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Background Electronic medical record systems are being implemented in many countries to support healthcare services. However, its adoption rate remains low, especially in developing countries due to technological, financial, and organizational factors. There is lack of solid evidence and empirical research regarding the pre implementation readiness of healthcare providers. The aim of this study is to assess health professionals’ readiness and to identify factors that affect the acceptance and use of electronic medical recording system in the pre implementation phase at hospitals of North Gondar Zone, Ethiopia. Methods An institution based cross-sectional quantitative study was conducted on 606 study participants from January to July 2013 at 3 hospitals in northwest Ethiopia. A pretested self-administered questionnaire was used to collect the required data. The data were entered using the Epi-Info version 3.5.1 software and analyzed using SPSS version 16 software. Descriptive statistics, bi-variate, and multi-variate logistic regression analyses were used to describe the study objectives and assess the determinants of health professionals’ readiness for the system. Odds ratio at 95% CI was used to describe the association between the study and the outcome variables. Results Out of 606 study participants only 328 (54.1%) were found ready to use the electronic medical recording system according to our criteria assessment. The majority of the study participants, 432 (71.3%) and 331(54.6%) had good knowledge and attitude for EMR system, respectively. Gender (AOR = 1.87, 95% CI: [1.26, 2.78]), attitude (AOR = 1.56, 95% CI: [1.03, 2.49]), knowledge (AOR = 2.12, 95% CI: [1.32, 3.56]), and computer literacy (AOR =1.64, 95% CI: [0.99, 2.68]) were significantly associated with the readiness for EMR system. Conclusions In this study, the overall health professionals’ readiness for electronic medical record system and utilization was 54.1% and 46.5%, respectively. Gender, knowledge, attitude, and computer related skills were the determinants of the presence of a relatively low readiness and utilization of the system. Increasing awareness, knowledge, and skills of healthcare professionals on EMR system before system implementation is necessary to increase its adoption.

Cloud-based electronic medical record (EMR) management system is an emerging paradigm that enables EMR owners to store and share their EMRs with intended group of healthcare personnel. And, it allows EMR users to retrieve desired records from the cloud when require. However, authentic EMR sharing and searching with security has been a challenging problem. In this paper, for the first time, we propose a searchable attribute-based signcryption for EMR storage and retrieval in cloud computing environment, termed as MediCare, that supports simultaneously the functionalities: fine-grained access control over encrypted EMRs, EMR owner authenticity and anonymity, Boolean formula-based keyword search over encrypted EMRs, keyword privacy, constant decryption cost for EMR users, non-interactive search results verification, and provably secure . We employ attribute-based framework in designing MediCare. Only authorized EMR owners can anonymously upload EMRs to the cloud, and an EMR user can search over encrypted EMRs using Boolean formula keyword policy. MediCare enables an EMR user to verify the correctness of the search results efficiently without interacting with any authority. We define more general security definitions of MediCare and provide rigorous security analysis. We also conduct experiments to evaluate MediCare’s performance.

BackgroundUnderwater endoscopic mucosal resection (UEMR) of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection (CEMR). This study aimed to evaluate the feasibility and safety of UEMR for colorectal lesions.MethodsThe PubMed, Embase, Cochrane and Web of Science databases were searched before May 10, 2020. The primary outcomes were en bloc resection rate (feasibility) and adverse event rate (safety). The secondary outcome was recurrence and residual adenoma rate. If there was a comparison between UEMR and CEMR, data about en bloc resection, delayed bleeding, and recurrence and residual adenoma were extracted and compared. The pooling of the effect size was conducted using random-effects models, and the Q-statistic, τ2, and I2 were used to evaluate heterogeneity.ResultsSeventeen studies (759 patients, 893 lesions) were included. The pooled estimate for the en bloc resection rate was 59% (95% CI 43–75%) with significant heterogeneity (I2 = 97%). Due to the heterogeneity, it is not suitable to conduct pooled estimates analysis, so the en bloc resection rate was from 10 to 89%. The pooled estimate for delayed bleeding was 2% (95% CI, 1%-3%) and only two cases had perforation. The pooled rate of recurrence and residual adenoma was 5% (95% CI 2%-8%). Compared with CEMR, UEMR could achieve a higher en bloc resection rate (OR 1.61; 95% CI 1.02–2.53; p = 0.04) with a lower rate of recurrence and residual adenoma (OR 0.18; 95% CI 0.07–0.46; p < 0.01).ConclusionsUEMR for colorectal lesions was capable of a high en bloc resection rate, low adverse event rate and low recurrence. UEMR may be considered an effective and safe alternative for treating colorectal lesions.

