Automatic Speech Recognition System to Record Progress Notes in a Mobile EHR: A Pilot Study.

Creating notes in the EHR is one of the most problematic aspects for health professionals. The main challenges are the time spent on this task and the quality of the records. Automatic speech recognition technologies aim to facilitate clinical documentation for users, optimizing their workflow. In our hospital, we internally developed an automatic speech recognition system (ASR) to record progress notes in a mobile EHR. The objective of this article is to describe the pilot study carried out to evaluate the implementation of ASR to record progress notes in a mobile EHR application. As a result, the specialty that used ASR the most was Home Medicine. The lack of access to a computer at the time of care and the need to perform short and fast evolutions were the main reasons for users to use the system.

Development of an ASR System for Medical Conversations.

In this work we document the development of an ASR system for the transcription of conversations between patient and doctor and we will point out the critical aspects of the domain. The system was trained with an acoustic base of spontaneous speech that has a domain language model and a supervised phonetic dictionary. Its performance was compared with two systems: a) NeMo End-to-End Conformers in Spanish and b) Google API ASR (Automatic Speech Recognition) Cloud. The evaluation was carried out on a set of 208 teleconsultations recorded during the year 2020. The WER (Word Error Rate) was evaluated in ASR, and Recall and F1 for recognized medical entities. In conclusion, the developed system performed better, reaching 72.5% accuracy in the domain of teleconsultations and an F1 for entity recognition of 0.80.

[Cognitive profile in hypertensive patients. Usefulness of the Clock Drawing Test]. / Perfiles cognitivos en pacientes hipertensos. Utilidad del test del reloj.

INTRODUCTION: Hypertension is the main cause of cognitive impairment and the executive dysfunction the most com- mon cognitive domain affected. The aims of this research have been to characterize the cognitive profiles (s) in hypertensive patients and to identify the most usefulness Test (s) in the routine clinical practice to identify them. METHODS: We assessed the cognitive status in 69 hypertensive patients who were administered a battery of cognitive Tests that included the MMSE, the Mini-Boston Naming Test, verbal fluency and the Clock drawing Test. RESULTS: The average of the sample was 72.2±10.1 years. The Clock-drawing Test and the Mini-Boston Naming Test differentiated 3 cognitive profiles: no cognitive impairment, minor cognitive disorder and major cognitive disorder. A strong association was observed between the semantic (0.87) and executive (0.75) components of the Clock-drawing Test with the Mini-Boston Naming Test (0.96). The analysis of clusters and switchings in the verbal fluency Test differentiated the severe forms of cognitive impairment. CONCLUSION: The results obtained confirm the value of the Clock-drawing Test to identify the different cognitive profiles in hypertensive patients, becoming a valid screening test to be used in routine clinical practice and a potential biomarker of cognitive dysfunction in hypertensive patients.

Preventive measures for COVID­19 among dental students and dentists during the mandatory social isolation in Latin America and the Caribbean in 2020.

BACKGROUND: Dentistry is one of the professions that are most exposed to the contagion with coronavirus disease 2019 (COVID­19). However, the prevalence and positivity rates of COVID­19 are low in dentists, indicating that the current measures of infection control may be sufficient to prevent infection in dental settings. OBJECTIVES: The aim of the study was to determine whether the preventive measures for COVID­19 during the mandatory social isolation were followed by dental students and dentists in Latin America and the Caribbean in 2020. MATERIAL AND METHODS: A cross­sectional study was conducted using anonymous virtual surveys in a convenience sample of 2,036 dental students and dentists from 21 Latin American and Caribbean coun­ tries. The variables were the preventive measures for COVID­19 and the sociodemographic characteristics. Descriptive and bivariate analyses were performed. RESULTS: The final sample included 2,036 dental students and dentists. The self­perceived level of know­ ledge about COVID­19 was found to be associated with age, sex, body mass index (BMI), the type of aca­ demic training, having a specialty in the case of professionals, the place of origin, and having met someone with COVID­19 (p < 0.05). The self­perceived level of concern regarding COVID­19 was associated with sex, BMI and having met someone with COVID­19 (p < 0.05). The number of days in the mandatory social isolation was associated with age, the type of academic training, having a specialty, the place of origin, and having met someone with COVID­19 (p < 0.05). The confinement level was associated with age, sex, BMI, the type of academic training, and having met someone with COVID­19 (p < 0.05). Following the preven­ tive measures for COVID­19 was associated with age, the type of academic training, having a specialty, the place of origin, and having met someone with COVID­19 (p < 0.05). The use of face masks, hand washing and social distancing were associated with age, BMI, the type of academic training, the place of origin, and having met someone with COVID­19 (p < 0.05). CONCLUSIONS: Dental students and dentists followed the preventive measures for COVID­19 during the mandatory social isolation period in Latin America and the Caribbean in 2020.

