Hybrid-Pattern Recognition Modeling with Arrhythmia Signal Processing for Ubiquitous Health Management.

We established a web-based ubiquitous health management (UHM) system, "ECG4UHM", for processing ECG signals with AI-enabled models to recognize hybrid arrhythmia patterns, including atrial premature atrial complex (APC), atrial fibrillation (AFib), ventricular premature complex (VPC), and ventricular tachycardia (VT), versus normal sinus rhythm (NSR). The analytical model coupled machine learning methods, such as multiple layer perceptron (MLP), random forest (RF), support vector machine (SVM), and naive Bayes (NB), to process the hybrid patterns of four arrhythmia symptoms for AI computation. The data pre-processing used Hilbert-Huang transform (HHT) with empirical mode decomposition to calculate ECGs' intrinsic mode functions (IMFs). The area centroids of the IMFs' marginal Hilbert spectrum were suggested as the HHT-based features. We engaged the MATLABTM compiler and runtime server in the ECG4UHM to build the recognition modules for driving AI computation to identify the arrhythmia symptoms. The modeling extracted the crucial data sets from the MIT-BIH arrhythmia open database. The validated models, including the premature pattern (i.e., APC-VPC) and the fibril-rapid pattern (i.e., AFib-VT) against NSR, could reach the best area under the curve (AUC) of the receiver operating characteristic (ROC) of approximately 0.99. The models for all hybrid patterns, without VPC versus AFib and VT, achieved an average accuracy of approximately 90%. With the prediction test, the respective AUCs of the NSR and APC versus the AFib, VPC, and VT were 0.94 and 0.93 for the RF and SVM on average. The average accuracy and the AUC of the MLP, RF, and SVM models for APC-VT reached the value of 0.98. The self-developed system with AI computation modeling can be the backend of the intelligent social-health system that can recognize hybrid arrhythmia patterns in the UHM and home-isolated cares.

Attitudes toward inter-hospital electronic patient record exchange: discrepancies among physicians, medical record staff, and patients.

BACKGROUND: In this era of ubiquitous information, patient record exchange among hospitals still has technological and individual barriers including resistance to information sharing. Most research on user attitudes has been limited to one type of user or aspect. Because few analyses of attitudes toward electronic patient records (EPRs) have been conducted, understanding the attitudes among different users in multiple aspects is crucial to user acceptance. This proof-of-concept study investigated the attitudes of users toward the inter-hospital EPR exchange system implemented nationwide and focused on discrepant behavioral intentions among three user groups. METHODS: The system was designed by combining a Health Level 7-based protocol, object-relational mapping, and other medical informatics techniques to ensure interoperability in realizing patient-centered practices. After implementation, three user-specific questionnaires for physicians, medical record staff, and patients were administered, with a 70 % response rate. The instrument showed favorable convergent construct validity and internal consistency reliability. Two dependent variables were applied: the attitudes toward privacy and support. Independent variables comprised personal characteristics, work characteristics, human aspects, and technology aspects. Major statistical methods included exploratory factor analysis and general linear model. RESULTS: The results from 379 respondents indicated that the patients highly agreed with privacy protection by their consent and support for EPRs, whereas the physicians remained conservative toward both. Medical record staff was ranked in the middle among the three groups. The three user groups demonstrated discrepant intentions toward privacy protection and support. Experience of computer use, level of concerns, usefulness of functions, and specifically, reason to use electronic medical records and number of outpatient visits were significantly associated with the perceptions. Overall, four categories of independent variables were associated with the mean difference in the perceptions. CONCLUSIONS: Discrepant attitudes toward privacy and support among the three user groups are identified. Patients may require further education and communication regarding the system. Culturally fit e-Consent should be incorporated into the system to fully utilize the computing power of the Internet when also considering workload. The concern for misuse of EPRs might lead to low support among physicians. Highly readable EPR documents and managerial incentives for information exchange may improve system use.

Effects of and satisfaction with short message service reminders for patient medication adherence: a randomized controlled study.

BACKGROUND: Medication adherence is critical for patient treatment. This study involved evaluating how implementing Short Message Service (SMS) reminders affected patient medication adherence and related factors. METHODS: We used a structured questionnaire to survey outpatients at three medical centers. Patients aged 20 years and older who were prescribed more than 7 days of a prescription medication were randomized into SMS intervention or control groups. The intervention group received daily messages reminding them of aspects regarding taking their medication; the control group received no messages. A phone follow-up was performed to assess outcomes after 8 days. Data were collected from 763 participants in the intervention group and 435 participants in the control group. RESULTS: After participants in the intervention group received SMS reminders to take medication or those in the control group received no messages, incidences of delayed doses were decreased by 46.4 and 78.8% for those in the control and intervention groups, respectively. The rate of missed doses was decreased by 90.1% for participants in the intervention group and 61.1% for those in the control group. We applied logistic regression analysis and determined that participants in the intervention group had a 3.2-fold higher probability of having a decrease in delayed doses compared with participants in the control group. Participants in the intervention group also showed a 2.2-fold higher probability of having a decrease in missed doses compared with participants in the control group. CONCLUSIONS: Use of SMS significantly affected the rates of taking medicine on schedule. Therefore, daily SMS could be useful for reminding patients to take their medicine on schedule.

