A simulated learning intervention using interactive virtual patient cases improved provider knowledge and confidence in managing diabetes compared to a control group. 341 resident physicians from 19 programs were randomized to an early intervention group that completed 12 virtual patient cases over 8 months or a late intervention control group. The early intervention group scored higher on a diabetes knowledge survey and reported greater confidence and knowledge in diabetes management topics compared to the control group. The results provide evidence that simulated learning can help transfer knowledge to improved care of real patients.
Predicting Stroke Patient Recovery from Brain Images: A Machine Learning Appr...alastair_charles_smith
This document describes a study that uses machine learning techniques to analyze CT brain images and predict functional recovery in stroke patients. The study aims to determine if machine learning can provide accurate predictions of recovery and identify which areas of the brain images inform the predictions. The document provides background on strokes, machine learning applications to neuroimaging, and describes the data acquisition and testing methodology used in the study.
- Ocrelizumab (OCR) significantly reduced disability progression and disease activity in patients with primary progressive multiple sclerosis (PPMS) compared to placebo in the ORATORIO clinical trial.
- Evaluation of efficacy in subgroups of patients with and without T1 gadolinium-enhancing (Gd+) lesions at baseline was a key objective. OCR reduced disability progression and disease activity in both subgroups.
- Specifically, OCR reduced the risk of 12-week and 24-week confirmed disability progression by 24-25% in the overall population and in both subgroups. It also reduced the worsening of walking ability and brain lesion volume over 120 weeks compared to placebo.
The document discusses the design of a proposed "Troops to Nurses" program using Schlossberg's model of transition. [1] The program would help transition military veterans with healthcare experience or degrees into nursing careers to address the nursing shortage. [2] Schlossberg's model focuses on the four S's - situation, self, support, and strategies - and has been applied to similar transition programs. [3] The document outlines how the model applies to the target population and program design.
The clinical study evaluated peripheral nerve stimulation of the occipital nerves for chronic migraine. 157 patients were randomly assigned to an active or control group in a 2:1 ratio. The primary endpoint of a 10% difference in responders between groups was not met. However, secondary analyses found that the active group experienced significantly greater reductions in headache days, migraine disability, and improvements in quality of life and satisfaction compared to the control group.
1) A phase 3 clinical trial evaluated the efficacy of ocrelizumab in reducing disability progression in patients with primary progressive multiple sclerosis (PPMS) with and without T1 gadolinium-enhancing lesions at baseline.
2) Results showed that ocrelizumab reduced the risk of 12-week and 24-week confirmed disability progression by 24% and 25% respectively compared to placebo in the overall study population.
3) When analyzing subgroups based on presence of T1 lesions at baseline, ocrelizumab reduced risk of disability progression in both subgroups, though the results did not reach statistical significance in the subgroup with lesions at baseline.
EIS technology : bioimpedance application in selective serotonin reuptakeES-Teck India
Through the 6 tactile electrodes, a weak DC current is sending alternatively between 2 electrodes with a sequence and the EIS-GS system is recording the electrical conductance of 11 pathways of the human body.
Understanding patient-reported outcome measures in Huntington disease: at wha...Huntington Study Group
Understanding patient-reported outcome measures in Huntington disease: at what point is cognitive impairment related to poor measurement reliability, presented by Nicole Carlozo, PhD, University of Michigan, HSG 2016
1) Both diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) require treatment, with the standard treatment for PDR being laser therapy. However, anti-VEGF therapy using ranibizumab is an alternative option supported by clinical evidence.
2) Several large randomized controlled trials found that ranibizumab treatment improved diabetic retinopathy severity scale (DRSS) scores and reduced the risk of DR progression and vision loss compared to laser therapy. Ranibizumab also led to better visual acuity outcomes in patients with and without DME.
3) Based on this evidence, the author prefers anti-VEGF therapy over laser therapy for their own PDR
Predicting Stroke Patient Recovery from Brain Images: A Machine Learning Appr...alastair_charles_smith
This document describes a study that uses machine learning techniques to analyze CT brain images and predict functional recovery in stroke patients. The study aims to determine if machine learning can provide accurate predictions of recovery and identify which areas of the brain images inform the predictions. The document provides background on strokes, machine learning applications to neuroimaging, and describes the data acquisition and testing methodology used in the study.
- Ocrelizumab (OCR) significantly reduced disability progression and disease activity in patients with primary progressive multiple sclerosis (PPMS) compared to placebo in the ORATORIO clinical trial.
- Evaluation of efficacy in subgroups of patients with and without T1 gadolinium-enhancing (Gd+) lesions at baseline was a key objective. OCR reduced disability progression and disease activity in both subgroups.
- Specifically, OCR reduced the risk of 12-week and 24-week confirmed disability progression by 24-25% in the overall population and in both subgroups. It also reduced the worsening of walking ability and brain lesion volume over 120 weeks compared to placebo.
The document discusses the design of a proposed "Troops to Nurses" program using Schlossberg's model of transition. [1] The program would help transition military veterans with healthcare experience or degrees into nursing careers to address the nursing shortage. [2] Schlossberg's model focuses on the four S's - situation, self, support, and strategies - and has been applied to similar transition programs. [3] The document outlines how the model applies to the target population and program design.
The clinical study evaluated peripheral nerve stimulation of the occipital nerves for chronic migraine. 157 patients were randomly assigned to an active or control group in a 2:1 ratio. The primary endpoint of a 10% difference in responders between groups was not met. However, secondary analyses found that the active group experienced significantly greater reductions in headache days, migraine disability, and improvements in quality of life and satisfaction compared to the control group.
1) A phase 3 clinical trial evaluated the efficacy of ocrelizumab in reducing disability progression in patients with primary progressive multiple sclerosis (PPMS) with and without T1 gadolinium-enhancing lesions at baseline.
