Physician Convenience Research Articles

The birthing chair, obstetric bed and gynecological chair in obstetrics and gynecology in Russia of XVIII-XX centuries

The purpose of the study is to investigate material culture of obstetrics in New and Modern history of Russia. The most important objective of research is to involve into scientific circulation Russian empirical material in order to study transformation of culture of childbirth during transition from traditional to biomedical model of childbirth exemplified by material culture items (maternity beds, chairs, armchairs). The key approaches were those of historical anthropology, social history of medicine, theory of social control and medicalization. The methods of content analysis, narrative and interpretive analysis were applied to analyze empirical data. In the Russian folk tradition included no such special devices as maternity beds and birth chairs that was explained by dominance of vertical maternity pose. The first birth chairs were brought into Russia by foreign midwives. With development of clinical obstetrics horizontal position of woman in labor was approving that was conditioned by convenience of physicians. Since last quarter of the XIX century, Russian physicians began to experiment, inventing most convenient version of maternity beds and gynecological chairs. The Soviet system of obstetrics was mass and publicly accessible, but consolidated technocratic model of childbirth. In maternity wards, the "Rakhmanov obstetric bed" became widespread. The chairs were not used during childbirth, being used exclusively in gynecology. The material culture of Soviet maternity hospitals turned out to be extremely stable and conservative. In modern Russian obstetrics, with transition to holistic model of childbirth and actualization of free positioning of woman in labor, transformer beds and fitballs began to be applied to provide optimal course of birth process. The material culture of obstetrics is closely related to dominant type of maternity culture.

Classification of temporomandibular joint osteoarthritis on cone beam computed tomography images using artificial intelligence system.

The use of artificial intelligence has many advantages, especially in the field of oral and maxillofacial radiology. Early diagnosis of temporomandibular joint osteoarthritis by artificial intelligence may improve prognosis. The aim of this study is to perform the classification of temporomandibular joint (TMJ) osteoarthritis and TMJ segmentation on cone beam computed tomography (CBCT) sagittal images with artificial intelligence. In this study, the success of YOLOv5 architecture, an artificial intelligence model, in TMJ segmentation and osteoarthritis classification was evaluated on 2000 sagittal sections (500 healthy, 500 erosion, 500 osteophyte, 500 flattening images) obtained from CBCT DICOM images of 290 patients. The sensitivity, precision and F1 scores of the model for TMJ osteoarthritis classification are 1, 0.7678 and 0.8686, respectively. The accuracy value for classification is 0.7678. The prediction values of the classification model are 88% for healthy joints, 70% for flattened joints, 95% for joints with erosion and 86% for joints with osteophytes. The sensitivity, precision and F1 score of the YOLOv5 model for TMJ segmentation are 1, 0.9953 and 0.9976, respectively. The AUC value of the model for TMJ segmentation is 0.9723. In addition, the accuracy value of the model for TMJ segmentation was found to be 0.9953. Artificial intelligence model applied in this study can be a support method that will save time and convenience for physicians in the diagnosis of the disease with successful results in TMJ segmentation and osteoarthritis classification.

A Decade of MRI Compatible Robots: Systematic Review

Magnetic resonance imaging (MRI) offers better visualization for diagnosis, interventional radiology, and surgery from other imaging modalities without X-ray exposure. Medical robots have provided solutions for many surgical and rehabilitation procedures. A symbiosis of MRI and robotics can allow manipulation in closed MR-gantry, decrease trauma, operation, and recovery time for patients and improve the dexterity, convenience, and surgical outcome for physicians. However, the inherent properties and limitations of MR scanners had hindered their development. Technological advancements in the field of computers, additive manufacturing, and sensing in the past decade have changed robotics and the focus shifted again toward MRI-compatible robots. This article provides a compendium of the state-of-the-art literature on robotic systems developed for the MRI environment presented between 2009 and 2021. The systematic review discusses surgical and fMRI study robots, the actuation, and sensing solutions developed to assist such robots, recent research emphasis, current limitations, and prospects.

TransFusionNet: Semantic and Spatial Features Fusion Framework for Liver Tumor and Vessel Segmentation Under JetsonTX2.

