1
|
Monczka J, Ayers P, Berger MM, Wischmeyer PE. Safety and quality of parenteral nutrition: Areas for improvement and future perspectives. Am J Health Syst Pharm 2024; 81:S121-S136. [PMID: 38869258 PMCID: PMC11170503 DOI: 10.1093/ajhp/zxae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
PURPOSE This article is based on presentations and discussions held at the International Safety and Quality of Parenteral Nutrition (PN) Summit (held November 8-10, 2021, at Charleston, SC, and Bad Homburg, Germany) and aims to raise awareness concerning unresolved issues associated with the PN process and potential future directions, including a greater emphasis on patients' perspectives and the role of patient support. SUMMARY Ensuring that every patient in need receives adequate PN support remains challenging. It is important to have a standardized approach to identify nutritional risk and requirements using validated nutritional screening and assessment tools. Gaps between optimal and actual clinical practices need to be identified and closed, and responsibilities in the nutrition support team clarified. Use of modern technology opens up opportunities to decrease workloads or liberate resources, allowing a more personalized care approach. Patient-centered care has gained in importance and is an emerging topic within clinical nutrition, in part because patients often have different priorities and concerns than healthcare professionals. Regular assessment of health-related quality of life, functional outcomes, and/or overall patient well-being should all be performed for PN patients. This will generate patient-centric data, which should be integrated into care plans. Finally, communication and patient education are prerequisites for patients' commitment to health and for fostering adherence to PN regimes. CONCLUSION Moving closer to optimal nutritional care requires input from healthcare professionals and patients. Patient-centered care and greater emphasis on patient perspectives and priorities within clinical nutrition are essential to help further improve clinical nutrition.
Collapse
Affiliation(s)
| | - Phil Ayers
- Clinical Pharmacy Services, Department of Pharmacy, Baptist Medical Center, Jackson, MS, and University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Mette M Berger
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Paul E Wischmeyer
- Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
2
|
Shiue M, Nyman A, Karvell R, Partington SL, Preminger TJ, Reda C, Ruckdeschel E, Sullivan K, Tobin L, Vaikunth SS, Saef J, Tedla BA, Kim YY. Experiences and Attitudes Toward Telemedicine in an Adult Congenital Heart Disease Clinic: Lessons Learned from the COVID-19 Pandemic. Pediatr Cardiol 2024:10.1007/s00246-024-03533-6. [PMID: 38836881 DOI: 10.1007/s00246-024-03533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has driven a broader adoption of telemedicine (TM). We aim to describe adult congenital heart disease (ACHD) patient experiences with TM and explore factors associated with positive attitude toward future TM visits. This is a cross-sectional, single-center study in an outpatient ACHD clinic from February to June, 2022. Between-group comparisons were made using Wilcoxon-Rank Sum, Chi-Square, or Fisher-Exact tests. Univariate logistic regression was performed for variables that could correlate with a "positive" attitude toward future TM visits. Significance was determined using an alpha level of 0.05. Of 262 patients (median age 33 years, 55% female, 81% White), 115 (44%) had a prior TM visit and 110 (96%) reported a positive experience. There were 64 (24%) with a positive attitude toward future TM visits. Concerns include lack of cardiac testing and limited quality of visit. Patients with visits every 3-6 months (Odds Ratio [OR] 2.44; p < 0.01) and prior TM visit (OR 1.89; p = 0.03) had higher odds of a positive attitude toward future TM, whereas males had lower odds (OR 0.53; p = 0.04). Age, annual income, disease complexity, distance from clinic, and employment status were not associated. There is high rate of satisfaction with TM among ACHD patients but only one-quarter indicated interest in using TM in the future. Factors associated with interest in TM visits are identified, and together with patient feedback, can be used to understand potential role of TM for the ACHD population in the post-pandemic era.