2) Results showed that ocrelizumab reduced the risk of 12-week and 24-week confirmed disability progression by 24% and 25% respectively compared to placebo in the overall study population.
3) When analyzing subgroups based on presence of T1 lesions at baseline, ocrelizumab reduced risk of disability progression in both subgroups, though the results did not reach statistical significance in the subgroup with lesions at baseline.
EIS technology : bioimpedance application in selective serotonin reuptakeES-Teck India
Through the 6 tactile electrodes, a weak DC current is sending alternatively between 2 electrodes with a sequence and the EIS-GS system is recording the electrical conductance of 11 pathways of the human body.
Understanding patient-reported outcome measures in Huntington disease: at wha...Huntington Study Group
Understanding patient-reported outcome measures in Huntington disease: at what point is cognitive impairment related to poor measurement reliability, presented by Nicole Carlozo, PhD, University of Michigan, HSG 2016
1) Both diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) require treatment, with the standard treatment for PDR being laser therapy. However, anti-VEGF therapy using ranibizumab is an alternative option supported by clinical evidence.
2) Several large randomized controlled trials found that ranibizumab treatment improved diabetic retinopathy severity scale (DRSS) scores and reduced the risk of DR progression and vision loss compared to laser therapy. Ranibizumab also led to better visual acuity outcomes in patients with and without DME.
3) Based on this evidence, the author prefers anti-VEGF therapy over laser therapy for their own PDR
This document summarizes results from the PRIDE-HD clinical trial of the drug pridopidine for Huntington's disease. The trial involved 437 patients across multiple countries and clinical sites. Key results included:
- Pridopidine did not show a significant effect on total motor score at 26 weeks, though some improvement was seen.
- Pridopidine showed a significant slowing of functional decline as measured by Total Functional Capacity (TFC) at 52 weeks, particularly in early stage patients.
- Responder analysis found more early stage patients on pridopidine maintained or improved TFC scores compared to placebo.
- Safety analysis found no new safety issues, though some psychiatric events were
Healthcare is undergoing a technological transformation, and it is imperative for the industry to leverage new technologies to generate, collect, and track novel data. Panel chaired by Ralf Reilmann of the George Huntington Institut, Muenster.
This document discusses delirium in the ICU, including:
1) Delirium is a common syndrome in ICU patients characterized by inattention and cognitive dysfunction. It is associated with increased mortality, length of stay, and long-term cognitive impairment.
2) Implementing an ABCDE bundle including awakening trials, breathing coordination, delirium monitoring/management, and early mobility can reduce delirium incidence and improve outcomes.
3) Non-pharmacological interventions like reorientation, mobility, and minimizing sedative exposure are important for preventing and treating delirium.
Journal club222 EEG as predictive tool for developmentYassin Alsaleh
Three sentences:
1) The study aimed to determine if early electroencephalographic (EEG) abnormalities could predict neurodevelopmental outcomes at 24 months for term infants with hypoxic-ischemic encephalopathy (HIE).
2) Fifty infants with HIE underwent continuous video-EEG monitoring within 6 hours of birth, and EEG findings at 6, 12, 24, and 48 hours were correlated with outcomes assessed at 24 months.
3) The results showed that normal or mildly abnormal EEG findings within the first 24 hours highly accurately predicted normal outcomes, while more severe abnormalities were strongly associated with abnormal neurodevelopment.
The document describes 3 experiments that tested the effectiveness of different video conditions on reducing prejudice toward schizophrenia among university students in Japan. Experiment 1 found that a video of a patient narration significantly reduced the cognitive "bad image" component of prejudice, while a video of a psychiatrist explanation did not. Experiment 2 replicated these results. Experiment 3 found that a video of a group home significantly reduced the cognitive component but increased the behavioral "social distance" component of prejudice. The most effective approach for reducing prejudice was found to be direct narratives by patients about their lives.
This document summarizes a presentation on physiotherapy for non-cancer chronic pain. It discusses that physiotherapy aims to restore and promote optimal physical function and quality of life for those with persistent pain. It provides an overview of evaluation processes in physiotherapy and various treatment modalities. It also summarizes evidence on approaches for common persistent pain conditions like low back pain, whiplash associated disorder, and osteoarthritis. Screening tools for risk of long-term disability are also briefly covered.
T Sornasse Elan Chi Accelerating Proof Of Concept 2010tsornasse
This document discusses opportunities and challenges for using biomarkers to accelerate proof-of-concept studies in neurodegenerative diseases. It highlights initiatives like ADNI that have advanced biomarkers for disease state and progression. These biomarkers allow for earlier patient enrichment, more sensitive endpoints, and smaller clinical trials. Biomarkers can also provide insights into drug-target engagement and pharmacodynamics/toxicodynamics. Integrating biomarkers throughout development could enable faster entry to Phase 3 and higher chances of success for disease-modifying therapies to address the growing burden of neurodegenerative diseases.
The best of_the_pem_literature_in_the_last_year_terry_klassen_presentationtrekkca
This document summarizes several key pediatric emergency medicine studies from 2012-2013. It discusses 10 topics:
1. A randomized controlled trial compared polyethylene glycol 3350 vs enema for fecal disimpaction, finding no significant differences in symptom improvement between groups at day 5.
2. A clinical practice guideline stratified appendicitis risk into low, medium, and high to guide imaging and surgical referral.
3. Two studies examined diagnostic tools and physician accuracy for diagnosing intussusception.
4. An intervention to improve structured pain management in the pediatric ED led to more patients receiving analgesics faster and more frequent reassessment.