Liver cancer is one of the most common malignant diseases worldwide. Segmentation and reconstruction of liver tumors and vessels in CT images can provide convenience for physicians in preoperative planning and surgical intervention. In this paper, we introduced a TransFusionNet framework, which consists of a semantic feature extraction module, a local spatial feature extraction module, an edge feature extraction module, and a multi-scale feature fusion module to achieve fine-grained segmentation of liver tumors and vessels. In addition, we applied the transfer learning approach to pre-train using public datasets and then fine-tune the model to further improve the fitting effect. Furthermore, we proposed an intelligent quantization scheme to compress the model weights and achieved high performance inference on JetsonTX2. The TransFusionNet framework achieved mean IoU of 0.854 in vessel segmentation task, and achieved mean IoU of 0.927 in liver tumor segmentation task. When profiling the Computational Performance of the quantized inference, our quantized model achieved 4TFLOPs on Node with NVIDIA RTX3090 and 132GFLOPs on JetsonTX2. This unprecedented segmentation effect solves the accuracy and performance bottleneck of automated segmentation to a certain extent.

A data-owner centric privacy model with blockchain and adapted attribute-based encryption for internet-of-things and cloud environment

Advances in internet of things (IoT) and cloud computing technologies have led to the emergence of new applications such as in e-health domain bringing convenience for both physicians and patients. However, the development of these new technologies makes users' privacy vulnerable. The threats on private data may arise from service providers themselves voluntarily or by inadvertence. As a result, the data owner would like to ensure that the collected data are securely stored and accessed only by authorised users. In this paper, we propose a novel data-owner centric privacy model in IoT/cloud environment. Our model combines two promising paradigms for data privacy, which are attribute-based encryption (ABE) and blockchain, to strengthen the data-owner privacy protection. We propose a new scheme of ABE that is, in one hand, suitable to resource-constrained devices by externalising the computing capabilities, thanks to fog computing paradigm and, in the other hand, combined with a blockchain-based protocol to overcome a single point of trust and to enhance data-owner access control.

A Multidisciplinary Effort to Decrease Time from Admission to Chemotherapy on an Inpatient Oncology Unit

▪BackgroundPatients with established cancer diagnoses often experience delays in starting scheduled inpatient chemotherapy (chemo) after arrival to the University of Virginia Medical Center oncology unit. These delays not only compromise the quality of individual patient care but also negatively impact hospital resource utilization, length of stay and delay other patient admissions.MethodsTo investigate these delays, we formed a multidisciplinary team of physicians, nurses, and pharmacists. Retrospective chart review was done and of the 340 planned chemo admission encounters in 2015, 100 were randomly reviewed to establish our baseline dataset. For each of these encounters, extensive patient demographic, clinical, and inpatient event data were collected and analyzed to determine time from patient arrival to start of chemotherapy (TTC). In the absence of national guidelines on TTC, we aimed to decrease TTC by 10%. With guidance from the American Society of Clinical Oncology's Quality Training Program, our team utilized multiple qualitative and quantitative tools to further understand factors contributing to TTC delays. These tools included a process map and Ishikawa cause-and-effect diagram to depict all the steps in between patient arrival on the inpatient oncology unit and the start of chemo, a Pareto chart to quantify delays of individual steps, and a priority matrix categorizing potential interventions based on impact and ease of implementation. XmR charts, a type of quality improvement control chart, were used to depict TTC and length of stay (LOS) of the baseline population and intervention groups.ResultsIn the baseline population, median TTC was 6.7 hours (h) and mean TTC was 12.1 h. The disparity in these numbers indicated the existence of extreme outliers in our population, most of which were due to urine parameter requirements. Two Plan-Do-Study-Act (PDSA) cycles of interventions were implemented and post-intervention data were collected and analyzed. The first PDSA cycle involved reforming the chemo consent process. Previously, paper forms were used for informed consent, but these forms were often lost and not scanned into the electronic medical record (EMR). When missing, chemo was not started until a physician obtained informed consent on a physical form again. This PDSA cycle involved electronic and searchable documentation of risk-benefit discussions regarding chemo in the EMR. Unfortunately, median TTC after PDSA cycle 1 (19 encounters) was unchanged at 7.2 h. Median LOS was also unchanged (4.87 days (d) in PDSA cycle 1, compared to 4.77 d at baseline). The chemo consent change, however, remained in place for the convenience of patients and physicians. A second PDSA cycle involved routine pre-review of the inpatient chemo treatment plans by a clinical pharmacist one business day prior to the patient's planned admission. This review was based on a standardized checklist of questions involving the admission, specific chemo regimen and parameters required. The XmR chart for PDSA cycle 2 showed a reduction in median TTC from 7.2 h to 6.2 h (52 encounters). This met the team's goal of improving TTC by 10%. Additionally, median LOS improved from 4.87 d in PDSA cycle 1 to 4.20 d in PDSA cycle 2. XmR charts depicting TTC of all dataset are shown in Figure 1.DiscussionThis project highlights the importance of forming a multidisciplinary team for a highly complex issue that involves multiple different types of patient care providers. Collaborative efforts to improve quality of care have far-reaching impact. The team plans to continue to make improvements in the timely administration of planned inpatient chemotherapy. The team will update the Cancer Center leadership and other UVA Medical Center leadership on key findings and proposed future interventions. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Class-driven content-based medical image retrieval using hash codes of deep features

