Development and Testing of the Smart Healthcare Prototype System through COVID-19 Patient Innovation.

Since the outbreak of the novel coronavirus disease 2019 (COVID-19), the epidemic has gradually slowed down in various countries and people's lives have gradually returned to normal. To monitor the spread of the epidemic, studies discussing the design of related healthcare information systems have been increasing recently. However, these studies might not consider the aspect of user-centric design when developing healthcare information systems. This study examined these innovative technology applications and rapidly built prototype systems for smart healthcare through a systematic literature review and a study of patient innovation. The design guidelines for the Smart Healthcare System (SHS) were then compiled through an expert review process. This will provide a reference for future research and similar healthcare information system development.

Patients with obstructive sleep apnea are at great risk of flavor disorders: a 15-year population-based cohort study.

OBJECTIVE: Obstructive sleep apnea (OSA) results from upper airway remodeling, which has been suggested to alter sensory and motor neuron function due to hypoxia or snore vibration. This study investigated whether OSA was associated with the risk of flavor disorder (FD). MATERIALS AND METHODS: Seven thousand and eight hundred sixty-five patients with OSA and 7865 propensity score-matched controls without OSA were enrolled between 1999 and 2013 through a nationwide cohort study. The propensity score matching was based on age, sex, comorbidities including hypertension, hyperlipidemia, chronic obstructive pulmonary disease (COPD), asthma, ankylosing spondylitis, and Charlson comorbidity index, and co-medications during the study period, including statins and angiotensin-converting enzyme (ACE) inhibitors. The adjusted hazard ratio (aHR) of incident FD following OSA was derived using a Cox proportional hazard model. A log-rank test was used to evaluate the time-dependent effect of OSA on FD. Age, sex, comorbidities, and co-medications were stratified to identify subgroups susceptible to OSA-associated FD. RESULTS: Patients with OSA were at a significantly great risk of FD (aHR = 1.91, 95% CI = 1.08-3.38), which was time-dependent (log-rank test p = 0.013). Likewise, patients with hyperlipidemia were at a significant great risk of FD (aHR = 2.99, 95% CI = 1.33-6.69). Subgroup analysis revealed that female patients with OSA were at higher risks of FD (aHR = 2.39, 95%CI = 1.05-5.47). CONCLUSIONS: Patients with OSA were at significantly great risk of incident FD during the 15-year follow-up period, especially in female patients with OSA. CLINICAL RELEVANCE: Timely interventions for OSA may prevent OSA-associated FD.

Voice Assessment in Patients With Obstructive Sleep Apnea Syndrome After Transoral Robotic Surgery.

Objectives: Removal of part of the tongue base, in combination with uvulopharyngopalatoplasty via transoral robotic surgery (TORS), for treating obstructive sleep apnea syndrome (OSAS) results in enlargement of the oropharynx and hypopharynx and change in the size of the resonance chamber. These procedures may also alter the laryngeal-hyoid bone complex, which is linked to vocal fold tension. Thus, there is the potential for change in phonation and pitch after surgery. Study Design: Prospective, nonrandomized, institutional board-approved study. Methods: From January to August 2018, 15 patients with OSAS receiving TORS underwent voice and pitch sampling. The multi-dimensional voice program (MDVP) was applied to the evaluation of preoperative sound parameters. Highest pitch and lowest pitch were obtained with real-time pitch software, with pitch synchronized to electronic organ or tuner. Subjects also completed the Voice Handicap Index-10 scale (VHI-10), to assess their subjective perception and to detect factors affecting the VHI-10 score. The relevant parameters were analyzed again 3 months after the operation. Results: There was an increase in VHI-10 score 3 months after operation that did not reach statistical significance. There were also no significant differences in sound parameters. Increases in highest pitch (353.18 Hz shift to 387.99 Hz), highest semitone ( F 5 # shift to F 5 # ), lowest pitch (117.45 Hz shift to 131.42 Hz), and lowest semitone (C3 shift to C3) did not reach statistical significance. The increase in the lowest semitone was significantly related to change in VHI-10 score (r = -0.808, P = 0.028). Conclusion: Patients with OSA undergoing TORS showed a negative correlation coefficient over 0.8 with change in VHI-10 score. That is, increase in the lowest semitone after operation correlated with increase in VHI-10 score which may cause perceive changes in subjective pronunciation.

Nurse anesthetist training Center on IFNA standards in Mainland China.

AIM: The first training center for nurse anesthetists in Jiangsu Province, China was established. The aim of this study is to understand the status of and effectiveness of a training program based on International Federation of Nurse Anesthetists (IFNA) standards for nurse anesthetists in China. BACKGROUND: China recently issued a clear policy to improve the quality of anesthesia care and to ensure the safety and comfort of patients. As a result, the roles of nurse anesthetists have received more attention, highlighting the importance of the development and implementation of relevant training. INTRODUCTION: IFNA standards were applied to the development of a specialized training program for nurse anesthetists, which is expected to serve as a reference for various medical institutions and to lead to increased uniformity and improvement in the quality and efficiency of care. METHODS: These standards are divided into two indicators: curriculum and core competencies. Through questionnaires, course evaluations, and satisfaction surveys before and after the implementation of the training program, the effectiveness of the training program was analyzed. RESULTS: Theoretical assessment of the program was higher after its completion than before and the core competencies of nurse anesthetists significantly improved. Overall, the curriculum was highly satisfactory and important. DISCUSSION: Curriculum design was based on IFNA standards. Nurse anesthetists who are trained in a systematic way can work better with other professionals in providing anesthesia care. The objectives are to improve anesthesia care, reduce errors, improve physician satisfaction, and allow nurse anesthetists to realize their value. Overall, quality of anesthesia care improved after implementation of IFNA-standard training.

