Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

ObjectiveSubstantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence.ConclusionsPerformance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.     

The impact of parkinson's disease on the cortical mechanisms that support auditory–motor integration for voice control

Several studies have shown sensorimotor deficits in speech processing in individuals with idiopathic Parkinson's disease (PD). The underlying neural mechanisms, however, remain poorly understood. In the present event‐related potential (ERP) study, 18 individuals with PD and 18 healthy controls were exposed to frequency‐altered feedback (FAF) while producing a sustained vowel and listening to the playback of their own voice. Behavioral results revealed that individuals with PD produced significantly larger vocal compensation for pitch feedback errors than healthy controls, and exhibited a significant positive correlation between the magnitude of their vocal responses and the variability of their unaltered vocal pitch. At the cortical level, larger P2 responses were observed for individuals with PD compared with healthy controls during active vocalization due to left‐lateralized enhanced activity in the superior and inferior frontal gyrus, premotor cortex, inferior parietal lobule, and superior temporal gyrus. These two groups did not differ, however, when they passively listened to the playback of their own voice. Individuals with PD also exhibited larger P2 responses during active vocalization when compared with passive listening due to enhanced activity in the inferior frontal gyrus, precental gyrus, postcentral gyrus, and middle temporal gyrus. This enhancement effect, however, was not observed for healthy controls. These findings provide neural evidence for the abnormal auditory–vocal integration for voice control in individuals with PD, which may be caused by their deficits in the detection and correction of errors in voice auditory feedback. Hum Brain Mapp 37:4248–4261, 2016. © 2016 Wiley Periodicals, Inc.     

Continuous prospectively navigated multi‐echo GRE for improved BOLD imaging of the kidneys

The objective of this study is to develop improved methods for renal blood oxygenation level dependent (BOLD) imaging. T2* mapping of the kidneys, or renal BOLD imaging, may depict renal oxygen levels and may be valuable as a noninvasive means of following the progression of renal disease. Current renal BOLD data is limited by imaging in a single breath hold, which results in low resolution and low signal‐to‐noise ratio (SNR). We compare a new free‐breathing renal BOLD method with conventional breath‐hold BOLD (BH‐BOLD). A multi‐echo GRE sequence with continuous prospective respiratory navigation and real‐time feedback was developed that allows high resolution and high SNR renal BOLD imaging with constant sequence repetition time (TR) during free‐breathing BOLD (FB‐BOLD). The sequence was evaluated in 10 normal volunteers and compared with conventional BH‐BOLD. Scan time for the FB‐BOLD sequence was approximately three minutes, compared with 15 seconds for the BH‐BOLD sequence. SNR of source images and residual error of T2* fitting were compared between the two methods. The FB‐BOLD sequence produced motion‐free T2* maps of the kidneys with SNR 1.9 times higher than BH‐BOLD images. Residual error of T2* fitting was consistently lower in the right kidney with FB‐BOLD (30% less than BH‐BOLD) but higher in the left kidney (80% more than BH‐BOLD), likely related to placement of the navigator on the right hemidiaphragm. A free‐breathing prospectively navigated renal BOLD sequence allows flexible tradeoff between scan time, resolution, and SNR.     

A body-weight-supported visual feedback system for gait recovering in stroke patients: A randomized controlled study

ObjectiveThe aim of this study was to determine the effectiveness of a novel body-weight-supported (BWS) gait training system with visual feedback, called Copernicus® (Rehalife, Italy). This computerized device provides comfortable, regular and repeatable locomotion in hemiplegic patients. Through visual real-time monitoring of gait parameters, patients are trained to transfer weight loading alternately on both feet.DesignA single-blind, randomized controlled study. A single center used a computer-generated randomization code to allocate treatments.SettingIntensive rehabilitation unit (IRU) at the Institute S. Anna (Italy).Participants63 first-ever stroke patients (39 men, age: 66.1 ± 9.6 years; 61.6 % with left-sided lesion) randomly distributed into three demographically/clinically matched groups.TreatmentsAll groups were treated five times a week for 2 -h sessions for six consecutive weeks. The first group (“control”) underwent a conventional physical therapy; the second group performed advanced BWS gait training sessions without visual feedback (Experimental VF- group); whereas the third group used BWS with visual feedback stimulation (Experimental VF+ group).Main Outcome MeasuresAbsolute changes were recorded using conventional clinical scales and kinematic measurement of static gait balance from baseline to follow-up.ResultsSignificant interaction Group*Time effects scales (F_2,126 = 5.1, p-level = 0.005, η²_p = 0.25; F_2,126 = 4.7, p-level = 0.007, η²_p = 0.19; respectively) were detected in the Functional Independence Measure and Tinetti-Balance scales. Post hoc analysis demonstrated that the recovery of motor functioning was greater for the VF + group with respect to other groups (all p’s ≤ 0.001). A similar pattern of findings was also obtained with a stabilometric analysis, demonstrating a better clinical improvement in static balance after VF + treatment.ConclusionThe proposed advanced rehabilitation system with visual feedback was more effective in improving gait recovery with respect to conventional and high-tech therapies without a sensor feedback.     