Collapse
Affiliation(s)
- Mia Shiue
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Annique Nyman
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Robert Karvell
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Sara L Partington
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Tamar J Preminger
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christian Reda
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Emily Ruckdeschel
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Kathleen Sullivan
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Lynda Tobin
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Sumeet S Vaikunth
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Joshua Saef
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Bruke A Tedla
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Yuli Y Kim
- Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Division of Cardiology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 2Nd Floor E. Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| |
Collapse
|
3
|
Miao H, Li C, Wang J. A Future of Smarter Digital Health Empowered by Generative Pretrained Transformer. J Med Internet Res 2023; 25:e49963. [PMID: 37751243 PMCID: PMC10565615 DOI: 10.2196/49963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/30/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023] Open
Abstract
Generative pretrained transformer (GPT) tools have been thriving, as ignited by the remarkable success of OpenAI's recent chatbot product. GPT technology offers countless opportunities to significantly improve or renovate current health care research and practice paradigms, especially digital health interventions and digital health-enabled clinical care, and a future of smarter digital health can thus be expected. In particular, GPT technology can be incorporated through various digital health platforms in homes and hospitals embedded with numerous sensors, wearables, and remote monitoring devices. In this viewpoint paper, we highlight recent research progress that depicts the future picture of a smarter digital health ecosystem through GPT-facilitated centralized communications, automated analytics, personalized health care, and instant decision-making.
Collapse
Affiliation(s)
- Hongyu Miao
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Chengdong Li
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, FL, United States
| |
Collapse
|
4
|
Leung T, Burton L, Loewen P, Wilson R, Singh S, Moroz L, Andrade JG. Patients' Experiences With the Fit of Virtual Atrial Fibrillation Care During the Pandemic: Qualitative Descriptive Study. JMIR Cardio 2023; 7:e41548. [PMID: 36716096 PMCID: PMC9926347 DOI: 10.2196/41548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/23/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In-person health care has been the standard model of care delivery for patients with atrial fibrillation (AF). Despite the growing use of remote technology, virtual health care has received limited formal study in populations with AF. Understanding the virtual care experiences of patients in specialized AF clinics is essential to inform future planning of AF clinic care. OBJECTIVE This qualitative descriptive study aimed to understand patients' virtual AF clinic care experiences during the COVID-19 pandemic. METHODS Participants were recruited from a pool of patients who were receiving care from an AF clinic and who were enrolled in a larger survey study. A total of 8 virtual focus groups (n=30) were conducted in 2 waves between March 2021 and May 2021. Facilitators used a semistructured discussion guide to ask participants questions about their experiences of virtual care and the perceived quality of virtual care and technology support. Three team members initially open coded group data to create a preliminary coding framework. As the analysis progressed, with subsequent focus groups, the code clusters were refined. RESULTS The participants were primarily male (21/30, 70%), aged ≥65 years (20/30, 67%), and college graduates (22/30, 73%). Patients found virtual care to be highly beneficial. Central to their experiences of virtual care was its fit or lack of fit with their health needs, which was integrally connected to communication effectiveness and their preferred virtual care future. Practical benefits included flexibility, convenience, and time and cost savings of virtual care. Virtual care fit occurred for small, quick, and mundane issues (eg, medication refills) but was suboptimal for new and more complex issues that patients thought warranted an in-person visit. Fit often reflected the effectiveness of communication between patient and provider and that of in-clinic follow-up. There was near-complete agreement among participants on the acceptability of virtual communication with their providers in addressing their needs, but this depended on adequate reciprocal communication. Without the benefit of in-person physical assessments, patients were uncertain and lacked confidence in communicating the needed, correct, and comprehensive information. Finally, participants described concerns related to ongoing virtual care with recommendations for their preferred future using a hybrid model of care and integrating patient-reported data (ie, blood pressure measurements) in virtual care delivery. CONCLUSIONS Virtual care from a specialty AF clinic provides practical benefits for patients, but they must be weighed against the need for virtual care's fit with patients' needs and problems. The stability and complexity of patients' health needs, their management, and their perceptions of communication effectiveness with providers and clinics must be considered in decisions about appointment modality. Patients' recommendations for future virtual care through use of hybrid models together with systems for data sharing have the potential to optimize fit.
