A retrospective study of differences in patients' anxiety and satisfaction between paper-based and computer-based tools for "Shared Decision-Making".

We aimed to investigate differences in patients' anxiety and satisfaction between patients undergoing paper-based patient decision aid (PDA) for shared decision-making (SDM) and those receiving computer-based PDA. We retrospectively collected questionnaires before and after SDM. Basic demographic data as well as anxiety, satisfaction, knowledge acquisition, and participation in SDM were recorded. We divided our population into subgroups according to use of paper-based or computer-based PDA. In addition, Pearson correlation analysis was applied to assess the relationships among variables. In total, 304 patients who visited our Division of Nephrology were included in the final analysis. Overall, over half of the patients felt anxiety (n = 217, 71.4%). Near half of the patients felt a reduction in anxiety after SDM (n = 143, 47.0%) and 281 patients (92.4%) were satisfied with the whole process of SDM. When we divided all the patients based on use of paper-based or computer-based PDA, the reduction of anxiety level was greater in the patients who underwent paper-based PDA when compared with that of those who underwent computer-based PDA. However, there was no significant difference in satisfaction between the two groups. Paper-based PDA was as effective as computer-based PDA. Further studies comparing different types of PDA are warranted to fill the knowledge gaps in the literature.

Implementation of an Electronic National Early Warning System to Decrease Clinical Deterioration in Hospitalized Patients at a Tertiary Medical Center.

The National Early Warning Score (NEWS) is an early warning system that predicts clinical deterioration. The impact of the NEWS on the outcome of healthcare remains controversial. This study was conducted to evaluate the effectiveness of implementing an electronic version of the NEWS (E-NEWS), to reduce unexpected clinical deterioration. We developed the E-NEWS as a part of the Health Information System (HIS) and Nurse Information System (NIS). All adult patients admitted to general wards were enrolled into the current study. The "adverse event" (AE) group consisted of patients who received cardiopulmonary resuscitation (CPR), were transferred to an intensive care unit (ICU) due to unexpected deterioration, or died. Patients without AE were allocated to the control group. The development of the E-NEWS was separated into a baseline (October 2018 to February 2019), implementation (March to August 2019), and intensive period (September. to December 2019). A total of 39,161 patients with 73,674 hospitalization courses were collected. The percentage of overall AEs was 6.06%. Implementation of E-NEWS was associated with a significant decrease in the percentage of AEs from 6.06% to 5.51% (p = 0.001). CPRs at wards were significantly reduced (0.52% to 0.34%, p = 0.012). The number of patients transferred to the ICU also decreased significantly (3.63% to 3.49%, p = 0.035). Using multivariate analysis, the intensive period was associated with reducing AEs (p = 0.019). In conclusion, we constructed an E-NEWS system, updating the NEWS every hour automatically. Implementing the E-NEWS was associated with a reduction in AEs, especially CPRs at wards and transfers to ICU from ordinary wards.

Enhancement of Hippocampal Spatial Decoding Using a Dynamic Q-Learning Method With a Relative Reward Using Theta Phase Precession.

Hippocampal place cells and interneurons in mammals have stable place fields and theta phase precession profiles that encode spatial environmental information. Hippocampal CA1 neurons can represent the animal's location and prospective information about the goal location. Reinforcement learning (RL) algorithms such as Q-learning have been used to build the navigation models. However, the traditional Q-learning ([Formula: see text]Q-learning) limits the reward function once the animals arrive at the goal location, leading to unsatisfactory location accuracy and convergence rates. Therefore, we proposed a revised version of the Q-learning algorithm, dynamical Q-learning ([Formula: see text]Q-learning), which assigns the reward function adaptively to improve the decoding performance. Firing rate was the input of the neural network of [Formula: see text]Q-learning and was used to predict the movement direction. On the other hand, phase precession was the input of the reward function to update the weights of [Formula: see text]Q-learning. Trajectory predictions using [Formula: see text]Q- and [Formula: see text]Q-learning were compared by the root mean squared error (RMSE) between the actual and predicted rat trajectories. Using [Formula: see text]Q-learning, significantly higher prediction accuracy and faster convergence rate were obtained compared with [Formula: see text]Q-learning in all cell types. Moreover, combining place cells and interneurons with theta phase precession improved the convergence rate and prediction accuracy. The proposed [Formula: see text]Q-learning algorithm is a quick and more accurate method to perform trajectory reconstruction and prediction.