Medical imaging provides the convenience of physicians to analyze the disease by providing visual data of the body parts required for clinical research and treatment. Today, increasing medical images following technological developments are stored for a better understanding of diseases and future diagnoses. Effective medical image indexing and retrieval systems are required to use these images from storage repositories in real-time. In this quest, this paper provides an effective indexing and retrieval framework using deep features for MR and CT image indexing and searching. The proposed system aims to produce the most effective and least parameterized hash codes by using image features. For this reason, deep features are obtained from medical images using the convolutional neural network (CNN) architecture, which is the most effective automatic feature extraction method. The length of the acquired raw deep feature vectors for an image is relatively inefficient for retrieval speed. Feature reduction methods are used for the most effective reduction of the length of the deep feature vector. The most effective feature reduction algorithm is determined in this study. The main reason for producing a reduced class-driven hash code with feature selection algorithms is the drawbacks of medical image datasets. These drawbacks prevent the CNN output from being used directly as hash-code. The performance of the proposed method is tested on NEMA MRI and NEMA CT datasets. The proposed method is able to outperform the other state-of-the-art algorithms in terms of average precision performance.

Inter-generational Effects of Technology: Why Millennial Physicians May Be Less at Risk for Burnout Than Baby Boomers.

Purpose of ReviewYounger generations of physicians are using technology more fluently than previous generations. This has significant implications for healthcare as these digital natives become a majority of the population’s patients, clinicians, and healthcare leaders.Recent FindingsHistorically, healthcare has been slow to adopt new technology. Many physicians have attributed burnout symptoms to technology-related causes like the EMR. This is partly due to policies and practices led by those who were less familiar and comfortable with using new technologies.SummaryYounger physicians will drive technological advancement and integration faster than previous generations, allowing technology to adapt more quickly to serve the needs of clinicians and patients. These changes will improve efficiency, allow more flexible working arrangements, and increase convenience for patients and physicians. The next generation of physicians will use technology to support their work and lifestyle preferences, making them more resilient to burnout than previous generations.

The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion Summary, Number 800.