Collapse
Affiliation(s)
| | - Lindsay Burton
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, Vancouver, BC, Canada
| | - Ryan Wilson
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Sarah Singh
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Lana Moroz
- Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Jason G Andrade
- Centre for Cardiovascular Innovation, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
5
|
Lam J, Ahmad K, Gin K, Chow CM. Deliver Cardiac Virtual Care (CVC) - A Primer for Cardiovascular Professionals in Canada. CJC Open 2021; 4:148-157. [PMID: 34661090 PMCID: PMC8502077 DOI: 10.1016/j.cjco.2021.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/04/2021] [Indexed: 12/22/2022] Open
Abstract
The COVID-19 pandemic, with its need for distancing, has necessitated the use of virtual care in never-before-seen volumes. This review article aims to provide a primer on virtual care for cardiovascular professionals in Canada. The technology to facilitate remote patient interactions is already available, but barriers exist. Adequate and effective cardiac virtual care must be further developed given the need for rapid evaluation and close ongoing follow-up of patients, as seen in the areas of management of heart failure, cardiac rehabilitation, electrophysiology, and hypertension. Many Canadian organizations have published resources to assist health care providers and patients navigate the unfamiliar virtual care landscape. Although there are concerns surrounding issues such as patient privacy, access to technology, language discrepancies, and billing, these deficits provide opportunities for growth by health care organizations and technology companies. The integration of virtual care, home-based devices, and disruptive technologies emphasize the trend toward virtualization of health care, with the potential for greater personalization of health care interactions and continuity of care. Funding models were rapidly developed at the beginning of the COVID-19 pandemic, and although some provinces have deemed these changes as permanent, the status from other provinces remains unknown. The foundations to support virtual care as a key modality for health care delivery in Canada have been built, and further developments may strengthen its viability as a long-term option.
Collapse
Affiliation(s)
- Jeffrey Lam
- Division of Internal Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Kamran Ahmad
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Gin
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Daniolou S, Rapp A, Haase C, Ruppert A, Wittwer M, Scoccia Pappagallo A, Pandis N, Kressig RW, Ienca M. Digital Predictors of Morbidity, Hospitalization, and Mortality Among Older Adults: A Systematic Review and Meta-Analysis. Front Digit Health 2021; 2:602093. [PMID: 34713066 PMCID: PMC8521803 DOI: 10.3389/fdgth.2020.602093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/17/2020] [Indexed: 12/17/2022] Open
Abstract
The widespread adoption of digital health technologies such as smartphone-based mobile applications, wearable activity trackers and Internet of Things systems has rapidly enabled new opportunities for predictive health monitoring. Leveraging digital health tools to track parameters relevant to human health is particularly important for the older segments of the population as old age is associated with multimorbidity and higher care needs. In order to assess the potential of these digital health technologies to improve health outcomes, it is paramount to investigate which digitally measurable parameters can effectively improve health outcomes among the elderly population. Currently, there is a lack of systematic evidence on this topic due to the inherent heterogeneity of the digital health domain and the lack of clinical validation of both novel prototypes and marketed devices. For this reason, the aim of the current study is to synthesize and systematically analyse which digitally measurable data may be effectively collected through digital health devices to improve health outcomes for older people. Using a modified PICO process and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, we provide the results of a systematic review and subsequent meta-analysis of digitally measurable predictors of morbidity, hospitalization, and mortality among older adults aged 65 or older. These findings can inform both technology developers and clinicians involved in the design, development and clinical implementation of digital health technologies for elderly citizens.
