Saving Time for Patient Care by Optimizing Physician Note Templates: A Pilot Study

Background: At times, electronic medical records (EMRs) have proven to be less than optimal, causing longer hours behind computers, shorter time with patients, suboptimal patient safety, provider dissatisfaction, and physician burnout. These concerning healthcare issues can be positively affected by optimizing EMR usability, which in turn would lead to substantial benefits to healthcare professionals such as increased healthcare professional productivity, efficiency, quality, and accuracy. Documentation issues, such as non-standardization of physician note templates and tedious, time-consuming notes in our mother-baby unit (MBU), were discussed during meetings with stakeholders in the MBU and our hospital's EMR analysts.Objective: The objective of this study was to assess physician note optimization on saving time for patient care and improving provider satisfaction.Methods: This quality improvement pilot investigation was conducted in our MBU where four note templates were optimized: History and Physical (H and P), Progress Note (PN), Discharge Summary (DCS), and Hand-Off List (HOL). Free text elements documented elsewhere in the EMR (e.g., delivery information, maternal data, lab result, etc.) were identified and replaced with dynamic links that automatically populate the note with these data. Discrete data pick lists replaced necessary elements that were previously free texts. The new note templates were given new names for ease of accessibility. Ten randomly chosen pediatric residents completed both the old and new note templates for the same control newborn encounter during a period of one year. Time spent and number of actions taken (clicks, keystrokes, transitions, and mouse-keyboard switches) to complete these notes were recorded. Surveys were sent to MBU providers regarding overall satisfaction with the new note templates.Results: The ten residents' average time saved was 23 min per infant. Reflecting this saved time on the number of infants admitted to our MBU between January 2016 and September, 2019 which was 9373 infants; resulted in 2.6 hours saved per day, knowing that every infant averages two days length of stay. The new note templates required 69 fewer actions taken than the old ones (H and P: 11, PN: 8, DCS: 18, HOL: 32). The provider surveys were consistent with improved provider satisfaction.Conclusion: Optimizing physician notes saved time for patient care and improved physician satisfaction.

Beyond the Lesion: Back to High Fidelity DNA Synthesis

High fidelity (HiFi) DNA polymerases (Pols) perform the bulk of DNA synthesis required to duplicate genomes in all forms of life. Their structural features, enzymatic mechanisms, and inherent properties are well-described over several decades of research. HiFi Pols are so accurate that they become stalled at sites of DNA damage or lesions that are not one of the four canonical DNA bases. Once stalled, the replisome becomes compromised and vulnerable to further DNA damage. One mechanism to relieve stalling is to recruit a translesion synthesis (TLS) Pol to rapidly synthesize over and past the damage. These TLS Pols have good specificities for the lesion but are less accurate when synthesizing opposite undamaged DNA, and so, mechanisms are needed to limit TLS Pol synthesis and recruit back a HiFi Pol to reestablish the replisome. The overall TLS process can be complicated with several cellular Pols, multifaceted protein contacts, and variable nucleotide incorporation kinetics all contributing to several discrete substitution (or template hand-off) steps. In this review, we highlight the mechanistic differences between distributive equilibrium exchange events and concerted contact-dependent switching by DNA Pols for insertion, extension, and resumption of high-fidelity synthesis beyond the lesion.

Video Pre-Caching Joint Hand-Off and Content Delivery in Multi-Access Edge Computing Based EONs

Multi-access Edge Computing (MEC) performs as a feasible solution when it comes to content delivery, for it can bring contents much closer to users. However, the hand-off (HO) and latency that occur in user movement reduce the users’ quality of service. In this work, we consider the problem of high mobility handoff and content delivery of video streaming in the MEC based EONs. We propose a video pre-caching algorithm considering handoff and content delivery. The algorithm firstly selects the content delivery method and chunks the video accordingly using a preset threshold. Secondly, the algorithm chooses the shortest transmission path and calculates the latency time using Dijkstra method. Simulation results show that our algorithm significantly reduces the latency time and balances the server load compared to the other two baselines.

Population coding and oscillatory subspace synchronization integrate context into actions

Contextual cues and prior evidence guide human goal-directed behavior. To date, the neurophysiological mechanisms that implement contextual priors to guide subsequent actions remain unclear. Here we demonstrate that increasing behavioral uncertainty introduces a shift from an oscillatory to a continuous processing mode in human prefrontal cortex. At the population level, we found that oscillatory and continuous dynamics reflect dissociable signatures that support distinct aspects of encoding, transmission and execution of context-dependent action plans. We show that prefrontal population activity encodes predictive context and action plans in serially unfolding orthogonal subspaces, while prefrontal-motor theta oscillations synchronize action-encoding population subspaces to mediate the hand-off of action plans. Collectively, our results reveal how two key features of large-scale population activity, namely continuous population trajectories and oscillatory synchrony, operate in concert to guide context-dependent human behavior.