This Committee Opinion provides guidance on the current uses of hysteroscopy in the office and the operating room for the diagnosis and treatment of intrauterine pathology and the potential associated complications. General considerations for the use of diagnostic and operative hysteroscopy include managing distending media, timing for optimal visualization, and cervical preparations. In premenopausal women with regular menstrual cycles, the optimal timing for diagnostic hysteroscopy is during the follicular phase of the menstrual cycle after menstruation. Pregnancy should be reasonably excluded before performing hysteroscopy. There is insufficient evidence to recommend routine cervical ripening before diagnostic or operative hysteroscopy, but it may be considered for those patients at higher risk of cervical stenosis or increased pain with the surgical procedure. In randomized trials, patients reported a preference for office-based hysteroscopy, and office-based procedures are associated with higher patient satisfaction and faster recovery when compared with hospital-based operative hysteroscopy. Other potential benefits of office hysteroscopy include patient and physician convenience, avoidance of general anesthesia, less patient anxiety related to familiarity with the office setting, cost effectiveness, and more efficient use of the operating room for more complex hysteroscopic cases. Appropriate patient selection for office-based hysteroscopic procedures for women with known uterine pathology relies on thorough knowledge and understanding of the target pathology, size of the lesion, depth of penetration of the lesion, patient willingness to undergo an office-based procedure, physician skills and expertise, assessment of patient comorbidities, and availability of proper equipment and patient support. Both the American College of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL) agree that vaginoscopy may be considered when performing office hysteroscopy because studies have shown that it can significantly reduce procedural pain with similar efficacy. The office hysteroscopy analgesia regimens commonly described in the literature include a single agent or a combination of multiple agents, including a topical anesthetic, a nonsteroidal antiinflammatory drug, acetaminophen, a benzodiazepine, an opiate, and an intracervical or paracervical block, or both. Based on the currently available evidence, there is no clinically significant difference in safety or effectiveness of these regimens for pain management when compared to each other or placebo. Patient safety and comfort must be prioritized when performing office hysteroscopic procedures. Patients have the right to expect the same level of patient safety as is present in the hospital or ambulatory surgery setting.

The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800.

This Committee Opinion provides guidance on the current uses of hysteroscopy in the office and the operating room for the diagnosis and treatment of intrauterine pathology and the potential associated complications. General considerations for the use of diagnostic and operative hysteroscopy include managing distending media, timing for optimal visualization, and cervical preparations. In premenopausal women with regular menstrual cycles, the optimal timing for diagnostic hysteroscopy is during the follicular phase of the menstrual cycle after menstruation. Pregnancy should be reasonably excluded before performing hysteroscopy. There is insufficient evidence to recommend routine cervical ripening before diagnostic or operative hysteroscopy, but it may be considered for those patients at higher risk of cervical stenosis or increased pain with the surgical procedure. In randomized trials, patients reported a preference for office-based hysteroscopy, and office-based procedures are associated with higher patient satisfaction and faster recovery when compared with hospital-based operative hysteroscopy. Other potential benefits of office hysteroscopy include patient and physician convenience, avoidance of general anesthesia, less patient anxiety related to familiarity with the office setting, cost effectiveness, and more efficient use of the operating room for more complex hysteroscopic cases. Appropriate patient selection for office-based hysteroscopic procedures for women with known uterine pathology relies on thorough knowledge and understanding of the target pathology, size of the lesion, depth of penetration of the lesion, patient willingness to undergo an office-based procedure, physician skills and expertise, assessment of patient comorbidities, and availability of proper equipment and patient support. Both the American College of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL) agree that vaginoscopy may be considered when performing office hysteroscopy because studies have shown that it can significantly reduce procedural pain with similar efficacy. The office hysteroscopy analgesia regimens commonly described in the literature include a single agent or a combination of multiple agents, including a topical anesthetic, a nonsteroidal antiinflammatory drug, acetaminophen, a benzodiazepine, an opiate, and an intracervical or paracervical block, or both. Based on the currently available evidence, there is no clinically significant difference in safety or effectiveness of these regimens for pain management when compared to each other or placebo. Patient safety and comfort must be prioritized when performing office hysteroscopic procedures. Patients have the right to expect the same level of patient safety as is present in the hospital or ambulatory surgery setting.

International Journal of Advanced Research in Electrical, Electronics and Instrumentation Engineering Smart Body Monitoring system using IoT and Machine Learning

In the modern health care environment, the usage of IoT technologies brings convenience of physicians and patients, since they are applied to various medical areas. The body sensor network (BSN) technology is one of the core technologies of IoT developments in healthcare system, where a patient can be monitored using a collection of tiny-powered and lightweight wireless sensor nodes. However, the development of this new technology in healthcare applications without considering security makes patient privacy vulnerable. In this paper, at first, we highlight the major security requirements in BSN-based modern healthcare system. Subsequently, we propose a secure IoT-based healthcare system using BSN, called BSN-Care, which can efficiently accomplish those requirements. The body sensor network (BSN) technology is one of the most imperative technologies used in IoT-based modern healthcare system. It is basically a collection of low-power and lightweight wireless sensor nodes that are used to monitor the human body functions and surrounding environment. Since BSN nodes are used to collect sensitive (life-critical) information and may operate in hostile environments, accordingly, they require strict security mechanisms to prevent malicious interaction with the system.