Collapse
Affiliation(s)
- Sofia Daniolou
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, University of Bern, Bern, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
7
|
Weng W, Blanchard C, Reed JL, Matheson K, McIntyre C, Gray C, Sapp JL, Gardner M, AbdelWahab A, Yung J, Parkash R. A virtual platform to deliver ambulatory care for patients with atrial fibrillation. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:63-70. [PMID: 35265891 PMCID: PMC8890105 DOI: 10.1016/j.cvdhj.2020.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There are little data on the use of virtual care for patients with arrhythmia. We evaluated a virtual clinic platform, in conjunction with specialist care, for patients with symptomatic atrial fibrillation (AF). Methods This was a prospective, observational cohort study evaluating an online educational and treatment platform, with a randomized sub-study examining the use of an ambulatory single-lead electrocardiogram heart monitor (AHM). Follow-up was 6 months. The main outcome was patients’ platform use; success was defined as 90% of patients using the platform at least once, and 75% using it at least twice. The primary outcome in the AHM sub-study was Atrial Fibrillation Symptom Severity (AFSS) score. Other outcomes included patient satisfaction questionnaires, quality of life, emergency department visits, and hospitalizations for AF. Results We enrolled 94 patients between July 2018 and May 2019; 83% of patients logged in at least once and 54.3% more than once. Patients who were older, were male, or had new-onset AF were more likely to log in to the platform. Satisfaction scores were high; 70%–94% of patients responded favorably. Quality-of-life scores improved at 3 and 6 months. In the AHM sub-study (n = 71), those who received an AHM had lower AFSS scores (least square mean difference -2.52, 95% CI -4.48 to -0.25, P = .03). There was no difference in emergency department visits or hospitalizations. Conclusion The online platform did not reach our feasibility target but was well received. Allocation of an AHM was associated with improved quality of life. Virtual AF care shows promise and should be evaluated in further research.
Collapse
|
8
|
Deep learning-based ambient assisted living for self-management of cardiovascular conditions. Neural Comput Appl 2021. [DOI: 10.1007/s00521-020-05678-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractAccording to the World Health Organization, cardiovascular diseases contribute to 17.7 million deaths per year and are rising with a growing ageing population. In order to handle these challenges, the evolved countries are now evolving workable solutions based on new communication technologies such as ambient assisted living. In these solutions, the most well-known solutions are wearable devices for patient monitoring, telemedicine and mHealth systems. This systematic literature review presents the detailed literature on ambient assisted living solutions and helps to understand how ambient assisted living helps and motivates patients with cardiovascular diseases for self-management to reduce associated morbidity and mortalities. Preferred reporting items for systematic reviews and meta-analyses technique are used to answer the research questions. The paper is divided into four main themes, including self-monitoring wearable systems, ambient assisted living in aged populations, clinician management systems and deep learning-based systems for cardiovascular diagnosis. For each theme, a detailed investigation shows (1) how these new technologies are nowadays integrated into diagnostic systems and (2) how new technologies like IoT sensors, cloud models, machine and deep learning strategies can be used to improve the medical services. This study helps to identify the strengths and weaknesses of novel ambient assisted living environments for medical applications. Besides, this review assists in reducing the dependence on caregivers and the healthcare systems.
Collapse
|
9
|
Liu D, Szili EJ, Ostrikov K(K. Plasma medicine: Opportunities for nanotechnology in a digital age. PLASMA PROCESSES AND POLYMERS (PRINT) 2020; 17:2000097. [PMID: 32837492 PMCID: PMC7361249 DOI: 10.1002/ppap.202000097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/10/2020] [Accepted: 06/28/2020] [Indexed: 05/05/2023]
Abstract
Advances in digital technologies have opened new opportunities for creating more reliable, time- and cost-effective, safer and mobile methods of diagnosing, managing and treating diseases. A few examples of advanced nano- and digital technologies are already FDA-approved for diagnosing and treating diseases. Plasma treatment is still emerging as a new healthcare technology, but it is showing a strong potential for treatment of many diseases including cancers and antimicrobial-resistant infections, with little or no adverse side effects. Here, we argue that with the ever-increasing complex healthcare challenges facing communities, including the ongoing COVID-19 pandemic, it is critical to consider combining unique properties of emerging healthcare technologies into a single multimodal treatment modality that could lead to unprecedented healthcare benefits. In this article, we focus on the healthcare opportunities created by establishing a nexus between plasma, nano- and digital technologies. We argue that the combination of plasma, nano- and digital technologies into a single multimodal healthcare package may significantly improve patient outcomes and comfort, and reduce the economic burden on community healthcare, as well as alleviate many problems related to overcrowded healthcare systems.