5. Studies found that rest improves concussion symptoms and reductions in
Patient Safety – The Danish Experience. Torben Mogensen. Presentation of the National Study of Adverse Events (Madrid, Ministry of Health and Consumer Affairs, 2006)
G093 Kodaira, T., Ito, T., Matsugami, S., & Inoue (2008). Can we reduce the ...Takehiko Ito
G093 Kodaira, T., Ito, T., Matsugami, S., & Inoue (2008). Can we reduce the prejudice among the people towards schizophrenia by a short-time video education? 13th Pacific Rim College of Psychiatrists Scientic Meeting Program & Abstracts, 296.
This document provides an adapted clinical practice guideline for the management of persistent non-specific low back pain from 6 weeks to 12 months in duration. It is based on a guideline originally developed by the National Institute for Health and Care Excellence in the UK. The guideline was adapted for use in Saudi Arabia using the ADAPTE process. It includes an introduction describing non-specific low back pain and available treatment options. The guideline aims to ensure episodes of low back pain do not result in long-term disability or withdrawal from normal activities. It provides recommendations for the management of non-specific low back pain through education, exercise, manual therapy, and combined physical and psychological interventions.
Huntexil® is a potential treatment for Huntington's disease being developed by NeuroSearch. Two phase 3 clinical trials failed to meet their primary endpoints but showed statistically significant improvement in motor function. Based on feedback from regulators, NeuroSearch is conducting a new phase 3 trial called Prime-HD to further evaluate Huntexil®'s efficacy and safety. There is a large unmet medical need for new treatments for Huntington's disease given its prevalence and limitations of current therapies. NeuroSearch is also evaluating the potential commercial value and cost-effectiveness of Huntexil® to support regulatory approval and reimbursement.
This document provides guidelines for the fourth edition of the treatment of tuberculosis. It outlines case definitions, standard treatment regimens for new and previously treated patients, monitoring during treatment, co-management of TB and HIV, supervision and patient support, treatment of drug-resistant TB, and treatment in special situations. The guidelines are intended to help national TB programs develop standards to effectively treat and manage TB patients.
IMPROVING PERFORMANCE OF ALGORITHMS TO POWER UNMET NEED AND EFFECTIVENESS IN ...Schiffon Wong
The presentation discussed developing and validating algorithms to identify health outcomes using electronic health records and claims data. It provided an example of developing an algorithm to identify multiple sclerosis subtypes using both EHR clinical notes and claims data. Validation of the algorithms calculated positive predictive values by manually reviewing a sample of patient records classified as certain, likely, possible, or no matches. The presentation emphasized that algorithm validation is important to determine accuracy and support interpretation of results from algorithm-identified health outcomes. Audience participation was invited to discuss experiences with algorithm development, validation methods, and lessons learned.
This presentation brings together 3 currents in my approach to treating pediatric epilepsy: a recognition of the importance of epilepsy comorbidities, partnering with families in patient assessment and decision making, and creative use of informatics/EHR's to gather information about clinical aspects of epilepsy. A presentation to the Missouri Valley Child Neurology Colloquium, March 2012.
The study examined the prevalence and characteristics of headaches among 372 medical students in Zagazig University in Egypt. The one-year prevalence of headache was 8.9%, with tension-type headache being more prevalent in males (7.7%) and migraine being more prevalent in females (6.9%). While the site, characteristics and frequency of headaches were similar between males and females, a positive family history of headaches had a statistically significant impact on prevalence among students. Further research is needed to better understand headaches in the college-aged population.
Online Patient Access to their Medical Record and Health Providers is Associa...HMO Research Network
This study investigated the impact of patients having online access to their medical records through Kaiser Permanente's MyHealthManager (MHM) system. The results showed that MHM users had a 18% higher rate of office visits and 9% higher rate of phone visits compared to non-users. Rates of after-hours clinic visits, emergency department visits, and hospitalizations also increased. While increased access seemed to lead to greater use of healthcare services, further research is still needed to understand the reasons and outcomes.
I Got Mine Have you Gotten Yours Email to Promote Colorectal Cancer Screening...HMO Research Network
This document describes a study that assessed people's willingness to encourage colorectal cancer screening among friends and family by sharing their own screening experiences via email. 386 individuals ages 50-70 were interviewed. Most were willing to share their screening experience in conversations, but fewer by email. 89% were willing to pass along a self-edited message, with more preferring email over postcards. Respondents estimated such messages would increase discussion of screening with providers, both for themselves and others. Reported reach was over 2,000 postcards and 4,000 emails.
Use of the Oncology Beacon Module snd Virtusl Dats Warehouse Data to Identify...HMO Research Network
This document summarizes a study examining variations in treatment and costs for patients diagnosed with stage III/IV colorectal cancer using data from the Oncology Beacon module and VDW (Virtual Data Warehouse). The study found significant variations in treatment intent, protocols, regimens, and reasons for discontinuation between stage III and IV patients. First line treatments often included oxaliplatin + fluorouracil + leucovorin. Missing data was common for some variables. Costs varied based on regimen and dosage. The study concluded that the VDW chemotherapy data is a rich source for comparative effectiveness research in colorectal cancer patients.
Trend Micro Titanium is an antivirus program that protects PCs from malware like viruses, spyware, worms and Trojans. It provides protection on Windows and Macs with tools to protect against fake antivirus software. Trend Micro is full of features to protect users on social media, email, chatting and networks with customer support always available. While Trend Micro has been tested and approved by labs, scoring relatively well on protection and usability, it has been absent from some tests and lags in some rankings compared to other programs. Trend Micro has pros like anti-phishing protection and cloud-based small code footprint, and cons like missing rescue CD and laptop modes and below average performance on some Windows 7 tests
This document summarizes results from the PRIDE-HD clinical trial of the drug pridopidine for Huntington's disease. The trial involved 437 patients across multiple countries and clinical sites. Key results included:
- Pridopidine did not show a significant effect on total motor score at 26 weeks, though some improvement was seen.
