Summary: 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 three-dimensional 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.

In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality ‘high-flow nasal cannula’ seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.

Over-reliance of traditional clinical findings and symptoms can potentially delay diagnosis of acute heart failure (AHF), prolonging the time to appropriate therapy The use of echocardiography and lung ultrasonography can help to improve diagnostic accuracy and monitor responses to interventions in patients with AHF Lung ultrasonography allows for rapid assessment of numerous conditions, including pulmonary oedema, pleural effusion, and pneumothorax Use of echocardiography has extended beyond the traditional application in stable patients to become widespread in the acute and emergency settings In the setting of AHF, echocardiography can be used to assess pericardial effusion, right ventricular dilatation, left ventricular systolic function, gross valvular abnormality, and potentially the presence of intracardiac masses Echocardiography can also be used to monitor treatment in patients with cardiogenic shock

Physicians in the emergency department (ED) need additional tools to stratify patients with acute heart failure (AHF) according to risk. To predict mortality using data that are readily available at ED admission. Prospective cohort study. 34 Spanish EDs. The derivation cohort included 4867 consecutive ED patients admitted during 2009 to 2011. The validation cohort comprised 3229 patients admitted in 2014. 88 candidate risk factors and 30-day mortality. Thirteen independent risk factors were identified in the derivation cohort and were combined into an overall score, the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score. This score predicted 30-day mortality with excellent discrimination (c-statistic, 0.836) and calibration (Hosmer–Lemeshow P = 0.99) and provided a steep gradient in 30-day mortality across risk groups (<2% for patients in the 2 lowest risk quintiles and 45% in the highest risk decile). These characteristics were confirmed in the validation cohort (c-statistic, 0.828). Multiple sensitivity analyses did not find important amounts of confounding or bias. The study was confined to a single country. Participating EDs were not selected randomly. Many patients had missing data. Measurement of some risk factors was subjective. This tool has excellent discrimination and calibration and was validated in a different cohort from the one that was used to develop it. Physicians can consider using this tool to inform clinical decisions as further studies are done to determine whether the tool enhances physician decision making and improves patient outcomes. Instituto de Salud Carlos III, Spanish Ministry of Health; Fundació La Marató de TV3; and Catalonia Govern.