Collapse
Affiliation(s)
- Dawei Liu
- State Key Lab of Advanced Electromagnetic Engineering and Technology, School of Electronic and Electrical EngineeringHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Endre J. Szili
- Future Industries InstituteUniversity of South AustraliaMawson LakesSouth AustraliaAustralia
| | - Kostya (Ken) Ostrikov
- School of Chemistry and Physics and Centre for Materials ScienceQueensland University of TechnologyBrisbaneQueenslandAustralia
- CSIRO‐QUT Joint Sustainable Processes and Devices LaboratoryLindfieldNew South WalesAustralia
| |
Collapse
|
10
|
Heusinkveld HJ, Staal YCM, Baker NC, Daston G, Knudsen TB, Piersma A. An ontology for developmental processes and toxicities of neural tube closure. Reprod Toxicol 2020; 99:160-167. [PMID: 32926990 PMCID: PMC10083840 DOI: 10.1016/j.reprotox.2020.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/12/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
In recent years, the development and implementation of animal-free approaches to chemical and pharmaceutical hazard and risk assessment has taken off. Alternative approaches are being developed starting from the perspective of human biology and physiology. Neural tube closure is a vital step that occurs early in human development. Correct closure of the neural tube depends on a complex interplay between proteins along a number of protein concentration gradients. The sensitivity of neural tube closure to chemical disturbance of signalling pathways such as the retinoid pathway, is well known. To map the pathways underlying neural tube closure, literature data on the molecular regulation of neural tube closure were collected. As the process of neural tube closure is highly conserved in vertebrates, the extensive literature available for the mouse was used whilst considering its relevance for humans. Thus, important cell compartments, regulatory pathways, and protein interactions essential for neural tube closure under physiological circumstances were identified and mapped. An understanding of aberrant processes leading to neural tube defects (NTDs) requires detailed maps of neural tube embryology, including the complex genetic signals and responses underlying critical cellular dynamical and biomechanical processes. The retinoid signaling pathway serves as a case study for this ontology because of well-defined crosstalk with the genetic control of neural tube patterning and morphogenesis. It is a known target for mechanistically-diverse chemical structures that disrupt neural tube closure The data presented in this manuscript will set the stage for constructing mathematical models and computer simulation of neural tube closure for human-relevant AOPs and predictive toxicology.
Collapse
Affiliation(s)
- Harm J Heusinkveld
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Yvonne C M Staal
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - George Daston
- Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH USA
| | - Thomas B Knudsen
- Center for Computational Toxicology and Exposure, U.S. Environmental Protection Agency, Research Triangle Park NC 27711, USA
| | - Aldert Piersma
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| |
Collapse
|
11
|
Kroll DS, Stanghellini E, DesRoches SL, Lydon C, Webster A, O'Reilly M, Hurwitz S, Aylward PM, Cartright JA, McGrath EJ, Delaporta L, Meyer AT, Kristan MS, Falaro LJ, Murphy C, Karno J, Pallin DJ, Schaffer A, Shah SB, Lakatos BE, Mitchell MT, Murphy CA, Gorman JM, Gitlin DF, Mulloy DF. Virtual monitoring of suicide risk in the general hospital and emergency department. Gen Hosp Psychiatry 2020; 63:33-38. [PMID: 30665667 DOI: 10.1016/j.genhosppsych.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/15/2018] [Accepted: 01/11/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether continuous virtual monitoring, an intervention that facilitates patient observation through video technology, can be used to monitor suicide risk in the general hospital and emergency department (ED). METHOD This was a retrospective analysis of a protocol in which select patients on suicide precautions in the general hospital and ED received virtual monitoring between June 2017 and March 2018. The primary outcome was the number of adverse events among patients who received virtual monitoring for suicide risk. Secondary outcomes were the percentage of patients for whom virtual monitoring was discontinued for behavioral reasons and the preference for observation type among nurses. RESULTS 39 patients on suicide precautions received virtual monitoring. There were 0 adverse events (95% confidence interval (CI) = 0.000-0.090). Virtual monitoring was discontinued for behavioral reasons in 4/38 cases for which the reason for terminating was recorded (0.105, 95%CI = 0.029-0.248). We were unable to draw conclusions regarding preference for observation type among nurses due to a low response rate to our survey. CONCLUSIONS Suicide risk can feasibly be monitored virtually in the general hospital or ED when their providers carefully select patients for low impulsivity risk.