Background and aimsWith an external additional working channel (AWC) endoscopic mucosal resection (EMR) as well as endoscopic submucosal dissection (ESD) can be extended to techniques termed “EMR+” and “ESD+.” These novel techniques are systematically compared to EMR and ESD under the use of a double-channel endoscope (DC).MethodsOur trial was conducted prospectively in a pre-clinical porcine animal model (EASIE-R simulator) with standardized gastric lesions measuring 3 or 4 cm.ResultsEMR+ and EMR DC showed both good results for 3 cm lesions with no adverse events and an en bloc resection rate of 73.33% (EMR+) and 60.00% (EMR DC, p = 0.70). They came to their limits in 4 cm lesions with muscularis damages of 20.00% (EMR+), 13.33% (EMR DC, p ≥ 0.99) and decreasing en bloc resection rates of 60.00% (EMR+) and 46.67% (EMR DC, p = 0.72).ESD+ and ESD DC were both reliable concerning en bloc resection rates (100% in all groups) and adverse events (0.00% in 3 cm lesions, 12.50% muscularis damages in both ESD+ and ESD DC in 4 cm lesions).Resection time was slightly shorter in all groups with the AWC compared to DC although only reaching significance in 3 cm ESD lesions (p < 0.05*).ConclusionsWith the AWC, a standard endoscope can easily be transformed to double-channel functionality. We could show that EMR+ and ESD+ are non-inferior to EMR and ESD under the use of a double-channel endoscope. Consequently, the AWC presents an affordable alternative to a double-channel endoscope for both EMR and ESD.

Background: As the amount of medical data in the electronic medical records system (EMR) is increasing tremendously, the required time to read it by health providers is growing by the exact proportionality. This means that physicians must increase the time spared for each patient again by the precise proportionality. This may lead to exposing the accuracy and quality of the course of action to be taken for the patients. Increasing the physician's required time for one patient means that the physician can see fewer patients. This will create an issue with the medical management authority as more physicians are needed, and higher expenses will be required. Purpose: The two questions that arise here are 1. Identify the potential opportunities and challenges for extensive data analysis in the healthcare sector. 2. Evaluate different ways in which big medical data can be analyzed? Methods: The authors identified the four concerned parties representing the four potential solutions dimensions to answer these two questions. These parties are 1. physicians, 2. health information systems management (HISM) departments, mainly the EMR system, and 3. Health management departments 4. Relevant Health Information Systems (HIS) parties. A literature review and 25 interviews were conducted. The interviews covered 1: Two global organizations: John Hopkins and Joint Commission International (JCI), 2: Three United Arab Emirates-based health organizations: Department of health in Abu Dhabi, SEHA in Abu Dhabi, Dubai health Authority (DHA) in Dubai, 3: 10 Physicians from different specialties, 4: Five EMR managers and 5: Five IT (Information Technology) professionals representing the HIS parties. Qualitative analysis is used as the approach for data analysis. Results: Identifying the managerial and the technical recommendations to be utilized mainly based on digital disruption technologies, tools, and processes. Conclusion: Healthcare has been slow in embracing digital disruption and transformation. In most areas, it is still in the initial stages. Recommendations are based on the UAE cases, highlighting the specific technologies and their features. Keywords: digital disruption, healthcare, big data, electronic medical records, EMR, health information systems, HIS

