Antiquated paperwork processes in hospitals: the problems and solutions with health information technology systems

BACKGROUND. The United States healthcare system is one of the most expensive in the world, equaling approximately one trillion dollars. However, the quality of healthcare is low, as indicated by mortality rates, prevalence of diseases, rates of readmission to hospitals, dissatisfaction rates, and much more. One of the inefficiencies in the healthcare system that is causing errors and a decline in patient care to occur is the current paperwork system. Physicians and nurses spend much more time taking care of patient paperwork rather than giving direct treatment to patients themselves, and it's been shown that patient dissatisfaction levels rise and errors occur more frequently as a result of current physician/nurse workload. In order to change from paperwork to electronic files, hospitals must invest the time and money to look for alternative mechanisms that would decrease turn-around time of paperwork completion by leveraging digital solutions. A study was carried out to observe log back of paperwork by counting the amount of papers for each physician before and after an electronic email message intervention. RESULTS. The results were as expected: a simple email message did not drastically affect the amount of paperwork back log by residents, and numbers stayed consistent throughout. More than 50% of patient paperwork for residents in year 1 and 3 was more than 28 days old, which signifies the lack of paperwork availability and accessibility to the residents while off-site. CONCLUSION. Addressing the problem of paperwork burden to residents requires alternative solutions that include changing the entire paperwork system to a paperless, electronic system. Other solutions that require less effort, time and cost are possible, such as an email reminder as was done in this study, but will most likely not be as effective as switching to a paperless system that allows for physician-patient communication on a more consistent basis even though they may be off site. These changes would significantly improve quality of patient care as well as decrease administrative costs and waste

The effect of sustained-release CARvedilol in patients with hypErtension and heart failure with preserved ejection fraction: a study protocol for a pilot randomized controlled trial (CARE-preserved HF)

BackgroundAlthough beta-blockers improve clinical outcomes in heart failure with reduced ejection fraction, the benefit of beta-blockers in heart failure with preserved ejection fraction (HFpEF) is uncertain. Global longitudinal strain (GLS) is a robust predictor of heart failure outcomes, and recent studies have shown that beta-blockers are associated with improved survival in those with low GLS (GLS <14%) but not in those with GLS ≥14% among patients with LVEF ≥40%. Therefore, the objective of this trial is to evaluate the effect of sustained-release carvedilol (carvedilol-SR) on the outcome [N-terminal pro-B-natriuretic peptide (NT-proBNP) concentration] in patients with hypertension and HFpEF and will assess the differential effects of these drugs on the outcome, according to the GLS categories.MethodsThis prospective randomized double-blind multicenter trial (CARE-preserved HF) will include 100 patients with HFpEF from three tertiary hospitals in South Korea. Patients with HFpEF and hypertension aged ≥20 years who have evidence of functional and structural heart disease on echocardiography and elevated natriuretic peptide will be enrolled. Eligible participants will be randomized 1:1 to either the carvedilol-SR group (n = 50) or the placebo group (n = 50). Patients in the carvedilol-SR group will receive 8, 16, 32, or 64 mg carvedilol-SR once daily for 6 months, and the dose of carvedilol will be up-titrated at the discretion of the treating physicians. The primary efficacy outcome was the time-averaged proportional change in N-terminal pro-B-natriuretic peptide concentration from baseline to months 3 and 6. We will also evaluate the differential effects of carvedilol-SR on primary outcomes according to GLS, using a cut-off of 14% or the median value.DiscussionThis randomized controlled trial will investigate the efficacy and safety of carvedilol-SR in patients with HFpEF and hypertension. Clinical Trial RegistrationClinicalTrial.gov, identifier NCT05553314

Tapered catheter-based transurethral photoacoustic and ultrasonic endoscopy of the urinary system

Early diagnosis is critical for treating bladder cancer, as this cancer is very aggressive and lethal if detected too late. To address this important clinical issue, a photoacoustic tomography (PAT)-based transabdominal imaging approach was suggested in previous reports, in which its in vivo feasibility was also demonstrated based on a small animal model. However, successful translation of this approach to real clinical settings would be challenging because the human bladder is located at a depth that far exceeds the typical penetration depth of PAT (???3 cm for in vivo cases). In this study, we developed a tapered catheter-based, transurethral photoacoustic and ultrasonic endoscopic probe with a 2.8 mm outer diameter to investigate whether the well-known benefits of PAT can be harnessed to resolve unmet urological issues, including early diagnosis of bladder cancer. To demonstrate the in vivo imaging capability of the proposed imaging probe, we performed a rabbit model-based urinary system imaging experiment and acquired a 3D microvasculature map distributed in the wall of the urinary system, which is a first in PAT, to the best of our knowledge. We believe that the results strongly support the use of this transurethral imaging approach as a feasible strategy for addressing urological diagnosis issues

The ReInforcement of adherence via self-monitoring app orchestrating biosignals and medication of RivaroXaban in patients with atrial fibrillation and co-morbidities: a study protocol for a randomized controlled trial (RIVOX-AF)