Collapse
Affiliation(s)
- David S Kroll
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA.
| | - Escel Stanghellini
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Stephanie L DesRoches
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Charles Lydon
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Allison Webster
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Molly O'Reilly
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Shelley Hurwitz
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Patricia M Aylward
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Jennifer A Cartright
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Elizabeth J McGrath
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Linda Delaporta
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Anna T Meyer
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Michael S Kristan
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Laurie J Falaro
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Colin Murphy
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Jennifer Karno
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Division of Social Work, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Adam Schaffer
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Sejal B Shah
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Barbara E Lakatos
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Monique T Mitchell
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Christine A Murphy
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Janet M Gorman
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - David F Gitlin
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Deborah F Mulloy
- Massachusetts Board of Registration in Medicine, 200 Harvard Mill Square, Wakefield, MA 01880, USA
| |
Collapse
|
12
|
Cryptopharmaceuticals: Increasing the Safety of Medication by a Blockchain of Pharmaceutical Products. J Pharm Sci 2019; 108:2838-2841. [DOI: 10.1016/j.xphs.2019.04.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
|
13
|
Bowyer A, Royse C. The future of recovery - Integrated, digitalised and in real time. Best Pract Res Clin Anaesthesiol 2018; 32:295-302. [PMID: 30522720 DOI: 10.1016/j.bpa.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
Traditional perioperative risk prediction recovery identifies patient populations at risk of suboptimal recovery but not individual patients in whom this actually occurs and in whom timely intervention is beneficial. Patient-focused recovery emphasises a return to a semblance of normality and an ability to perform activities previously undertaken. A patient's sense of self-efficacy and engagement in their own care positively influences functional improvement and emotive recovery. The future of recovery assessment is that which is individualised, digitalised, integrated and in real time. Real-time recovery (RTR) assessment is the contemporaneous collection, analysis and reporting of data that enable the identification of suboptimal recovery in individual patients in a timeframe that minimises the delay in the implementation of the targeted treatment. There is a need to validate the clinical utility of existing biometric technology, wireless hybrid devices and digitalised platforms in providing both clinician and patient with RTR data and to determine the effect, if any, that RTR has on patient engagement and outcome.
Collapse
Affiliation(s)
- Andrea Bowyer
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Grattan St, Parkville, 3052, Australia.