Asynchronous Speech Recognition Affects Physician Editing of Notes.

Clinician progress notes are an important record for care and communication, but there is a perception that electronic notes take too long to write and may not accurately reflect the patient encounter, threatening quality of care. Automatic speech recognition (ASR) has the potential to improve clinical documentation process; however, ASR inaccuracy and editing time are barriers to wider use. We hypothesized that automatic text processing technologies could decrease editing time and improve note quality. To inform the development of these technologies, we studied how physicians create clinical notes using ASR and analyzed note content that is revised or added during asynchronous editing. We analyzed a corpus of 649 dictated clinical notes from 9 physicians. Notes were dictated during rounds to portable devices, automatically transcribed, and edited later at the physician's convenience. Comparing ASR transcripts and the final edited notes, we identified the word sequences edited by physicians and categorized the edits by length and content. We found that 40% of the words in the final notes were added by physicians while editing: 6% corresponded to short edits associated with error correction and format changes, and 34% were associated with longer edits. Short error correction edits that affect note accuracy are estimated to be less than 3% of the words in the dictated notes. Longer edits primarily involved insertion of material associated with clinical data or assessment and plans. The longer edits improve note completeness; some could be handled with verbalized commands in dictation. Process interventions to reduce ASR documentation burden, whether related to technology or the dictation/editing workflow, should apply a portfolio of solutions to address all categories of required edits. Improved processes could reduce an important barrier to broader use of ASR by clinicians and improve note quality.

A Novel Implementation for Patient Monitoring in Rural Areas Using IOT Technology

Now a day’s there is a rapid growth in technology. In the modern health care environment, the usage of IOT technologies brings convenience of physicians and patients since they are applied to various medical areas. The development of this new technology in healthcare applications without considering security makes patient privacy vulnerable. In this paper at first we highlight the major security requirements while storing the patient information in the cloud. Through IOT Doctor’s Treatment suggestions, the patient updated treatment information will be directly stored in the cloud. In order to achieve effective for storing the information in cloud we provide secure communication protocols. We also propose a secure IOT based on sensors used in modern healthcare.

The available intravenous iron formulations: History, efficacy, and toxicology.

A number of intravenous iron formulations have been developed over the past 65 years which rely on dextran or other compounds to prevent uncontrolled release of free iron to the circulation. High molecular weight dextran was associated with a number of serious adverse reactions and was removed from markets worldwide in 2009. The preponderance of published evidence suggests that the formulations of parenteral iron currently available in the United States, including low molecular weight iron dextran, are all safe and effective and there are no major, clinically important differences among them in terms of either efficacy or safety. For patients with chemotherapy induced anemia or with anemia of end stage renal disease who are being treated with hemodialysis, it is reasonable to use any of the iron formulations, including iron sucrose and ferric gluconate, as frequent patient encounters with health caregivers are a routine part of care and the need to administer multiple low doses of IV iron is not a major disadvantage. However, a single infusion of a total iron dose is as effective and safe when giving iron preparations containing low molecular weight iron dextran, ferumoxytol, iron isomaltoside, or ferric carboxymaltose. Use of a single total dose infusion results in a decreased number of intravenous infusions with a lower cumulative risk for infusion reactions or extravasations, a reduced need for multiple office visits and repeated utilization of medical staff, and increased convenience for physicians and patients.

PEG-asparaginase in BFM-90 regimen improves outcomes in adults with newly diagnosed lymphoblastic lymphoma.

