A multisector community-engaged collaborative for mental health integration in primary care and housing developments: Protocol for a stepped-wedge randomized controlled trial (the Harlem Strong Program).

Background: Addressing mental health disparities following COVID-19 requires adaptive, multi-sectoral, equity-focused, and community-based approaches. Mental health task-sharing in gateway settings has been found to address mental health care gaps in low- and middle-income countries, but is not a common practice in the U.S.

A Framework to Develop an Immersive Virtual Reality Simulation Tool for Postpartum Hemorrhage Management Nurse Training.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity. Effective nurse training for PPH management can reduce negative health impacts on childbearing women. This article discusses a framework for the development of an innovative immersive virtual reality simulator for PPH management training.

Telehealth as a Means of Enabling Health Equity.

Objective: The goal of this paper is to provide a consensus review on telehealth delivery prior to and during the COVID-19 pandemic to develop a set of recommendations for designing telehealth services and tools that contribute to system resilience and equitable health.

Methods: The IMIA-Telehealth Working Group (WG) members conducted a two-step approach to understand the role of telehealth in enabling global health equity. We first conducted a consensus review on the topic followed by a modified Delphi process to respond to four questions related to the role telehealth can play in developing a resilient and equitable health system.

Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.

XML Data and Knowledge-Encoding Structure for a Web-Based and Mobile Antenatal Clinical Decision Support System: Development Study.

Background: Displeasure with the functionality of clinical decision support systems (CDSSs) is considered the primary challenge in CDSS development. A major difficulty in CDSS design is matching the functionality to the desired and actual clinical workflow. Computer-interpretable guidelines (CIGs) are used to formalize medical knowledge in clinical practice guidelines (CPGs) in a computable language.

SIM-CIG: A Serious Game to Practice and Improve Clinical Guidelines Adoption Based on Computer-Interpretable Guidelines.

Serious games have been used to increase the accuracy and usege of clinical guidelines during routine clinical practice. This document presents the development of a serious game called SIM-GIC, a video game designed to simulate virtual patients and evaluate the decision making of players based on computer-interpretable clinical guidelines. The system is currently being developed with a content focus on antenatal care guidelines, where a number of obstetric guidelines were coded in XML files.

Design of an Information System for Palliative Care: User Analysis.

Objective: To explore the demographic factors and the level of knowledge related to information and communication technologies of potential users of a palliative care information system.

Methods: The Task, User, Representation, Functionality (TURF) framework was applied to characterize potential users (patients and caregivers) of an information system for palliative care in a private clinic in Medellin, Colombia, through a survey.

Results: We analyzed 35 patients and 39 caregivers.

Measuring Workload Demand of Informatics Systems with the Clinical Case Demand Index.

The increasing use of Health Information Technology (HIT) can add substantially to workload on clinical providers. Current methods for assessing workload do not take into account the nature of clinical cases and the use of HIT tools while solving them. The Clinical Case Demand Index (CCDI), consisting of a summary score and visual representation, was developed to meet this need.

Rapid Development and Distribution of Mobile Media-Rich Clinical Practice Guidelines Nationwide in Colombia.

Development and electronic distribution of Clinical Practice Guidelines production is costly and challenging. This poster presents a rapid method to represent existing guidelines in auditable, computer executable multimedia format. We used a technology that enables a small number of clinicians to, in a short period of time, develop a substantial amount of computer executable guidelines without programming.

Development of a Dynamic and Adaptive Simulator for Health.

One of the ways to develop health simulations is through the use of computers. This paper presents the use of Intelligent Computer-aided Instruction (ICAI) for the development of an interactive simulator for learning Cardio Pulmonary Resucitation (CPR) which incorporates online tutorials, training and evaluation.

Decreasing workload among community health workers using interactive, structured, rich-media guidelines on smartphones.

Background: Currently, in developing countries, there is considerable interest in using mobile phones as job-aids for community health workers (CHWs) to improve the care they provide. However, acceptance of new technologies can be inhibited if the workload imposed is perceived as excessive compared to existing methods.

Objective: To compare perceived workload of CHWs using clinical care guidelines presented on mobile phones versus using conventional paper-based guidelines.

Mosaics versus Early Treatment Diabetic Retinopathy seven standard fields for evaluation of diabetic retinopathy severity.

Purpose: To compare agreement between mosaicked and seven field photographs for classification of the diabetic retinopathy (DR) severity.