Research has shown that when a microcontroller (MCU) is powered up, the emitted electromagnetic radiation (EMR) patterns are different depending on the executed instructions. This becomes a security concern for embedded systems or the Internet of Things. Currently, the accuracy of EMR pattern recognition is low. Thus, a better understanding of such issues should be conducted. In this paper, a new platform is proposed to improve EMR measurement and pattern recognition. The improvements include more seamless hardware and software interaction, higher automation control, higher sampling rate, and fewer positional displacement alignments. This new platform improves the performance of previously proposed architecture and methodology and only focuses on the platform part improvements, while the other parts remain the same. The new platform can measure EMR patterns for neural network (NN) analysis. It also improves the measurement flexibility from simple MCUs to field programmable gate array intellectual properties (FPGA-IPs). In this paper, two DUTs (one MCU and one FPGA-MCU-IP) are tested. Under the same data acquisition and data processing procedures with similar NN architectures, the top1 EMR identification accuracy of MCU is improved. The EMR identification of FPGA-IP is the first to be identified to the authors’ knowledge. Thus, the proposed method can be applied to different embedded system architectures for system-level security verification. This study can improve the knowledge of the relationships between EMR pattern recognitions and embedded system security issues.

Background and aimsA new external additional working channel (AWC) was recently introduced by which endoscopic submucosal dissection (ESD) can be converted to a technique termed “ESD+ ”. We aim to systematically evaluate this novel technique in flat gastric lesions and compare it to classical ESD.MethodsThe study was prospectively conducted in a pre-clinical ex vivo animal model (EASIE-R simulator) with porcine stomachs. Prior to intervention, we set standardized lesions measuring 3 cm or 4 cm in antegrade as well as in retrograde positions.ResultsOverall, 64 procedures were performed by an experienced endoscopist. Both techniques were reliable and showed en bloc resection rates of 100%. Overall, ESD+ reduced time of procedure compared to ESD (24.5 vs. 32.5 min, p = 0.025*). Particularly, ESD+ was significantly faster in retrograde lesions with a median of 22.5 vs. 34.0 min in 3 cm retrograde lesions (p = 0.002*) and 34.5 vs. 41.0 min (p = 0.011*) in 4 cm retrograde lesions. There were 0 perforations with both techniques. In ESD+ , 1 muscularis damage occurred (3.13%) compared to 6 muscularis damages with ESD (18.75%, p = 0.045*).ConclusionsBy its grasp-and-mobilize technique, ESD+ allows potentially faster and safer resections of flat gastric lesions compared to conventional ESD in an ex vivo porcine model. The potential advantages of ESD+ in terms of procedure time may be particularly relevant for difficult lesions in retrograde positions.

BackgroundGastric adenomas can be successfully treated with endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). The aim of this study was to evaluate and compare the efficacy of ESD and EMR with circumferential precutting (EMR-P) in the treatment of small gastric adenomas.MethodsThis study included 1014 gastric adenomas ≤ 15 mm in diameter treated with ESD or EMR-P from 2012 to 2019, retrospectively. Propensity score matching between the ESD and EMR-P groups (1:1 to 3:1) was performed according to age, sex, tumor size, tumor location (upper, middle, and lower thirds), morphology, and preprocedural histology. The procedure time and the rates of en bloc resection, complete resection, adverse events, and local recurrence were compared between the two groups.ResultsAfter propensity score matching, 478 lesions (ESD: 295, EMR-P: 183) were analyzed. The rates of en bloc resection (94.9% vs. 93.4%, p = 0.498), complete resection (93.6% vs. 90.2%, p = 0.177), bleeding (8.1% vs. 3.8%, p = 0.063), and local recurrence (0.0% vs. 1.4%, p = 0.185) did not significantly differ between the two groups. The procedure time was significantly longer for ESD than for EMR-P (p < 0.001). In the EMR-P group, the complete resection rate was significantly lower in the upper third than in the middle and lower thirds (p < 0.001).ConclusionEMR-P is as effective as ESD for the treatment of small gastric adenomas. However, the efficacy of EMR-P is lower for gastric adenomas in the proximal stomach.