- Pridopidine showed a significant slowing of functional decline as measured by Total Functional Capacity (TFC) at 52 weeks, particularly in early stage patients.
- Responder analysis found more early stage patients on pridopidine maintained or improved TFC scores compared to placebo.
- Safety analysis found no new safety issues, though some psychiatric events were
Healthcare is undergoing a technological transformation, and it is imperative for the industry to leverage new technologies to generate, collect, and track novel data. Panel chaired by Ralf Reilmann of the George Huntington Institut, Muenster.
This document discusses delirium in the ICU, including:
1) Delirium is a common syndrome in ICU patients characterized by inattention and cognitive dysfunction. It is associated with increased mortality, length of stay, and long-term cognitive impairment.
2) Implementing an ABCDE bundle including awakening trials, breathing coordination, delirium monitoring/management, and early mobility can reduce delirium incidence and improve outcomes.
3) Non-pharmacological interventions like reorientation, mobility, and minimizing sedative exposure are important for preventing and treating delirium.
Journal club222 EEG as predictive tool for developmentYassin Alsaleh
Three sentences:
1) The study aimed to determine if early electroencephalographic (EEG) abnormalities could predict neurodevelopmental outcomes at 24 months for term infants with hypoxic-ischemic encephalopathy (HIE).
2) Fifty infants with HIE underwent continuous video-EEG monitoring within 6 hours of birth, and EEG findings at 6, 12, 24, and 48 hours were correlated with outcomes assessed at 24 months.
3) The results showed that normal or mildly abnormal EEG findings within the first 24 hours highly accurately predicted normal outcomes, while more severe abnormalities were strongly associated with abnormal neurodevelopment.
The document describes 3 experiments that tested the effectiveness of different video conditions on reducing prejudice toward schizophrenia among university students in Japan. Experiment 1 found that a video of a patient narration significantly reduced the cognitive "bad image" component of prejudice, while a video of a psychiatrist explanation did not. Experiment 2 replicated these results. Experiment 3 found that a video of a group home significantly reduced the cognitive component but increased the behavioral "social distance" component of prejudice. The most effective approach for reducing prejudice was found to be direct narratives by patients about their lives.
This document summarizes a presentation on physiotherapy for non-cancer chronic pain. It discusses that physiotherapy aims to restore and promote optimal physical function and quality of life for those with persistent pain. It provides an overview of evaluation processes in physiotherapy and various treatment modalities. It also summarizes evidence on approaches for common persistent pain conditions like low back pain, whiplash associated disorder, and osteoarthritis. Screening tools for risk of long-term disability are also briefly covered.
T Sornasse Elan Chi Accelerating Proof Of Concept 2010tsornasse
This document discusses opportunities and challenges for using biomarkers to accelerate proof-of-concept studies in neurodegenerative diseases. It highlights initiatives like ADNI that have advanced biomarkers for disease state and progression. These biomarkers allow for earlier patient enrichment, more sensitive endpoints, and smaller clinical trials. Biomarkers can also provide insights into drug-target engagement and pharmacodynamics/toxicodynamics. Integrating biomarkers throughout development could enable faster entry to Phase 3 and higher chances of success for disease-modifying therapies to address the growing burden of neurodegenerative diseases.
The best of_the_pem_literature_in_the_last_year_terry_klassen_presentationtrekkca
This document summarizes several key pediatric emergency medicine studies from 2012-2013. It discusses 10 topics:
1. A randomized controlled trial compared polyethylene glycol 3350 vs enema for fecal disimpaction, finding no significant differences in symptom improvement between groups at day 5.
2. A clinical practice guideline stratified appendicitis risk into low, medium, and high to guide imaging and surgical referral.
3. Two studies examined diagnostic tools and physician accuracy for diagnosing intussusception.
4. An intervention to improve structured pain management in the pediatric ED led to more patients receiving analgesics faster and more frequent reassessment.
5. Studies found that rest improves concussion symptoms and reductions in
Patient Safety – The Danish Experience. Torben Mogensen. Presentation of the National Study of Adverse Events (Madrid, Ministry of Health and Consumer Affairs, 2006)
G093 Kodaira, T., Ito, T., Matsugami, S., & Inoue (2008). Can we reduce the ...Takehiko Ito
G093 Kodaira, T., Ito, T., Matsugami, S., & Inoue (2008). Can we reduce the prejudice among the people towards schizophrenia by a short-time video education? 13th Pacific Rim College of Psychiatrists Scientic Meeting Program & Abstracts, 296.
This document provides an adapted clinical practice guideline for the management of persistent non-specific low back pain from 6 weeks to 12 months in duration. It is based on a guideline originally developed by the National Institute for Health and Care Excellence in the UK. The guideline was adapted for use in Saudi Arabia using the ADAPTE process. It includes an introduction describing non-specific low back pain and available treatment options. The guideline aims to ensure episodes of low back pain do not result in long-term disability or withdrawal from normal activities. It provides recommendations for the management of non-specific low back pain through education, exercise, manual therapy, and combined physical and psychological interventions.
Huntexil® is a potential treatment for Huntington's disease being developed by NeuroSearch. Two phase 3 clinical trials failed to meet their primary endpoints but showed statistically significant improvement in motor function. Based on feedback from regulators, NeuroSearch is conducting a new phase 3 trial called Prime-HD to further evaluate Huntexil®'s efficacy and safety. There is a large unmet medical need for new treatments for Huntington's disease given its prevalence and limitations of current therapies. NeuroSearch is also evaluating the potential commercial value and cost-effectiveness of Huntexil® to support regulatory approval and reimbursement.
