High User Satisfaction Research Articles

Managing difficult catheterisation in nurse‐led catheterisation services: Does guidewire‐assisted urethral catheterisation make a difference?

AbstractThe use of guidewires is well established in medical practice, but relatively new in nurse‐led catheterisation services (NCS). We investigate the incidence of difficult urethral catheterisation and whether guidewire‐assisted catheterisation reduces disrupted patient care. A retrospective Audit (September 2016‐August 2017) recorded incidence and management of difficult catheterisation in two NCS. In NCS‐A, nurses were familiar with improvised guidewire‐assisted catheterisation, whereas in NCS‐B nurses were not enabled and had to refer patients to urologists when they encountered problems. From September 2017 to August 2018, a National Institute for Health and Care Excellence (NICE)‐approved urethral catheterisation device with integrated guidewire (Urethrotech UCD) was used in NCS‐B for difficult urethral catheterisation. User and patient satisfaction was evaluated prospectively. Of 540 men attending NCS‐A for trial without catheter (TWOC), 31% (169/540) were recatheterized, of whom 4%(6/169) required a guidewire‐catheterisation technique to manage difficult catheterisation without problems. This was also done in 45 of 146 men attending for long‐term catheter change with known history of difficult catheter change. Of 1002 men attending NCS‐B for TWOC, 23% (226/1002) were recatheterized. This was difficult in 25% (57/226), of which 40% (23/57) suffered complications with bleeding from repeated catheterisation attempts and 10 men had to be admitted for specialist interventions to manage retention and catheterisation‐associated urethral injury. During the prospective audit, 945 men attended the TWOC‐clinic of NCS‐B. In 11% (13/120), the UCD was used for failed Foley‐catheterisation without complications. Patients and users were very satisfied because the difficult recatheterisation episode was managed successfully without patient harm and care delay. Difficult urethral catheterisation is a frequent occurrence in NCS with significant risk of urethral trauma. Catheterisation‐associated urethral injury can be prevented with guidewire‐assisted urethral catheterisation techniques. The NICE‐approved UCD with integrated guidewire was easy to use with high user and patient satisfaction avoiding patient care delay and is supporting nurses to manage difficult urethral catheterisation safely making efficient use of specialist resources.

Emotional factors and physical properties of ballpoint pens that affect user satisfaction: Implications for pen and stylus design

Many studies of ballpoint pens have been conducted. However, those studies have not considered the emotional factors that can enhance user experience. Styluses resemble ballpoint pens in many ways, which are widely available in a variety of styles. Therefore, in the present study, we explored the physical and emotional attributes that improve user satisfaction with typical ballpoint pens, with the goal of also understanding what factors might be important for stylus design. First, 14 emotional factors associated with the pens were derived. Second, 16 different types of ball-point pens were measured for six physical properties. Then, an experiment was performed to assess user satisfaction and emotional factors for pens. The House of Quality (HOQ) was used to obtain the chief physical properties. Results showed that to increase user satisfaction it is necessary to make pens be comfortable, fine, refined, deep, and natural. Also, we found that for high user satisfaction pens need to be heavier and longer, have thick and antislip grips and thin nibs, and their center of gravity should be located close to the nib to increase user satisfaction.

LEVEL OF USER SATISFACTION GRADUATES OF THE BUILDING ENGINEERING EDUCATION STUDY PROGRAM AT JAKARTA STATE UNIVERSITY IN THE NON EDUCATION FIELD

This research aims to determine the level of graduate user satisfaction with the performance graduates of the PTB FT UNJ Study Program in the non-educational field (construction services). This research was conducted in March to July 2019.
 
 This research was conducted to graduates of the PTB FT UNJ Study Program, the research method used was descriptive quantitative method, data collection techniques by distributing questionnaires / questionnaires to graduate users. The population in this research were 70 companies that became workplaces of 127 graduates working in the non-educational field. The sample in this research was 28 companies which were the workplaces of 37 graduates as engineers, estimators, and quantity surveyors assessed by 62 respondents both direct, indirect, and work partners of graduates.
 
 The results obtained from this research that the satisfaction of graduates in the ethical aspects of high, satisfaction in the aspect of expertise in the field of science is classified as moderate / sufficient, satisfaction in aspects of English proficiency is low / less, satisfaction of graduates in the aspects of technology & information is high, satisfaction in the aspect of communication ability classified as low / lacking, satisfaction in the aspect of teamwork is high and graduate user satisfaction in the aspect of self-development is classified as moderate / sufficient.

