (84.62%) remained compliant in the control group (adherence exceeding 95%), whereas all 8 participants in the intervention group (100.00%) remained compliant. In contrast, the counting pills method indicated that the number of compliant participants was 5 (38.46%) for the control group and 4 (50.00%) for the intervention group. Microelectronic monitoring indicated that 6 participants in the control group (46.15%) were adherent during the entire 4-month period compared to 6 participants in the intervention group (75.00%). According to the feedback of the 8 participants who completed the research in the intervention group, along with the feedback of 3 patients who received SMS for less than 4 months, that is, did not complete the study, 9 (81.81%) believed that the SMS messages aided them in treatment adherence, and 10 (90.90%) responded that they would like to continue receiving SMS messages. SMS messaging can help Brazilian women living with HIV/AIDS to adhere to antiretroviral therapy for a period of at least 4 months. In general, the results are encouraging because the SMS messages stimulated more participants in the intervention group to be adherent to their treatment, and the patients were satisfied with the messages received, which were seen as reminders, incentives and signs of affection by the health clinic for a marginalized population.

Objective: The International Medical Informatics Association (IMIA) agreed on revising the existing international recommendations in health informatics /medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop existing educational activities in the various nations and to support international initiatives concerning education in biomedical and health informatics (BMHI), particularly international activities in educating BMHI specialists and the sharing of courseware. Method: An IMIA task force, nominated in 2006, worked on updating the recommendations' first version. These updates have been broadly discussed and refined by members of IMIA's National Member Societies, IMIA's Academic Institutional Members and by members of IMIA's Working Group on Health and Medical Informatics Education. Results and Conclusions: The IMIA recommendations center on educational needs for health care professionals to acquire knowledge and skills in information processing and information and communication technology. The educational needs are described as a threedimensional framework. The dimensions are: 1) professionals in health care (e.g. physicians, nurses, BMHI professionals), 2) type of specialization in BMHI (IT users, BMHI specialists), and 3) stage of career progression (bachelor, master, doctorate). Learning outcomes are defined in terms of knowledge and practical skills for health care professionals in their role a) as IT user and b) as BMHI specialist. Recommendations are given for courses /course tracks in BMHI as part of educational programs in medicine, nursing, health care management, dentistry, pharmacy, public health, health record administration, and informatics /computer science as well as for dedicated programs in BMHI (with bachelor, master or doctor degree). To support education in BMHI, IMIA offers to award a certificate for high-quality BMHI education. It supports information exchange on programs and courses in BMHI through its Working Group on Health and Medical Informatics Education.

Summary Background: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework. Objectives: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings. Methods: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics. Results: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains “data, information, knowledge”, “information exchange and information sharing”, “ethical and legal issues”, “systems life cycle management”, “management” and “biostatistics and medical technology”, all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas. Conclusions: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.

No abstract

Background Celiac disease (CD) is a difficult-to-diagnose condition because of its multiple clinical presentations and symptoms shared with other diseases. Gold-standard diagnostic confirmation of suspected CD is achieved by biopsying the small intestine. Objective To develop a clinical decision–support system (CDSS) integrated with an automated classifier to recognize CD cases, by selecting from experimental models developed using intelligence artificial techniques. Methods A web-based system was designed for constructing a retrospective database that included 178 clinical cases for training. Tests were run on 270 automated classifiers available in Weka 3.6.1 using five artificial intelligence techniques, namely decision trees, Bayesian inference, k-nearest neighbor algorithm, support vector machines and artificial neural networks. The parameters evaluated were accuracy, sensitivity, specificity and area under the ROC curve (AUC). AUC was used as a criterion for selecting the CDSS algorithm. A testing database was constructed including 38 clinical CD cases for CDSS evaluation. The diagnoses suggested by CDSS were compared with those made by physicians during patient consultations. Results The most accurate method during the training phase was the averaged one-dependence estimator (AODE) algorithm (a Bayesian classifier), which showed accuracy 80.0%, sensitivity 0.78, specificity 0.80 and AUC 0.84. This classifier was integrated into the web-based decision–support system. The gold-standard validation of CDSS achieved accuracy of 84.2% and k = 0.68 (p < 0.0001) with good agreement. The same accuracy was achieved in the comparison between the physician’s diagnostic impression and the gold standard k = 0. 64 (p < 0.0001). There was moderate agreement between the physician’s diagnostic impression and CDSS k = 0.46 (p = 0.0008). Conclusions The study results suggest that CDSS could be used to help in diagnosing CD, since the algorithm tested achieved excellent accuracy in differentiating possible positive from negative CD diagnoses. This study may contribute towards developing of a computer-assisted environment to support CD diagnosis.