This document provides guidelines for the fourth edition of the treatment of tuberculosis. It outlines case definitions, standard treatment regimens for new and previously treated patients, monitoring during treatment, co-management of TB and HIV, supervision and patient support, treatment of drug-resistant TB, and treatment in special situations. The guidelines are intended to help national TB programs develop standards to effectively treat and manage TB patients.
IMPROVING PERFORMANCE OF ALGORITHMS TO POWER UNMET NEED AND EFFECTIVENESS IN ...Schiffon Wong
The presentation discussed developing and validating algorithms to identify health outcomes using electronic health records and claims data. It provided an example of developing an algorithm to identify multiple sclerosis subtypes using both EHR clinical notes and claims data. Validation of the algorithms calculated positive predictive values by manually reviewing a sample of patient records classified as certain, likely, possible, or no matches. The presentation emphasized that algorithm validation is important to determine accuracy and support interpretation of results from algorithm-identified health outcomes. Audience participation was invited to discuss experiences with algorithm development, validation methods, and lessons learned.
This presentation brings together 3 currents in my approach to treating pediatric epilepsy: a recognition of the importance of epilepsy comorbidities, partnering with families in patient assessment and decision making, and creative use of informatics/EHR's to gather information about clinical aspects of epilepsy. A presentation to the Missouri Valley Child Neurology Colloquium, March 2012.
The study examined the prevalence and characteristics of headaches among 372 medical students in Zagazig University in Egypt. The one-year prevalence of headache was 8.9%, with tension-type headache being more prevalent in males (7.7%) and migraine being more prevalent in females (6.9%). While the site, characteristics and frequency of headaches were similar between males and females, a positive family history of headaches had a statistically significant impact on prevalence among students. Further research is needed to better understand headaches in the college-aged population.
Online Patient Access to their Medical Record and Health Providers is Associa...HMO Research Network
This study investigated the impact of patients having online access to their medical records through Kaiser Permanente's MyHealthManager (MHM) system. The results showed that MHM users had a 18% higher rate of office visits and 9% higher rate of phone visits compared to non-users. Rates of after-hours clinic visits, emergency department visits, and hospitalizations also increased. While increased access seemed to lead to greater use of healthcare services, further research is still needed to understand the reasons and outcomes.
I Got Mine Have you Gotten Yours Email to Promote Colorectal Cancer Screening...HMO Research Network
This document describes a study that assessed people's willingness to encourage colorectal cancer screening among friends and family by sharing their own screening experiences via email. 386 individuals ages 50-70 were interviewed. Most were willing to share their screening experience in conversations, but fewer by email. 89% were willing to pass along a self-edited message, with more preferring email over postcards. Respondents estimated such messages would increase discussion of screening with providers, both for themselves and others. Reported reach was over 2,000 postcards and 4,000 emails.
Use of the Oncology Beacon Module snd Virtusl Dats Warehouse Data to Identify...HMO Research Network
This document summarizes a study examining variations in treatment and costs for patients diagnosed with stage III/IV colorectal cancer using data from the Oncology Beacon module and VDW (Virtual Data Warehouse). The study found significant variations in treatment intent, protocols, regimens, and reasons for discontinuation between stage III and IV patients. First line treatments often included oxaliplatin + fluorouracil + leucovorin. Missing data was common for some variables. Costs varied based on regimen and dosage. The study concluded that the VDW chemotherapy data is a rich source for comparative effectiveness research in colorectal cancer patients.
Trend Micro Titanium is an antivirus program that protects PCs from malware like viruses, spyware, worms and Trojans. It provides protection on Windows and Macs with tools to protect against fake antivirus software. Trend Micro is full of features to protect users on social media, email, chatting and networks with customer support always available. While Trend Micro has been tested and approved by labs, scoring relatively well on protection and usability, it has been absent from some tests and lags in some rankings compared to other programs. Trend Micro has pros like anti-phishing protection and cloud-based small code footprint, and cons like missing rescue CD and laptop modes and below average performance on some Windows 7 tests
Blogs have become increasingly popular in recent months. Many individuals and companies now use blogs to express thoughts, provide information to consumers, and market products. Blogs are a good way for companies to increase marketing because there are many people who read blogs for news, reviews, and personal experiences. Customizing a blog's design with things like banners, photos, and icons can help it stand out and increase traffic.
Generalized Anxiety and Depression Among Chronic Pain Patients on Opiod Thera...HMO Research Network
This study found:
1) Anxiety and depression among chronic pain patients were associated with higher levels of pain-related impairment, increased healthcare utilization, and poorer overall health.
2) 35.1% of patients met criteria for lifetime opioid dependence, and 25.4% met criteria for current opioid dependence based on the DSM-IV. Patients with a history of anxiety, depression, or other substance dependence disorders were more likely to meet criteria for opioid dependence.
3) The results were very similar when comparing diagnoses of opioid use disorder based on DSM-IV vs. DSM-5 criteria, with a kappa of 0.873, indicating almost perfect agreement between the diagnostic systems.
This study conducted a prospective population-based cohort study and systematic review/meta-analysis to evaluate the risk of stroke in patients with asymptomatic carotid stenosis receiving medical therapy alone. The cohort study included patients found to have asymptomatic carotid stenosis between 2002-2017 who received contemporary medical management including antiplatelet/statin therapy and blood pressure control. The primary outcome was ipsilateral ischemic stroke. A systematic review/meta-analysis of previous studies on this topic was also performed to determine stroke risks with medical therapy alone and evaluate if routine carotid intervention is still warranted.
The document summarizes a presentation on neurocognitive complications of HIV disease. The presentation was given at the UC San Diego AntiViral Research Center, which sponsors weekly presentations on infectious diseases research. The goal is to provide current research, clinical practices, and trends in diseases like HIV, HBV, HCV, and TB. The slides from this particular presentation on neurocognitive complications of HIV are intended for educational purposes of the audience and may not be used for other purposes without permission.