Design of Step-by-step teaching System for English Writing based on Cloud Network Technology

Aiming at the problems of low user satisfaction, low user interaction accuracy and high user help-seeking rate in the step-by-step teaching system of English writing designed by the present method, a step-by-step teaching system of English writing based on cloud network technology is proposed. In the functional module design part of the system, the foreground and background display modules of the system are designed. The front-end display module includes online question answering, video learning, data learning, etc. The back-end display module includes learning and data management, the design of step-by-step teaching website for English writing, online learning system and teaching mode. Through the design of functional modules and step-by-step teaching website of English writing, the design of step-by-step teaching system of English writing is finally completed. The experimental results show that the system designed by this method has higher user satisfaction, higher user interaction accuracy and lower user help-seeking rate.

Development and validation of the audio processor satisfaction questionnaire (APSQ) for hearing implant users

Objective: The satisfaction experienced with using an audio processor is very important to hearing implant system users. Currently there are no measures that can be used to assess user satisfaction with an audio processor. This study aims to develop and validate a specific and standardised questionnaire that focuses on user satisfaction with their audio processor.Design: A preliminary version of the questionnaire was initially developed by experts in the field. Following validation of these results, the final version of the Audio Processor Satisfaction Questionnaire (APSQ) was developed consisting of 15 items. Item analyses and questionnaire validation measurements were assessed.Study sample: Sixty-nine subjects were recruited and asked to complete the APSQ twice within 2–4 weeks.Results: Subjects reported a high user satisfaction with the questionnaire and with their audio processor. The questionnaire had good reliability and results for test-retest reliability were high and significant across all items and across subscale analyses.Conclusion: Item analyses and reliability analyses show that the questionnaire is a valid and reliable tool to assess user satisfaction across different audio processors and hearing implant systems. The APSQ is a quick and easy tool to measure user satisfaction with their audio processor.

Using fuzzy set qualitative comparative analysis for evaluating the effectiveness of relationship marketing and innovation in 3D printing medical market

This study aims to explore the configurations of potential relevant antecedents in 3D printing medical Market for achieving high user satisfaction from both the suppliers’ and users’ perspectives. The important antecedents in this study include relationship marketing, innovation, 3D printing perceived values, and 3D printing perceived risk. Firstly, this study investigates the relationships among potential relevant antecedents and user satisfaction. Furthermore, to explore the gap between users’ evaluation and innovation suppliers’ perception, this study addresses this issue based on both perspectives of suppliers and buyers. To assess the applicability of the proposed model, we employed questionnaires survey and collected primary data from 3D printing suppliers and their customers. Moreover, the fuzzy set qualitative comparative analysis (fsQCA) approach has been applied for evaluating the effectiveness of relationship marketing and innovation in 3D printing medical market. Finally, the numerical results indicate that there is one causal configuration (i.e., 1A) found to be sufficient for high user satisfaction for the perspectives of 3D printing suppliers and three configurations for the perspectives of 3D printing customers. In the perspectives of 3D printing suppliers, the combination of relationship marketing, innovation, and 3D printing perceived value is sufficient conditions causing high user satisfaction. However, there are three causal configurations (i.e., 1B, 2B, and 3B) found to be sufficient for high user satisfaction for the perspectives of 3D printing customers.

Design and Validation of Education Multimedia Program for Patients With Fecal Diversions: A Quality Improvement Project to Enhance Self-Care.

The purpose of this quality improvement project was to design and validate a multimedia educational software program for patients with fecal diversions. Ten individuals who had fecal diversion surgery and 10 experts including nurses, physicians, nutritionists, and information technologists from Imam Khomeini and Rasule Akram Hospitals, Tehran, Iran, the 2 main centers in which fecal diversion surgery took place, were included in the study. The multimedia educational software for patients with ostomy was developed in 3 phases including development and creation, validity, and modification of the software. Data for phase 1 were collected using 2 questionnaires, the Multimedia Survey Questionnaire for Clients and the Multimedia Survey Questionnaire for Experts, and several open-ended questions to further determine the content and face validity of the multimedia content for the education prototype. The mean ± standard deviation [SD] of multimedia evaluation by the 10 patients was 60 ± 3.27, indicating high user satisfaction. The mean ± SD of multimedia evaluation by the 10 experts was 171.1 ± 19.2, suggesting the content was of high quality. Content and face validity were reported to be 0.91 and 0.96, respectively. The program was then created and called "Self-Care of Ostomy," which consisted of 8 computer-based modules with 22 short videos and slide presentations available for viewing by patients with newly created ostomies. This multimedia program can provide patients with simple, portable, understandable, objective, user-friendly information about ostomy care. Future studies should address the effectiveness of ostomy management among patients, families, and care providers.