[Cognitive impairment during the COVID-19- social isolation period]. / Restricción cognitiva durante la cuarentena por COVID-19.

The COVID-19 social isolation period entailed changes in daily habits and routines, testing the adjustment abilities of the population to address unusual situations. Given that the activities of daily living require a normally functioning cognitive system, the study of cognitive-functional interaction under social isolation is relevant. The object of this work was to obtain information on the cognitive-functional impact of social isolation, analyze the changes induced in daily routines and habits, and assess the cognitive adjustment of the adult population to the isolation requirements. We carried out an online adult population survey, that combined multiple choice or binary questions following a Likert ordinal scale, performing a percentage analysis as well as a principal component analysis of the results. We surveyed 1095 subjects, 68% of which were residents of the Buenos Aires Metropolitan Area (AMBA), of an average age of 52.7 ± 12.8 years, and 15.6 ± 2.2 years of education. All age groups reported attention and memory impairment, more significant in lower age groups and women. The principal component analysis showed an associated correlation of the functional challenge brought about by social isolation on the executive system, with the negative impact on cognitive functions such as attention and memory. Social isolation significantly impacted on the attentional, mnesic and executive cognitive systems, ratifying the role of cognitive abilities in the generation of means and strategies to overcome unusual situations, and highlighting the importance of cognitive-functional interaction.

El período de aislamiento social por COVID-19 generó cambios en los hábitos y rutinas, poniendo a prueba capacidades adaptativas para resolver situaciones infrecuentes. Dado que el sistema cognitivo es el sustrato de las actividades funcionales cotidianas, nuestro objetivo fue conocer el impacto cognitivofuncional del aislamiento, obtener información acerca de los cambios de hábitos y rutinas diarias y evaluar la modalidad de adaptación de la población adulta a la cuarentena. En el marco del Instituto de Salud Pública y Medicina Preventiva de la UBA, realizamos una encuesta online donde se incluyeron preguntas con respuesta de elección según escala ordinal Likert, de tipo binario y de elección múltiple. Se realizó un análisis porcentual de los resultados y un análisis de componentes principales. Encuestamos 1095 sujetos, el 68% fueron residentes en el Área metropolitana de Buenos Aires, edad 52.7 ± 12.8 años y 15.6 ± 2.2 años de instrucción. Todos los grupos de edad refirieron empeoramiento de la atención y memoria, siendo más significativo en las franjas de menor edad y en el género femenino. El análisis de componentes principales mostró una correlación asociada al efecto negativo de factores cognitivos previos como la memoria y la atención con la dificultad durante la cuarentena en el dominio ejecutivo. El aislamiento social impactó en el sistema atencional, mnésico y de funciones ejecutivas. Resultó corroborado el importante rol de las capacidades cognitivas en la generación de recursos y la aplicación de estrategias para adaptarse a situaciones poco habituales, poniendo de manifiesto la interacción cognitivo-funcional.