- This randomized controlled trial investigated whether prophylactic melatonin reduces delirium prevalence in critically ill patients compared to placebo. Over 800 patients received either 4mg of melatonin or placebo each night for 14 days or until ICU discharge. The trial found no significant differences between the melatonin and placebo groups in the proportion of delirium-free assessments, delirium prevalence, severity or duration, sleep quality, or other clinical outcomes such as mortality and length of stay. Prophylactic melatonin did not demonstrate a benefit for preventing delirium in critically ill patients in the ICU according to this study.
Here are 3 key questions the research group may want to consider:
1. Standardizing outcomes and assessments across sites while allowing for local flexibility. What core metrics and tools can be used consistently, while permitting some customization?
2. Developing a governance structure and processes that are inclusive yet efficient. How will decisions be made to balance needs of all members?
3. Determining authorship guidelines upfront to avoid future disputes. What qualifies someone as an author on multi-site studies?
The group should discuss these issues early to facilitate collaborative work and trust within the network. Clear policies can help maximize the benefits of this innovative research model.
This document summarizes evidence from a systematic review on effective interventions to improve antibiotic prescribing in primary care. The review found that interventions involving multiple components, including educational materials and meetings for physicians, were most effective at reducing total antibiotic prescribing. Delayed prescribing strategies that provide clear instructions on use were also effective. Communication skills training for physicians, with or without decision aids, reduced prescribing for respiratory tract infections. The use of near-patient tests also reduced prescribing when combined with clinical training.
Clinical Trial Simulation training with simulo 20161124Ruben Faelens
In collaboration with the University of Lyon, we presented a 2-hour session in Clinical Trial Simulation. This session fitted nicely within the Master's program curated by Emilie Henin (Calvagone).
The 10 students managed to explore the PK model for Sunitinib. 4 students struck gold at the end, managing to create an efficient design that proved biosimilarity.
This document provides an overview of a proposed new drug called Regenozene to treat multiple sclerosis (MS) by inhibiting Death Receptor 6 (DR-6). The drug aims to promote remyelination of neurons in MS patients. If successful, Regenozene could potentially stop relapses and reverse disability from MS, addressing major unmet needs. The document outlines the pathogenesis of MS, Regenozene's proposed mechanism of action, target product profile, development plan through clinical trials and regulatory approval, manufacturing and intellectual property considerations, market analysis and financial projections. The virtual business model aims to minimize risk through partnerships while maintaining control over development.
An electronic early warning score system was proposed to address the shortcomings of a manual paper-based system. The electronic system would calculate scores based on recorded vital sign observations and trigger alerts and escalation pathways for deteriorating patients. The system could be deployed on mobile devices at bedsides or fixed iPads to facilitate real-time data entry and alerts. It leverages an existing electronic medical record platform already in use in New Zealand to provide an integrated, feasible solution.
Dr Andrea Jorgensen - The future of innovation in atrial fibrillation and str...Innovation Agency
Presentation by Dr Andrea Jorgensen, Senior Lecturer - Biostatistics, University of Liverpool: Personalised Medicine in the treatment of AF at The future of innovation in AF and stroke prevention in the NWC, 27 June 2018, Haydock Park Racecourse
This multicenter observational study evaluated the impact of enteral feeding protocols on nutrition delivery in critically ill patients. The study found that sites using a feeding protocol had better enteral nutrition adequacy, started enteral nutrition earlier, and had higher overall nutritional adequacy compared to sites without a protocol. Specifically, sites with a protocol achieved 45.4% enteral nutrition adequacy compared to 34.7% for sites without. The presence of a protocol was associated with a 4.1% increase in enteral nutrition adequacy after adjusting for patient and site characteristics. However, overall nutritional adequacy remained below targets, indicating need for further refinement of feeding protocols.
1) The document discusses different types of evidence used in managing NEC, including textbooks, experience, published studies, and guidelines. Higher levels of evidence include systematic reviews and randomized controlled trials.
2) Factors that can help or hinder the development of NEC are discussed, such as breast milk, feeding strategies, and supplements like arginine and glutamine. Studies have looked at whether interventions like H2 blockers or probiotics can prevent NEC.
3) The best evidence for managing NEC comes from meta-analyses, randomized trials, and guidelines, but these are not always possible. It is important to consider other outcomes in addition to NEC.
11 cpg management of jaundice in healthy newbornsLily Tensai
The document provides clinical practice guidelines for the management of jaundice in healthy term newborns. It outlines recommendations for assessing newborns with jaundice through history, physical examination, and lab investigations. The guidelines also cover evaluating severity, indications for hospital referral, and treatment approaches including phototherapy and exchange transfusion.
With @Atreja at the NODE Health Conference - Digital Medicine http://digitalmedicineconference.com/ on the events and studies which moved the field forward
This document discusses a point-of-care diagnostic test called Simtomax for detecting celiac disease and gluten intolerance.
1) Simtomax is a rapid blood test that can detect celiac disease and gluten intolerance in 10 minutes using a small blood sample, providing an alternative to invasive laboratory tests.
2) Clinical studies have shown Simtomax to have a high diagnostic accuracy of 94.8% compared to laboratory tests, correctly identifying all patients with celiac disease or IgA deficiency.
Build Your Own Nursing Clinical Judgment Question.pptxLucindaStanley
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A Simulated Diabetes Learning Intervention Improves Provider Knowledge and Co...