An Optimal Scheduling and Distributed Pricing Mechanism for Multi-Region Electric Vehicle Charging in Smart Grid

Despite the universal importance of price based demand response (DR) for managing electric vehicle (EV) charging load, the academic literature has explored various mechanisms to its implementation. The prequel to this work has demonstrated that implementation of load management schemes on the basis of price based DR programs leads to costlier scheduling for low or constant energy consumers. In this regard, the proposed work has considered and expanded the same idea from analytical as well as implementation point of view to multiple EV charging regions and respective loads. We present a novel mechanism to calculate EV charging prices using individualized energy consumption patterns of EVs in each region. In this regard, all EV regions/stations receive a dynamic price signal which is non-discriminatory in nature. The dynamic price signals are specifically designed to mitigate the impact of discriminatory prices on end user’s cost. Furthermore, the other objectives of these non-discriminatory prices are to lower energy cost and rebound peaks without affecting utility objective (i.e., net revenue). Initially, a new mathematical model is presented to calculate charging prices based on real time load demand and market dynamics. Then relatively a well behaved functional form of the optimization problem is formulated and the cost minimization objective function is solved by using genetic algorithm (GA). The optimization program successfully converges to give global optimum solution validating the effectiveness of proposed mechanism. Finally, the analytical and simulation results are conducted to show the achievements of our proposed work in terms of fair cost distribution with high user satisfaction. It is also proved that in both mechanisms, the utility’s revenue remains unaffected.

A Diverse and Personalized POI Recommendation Approach by Integrating Geo-Social Embedding Relations

User-POI rating matrix is one of the current research hotspot of POI recommendation algorithms, the goal of which is to obtain the POIs with the highest user satisfaction. However, most existing POI recommendation algorithms ignore the diversity of recommended POI list, and the POIs in the recommended list are usually similar to each other, which cannot effectively broad the user’s perspectives. To solve this problem, a diverse and personalized recommendation method EBPRMF (Embedded Bayesian Personalized Ranking Matrix Factorization) that integrates the embedded features of the geographic-social relationships of POIs is proposed. First, by embedding and compressing the geographic and social relationships between POIs, a geographic-social relationship embedding model is constructed to evaluate the coupled correlation between POIs. The correlation between all POIs forms a POI correlation matrix. And then the spectral clustering method is leveraged to cluster the POIs according to the correlation matrix, and several different POI clusters can be obtained. Next, the Bayesian personalized ranking matrix factorization model is proposed to select POI that is close to the user’s preference from each cluster, and finally a recommendation list of POIs that is both diverse and personalized is obtained. Experimental results demonstrate that the geographic-social relationship embedding model can well represent the location and social relationship between POIs, and has a good clustering effect. The diversity of recommendation list is high, and the sorted list can be well satisfied with user preferences.

Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator

Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator. A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion-tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device-derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure. A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity. A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.

Quality of websites about long-acting reversible contraception: a descriptive cross-sectional study

BackgroundToday, there are various short- and long-acting contraceptive alternatives available for those who wish to prevent unintended pregnancy. Long-acting reversible contraception are considered effective methods with a high user satisfaction. High-quality information about contraception is essential in order to empower individuals to reach informed decisions based on sufficient knowledge. Use of the Web for information about contraception is widespread, and there is a risk that those who use it for this purpose could come in contact with sources of low quality.ObjectiveThe overarching aim was to investigate the quality of websites about long-acting reversible contraception.MethodsSwedish client-oriented websites were identified through searches in Google (n = 46 included websites). Reliability and information about long-acting reversible contraceptive choices were assessed by two assessors with the DISCERN instrument, transparency was analyzed with the Journal of the American Medical Association benchmarks, completeness was assessed with inductive content analysis and readability was analyzed with Readability Index.ResultsThe mean DISCERN was 44.1/80 (SD 7.7) for total score, 19.7/40 (SD 3.7) for reliability, 22.1/35 (SD 4.1) for information about long-acting reversible contraceptive choices, and 2.3/5 (SD 1.1) for overall quality. A majority of the included websites had low quality with regard to what sources were used to compile the information (n = 41/46, 89%), when the information was produced (n = 40/46, 87%), and if it provided additional sources of support and information (n = 30/46, 65%). Less than half of the websites adhered to any of the JAMA benchmarks. We identified 23 categories of comprehensiveness. The most frequent was contraceptive mechanism (n = 39/46, 85%) and the least frequent was when contraception may be initiated following an abortion (n = 3/46, 7%). The mean Readability Index was 42.5 (SD 6.3, Range 29–55) indicating moderate to difficult readability levels, corresponding to a grade level of 9.ConclusionsThe quality of client-oriented websites about long-acting reversible contraception is poor. There is an undeniable need to support and guide laypersons that intend to use web-based sources about contraceptive alternatives, so that they may reach informed decisions based on sufficient knowledge.