Methods: Mosaic digital (MosD) images were compared with seven field stereo film (7FF) and stereo digital (7FD) photographs from a 152-eye cohort with full-spectrum Early Treatment of Diabetic Retinopathy severity levels for agreement on severity level, DR presence with ascending severity thresholds, DR index lesion presence, and classification repeatability.

Results: There was a substantial agreement classifying the Early Treatment Diabetic Retinopathy Study DR severity level between MosD and 7FF (kunweighted = 0.

Comparability of digital photography with the ETDRS film protocol for evaluation of diabetic retinopathy severity.

Purpose: To evaluate digital photography parameters affecting comparability with the Early Treatment Diabetic Retinopathy Study (ETDRS) film protocol for diabetic retinopathy (DR) severity grading.

Methods: ETDRS protocol photographs and four variations of digital images (uncompressed stereoscopic, compressed stereoscopic, uncompressed monoscopic, and uncompressed monoscopic wide-angle mosaic) of 152 eyes were independently evaluated by using ETDRS classifications. Digital formats were compared to film and each other for agreement on severity level, DR presence at ascending threshold, presence of the DR index lesion, and repeatability of grading.

Performance factors of mobile rich media job aids for community health workers.

Objective: To study and analyze the possible benefits on performance of community health workers using point-of-care clinical guidelines implemented as interactive rich media job aids on small-format mobile platforms.

Design: A crossover study with one intervention (rich media job aids) and one control (traditional job aids), two periods, with 50 community health workers, each subject solving a total 15 standardized cases per period per period (30 cases in total per subject).

Measurements: Error rate per case and task, protocol compliance.

Grading diabetic retinopathy severity from compressed digital retinal images compared with uncompressed images and film.

Purpose: To compare research grading of diabetic retinopathy (DR) severity level from compressed digital images versus uncompressed images and film.

Methods: Compressed (JPEG2000, 37:1) digital images (C) were compared with uncompressed digital (U) and film (F) stereoscopic photographs from a 152-eye cohort with full-spectrum Early Treatment Diabetic Retinopathy Study severity levels for agreement on severity level, DR presence with ascending severity threshold, presence of DR index lesions, and repeatability of grading.

Results: Classification of Early Treatment Diabetic Retinopathy Study severity levels from C images agreed substantially with results from F images (κ = 0.

Comparison of multiple stereoscopic and monoscopic digital image formats to film for diabetic macular edema evaluation.

Purpose: To assess agreement between evaluations of monoscopic and stereoscopic digital images versus stereo film photographs in diabetic macular edema (DME).

Methods: A 152-eye group of digital monoscopic macular images (seven-field sets and wide-angle mosaics) were compared with digital stereoscopic images (uncompressed and compressed seven-field sets) and stereo 35-mm film photos (Early Treatment Diabetic Retinopathy Study protocol) for the presence of hard exudates (HE), retinal thickening (RT), clinically significant macular edema (CSME), and RT at the center of the macular (RTCM).

Results: Agreement, according to the κ statistic, was almost perfect in identifying HE and RT between all digital formats and stereo film (HE, κ = 0.

Digital versus film Fundus photography for research grading of diabetic retinopathy severity.

Purpose: To assess agreement between digital and film photography for research classification of diabetic retinopathy severity.

Methods: Digital and film photographs from a 152-eye cohort with a full spectrum of Early Treatment Diabetic Retinopathy Study (ETDRS) severity levels were assessed for repeatability of grading within each image medium and for agreement on ETDRS discrete severity levels, ascending severity thresholds, and presence or absence of diabetic retinopathy index lesions, between digital and 35-mm slides (film). Digital photographs were color balanced to match film.

Monoscopic versus stereoscopic retinal photography for grading diabetic retinopathy severity.

Purpose: To assess agreement between monoscopic and stereoscopic photography for research classification of the severity of diabetic retinopathy (DR).

Methods: Monoscopic digital (MD) images were compared with stereo digital (SD) and film (SF) photographs from a 152-eye cohort with full-spectrum Early Treatment Diabetic Retinopathy Study (ETDRS) severity levels for agreement on severity level, DR presence with ascending severity threshold, presence of DR index lesions, and repeatability of grading.

Results: There was substantial agreement classifying ETDRS DR severity levels between MD and SF (kappa = 0.