A Simulated Diabetes Learning Intervention Improves Provider Knowledge and Confidence in Managing Diabetes HILLEN
1. A Simulated Diabetes Learning
Intervention Improves Provider
Knowledge and Confidence in
Managing Diabetes
JoAnn Sperl-Hillen, MD
Co-director of Center for Chronic Care Innovation
HealthPartners Research Foundation, Minneapolis, MN
Wednesday May 2, 2012 8-9:30am
18th Annual HMO Research Network Conference
Seattle, WA
Accelerating excellence in health performance
through education, advocacy, and collaboration
2. Team Members
JoAnn Sperl-Hillen Steve Asche
Patrick O’Connor George Biltz*
Heidi Ekstrom Deb Curran
William Rush Paul Johnson*
Omar Fernandes Andrew Rudge
Jerry Amundson Todd Gilmer**
Deepika Appana
HealthPartners Research Foundation and HealthPartners
Institute for Medical Education, Minneapolis, MN;
* Carlson School of Management, University of
Minnesota, Minneapolis MN;
** Department of Family and Preventive Medicine, University
of California, San Diego, La Jolla, CA
3. Presenter Disclosures
NIH research support
Listed inventor on a U.S. patent application filed
related to simulation technology
HPRF has recently entered into a royalty-bearing
license agreement with a third party to commercialize
the simulated learning technology for the purpose of
broader dissemination.
Non-paid director on the board of directors for that
licensee (SimCare Health)
4. Why is provider training
needed?
Provider performance varies, even
within the same clinic populations
Clinical inertia is common, particularly
for insulin treatment
Provider knowledge varies
The cognitive processes and tasks
related to diabetes are complex
5. Barriers to Provider Training
Time constraints
Lack of continuity experiences
Relatively limited ambulatory
experience in residency training
Complicated diseases with need for
personalization of care
Experts & opinion leaders are often not
available or affordable, and teaching is
difficult to standardize
6. What is simulation?
―Simulation is a technique—not a technology—to replace
or amplify real experiences with guided experiences that
evoke or replicate substantial aspects of the real world in
a fully interactive manner.‖ Gaba (2004)
History of Simulation
Aviation
NASA
Military
Medical
1960s First Mannequin: Resusci-Annie
1960s-70s Computer-assisted learning program in
medicine
1990 High fidelity mannequins become available
7. What are the advantages to
simulation?
Efficient & cost effective
Sustainable & standardized
In line with adult learning principles
Personalized (case-based). Case-based
simulations provide a context for learning
People are more likely to remember learning
and replicate in real-world situations.
Capture the importance of continuity of care
Proven satisfaction & effectiveness
8. Elements needed to create a
simulated learning program
1. Identify the learning needs and
create a library of case scenarios
2. Create an interactive web-interface
3. Model and program the physiology
4. Program the feedback – to critique
action the provider takes between
encounters
9. Demo of SimCare available at www.simcarediabetes.org
Patient “snapshot” screen shot
12. Early SimCare Study
Funding through R01HS10639, Physician Intervention to Improve Diabetes Care
57 consented PCP’s and their 2,020 patients.
Randomized to one of 3 groups:
(A) no intervention
(B) learning intervention (SimCare) consisting
of 3 simulated learning cases (1 hr)
(C) SimCare + physician opinion leader
Results:
SimCare reduced risky prescribing of
metformin in patients with renal impairment
(p=0.03).
Group B (SimCare alone) achieved slightly
better glycemic control than A or C (p=.04)
13. SimCare Version 2
Funding through R01DK068314, Reducing Clinical Inertia in Diabetes
Eleven clinics with 41 consenting PCP’s
Randomized to receive or not receive an
improved version of SimCare (12 cases
assigned based on profiled ―needs‖, 3 hrs)
Results: Patients of intervention providers
with baseline A1c > 7% had significantly
greater A1c reduction (-.19%) relative to
patients of non-intervention providers.
14. SimCare Version 3
Funding through R18DK079861, Simulated Diabetes Training for Resident Physicians
19 eligible residency programs
linked to 723 residents
382 residents did
not consent
341 residents consented
Intervention – Early learning 10) Control – Late learning (9)
Residents (177) Residents (164)
Completion rates
Completion rates
Learning cases (142)
Assessment cases (135)
Assessment cases (97)
Knowledge survey (128)
Knowledge survey (92)
Evaluation (94)
15. Implementing the learning program
Residents at 19 programs were given a brochure that
we provided and asked to sign up online
Resident participation was voluntary.
Time commitment – 18 cases, 1 hour/month for 8
months if randomized to the early intervention group
Incentives - $50 Target gift card on completion of the
assigned tasks
Promotions – 4 iPad raffle promotions and 1 Target
gift card promotion to achieve acceptable learning
and assessment case completion rates
16. Baseline characteristics of residents
Intervention Control
P-value
(n=92) (n=128)
% female 48% 57% 0.31
% white 48% 58% 0.41
Age (median) 29 29 0.69
Specialty
Family Medicine 34% 49%
Internal Medicine 54% 42% 0.15
Med-Peds 8% 7%
Other 4% 2%
Post graduate year
35% 34%
1
36% 34%
2 0.70
28% 28%
3
1% 4%
4
17. Example Knowledge Question
2. A 77 year old black man is seeing you for follow up. He has a 13 year history of type 2
diabetes, coronary heart disease (CABG at age 58), chronic stable angina, and
dyslipidemia. He has been eating out a lot and gaining weight. His current medications are
metformin 1000 mg bid, atenolol 50 mg qd, and simvastatin 40 mg qd. His BMI is 37, BP is
165/86, A1c 9.3%, Cr 2. 2 mg/dl, eGFR 28, LDL 94 mg/dl, HDL 36 mg/dl, and TG 278
mg/dl.
Which of the following would be your MOST likely recommended action?
A. Start basal insulin and treat to an A1c goal of < 7%. No change in other glycemia
medications.
B. Discontinue metformin and start basal insulin. Follow up with patient for insulin
adjustments with an A1c goal of < 7%.