ObjectiveAlthough L-asparaginase (L-ASP) is a standard treatment for lymphoblastic lymphoma (LBL), hypersensitivity reactions by some patients limit its application. Polyethylene glycol-conjugated asparaginase (PEG-ASP) has a lower immunogenicity and is a standard treatment in all pediatric acute lymphoblastic leukemia (ALL). In this study, we investigated the efficacy and toxicity of PEG-ASP instead of L-ASP as used in the BFM-90 regimen (PEG-ASP-BFM-90) for adult LBL.MethodsBetween June 2012 and July 2015, we treated 30 adult patients with newly diagnosed LBL, using PEG-ASP-BFM-90 in a prospective, multicenter and single-arm clinical study at 5 participating institutions in China.ResultsAll the 30 patients, including 19 males and 11 females with a median age of 30 (range: 18–62) years, completed 128 times of the PEG-ASP, with the median of 4 (range: 2–6) times. Patients did not receive radiotherapy at this time. The overall response rate was 86.7% (26/30), with 50.0% (15/30) complete response and 36.7% (11/30) partial response. The 3-year overall survival was 46.0% [95% confidence interval (95% CI), 28.2%–64.8%], and the 3-year progression-free survival was 43.0% (95% CI, 25.7%–62.0%). Major adverse events were myelosuppression, reduced fibrinogen, liver dysfunction and digestive tract toxicities. No allergic reaction and no treatment-related mortality or severe complications were recorded.ConclusionsOur clinical data and observed outcomes indicate that 1 dose of PEG-ASP can replace multiple doses of native L-ASP in BFM-90, with predominantly grade 3–4 neutropenia for adult LBL, and no therapy-related deaths. The effect is similar to previous reports of PEG-ASP-containing regimens for adult ALL. Major advantages include less serious allergic reactions, 2–3 weeks of action duration, and convenience for patients and physicians.

Which is the best intrauterine insemination timing choice following exogenous hCG administration during ovulation induction by using clomiphene citrate treatment? A retrospective study.

ObjectiveTo evaluate the impact of intrauterine insemination timing performed 24 or 36 h later following ovulation trigger on clinical pregnancy rate during ovulation induction with clomiphene citrate among infertile women was the objective of this study.MethodsThe medical records of 280 infertile patients who have underwent ovulation induction by using clomiphene citrate have been evaluated and cycle outcomes of the patients have been investigated specifically based on the timing of intrauterine insemination during the treatment cycle.ResultsThe clinical pregnancy rate of the study group based on the timing of intrauterine insemination (24 vs. 36 h following hCG trigger) was found to be similar regardless of infertility type. The cycle day of which hCG trigger has been performed was found to be significantly longer for patients who have achieved clinical pregnancy than patients who have not got pregnant following the treatment cycle. Dominant follicle diameter has not been found to affect clinical pregnancy rate during treatment cycles with clomiphene citrate.ConclusionsIn this study, intrauterine insemination timing did not affect the cycle outcomes whether the procedure has been performed 24 or 36 h later following ovulation trigger with exogenous hCG utilization. The longer period of treatment cycle during ovulation induction with clomiphene citrate resulted with higher clinical pregnancy rate. Intrauterine insemination can be done successfully at either 24 or 36 h after hCG in clomiphene citrate stimulated cycles. This will allow more flexibility and convenience for both physicians and patients, especially during weekends.

The Role Of NOACs in Atrial Fibrillation Management: A Qualitative Study.

Patients with atrial fibrillation (AF) benefit from anticoagulation to reduce stroke risk. However, 30-60% of patients with AF are not anticoagulated. This study explored physicians' reasons for under-treatment of AF, focusing on the role of the novel oral anticoagulants (NOACs). We interviewed primary care physicians and cardiologists involved in AF management in a variety of practice settings. We conducted interviews using a semi-structured format and analyzed the data using the Framework Method. Four themes emerged. First, the likelihood of physicians to prescribe NOACs depends upon their willingness to try new medications and their successful experience with them. Second, physicians typically balance the benefits and risks of anticoagulation in AF patients, although not always accurately. Third, patient convenience and preferences, as well as physician convenience, are important when considering anticoagulation. Finally, concerns regarding the out-of-pocket cost of NOACs deter many physicians from prescribing them. The persistence of under-treatment in AF despite the availability of effective therapies suggests that new strategies are needed to improve physician knowledge and practice. These strategies should enhance physician awareness of AF under-treatment, emphasize accurate assessment of bleeding risk among AF patients, compare the safety, efficacy, and convenience of NOACs relative to warfarin, and address physician concerns regarding the out-of-pocket cost of NOACs. Guidelines and decision supports which promote physician knowledge in these areas have the potential to increase oral anticoagulant use and reduce preventable morbidity and mortality.