Heritage retrofit and cultural empathy; a discussion of challenges regarding the energy performance of historic UK timber-framed dwellings

PurposeThe energy retrofit of the existing building stock, and specifically the thermal upgrading of the buildings’ envelopes, has been identified as a key action for both the decarbonisation of the built environment and the reduction in fuel poverty. When considering the energy retrofit of heritage buildings it is, however, important to recognise both the technical issues that this entails and the potential impact on their cultural value and the emotional responses to it. The purpose of this paper is to focus on the thermal upgrading of historic timber-framed buildings in the UK.Design/methodology/approachThe paper begins by exploring the cultural significance of this form of building construction, before examining three case studies using both quantitative and qualitative methodologies.FindingsThe results show that whilst the application of energy retrofit actions to this emblematic typology may have limited success, the emotional connection of the buildings’ occupants often results in the work resulting in higher user satisfaction than would otherwise be expected.Research limitations/implicationsAlthough limited in number, the three case studies provide an insight into the complex issues surrounding the low energy retrofit of historic timber-framed buildings. Further research into this area is encouraged.Practical implicationsThe paper contains the monitoring of specific retrofit details, the results of which should inform future projects.Social implicationsThe review of the cultural significance of historic timber-frame buildings in the UK underlines the importance of the conservation and continuing survival of these buildings.Originality/valuePrevious heritage retrofit research in the UK has focussed on solid wall construction with little investigation into the issues surrounding the retrofit of historic timber-frame buildings. This paper explores this previously under-researched area. Additionally, this paper begins to explore the possible links between occupants’ emotional connection to historic buildings and their perceived levels of comfort.

I see, you design: user interface intelligent design system with eye tracking and interactive genetic algorithm

User interfaces are important for streamlining the interactions between humans and computers. However, there are few effective approaches for collecting users’ preferences implicitly and objectively for the purpose of user interface (UI) design optimization. This paper presents an effective approach to interactive genetic algorithm (IGA) optimization-based UI design via eye tracking, including eye-movement data based users’ preference inferring, gene coding for real UI components and design features, and the visualization and interaction mechanisms. Then we design and build a prototype system that applies IGA to generate and optimize music player UI solutions automatically. An evaluation of our prototype system suggests that it can generate and identify personalized UI designs reliably with minimal user intervention and high efficiency and user satisfaction.

419. Initial Evaluation of Engagement and Utilization of the National Sexually Transmitted Diseases Curriculum

BackgroundThe National Sexually Transmitted Diseases Curriculum (NSTDC) is an online, guideline-based, interactive curriculum developed at the University of Washington in Seattle with funding from the Centers for Disease Control and Prevention (CDC) National Network of STD Clinical Prevention Training Centers (NNPTC). The NSTDC has dual-functionality to provide users with the option of engaging in (1) sequential, longitudinal learning and/or (2) quick access to specific content. We describe the first evaluation of the reach, utilization and effectiveness of the NSTDC.MethodsWe evaluated user data collected from survey completion, Google Analytics, and the Health Professional Application for Training (HPAT) between the launch of NSTDC in February 1, 2017 through August 31, 2018. Chi-square and ANOVA tests were used to determine significant differences between prescribers, nurses, and non-clinicians.Resultsmonth period and 54,910 hours of CE awarded. Registered users were mostly women (16,133, 84%), and 8,476 (44%) were registered nurses, with an additional 6,052 (34%) prescribing providers (physicians, nurse practitioners, physician assistants, and dentists). The most common programmatic focus was primary care (4,886, 25%). While 18,175 (95%) of users were in the United States, users were located around the world (Figure 1). Referral patterns differed significantly by occupation (Figure 2). Users engaged deeply with the curriculum. Average site session time was 28 minutes for registered users and 14 minutes for all users. Registered users completed an average of 4.37 out of 7 total modules. Nurses were more likely to complete all modules, (48% vs. 34% of prescribers and 30% of non-clinicians, P < 0.0001). Over 15,000 users answered at least one optional check-on-learning (COL) question. On average, 77% of COL questions were answered in modules where COL questions were initiated. Over 60% of the users found the content and experience highly satisfying. Overall 39% of users intended to change practice following completion of the modules.ConclusionThe NSTDC has a broad reach, leads to high user engagement and satisfaction, and fosters intent to change practice. This web-based curriculum is a novel and effective strategy to disseminate recommendations from CDC Guidelines. Disclosures All authors: No reported disclosures.

