Abstract
Background: An asynchronous eLearning system was developed for radiographers in order to promote a better knowledge about senology and mammography. Objectives: to assess the learners' satisfaction. Methods: Target population included radiographers and radiography students, in order to assess eLearning satisfaction according to different experience levels in breast imaging. Satisfaction was measured through a questionnaire developed especially for eLearning systems, using a seven-point Likert scale. Main topics related are content, interface, personalization and learning community. Results: Overall, 85% of learners were satisfied with the course and 87,5% considered that the course is successful. Main areas that were evaluated by most learners in a positive way were interface and content (between six and seven-point); on the other hand, learning community presented a wider distribution of answers. Conclusions: The course provides an overall high degree of learner satisfaction, thus providing more effective knowledge gain on breast imaging for radiographers.

Abstract
The incidence of colorectal cancer cases in the Portuguese Institute of Oncology of Porto created the need of a telenursing program in the Gastro-Intestinal Cancer Unit. After staging, treatment may involve surgery radio and chemotherapy (either oral or IV). Patients with no treatment after surgery are scheduled for medical exams every 3 months in the first 2 years. Patients on chemotherapy need to be compliant and to have a close monitoring of adverse events. The GI Cancer Unit uses a telenursing information system to help assess colorectal cancer patients' follow-up after surgery, medical treatment compliance and adverse events. A mixed-methods evaluation was done to a) describe the target population, b) detect problems in the telenursing information system, and c) suggest changes to meet users' requirements. From 181 outbound phone calls, representing 67 patients (49 in treatment and 18 in follow-up), patients' main characteristics were extracted and system's problems were identified by the intervening nurses. Recommendations will be useful for a further development of the system.

Abstract
The amount of data currently being produced, stored and used in hospital settings is stressing information technology infrastructure, making clinical reports to be stored in secondary memory devices. The aim of this work was to develop a model that predicts the probability of visualization, within a certain period after production, of each clinical report. We collected log data, from January 2013 till May 2011, from an existing virtual patient record, in a tertiary university hospital in Porto, Portugal, with information on report creation and report first-time visualization dates, along with contextual information. The main factors associated with visualization were defined using logistic regression. These factors were then used as explanatory variables for predicting the probability of a piece of information being accessed after production, using Kaplan-Meier analysis and the Weibull probability distribution. Clinical department, type of encounter and report type were found significantly associated with time-to-visualization and probability of visualization.

Abstract
Background: Audit Trails (AT) are fundamental to information security in order to guarantee access traceability but can also be used to improve Health information System's (HIS) quality namely to assess how they are used or misused. This paper aims at analysing the existence and quality of AT, describing scenarios in hospitals and making some recommendations to improve the quality of information. Methods: The responsibles of HIS for eight Portuguese hospitals were contacted in order to arrange an interview about the importance of AT and to collect audit trail data from their HIS. Five institutions agreed to participate in this study; four of them accepted to be interviewed, and four sent AT data. The interviews were performed in 2011 and audit trail data sent in 2011 and 2012. Each AT was evaluated and compared in relation to data quality standards, namely for completeness, comprehensibility, traceability among others. Only one of the AT had enough information for us to apply a consistency evaluation by modelling user behaviour. Results: The interviewees in these hospitals only knew a few AT (average of 1 AT per hospital in an estimate of 21 existing HIS), although they all recognize some advantages of analysing AT. Four hospitals sent a total of 7 AT - 2 from Radiology Information System (RIS), 2 from Picture Archiving and Communication System (PACS), 3 from Patient Records. Three of the AT were understandable and three of the AT were complete. The AT from the patient records are better structured and more complete than the RIS/PACS. Conclusions: Existing AT do not have enough quality to guarantee traceability or be used in HIS improvement. Its quality reflects the importance given to them by the CIO of healthcare institutions. Existing standards (e.g. ASTM: E2147, ISO/TS 18308: 2004, ISO/IEC 27001: 2006) are still not broadly used in Portugal.