BSN-Care: A Secure IoT-Based Modern Healthcare System Using Body Sensor Network

Advances in information and communication technologies have led to the emergence of Internet of Things (IoT). In the modern health care environment, the usage of IoT technologies brings convenience of physicians and patients, since they are applied to various medical areas (such as real-time monitoring, patient information management, and healthcare management). The body sensor network (BSN) technology is one of the core technologies of IoT developments in healthcare system, where a patient can be monitored using a collection of tiny-powered and lightweight wireless sensor nodes. However, the development of this new technology in healthcare applications without considering security makes patient privacy vulnerable. In this paper, at first, we highlight the major security requirements in BSN-based modern healthcare system. Subsequently, we propose a secure IoT-based healthcare system using BSN, called BSN-Care, which can efficiently accomplish those requirements.

84: Routine versus delayed timing of morning hospital rounds for postpartum women on patient satisfaction: A randomized quality improvement trial

Early morning physician rounding is a part of traditional hospital culture. Benefits include early patient discharge as well as physician convenience to begin other clinical duties. Potential disadvantages include inadequate communication and sleep disruption. The objective of this study was to determine whether timing of physician rounding of postpartum women impacts patient satisfaction. Women under the care of a university-based OB/GYN faculty practice who delivered at a tertiary care medical center were randomly allocated to either routine rounding (4 - 7am) or delayed physician rounding (after 8 am) from postpartum day 1 until discharge. Women with medical conditions or delivery complications that precluded the ability to delay rounding were excluded. On day of discharge, research staff blinded to rounding group distributed a standardized survey that included questions regarding physician communication and hospital experience. Based on delivery volumes, we planned to conduct the study over a pre-defined two month period. We estimated that the study would require 74 total subjects (N=37 per group) to detect a 20% difference in overall rating of the hospital (0-10 score) between groups (assumption P=0.05 and power 90%). 155 women participated in the study (N= 76 routine rounding; N= 76 delayed rounding). Maternal demographics and clinical characteristics were similar between groups except for delivery mode. More women had cesarean delivery in the routine compared to delayed rounding group (47.4% vs. 22.4%). Patient satisfaction scores were improved not only for quality of physician communication, but also for hospital experience and overall hospital rating (see Table). Adjustment for delivery mode with linear regression did not alter the findings (p < 0.001). There were no differences between groups in timing of maternal discharge occurring after 10 am (25% routine vs. 30.3% delayed; p=0.47) or timing of neonatal discharge after 10 am, 94.7% vs. 90.8% (p=0.35). Postpartum women who received delayed physician rounding were more satisfied with physician communication and overall hospital experience without prolonging their hospital stay or time of discharge.

Safety and efficacy of total dose infusion of 1,020 mg of ferumoxytol administered over 15 min

For the majority of patients with iron deficiency anemia (IDA), a full course of intravenous (IV) iron is 1 g. Most IV irons require 5-10 administrations of 100-300 mg. We have successfully employed 1 g low molecular weight iron dextran over 1 hr. For further convenience for patients and physicians, we explored the administration of 1.02 g of ferumoxytol over 15 min instead of the approved 2 × 510 mg injections. Sixty patients with IDA, (hemoglobin <11 g/dL, transferrin saturation [TSAT] ≤20%, and ferritin <100 ng/mL) with an inadequate response or intolerance to oral iron, received 1020 mg ferumoxytol over 15 min. Vital signs were measured for 1 hr. Adverse events (AEs) were collected via telephone at 1, 2, and 7 days. Follow-up visits occurred at 4 and 8 weeks for efficacy assessments. The primary endpoint was safety and tolerability. Secondary efficacy endpoints included mean change in hemoglobin, TSAT, and red cell distribution width. No serious adverse events (SAEs) occurred. Fifty-eight patients received the planned dose. Twenty-six out of sixty (43.3%) patients reported AEs of which 13 were mild and transient during infusion. All resolved within minutes. Fourteen patients reported self-limited arthralgias, myalgias, and/or headache within 24-48 hr. At Baseline, the mean hemoglobin was 9.4 g/dL. The mean increments at Week 4 and 8 were 2.1 and 2.6 g/dL, respectively. Ferumoxytol, administered as 1.02 g infusion over 15 min was well tolerated with no SAEs and demonstrated excellent efficacy. If corroborated in future studies this represents an improved method of treating IDA.