Design and realisation of the Passive House concept in different climate zones

The term Passive House refers to a performance-based energy standard for high-efficiency buildings. It is clearly defined, with validity for all climates of the world. Under cold climate conditions, the design typically focuses on minimising heat losses and optimising solar gains. In milder climates, moderate insulation, including improved window qualities, is sufficient, but on the other hand, the building performance during summer requires more careful consideration. For hotter climates, the insulation requirements increase again, and solar loads through windows, walls and roofs must be limited. In hot and humid climates, humidity loads are also minimised or reduced. In practical implementation, every Passive House has its own, specific boundary conditions which lead to different constructions and technical solutions to fulfil the stringent requirements of the Passive House standard. The paper briefly introduces Passive House design principles and criteria. Then, nine examples for passive houses in climates of Canada, the USA, Germany, China, Greece, Spain, Taiwan, Mexico and the United Arab Emirates illustrate the bandwidth of possible solutions. For many projects, practical experiences are available, which typically reveal high user satisfaction and energy consumptions close to what would be expected from the design calculations. In some cases, a potential for further improvements is described.

Text message reminders to improve infant immunization in Guatemala: A randomized clinical trial

ObjectiveMillions of infants worldwide remain under-immunized and at risk for unnecessary morbidity and mortality. Text messaging may offer a low-cost solution. We aimed to evaluate text message reminders to improve infant immunization in Guatemala. MethodsA randomized clinical trial was conducted at four public health clinics in rural and urban Guatemala. Infants ages six weeks to six months presenting for the first visit of the primary immunization series were randomly and equally allocated to an intervention or usual care group. Intervention participants were sent three text reminders before the second and third vaccine visits. The main outcome was timeliness of the second and third visits of the primary immunization series. ResultsOf 1088 families approached for enrollment between March to November 2016, 871 were eligible and 720 (82.7%) participated; only 54 families did not own a cell phone. Due to country-wide vaccine shortages, visit completion was used as a proxy for overall immunization coverage. In intention to treat analysis, both intervention and usual care groups had high rates of visit completion, but intervention participants presented on the scheduled date more often (151 [42.2%] of 358 intervention vs. 111 [30.7%] of 362 usual care participants for visit 2, p = 0.001, and 112 [34.0%] of 329 intervention vs. 90 [27.0%] of 333 usual care participants for visit 3, p = 0.05). Intervention caregivers were significantly more likely to want to receive future text message reminders for vaccines and other appointments and were more willing to pay for these reminders. ConclusionCaregivers who were sent text message reminders in urban and rural Guatemala were less delayed for their child’s immunization visits and reported high user satisfaction. Text message reminders may be an effective tool to increase infant vaccination coverage in low-income settings by reminding parents to vaccinate.Trial Registration: NCT02567006 at clinicaltrials.gov.

An Integrated Kidney Care eConsult Practice Model: Results from the iKinect Project