Restricción cognitiva durante la cuarentena por COVID-19 / Cognitive impairment during the COVID-19- social isolation period

Resumen El período de aislamiento social por COVID-19 generó cambios en los hábitos y rutinas, poniendo a prueba capacidades adaptativas para resolver situaciones infrecuentes. Dado que el sistema cog nitivo es el sustrato de las actividades funcionales cotidianas, nuestro objetivo fue conocer el impacto cognitivo-funcional del aislamiento, obtener información acerca de los cambios de hábitos y rutinas diarias y evaluar la modalidad de adaptación de la población adulta a la cuarentena. En el marco del Instituto de Salud Pública y Medicina Preventiva de la UBA, realizamos una encuesta online donde se incluyeron preguntas con respuesta de elección según escala ordinal Likert, de tipo binario y de elección múltiple. Se realizó un análisis porcentual de los resultados y un análisis de componentes principales. Encuestamos 1095 sujetos, el 68% fueron residentes en el Área metropolitana de Buenos Aires, edad 52.7 ± 12.8 años y 15.6 ± 2.2 años de instrucción. Todos los grupos de edad refirieron empeoramiento de la atención y memoria, siendo más significativo en las franjas de menor edad y en el género femenino. El análisis de componentes principales mostró una correlación asociada al efecto negativo de factores cognitivos previos como la memoria y la atención con la dificultad durante la cua rentena en el dominio ejecutivo. El aislamiento social impactó en el sistema atencional, mnésico y de funciones ejecutivas. Resultó corroborado el importante rol de las capacidades cognitivas en la generación de recursos y la aplicación de estrategias para adaptarse a situaciones poco habituales, poniendo de manifiesto la interacción cognitivo-funcional.

Abstract The COVID-19 social isolation period entailed changes in daily habits and routines, testing the adjustment abilities of the popula tion to address unusual situations. Given that the activities of daily living require a normally functioning cognitive system, the study of cognitive-functional interaction under social isolation is relevant. The object of this work was to obtain information on the cognitive-functional impact of social isolation, analyze the changes induced in daily routines and habits, and assess the cognitive adjustment of the adult population to the isolation requirements. We carried out an online adult population survey, that combined multiple choice or binary questions following a Likert ordinal scale, performing a percentage analysis as well as a principal component analysis of the results. We surveyed 1095 subjects, 68% of which were residents of the Buenos Aires Metropolitan Area (AMBA), of an average age of 52.7 ± 12.8 years, and 15.6 ± 2.2 years of education. All age groups reported attention and memory impairment, more significant in lower age groups and women. The principal component analysis showed an associated correlation of the functional challenge brought about by social isolation on the executive system, with the negative impact on cognitive functions such as attention and memory. Social isolation significantly impacted on the attentional, mnesic and executive cognitive systems, ratifying the role of cognitive abilities in the generation of means and strategies to overcome unusual situations, and highlighting the importance of cognitive-functional interaction.

Design and Evaluation of an Automatic Speech Recognition Model for Clinical Notes in Spanish in a Mobile Online Environment.

Clinical documentation in healthcare institutions is one of the daily tasks that consumes most of the time for those involved. The adoption of mobile devices in medical practice increases efficiency among healthcare professionals. We describe the design and evaluation of an automatic speech recognition system that enables the transcription of audio to text of clinical notes in a mobile environment. Our system achieved 94.1% word accuracy when evaluated on pediatrics, internal medicine and surgery services.

[New predictors in prodromal Alzheimer: Deferred phase in word recall of MIS test]. / Nuevos predictores en Alzheimer prodrómico: fase diferida en el test MIS de recuerdo de palabras.

BACKGROUND: The Memory Impairment Screen (MIS-A) is a validated test to detect Alzheimer's Disease (AD) and other dementias. We have modified this test to suit a Spanish speaking population and added a new component, delayed recall (MIS-D). OBJECTIVES: 1) To test a Spanish version of MIS-A and MIS-D. 2) To assess the discriminative validity of MIS-D as a screening tool for the amnestic variant of Mild Cognitive Impairment (aMCI). METHODS: A case-control study of a cohort of 739 aged 65 years old and over, of whom 436 were healthy controls and 303 had a diagnosis of aMCI. The MCI group was patients from the Geriatric Unit for the Elderly at the Italian Hospital of Buenos Aires staffed by geriatricians. MEASUREMENTS: ANOVA test and test t de Student mean comparison. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NVP) were estimated for MIS-D and MIS-A. RESULTS: Normative values for MIS-A and MIS-D were obtained from the control population. Both age and education significantly affected these values (p<0.0001). The cut-off for MIS-A should be 7.5 and for MIS-D, 5.5. Comparison between control population and aMCI population using ROC curve gave a result of 5.5 in MIS-D, with 97% specificity and 76% sensitivity. CONCLUSION: MIS-D was positively predictive of Amci. An extension of the sample in other health care contexts would enable us to verify its clinical validity for other populations.