| | - Colin Royse
- Department of Surgery, University of Melbourne, Level 6, Centre for Medical Research, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
| |
Collapse
|
14
|
Furniturewalla A, Chan M, Sui J, Ahuja K, Javanmard M. Fully integrated wearable impedance cytometry platform on flexible circuit board with online smartphone readout. MICROSYSTEMS & NANOENGINEERING 2018; 4:20. [PMID: 31057908 PMCID: PMC6220260 DOI: 10.1038/s41378-018-0019-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/27/2018] [Accepted: 05/09/2018] [Indexed: 05/07/2023]
Abstract
We present a wearable microfluidic impedance cytometer implemented on a flexible circuit wristband with on-line smartphone readout for portable biomarker counting and analysis. The platform contains a standard polydimethylsiloxane (PDMS) microfluidic channel integrated on a wristband, and the circuitry on the wristband is composed of a custom analog lock-in amplification system, a microcontroller with an 8-bit analog-to-digital converter (ADC), and a Bluetooth module wirelessly paired with a smartphone. The lock-in amplification (LIA) system is implemented with a novel architecture which consists of the lock-in amplifier followed by a high-pass filter stage with DC offset subtraction, and a post-subtraction high gain stage enabling detection of particles as small as 2.8 μm using the 8-bit ADC. The Android smartphone application was used to initiate the system and for offline data-plotting and peak counting, and supports online data readout, analysis, and file management. The data is exportable to researchers and medical professionals for in-depth analysis and remote health monitoring. The system, including the microfluidic sensor, microcontroller, and Bluetooth module all fit on the wristband with a footprint of less than 80 cm2. We demonstrate the ability of the system to obtain generalized blood cell counts; however the system can be applied to a wide variety of biomarkers by interchanging the standard microfluidic channel with microfluidic channels designed for biomarker isolation.
Collapse
Affiliation(s)
- Abbas Furniturewalla
- Department of Electrical and Computer Engineering, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Matthew Chan
- Department of Electrical and Computer Engineering, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Jianye Sui
- Department of Electrical and Computer Engineering, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Karan Ahuja
- Department of Electrical and Computer Engineering, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Mehdi Javanmard
- Department of Electrical and Computer Engineering, Rutgers, The State University of New Jersey, New Brunswick, USA
| |
Collapse
|
15
|
Raj LM, Saxon LA. Haemodynamic Monitoring Devices in Heart Failure: Maximising Benefit with Digitally Enabled Patient Centric Care. Arrhythm Electrophysiol Rev 2018; 7:294-298. [PMID: 30588319 DOI: 10.15420/aer.2018.32.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/24/2018] [Indexed: 12/11/2022] Open
Abstract
ICDs and resynchronisation devices are routinely implanted in patients with heart failure for primary prevention of sudden cardiac death or to treat the condition. The addition of device features and algorithms that directly or indirectly monitor cardiac haemodynamics to assess heart failure status can provide additional benefit by treating heart failure more continuously. Established and emerging devices and sensors aimed at treating or measuring cardiac haemodynamics represent the next era of heart failure disease management. Digitally enabled models of heart failure care, based on frequent haemodynamic measurements, will increasingly involve patients in their own disease management. Software tools and services tailored to provide patients with personalised information to guide diet, activity, medications and haemodynamic management offer an unprecedented opportunity to improve patient outcomes. This will enable physicians to care for larger populations because management will be exception based, automated and no longer depend on one-to-one patient and physician interactions.
Collapse
Affiliation(s)
- Leah M Raj
- University of Southern California, USC Center for Body Computing, Keck School of Medicine Los Angeles, CA, USA
| | - Leslie A Saxon
- University of Southern California, USC Center for Body Computing, Keck School of Medicine Los Angeles, CA, USA
| |
Collapse
|
16
|
Shinbane JS, Saxon LA. Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation. J Cardiovasc Comput Tomogr 2017; 12:16-27. [PMID: 29198733 DOI: 10.1016/j.jcct.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 01/17/2023]
Abstract
Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality, cost effectiveness, and overall value to medical care.
Collapse
Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Leslie A Saxon
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
17
|
Akar JG, Hummel JP. Editorial commentary: Virtual medicine-A better reality? Trends Cardiovasc Med 2016; 26:731-732. [PMID: 27737760 DOI: 10.1016/j.tcm.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph G Akar
- Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT.
| | - James P Hummel
- Division of Cardiology, University of North Carolina, Chapel Hill, NC
| |
Collapse
|