Abstract
AIM: To identify demographic and clinical factors associated with disabling Crohn's disease (CD). METHODS: A systematic review and meta-analysis of observational studies, focusing on the factors that can predict the prognosis of different outcomes of CD was undertaken. PubMed, ISI Web of Knowledge and Scopus were searched to identify studies investigating the above mentioned factors in adult patients with CD. Studies were eligible for inclusion if they describe prognostic factors in CD, with inclusion and exclusion criteria defined as follows. Studies with adult patients and CD, written in English and studying association between clinical factors and at least one prognosis outcome were included. Meta-analysis of effects was undertaken for the disabling disease outcome, using odds ratio (OR) to assess the effect of the different factors in the outcome. The statistical method used was MantelHaenszel for fixed effects. The 16-item quality assessment tool (QATSDD) was used to assess the quality of the studies (range: 0-42). RESULTS: Of the 913 papers initially selected, sixty studies were reviewed and three were included in the systematic review and meta-analysis. The global QATSDD scores of papers were 18, 21 and 22. Of a total of 1961 patients enrolled, 1332 (78%) were classified with disabling disease five years after diagnosis. In two studies, age at diagnosis was a factor associated with disabling disease five years after diagnosis. Individuals under 40 years old had a higher risk of developing disabling disease. In two studies, patients who were treated with corticosteroids on the first flare developed disabling disease five years after diagnosis. Further, perianal disease was found to be relevant in all of the studies at two and five years after diagnosis. Finally, one study showed localization as a factor associated with disabling disease five years after diagnosis, with L3 being a higher risk factor. This meta-analysis showed a significantly higher risk of developing disabling disease at five years after initial diagnosis among patients younger than 40 years of age (OR = 2.47, 95% CI: 1.74-3.51), with initial steroid treatment for first flare (OR = 2.42, 95% CI: 1.87-3.11) and with perianal disease (OR = 2.00, 95% CI: 1.41-2.85). CONCLUSION: Age at diagnosis, perianal disease, initial use of steroids and localization seem to be independent prognostic factors of disabling disease.

Abstract
Purpose: To develop a clinical staging system based on the PIRO concept (Predisposition, Infection, Response and Organ dysfunction) for hospitalized patients with infection. Methods: One year prospective cohort study of all hospitalized patients with infection (n = 1035), admitted into a large tertiary care, university hospital. Variables associated with hospital mortality were selected using logistic regressions. Based on the regression coefficients, a score for each PIRO component was developed and a classification tree was used to stratify patients into four stages of increased risk of hospital mortality. The final clinical staging system was then validated using an independent cohort (n = 186). Results: Factors significantly associated with hospital mortality were . for Predisposition: age, sex, previous antibiotic therapy, chronic hepatic disease, chronic hematologic disease, cancer, atherosclerosis and a Karnofsky index, 70; . for Insult/Infection: type of infection . for Response: abnormal temperature, tachypnea, hyperglycemia and severity of infection and . for Organ dysfunction: hypotension and SOFA score >= 1. The area under the ROC curve (CI95%) for the combined PIRO model as a predictor for mortality was 0.85 (0.82-0.88). Based on the scores for each of the PIRO components and on the cut-offs estimated from the classification tree, patients were stratified into four stages of increased mortality rates: stage I: <= 5%, stage II: 6-20%, stage III: 21-50% and stage IV: >50%. Finally, this new clinical staging system was studied in a validation cohort, which provided similar results (0%, 9%, 31% and 67%, in each stage, respectively). Conclusions: Based on the PIRO concept, a new clinical staging system was developed for hospitalized patients with infection, allowing stratification into four stages of increased mortality, using the different scores obtained in Predisposition, Response, Infection and Organ dysfunction. The proposed system will likely help to define inclusion criteria in clinical trials as well as tailoring individual management plans for patients with infection.