Reactive oxygen species (ROS) ubiquitously exist in mammalian cells to participate in various cellular signaling pathways. The intracellular ROS levels are dependent on the dynamic balance between ROS generation and elimination. In this review, we summarize reported studies about the influences of magnetic fields (MFs) on ROS levels. Although in most cases, MFs increased ROS levels in human, mouse, rat cells, and tissues, there are also studies showing that ROS levels were decreased or not affected by MFs. Multiple factors could cause these discrepancies, including but not limited to MF type/intensity/frequency, exposure time and assay time-point, as well as different biological samples examined. It will be necessary to investigate the influences of different MFs on ROS in various biological samples systematically and mechanistically, which will be helpful for people to get a more complete understanding about MF-induced biological effects. In addition, reviewing the roles of MFs in ROS modulation may open up new scenarios of MF application, which could be further and more widely adopted into clinical applications, particularly in diseases that ROS have documented pathophysiological roles.

Sydney Children’s Hospitals Network (SCHN) is the largest network of hospitals and services for children in Australia. It is a public service of NSW (New South Wales) Health, part of the NSW Government. The NSW geographic area serviced is 800,628 square km, with a population of 7,861,100 people, but children come from across Australia for the expert care SCHN provides. SCHN cares for 151,000 children every year, with over 50,000 inpatient admissions and over 1.1m outpatient encounters. More than 65% of these presentations consist of patients who have an established relationship with SCHN due to the complex/chronic nature of their diagnosis(s). SCHN wanted to connect with their outpatients, to inform/support changing care needs, to improve patients’ understanding of their conditions and to connect information across providers. All patients have providers locally outside the network, so SCHN wanted to support the patient as the conduit of their information, ultimately improving the care experience and health outcomes. SCHN had a vision of giving patients a digital record they could interact with meaningfully, centered around them. This digital vision would address several care delivery challenges: inefficient communication missed appointments managing changing conditions and medications lack of a shared record The digital vision became a co-design project with SCHN’s consumers, named the “Memory” project. The vision became reality in May 2017 with the successful trial of the “My Health Memory” (MHM) smartphone application. The first iteration of MHM allowed patients and carers to: Efficiently manage appointments and minimise care delays: receive new and updated appointments (including telehealth links straight to device) automatically from the EHR to their app request reschedules from their app receive appointment reminders, ensuring they come to appointments, are ready for care, and can find their way with digital wayfinding instructions staff can asynchronously review and reschedule requests via a request list and rebook Exchange clinical data to support care: access discharge summaries, care plans and reconciled medication lists from their app. push education to the app Communicate securely: clinical staff can securely message patients/carers from their workflow, and patients/carers can respond from their app. communications are automatically saved as a progress note in the EHR, eliminating manual documentation trial group implementation was a success resulting in a hospital wide implementation March 2018. Metrics achieved include: 80% of eligible patients registered (from trial group) Outpatient clinic No Show rates decreased by 74%.  8,748 messages sent between MHM and the EHR resulting in 30% fewer outpatient calls to nursing staff Reduction in secondary sources of truth for patient communication, reducing iatrogenic risk. 94.9% of app users have rated MHM as being useful in the care of their child. over 7,000 EHR documents shared to the app Over 6,000 activated users (October 2018) The 6 month MHM app roadmap includes; patient/carer uploaded documents and document sharing. Surveys with EHR integration & integration to Australia’s My Health Record. Sydney University have commenced a study On the MHM app titled Leveraging e-Applications for Patients (and families)