BackgroundBecause of the short half-life of non-vitamin K antagonist oral anticoagulants (NOACs), consistent drug adherence is crucial to maintain the effect of anticoagulants for stroke prevention in atrial fibrillation (AF). Considering the low adherence to NOACs in practice, we developed a mobile health platform that provides an alert for drug intake, visual confirmation of drug administration, and a list of medication intake history. This study aims to evaluate whether this smartphone app-based intervention will increase drug adherence compared with usual care in patients with AF requiring NOACs in a large population.MethodsThis prospective, randomized, open-label, multicenter trial (RIVOX-AF study) will include a total of 1,042 patients (521 patients in the intervention group and 521 patients in the control group) from 13 tertiary hospitals in South Korea. Patients with AF aged ≥19 years with one or more comorbidities, including heart failure, myocardial infarction, stable angina, hypertension, or diabetes mellitus, will be included in this study. Participants will be randomly assigned to either the intervention group (MEDI-app) or the conventional treatment group in a 1:1 ratio using a web-based randomization service. The intervention group will use a smartphone app that includes an alarm for drug intake, visual confirmation of drug administration through a camera check, and presentation of a list of medication intake history. The primary endpoint is adherence to rivaroxaban by pill count measurements at 12 and 24 weeks. The key secondary endpoints are clinical composite endpoints, including systemic embolic events, stroke, major bleeding requiring transfusion or hospitalization, or death during the 24 weeks of follow-up.DiscussionThis randomized controlled trial will investigate the feasibility and efficacy of smartphone apps and mobile health platforms in improving adherence to NOACs.Trial registrationThe study design has been registered in ClinicalTrial.gov (NCT05557123)

Energy-Aware Control of Error Correction Rate for Solar-Powered Wireless Sensor Networks

In a wireless sensor network (WSN) environment with frequent errors, forward error correction (FEC) is usually employed at the link layer to achieve reliable transmission. In the FEC scheme, the error correction rate varies depending on the length of parity used for the recovery of broken data. The longer the parity length, the higher the possible error correction rate. However, this also means that the energy consumption increases. Meanwhile, in a solar-powered WSN, the energy of each node can be periodically collected, but the amount of collected energy varies drastically depending on the harvesting environment, including factors such as the weather, season and time of day. Therefore, each node must control energy consumption according to the energy harvesting rate. The scheme proposed in this study executes this control by adaptively adjusting the parity length of FEC according to the given energy budget of a node for the next period. This means that the error recovery rate can be increased as much as possible without adversely affecting the blackout time. Simulation results show that the proposed scheme improves the amount of data collected from the entire network for each environment compared with previous schemes

Attention-based speech feature transfer between speakers

In this study, we propose a simple yet effective method for incorporating the source speaker's characteristics in the target speaker's speech. This allows our model to generate the speech of the target speaker with the style of the source speaker. To achieve this, we focus on the attention model within the speech synthesis model, which learns various speaker features such as spectrogram, pitch, intensity, formant, pulse, and voice breaks. The model is trained separately using datasets specific to the source and target speakers. Subsequently, we replace the attention weights learned from the source speaker's dataset with the attention weights from the target speaker's model. Finally, by providing new input texts to the target model, we generate the speech of the target speaker with the styles of the source speaker. We validate the effectiveness of our model through similarity analysis utilizing five evaluation metrics and showcase real-world examples

Foliar Accumulation of Melatonin Applied to the Roots of Maize (Zea mays) Seedlings

Plants absorb melatonin from the environments as well as they synthesize the regulatory molecule. We applied melatonin to the roots of maize (Zea mays) seedlings and examined its accumulation in the leaves. Melatonin accumulation in the leaves was proportional to the exogenously applied concentrations up to 5 mM, without saturation. Time-course analysis of the accumulated melatonin content did not show an adaptable (or desensitizable) uptake system over a 24-h period. Melatonin accumulation in the leaves was reduced significantly by the plant hormones abscisic acid (ABA) and salicylic acid (SA), which commonly cause stomatal closure. The application of ABA and benzo-18-crown-6 (18-CR, a stomata-closing agent) induced stomatal closure and simultaneously decreased melatonin content in the leaves. When plants were shielded from airflow in the growth chamber, melatonin accumulation in the leaves decreased, indicating the influence of reduced transpiration. We conclude that melatonin applied exogenously to the root system is absorbed, mobilized upward according to the transpirational flow, and finally accumulated in the leaves

Optimal Water Backwashing Condition in Combined Water Treatment of Alumina Microfiltration and PP Beads

Membrane fouling is a dominant limit of the membrane separation process. In this research, the optimal water backwashing to solve the membrane fouling problem was investigated in the combined water treatment process of alumina MF and pure polypropylene (PP) beads. Additionally, the influence of membrane shape (tubular or seven channel) was examined, depending on the water backwashing period. The optimal backwashing time (BT) could be 20 s in the combined water treatment process, because of the highest total treated volume (VT) in our BT 6–30 s conditions. The optimal backwashing period (BP) could be 6 min, because of the minimum membrane fouling and the maximum VT in the combined process of tubular alumina MF and PP beads. The resistance of reversible membrane fouling (Rrf) showed a major resistance of total membrane fouling, and that of irreversible membrane fouling (Rif) was a minor one, in the combined process using tubular or seven channel MF. The Rif showed a decreasing trend obviously, as decreasing BT from NBW to 2 min for seven channel MF. It means that the more frequent water backwashing could be more effective to control the membrane fouling, especially irreversible fouling, for seven channel membranes than tubular membranes