Background: Collaborative management of kidney disease relies on coordinated and effective partnerships between multiple provider teams. Siloed care contributes to limited access between physicians, resulting in delays in the diagnosis and treatment of kidney disease and inappropriate use of healthcare resources. These gaps contribute to dissatisfied and disempowered providers and patients. Digital systems such as eConsult can support collaborative management and address these gaps, thereby streamlining the consultation and referral process between primary care physicians (PCPs) and nephrologists. In this study, we evaluated an established eConsult platform integrated with a central triage process for a network of PCPs and nephrologists. The study aimed to assess the acceptability, feasibility, and impact on access to nephrology when using eConsult integrated into the management of kidney disease between PCPs and nephrologists. Methods: We conducted a 1-year pilot study and used mixed methods to measure the acceptability and feasibility of using eConsult for the management of kidney disease. We compared eConsult and traditional referrals with respect to types of consultation, referrals, and times to response to determine impact on access to kidney care. We conducted semi-structured interviews of PCPs and nephrologists to assess physician experience. Results: From January 8, 2018, to January 11, 2019, 52 PCPs and 23 nephrologists participated in the study, with 250 traditional referrals and 106 eConsults submitted during that period. The median response time for eConsult was 15 (3–64) h, with 25% originating outside the central Toronto region. The median time to first clinic appointment from a traditional referral was 4 months (111 [61–163] days). PCP and nephrologist interviews revealed high user satisfaction, citing efficiency and timely response as key facilitators. Conclusion: The eConsult platform was acceptable, feasible, and facilitated access to nephrology care compared to traditional referrals. Physicians report improvements in physician care delivery, nephrology care gaps, patient experience, and healthcare utilization.

Music Recommendation System Using Human Activity Recognition From Accelerometer Data

Music listening is a very personal and situational behavior for modern people who always carry smartphones in everyday life. Therefore, contextual information, such as user’s current activity and mood state could be used to greatly improve music recommendations. In this paper, we develop a smartphone-based mobile system that includes two core modules for recognizing human activities and then accordingly recommending music. In the proposed method, a deep residual bidirectional gated recurrent neural network is applied to obtain high activity recognition accuracy from accelerometer signals on the smartphone. In order to improve the performance of tempo-oriented music classification, an ensemble of dynamic classification using a long-term modulation spectrum and sequence classification using a short-term spectrogram is used. Music recommendation is performed using the relationship between the recognized human activities and the music files indexed by tempo-oriented music classification that reflects user preference models in order to achieve high user satisfaction. The results of comprehensive experiments on real data confirm the accuracy of the proposed activity-aware music recommendation framework.

Protecting healing relationships in the age of electronic health records: report from an international conference

We present findings of an international conference of diverse participants exploring the influence of electronic health records (EHRs) on the patient–practitioner relationship. Attendees united around a belief in the primacy of this relationship and the importance of undistracted attention. They explored administrative, regulatory, and financial requirements that have guided United States (US) EHR design and challenged patient-care documentation, usability, user satisfaction, interconnectivity, and data sharing. The United States experience was contrasted with those of other nations, many of which have prioritized patient-care documentation rather than billing requirements and experienced high user satisfaction. Conference participants examined educational methods to teach diverse learners effective patient-centered EHR use, including alternative models of care delivery and documentation, and explored novel ways to involve patients as healthcare partners like health-data uploading, chart co-creation, shared practitioner notes, applications, and telehealth. Future best practices must preserve human relationships, while building an effective patient–practitioner (or team)-EHR triad.

AutoTune: Game-Based Adaptive Bitrate Streaming in Cloud-Based Hybrid VoD Systems

Hybrid peer-to-peer assisted cloud-based video-on-demand (VoD) systems augment cloud-based VoD systems with P2P networks to improve scalability and save bandwidth costs in the cloud. In these systems, the VoD service provider (e.g., NetFlix) relies on the cloud to deliver videos to users and pays for the cloud bandwidth consumption. The users can download videos from both the cloud and peers in the P2P network. It is important for the VoD service provider to i) minimize the cloud bandwidth consumption, and ii) guarantee users’ satisfaction (i.e., quality-of-experience). Though previous adaptive bitrate streaming (ABR) methods improve video playback smoothness, they cannot achieve these two goals simultaneously. To tackle this challenge, we propose AutoTune, a game-based adaptive bitrate streaming method. In AutoTune, we formulate the bitrate adaptation problem in ABR as a noncooperative Stackelberg game, where VoD service provider and the users are players. The VoD service provider acts as a leader and it decides the VoD service price for users with the objective of minimizing cloud bandwidth consumption while ensuring users’ participation. In response to the VoD service price, the users select video bitrates that lead to maximum utility (defined as a function of its satisfaction minus associated VoD service fee). Finally, the Stackelberg equilibrium is reached in which the cloud bandwidth consumption is minimized while users are satisfied with selected video bitrates. To enhance the performance of AutoTune, we further propose the reputation-based incentive scheme and the popularity-based cache management scheme. Experimental results from the PeerSim simulator and the PlanetLab real-world testbed show that compared to existing methods, AutoTune can provide high user satisfaction and save cloud bandwidth consumption. Also, the proposed enhancement schemes are effective in improving the performance of AutoTune.