Altered spinal-level sensorimotor control related to pain and perceived instability in people with chronic ankle instability

Objectives

To compare soleus spinal reflex excitability, presynaptic inhibition and recurrent inhibition between chronic ankle instability (CAI), acute Lateral Ankle Sprain coper (LAS-coper) and healthy populations. The relationship between spinal reflex excitability and pain and perceived instability in people with CAI was also examined.

Influence of intra‐oral sensory impairment by anaesthesia on food comminution and mixing in dentate subjects

Sensory input from sensory receptors regarding food morsels can affect jaw motor behaviours during mastication. The aim was to clarify the effects of intra‐oral sensory input on the food‐comminuting and food‐mixing capacities of dentate subjects. Eleven dentate subjects without sensory dysfunction in their oro‐facial region participated in this study. Local anaesthesia was achieved on the periodontal structures and on the oral mucosa of the subjects' preferred chewing side by injecting a lidocaine solution with adrenalin. At baseline (control) and after anaesthesia, data on the subjects' food‐comminuting and food‐mixing capacities were gathered. The food‐comminuting capacity was quantified by measuring the degree of pulverisation of peanuts (objective hardness; 45·3 [Newton, N]) after a prescribed 20 chewing strokes. The food‐mixing capacity was measured as the degree of immixture of a two‐coloured paraffin wax cube after 10 chewing strokes. Wax cubes of three different hardness levels were used (soft, medium and hard: 20·3, 32·6 and 75·5 [N], respectively) and were chewed in random order. After anaesthesia, the subjects' food‐comminuting capacity significantly decreased (P < 0·001), as did the food‐mixing capacity for each hardness level of the wax cubes (P < 0·01). A significant correlation was observed between the objective hardness values and the anaesthesia effects for the food‐mixing capacity (P < 0·05), indicating that after anaesthesia, deterioration of the mixing capacity increased as the hardness increased. In conclusion, intra‐oral sensory input can affect both food‐comminuting and food‐mixing capacities.     

基于时滞关联特征患者就诊反馈分析

抓取“微医网”医患评论数据，对其中时滞与患者满意度进行关联分析，并对评论内容进行主题挖掘，提取不同时滞区间内患者重点关注的内容。通过对患者评论文本不同时滞区间内容的分析，寻找满意度提升策略，以缓解医患关系。使用K-means将患者反馈数据根据就诊后时长反馈分为“短期”和“长期”，通过LDA主题提取模型，对满意度划分后的患者评论文本挖掘不同时滞区间内患者所关注的重点内容，将其差异进行对比分析发现，患者就诊满意度随着时滞呈现趋高现象，不同时滞文本显示患者评论维度大致相同，但随着时滞区间的转移，患者所关注的就诊体验内容也有所变化。     

Bubble-Induced Color Doppler Feedback Correlates with Histotripsy-Induced Destruction of Structural Components in Liver Tissue

Bubble-induced color Doppler (BCD) is a histotripsy-therapy monitoring technique that uses Doppler ultrasound to track the motion of residual cavitation nuclei that persist after the collapse of the histotripsy bubble cloud. In this study, BCD is used to monitor tissue fractionation during histotripsy tissue therapy, and the BCD signal is correlated with the destruction of structural and non-structural components identified histologically to further understand how BCD monitors the extent of treatment. A 500-kHz, 112-element phased histotripsy array is used to generate approximately 6-?×?6-?×?7-mm lesions within ex vivo bovine liver tissue by scanning more than 219 locations with 30–1000 pulses per location. A 128-element L7-4 imaging probe is used to acquire BCD signals during all treatments. The BCD signal is then quantitatively analyzed using the time-to-peak rebound velocity (t_prv) metric. Using the Pearson correlation coefficient, the t_prv is compared with histologic analytics of lesions generated by various numbers of pulses using a significance level of 0.001. Histologic analytics in this study include viable cell count, reticulin-stained type III collagen area and trichrome-stained type I collagen area. It is found that the t_prv metric has a statistically significant correlation with the change in reticulin-stained type III collagen area with a Pearson correlation coefficient of ?0.94 (p?<0.001), indicating that changes in BCD are more likely because of destruction of the structural components of tissue.