Sistemas de análisis acústico y de reconocimiento automático en habla espontánea / Acoustic analysis and automatic recognition systems in spontaneous spech

En este trabajo se presentan dos sistemas de análisis acústico del habla con aplicaciones a la descripción de segmentos de discurso espontáneo y un sistema de reconocimiento automático de habla espontánea orientado a la detección de palabras. El primer sistema de análisis presenta detalladamente todos los rasgos instintivos segmentales y suprasegmentales del habla en forma simultánea asociados a la frecuencia, energía y duración. El segundo presenta automáticamente los parámetros físicos asociados a la entonación en una superficie que cuantifica el campo vocal del hablante y mide el rango vocal y dinámico en el discurso hablado. Se presenta un histograma de la frecuencia fundamental útil para comparar las tendencias entonativas de sesión a sesión. Finalmente se ha desarrollado una herramienta de reconocimiento con modelos acústicos para el español hablado en la Argentina. El mismo transcribe los sonidos grabados a texto y posibilita la aplicación de otras herramientas para el procesamiento de lenguaje natural.

In this paper two acoustic speech analysis systems are presented with applications to the description of spontaneous speech segments and a system of automatic spontaneousspeech recognition oriented to word detection. The first analysis system presents in detail all segment and supra-segment instinct speech features simultaneously and associated frequency, power and duration. The second automatically displays thephysical parameters associated to intonation in a surface that quantifies the vocal field of the speaker and measures the vocal and dynamic range in spoken discourse. A histogram of the fundamental frequency proves useful to compare intonation tendencies from session to session. Finally a recognition tool with acoustic models was developed for Spanish spoken in Argentina. It transcribes the recorded text sounds and enables the application of other tools for natural language processing.

Sistemas de análisis acústico y de reconocimiento automático en habla espontánea / Acoustic analysis and automatic recognition systems in spontaneous spech

En este trabajo se presentan dos sistemas de análisis acústico del habla con aplicaciones a la descripción de segmentos de discurso espontáneo y un sistema de reconocimiento automático de habla espontánea orientado a la detección de palabras. El primer sistema de análisis presenta detalladamente todos los rasgos instintivos segmentales y suprasegmentales del habla en forma simultánea asociados a la frecuencia, energía y duración. El segundo presenta automáticamente los parámetros físicos asociados a la entonación en una superficie que cuantifica el campo vocal del hablante y mide el rango vocal y dinámico en el discurso hablado. Se presenta un histograma de la frecuencia fundamental útil para comparar las tendencias entonativas de sesión a sesión. Finalmente se ha desarrollado una herramienta de reconocimiento con modelos acústicos para el español hablado en la Argentina. El mismo transcribe los sonidos grabados a texto y posibilita la aplicación de otras herramientas para el procesamiento de lenguaje natural.(AU)

In this paper two acoustic speech analysis systems are presented with applications to the description of spontaneous speech segments and a system of automatic spontaneousspeech recognition oriented to word detection. The first analysis system presents in detail all segment and supra-segment instinct speech features simultaneously and associated frequency, power and duration. The second automatically displays thephysical parameters associated to intonation in a surface that quantifies the vocal field of the speaker and measures the vocal and dynamic range in spoken discourse. A histogram of the fundamental frequency proves useful to compare intonation tendencies from session to session. Finally a recognition tool with acoustic models was developed for Spanish spoken in Argentina. It transcribes the recorded text sounds and enables the application of other tools for natural language processing.(AU)