suportar a implementação deste protocolo. Para a avaliação da usabilidade do sistema web, foi utilizado o questionário System Usability Scale (SUS). O SUS-score resultou em um valor médio de 83,5±10,0, o que indica que o sistema web foi considerado de fácil uso e de acordo com a satisfação do usuário. O sistema web implementou adequadamente o protocolo. A utilização do protocolo eletrônico mostrou-se válida para o atendimento e monitoramento do paciente com doença celíaca, pois manteve a especificidade dos dados clínicos e a rotina dos profissionais envolvidos.

RESUMOA Informática em Enfermagem é a área de conhecimento que estuda a aplicação dos recursos tecnológicos no ensino, na prática, na assistência e no gerenciamento da assistência e do cuidado. Recursos como reconhecimento de voz, bancos de conhecimento, projeto genoma e mesmo a Internet, têm oferecido para a Enfermagem uma gama de possibilidades para melhoria do desempenho profissional e melhoria do atendimento ao cliente/paciente. Este texto relata e exemplifica como tais recursos estão causando impactos e oportunidades para o ensino, pesquisa e principalmente, para a assistência de enfermagem ao cliente/paciente, ainda alerta para a importância do cuidado humanizado num cenário de alta tecnologia. Descritores: Informática; Informática em enfermagem; Bases de conhecimento. A Informática em Enfermagem é uma área de conhecimento com mais de 30 anos de aplicação e desenvolvimento. Porém, ainda é, para muitos profissionais em nossa realidade, um desafio, uma área desconhecida e um mistério a ser respeitado e temido. Para outros, representa grande perspectiva de atuação e crescimento, utilizando seus recursos e produtos, quer seja como auxílio para o dia-adia na prática e no cuidado direto ao paciente, quer seja na realização de pesquisas, quer seja no ensino, como um instrumento a mais para estimular alunos e pacientes, na busca de informações com qualidade. ABSTRACTOs computadores entraram na enfermagem, principalmente na área de maior atuação do enfermeiro à época, ou seja, nos hospitais, na década de 50. No início, o interesse pela capacidade do hardware e do software era o maior desafio. Estes até dominavam a forma de desenvolvimento das aplicações e as áreas gerenciais eram as mais favorecidas. Hoje, embora não tenhamos que ter obrigatoriamente tanta preocupação com os recursos de hardware e software, já que as opções são as mais variadas possíveis, temos que concentrar nossa atenção para a aplicabilidade destes tantos recursos, de forma a trazer vantagens e melhoria na atuação do enfermeiro, em qualquer área de especialidade. Assim,

The objectives of this study were to develop, to implement and to evaluate a web-based simulation for critical care nursing, as a tool for teaching nursing students at the undergraduate level. An adapted methodology was used to develop teaching material in a web-based learning environment, consisting of three evaluation phases (ergonomic, pedagogical and usability), carried out by web-designers/programmers, nursing teachers/nurses, and undergraduate nursing students. The research tools used were three different evaluation forms, based on a five-point Likert scale, which were applied after using the simulation. The results garnered from the forms show positive analyses in every evaluation, with special emphasis on the encouragement of learning in the pedagogical evaluation period. In the usability evaluation, the highlight was on the students' satisfaction in using the environment and how easy it was to navigate. This shows the feasibility of using this simulation to improve the learning process.