Evaluating the suicide risk-screening scale used by general nurses on patients with chronic obstructive pulmonary disease and lung cancer: a questionnaire survey.

AIM: The aim of this study was to evaluate the interview version of the screening of risk for suicide with redefined items for the hospitalised patients. BACKGROUND: Patients hospitalised in general hospitals with physical illnesses performed suicidal acts more rapidly after admission. DESIGN: A two-hour screening skills training course was provided to general nurses caring for hospitalised patients. The patients were rated by trained nurses according to the screening of risk for suicide. Then, patients did self-rating of repulsion of life scale and symptom distress. The participants were 54 trained nurses and 205 patients, 76 of whom had chronic obstructive pulmonary disease and 129 had lung cancer. METHODS: The trained nurses used the screening of risk for suicide to screen patients and compared their results with their trainers within 24 hours for inter-rater consistency, followed by patients' self-rating. RESULTS: The inter-rater reliability between nurses and their trainers was 0·85. The screening of risk for suicide rated by nurses correlated significantly with repulsion to life and symptom distress rated by patients. There were 26·3% (20) of patients with chronic obstructive pulmonary disease and 14·0% (18) of patients with lung cancer who showed moderate-to-high suicide risk, most of them having poor social support. The nurse's score on patient with chronic obstructive pulmonary disease was higher than patient's self-rating. CONCLUSIONS: The screening of risk for suicide was useful in alerting the general nurses to high-risk patients and the nurse' screening collected more in-depth data than patients' self-rating. It is suggested that this suicide risk-screening training should incorporate into continuing education in general hospital and the use of Screening of Risk for Suicide incorporating into new patient nursing assessment. RELEVANCE TO CLINICAL PRACTICE.: The two-hour suicide risk-screening training could renew the general nurse skill of risk screening for the hospitalised patients.

Evaluation of computer-assisted multimedia instruction in intravenous injection.

The purpose of this study was to develop a computer-assisted multimedia training course for intravenous injection and evaluate its effect on the knowledge and self-perceived performance of intravenous injection for novice nurses. Eighty-one novice nurses randomly assigned to the experimental group and control group participated a designed training procedure and took pretest and posttests. The test results were analyzed using statistical methods. From the study it could be concluded that the training course had a significant effect on the intravenous injection's knowledge. Besides, a high rate of satisfaction for the multimedia program showed the self-developed program was successful.

The use of virtual reality computer simulation in learning Port-A cath injection.

Cost-benefit management trends in Taiwan healthcare settings have led nurses to perform more invasive skills, such as Port-A cath administration of medications. Accordingly, nurses must be well-prepared prior to teaching by the mentor and supervision method. The purpose of the current study was to develop a computer-assisted protocol using virtual reality (VR) in performing Port-A cath as a training program for novice nurses. A pre-tested and post-tested control group experimental design was used in this study. Seventy-seven novice nurses were invited from one large medical center hospital in North Taiwan. Thirty-seven and forty nurses were randomly assigned to experimental and control groups. First, we designed a 40 minute port-A cath injection VR simulation. Then, the experimental group practiced this simulation two times over 3 weeks. The control group attended the traditional class. The post-test 1 was right after completion of the simulation practice. The post-test 2 was after the second simulation practice in 3 weeks. The results showed that most novice nurses lacked Port-A cath experience both in the classroom and during the period of their practice training. The knowledge score regarding the Port-A cath technique was significantly higher in the nurses that participated in the simulation training than in the control group. The novice nurses were most satisfied with the reduction in their fear of performing the Port-A cath technique and their enhanced clinical skills. VR simulation significantly reduced error rates and increased correct equipment selection, showing that nurses who participated in the simulation may be better prepared for inserting Port-A cath.

Developing and validating a nursing website evaluation questionnaire.

AIM: The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites. BACKGROUND: Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated. METHODS: A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's alpha, Guttman split-half reliability and factor analysis. FINDINGS: Internal consistency was good, with a Cronbach's alpha of 0.93 in Part I and a KR-20 (Kuder Richardson) of 0.85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression. CONCLUSION: The nursing website evaluation questionnaire had good construct validity and internal consistency.