Syntaxin 12 and COMMD3 are new factors that function with VPS33B in the biogenesis of platelet α-granules

Platelet a-granules regulate hemostasis and myriad other physiological processes but their biogenesis is unclear. Mutations in only three proteins are known to cause a-granule defects and bleeding disorders in humans. Two such proteins, VPS16B and VPS33B, form a complex mediating transport of newly synthesized a-granule proteins through megakaryocyte endosomal compartments. It is unclear how the VPS16B/VPS33B complex accomplishes this function. Here we report VPS16B/VPS33B associates physically with Stx12, a SNARE protein that mediates vesicle fusion at endosomes. Importantly, Stx12 deficient megakaryocytes display reduced a-granule numbers and overall levels of a-granule proteins, thus revealing Stx12 as new component of the a-granule biogenesis machinery. VPS16B/VPS33B also binds CCDC22, a component of the CCC complex working at endosome exit sites. CCDC22 competes with Stx12 for binding to VPS16B/VPS33B suggesting a possible hand-off mechanism. Moreover, the major CCC form expressed in megakaryocytes contains COMMD3, one of ten COMMD proteins. Deficiency of COMMD3/CCDC22 causes reduced a-granule numbers and overall levels of a-granule proteins, establishing the COMMD3/CCC complex as a new factor in a-granule biogenesis. Furthermore, P-Selectin traffics through the cell surface in a COMMD3-dependent manner and depletion of COMMD3 results in lysosomal degradation of P-Selectin and PF4. Stx12 and COMMD3/CCC deficiency cause less severe phenotypes than VPS16B/VPS33B deficiency, suggesting Stx12 and COMMD3/CCC assist but are less important than VPS16B/VPS33B in a-granule biogenesis. Mechanistically, our results suggest VPS16B/VPS33B coordinates the endosomal entry and exit of a-granule proteins by linking the fusogenic machinery with a ubiquitous endosomal retrieval complex that is repurposed in megakaryocytes to make a-granules.

Launching chat service during the pandemic: inaugurating a new public service under emergency conditions

PurposeThis article details the implementation of a live online chat service which was suddenly necessitated by the worldwide coronavirus disease 2019 (COVID-19) pandemic. The approaches used to train chat operators during this time inform both current and future training initiatives toward continuous improvement in this academic library setting.Design/methodology/approachChat transcripts from the period of March 2020–April 2021 serve as the dataset for this study.FindingsIn bringing a live chat service online during a global pandemic, chat transcripts from this period reveal 19.3% of all chat interactions related directly to COVID-19. The transcripts also reveal the types of questions, whether reference or directional, and these, combined with staffing patterns, indicate that staff were addressing reference questions more often than librarians. In addition, 25.2% of all transactions, whether by staff or librarians, resulted in tickets or referrals to hand off the question to a subject or functional specialist. These findings help to inform targeted face-to-face refresher training for chat operators.Originality/valueWhile bringing a live chat service online is certainly not novel, the impetus behind the quick setup was. This unusual circumstance allowed for an in-depth look at the nature of chat and its training requirements and limitations due to campus stay-at-home orders. It also provided a new understanding that influenced subsequent face-to-face trainings.

Factors That Matter for Financial Inclusion: Evidence from Sub-Sharan Africa - The Zimbabwe Case

The study intended to investigate the factors that are important in influencing the financial inclusion of smallholder farming households in Sub-Saharan Africa with a specific focus on Zimbabwe. Motivated by the fact that there is an increase in the evidence of the importance of financial inclusion in fighting poverty and the fact that by merely having a bank account, financial inclusion cannot be guaranteed, the study went further to interrogate factors that influence smallholder farmers to have a transaction account, to borrow and to have insurance. Since the dependent variable of financial inclusion had more than two categories, with three unordered categories, transaction account, savings/credit account, and insurance, the multinomial logistic regression was used to estimate the determinants of financial inclusion from these three categories of the dependent variable. The multinomial logit model results, with insurance as the reference category, indicated that the size of the household, transaction costs, gender and agricultural extension service were the factors influencing the demand for a household to open a transaction account. On the other hand, off-farm income and age of the household were the only two factors significantly influencing households to borrow. Therefore, it is imperative for, the government of Zimbabwe to come up with more policies that encourage farmers to participate in the formal financial market as financial inclusion can help to fight poverty and the general developments of societies. Received: 28 April 2021 / Accepted: 31 August 2021 / Published: 5 November 2021