Ankylosing Spondylitis Is Associated With Risk of New-Onset Obstructive Sleep Apnea: A Nationwide Population-Based Cohort Study.

Objectives: Investigating the risk of obstructive sleep apnea(OSA) among ankylosing spondylitis (AS) patients based on administrative healthcare databases. Methods: We conducted a nationwide cohort study by using the Taiwan National Health Insurance Research Database with 1997-2013 claim records. The AS cohort included 2,210 patients who were newly diagnosed between 2003 and 2013. Randomly selected non-AS controls were matched at a 1:4 ratio. The endpoint was set as OSA occurrence or the end of 2013. Cumulative incidences, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated after adjusting for age, gender, comorbidities, and co-medication. Multivariate analyses were performed using the Cox proportional hazards model. Due to the violation of the proportionality assumption, landmark analysis was conducted to explore the risk of OSA during specific follow-up periods. Results: The adjusted HR (aHR) of OSA in the AS group was 2.826 (95% C.I. = 1.727-4.625) compared to the control group. On landmark analysis, aHR was 7.919 (95% C.I. = 3.169-19.792) for the AS group 0-24 months from the index date and decreased to 1.816 (95% C.I. = 0.944-3.494) at ≥ 24 months from the index date. The increased risks of OSA in the AS group compared to the control group were found for both males and females (aHRs were 4.533 and 2.672). On age-stratified analysis, a significant risk only for the 40-59 age group with aHR of 3.913 (95% C.I. = 1.890-8.102). Conclusions: A higher risk of developing OSA was found among newly diagnosed AS cohort during the maximum 11-year follow-up period, especially within 2 years after newly diagnosed AS and in the 40-59 age group.

The in vitro anti-herpes simplex virus type-1 and type-2 activity of Long Dan Xie Gan Tan, a prescription of traditional Chinese medicine.

BACKGROUND: Long Dan Xie Gan Tan (LDXGT), a decoction of radix gentianae for purging the pathogenic inflammation of the liver, is a widely used prescription among many in traditional Chinese medicine. The prescription is primarily used to treat the disorders induced by damp-heat in the liver and the gall bladder. METHODS: In this study, the in vitro anti-herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2) activity of the water extract of LDXGT was investigated. RESULTS: LDXGT water extract was shown to exhibit anti-HSV activity. The IC(50) values of LDXGT against HSV-1 and HSV-2 infections were 257.5 +/- 12.2 and 494.6 +/- 1.8 microg/ml, respectively. It had a CC(50) value of 4,077.2 +/- 2.4 microg/ml towards Vero cells and showed no cytotoxic effect at a concentration of 2,000 microg/ml or below. The prescription was also found to inactivate HSV-2 infectivity in a dose-, time- and temperature-dependent manner. CONCLUSIONS: In summary, the water extract of LDXGT was concluded to inhibit HSV-1 and HSV-2 infection at different magnitudes of potency, and our observations also suggested that the effect was likely mediated by directly inactivating the virus infectivity.

Yin Chen Hao Tang, a Chinese prescription, inhibits both herpes simplex virus type-1 and type-2 infections in vitro.

Yin Chen Hao Tang (YCHT) is one of the most frequently used prescriptions in the long history of traditional Chinese medicine practice. The prescription contains three Chinese herbs, namely Artemisia capillaries Thunb. (Compositae), Rheum officinale Baillon (Polygonaceae), and Gardenia jasminoids Ellis (Rubiaceae), and has been widely used to treat acute hepatitis with jaundice. In this study, the in vitro anti-HSV-1 and HSV-2 activities of the water extract of YCHT were investigated. Results showed that YCHT water extract inhibited both HSV-1 and HSV-2 infections. However, the inhibition was more effective against HSV-2 than against HSV-1. The IC(50) and IC(90) values of YCHT water extract against HSV-1 infection were in the range of 142.5-150.1 and 191.3-393.9 microg/ml, and against HSV-2 infection they were in the range of 19.6-29.4 and 42.2-97.7 microg/ml, respectively. The water extract of YCHT showed no cytotoxic effect at a concentration of 500 microg/ml or below, and had a CC(50) value of 850.7+/-1.7 microg/ml. The prescription was found to diminish HSV-2 infectivity in a dose-dependent manner, and the activity was influenced by the incubation periods and the incubation temperatures. Concurrent addition of virus with YCHT or pre-treatment of the virus with the prescription extract both protected the cells from infection. In summary, the water extract of YCHT was concluded to inhibit infections by HSV-1 and HSV-2 and this effect was likely mediated through direct inactivation of the virus infectivity.