C. Start basal insulin and follow up with the patient for insulin adjustments with an A1c goal
of < 8%. No change in other glycemia medications.
D. Discontinue metformin and start basal insulin. Follow up with patient for insulin
adjustments with an A1c goal of < 8%.
E. No change now because I would address other patient problems
Correct answer D (59% intervention, 26% control)
18. P-
Q# Knowledge topics covered Early Late
value
1 Screen for DM (using an A1c) 75.0 75.8 .894
2 Basal insulin start, individualized A1c goal < 8% 58.7 25.8 <.0001
Check ketones in newly diagnosed symptomatic patients &
3 31.5 28.1 .586
start insulin
Reduce basal insulin due to nocturnal hypoglycemia
4 64.1 70.3 .333
(Somogyii)
5 Relax A1c target due to hypoglycemia unawareness 57.6 32.8 .0002
6 Start insulin in a newly diagnosed symptomatic patient 33.7 11.7 <.0001
Use of a loop diuretic rather than thiazide in patient with renal
7 insufficiency. Fenofibrate not beneficial in addition to statin. 44.6 19.5 <.0001
DC metformin due to renal contraindication.
Initiate BP tx (without confirmatory testing) if BP > 180/100.
8 59.8 44.5 0.026
Statins may be helpful for most patients with DM.
9 Start a statin, screen for depression, basal insulin start 66.3 57.0 .164
Geriatric polypharmacy concerns, depression screening,
10 46.7 41.4 .431
hypoglycemia management, statin use in the elderly
19. Results of Knowledge Testing
Number of items
Intervention Control
correct out of 10
0-4 29% 66%
5-7 60% 32%
8-10 11% 2%
Mean score 5.31 4.10
p < .001
(95% CI) (4.87-5.75) (3.69-4.50)
N=220 completers of knowledge survey
20. Results of self-rated confidence and
knowledge about diabetes management
Topic Intervention Control P-value
How knowledgeable are you about how to
use all available drug classes to manage 61 25 <.001
patients with diabetes?
How knowledgeable are you about how to
83 45 <.001
start and adjust insulin?
How knowledgeable are you about
interpreting patient self-monitored glucose 85 59 .009
values (SMBGs)?
How knowledgeable are you about setting
individualized treatment goals for people 83 44 <.001
with diabetes?
How confident are you in managing patients
79 44 <.001
with diabetes?
21. Evidence for learning transfer
to actual patient care
77% applied learning to actual patients
63% shortened visit intervals
78% more likely to add or increase drugs if patient is
not at goal
92% more confident about insulin use in actual
patients
….and results of two trials had demonstrated improved outcomes
of actual patients of practicing providers who used earlier
versions of SimCare
22. Study limitations
Voluntary participation, not all completed the learning
program and completed evaluations
No outcome data on non-completers
Survey completion rates were lower in the intervention
(52%) than the control groups (78%)
No actual patient data to evaluate
Assessment case outcomes not yet available
23. Thank you! For additional questions, please
contact…
JoAnn Sperl-Hillen:
joann.m.sperlhillen@healthpartners.com
Patrick O’Connor:
patrick.j.oconnor@healthpartners.com
Heidi Ekstrom:
heidi.l.ekstrom@healthpartners.com
24. Talk References
Simulated Physician Learning Intervention to
Improve Safety and Quality of Diabetes Care: A
Randomized Trial
O’Connor PJ, Sperl-Hillen JM, et al. Simulated physician
learning intervention to improve safety and quality of diabetes
care: A Randomized Trial. Diabetes Care. 2009;32(4): 585-590.
Simulated Physician Learning Program Improves
Glucose Control in Adults with Diabetes
Sperl-Hillen JM, O’Connor PJ, Rush WA, Johnson PE, Gilmer
TP, Biltz G, Asche SE, Ekstrom HL. Simulated Physician
Learning Program Improves Glucose Control in Adults with
Diabetes. Diabetes Care. 2010;33(8): 1727-1733.
Editor's Notes
Knowledge - Knowing the right thing to doComplexity of cognitive processes and tasks related to diabetesPrioritization - Addressing competing clinical prioritiesAbility to anticipate treatment effects & determine the best follow-up intervalSafety and monitoring routines - Avoiding potential safety hazardsLack of guideline consensus on goals makes is also a reason
High clinical inertia ratesProvider performance variability
In general terms, simulation is a technique or device that attempts to create characteristics of the real world. In health care, simulation may refer to a device representing a simulated patient or part of a patient. Such a device can respond to and interact with the actions of the learner. Simulation also refers to activities that mimic the reality of a clinical environment and that are designed for use in demonstrating procedures and promoting decisionmaking and critical thinking. In health care education, simulation can take many forms, from relatively simple to highly complex Medical simulation has its foundations in aviation, the military and industry.A flight simulator was developed in the 1920s to create an easier, safer and less expensive way to learn how to fly, but it wasn’t until after several catastrophic events in the ‘30s that the military purchased several of these “Link trainers”. Military needs during WWII increased usage & initiated the development of additional simulators. In the 1950s the FAA required simulation recertification to maintain commercial pilots’ licenses. In the 1970s, NASA used simulations to bring the Apollo 13 crew home. Later in the 1970s, human factors were recognized as the source of many events and the concepts of cockpit or crew resource management were formed. Use of simulation in these industries have continued to grow. Modern medical simulation started much later, in the 60’s with the first resuscitation mannequin. By the end of the decade, Harvey, a cardiology mannequin was launched. A rudimentary computer program was also developed for medical education. Since the 1990s simulation in healthcare has exploded and new simulators are in development.
Simulation allows health care providers to develop their skills without endangering the patient or affecting their own self confidence. Because a situation or encounter is simulated, it can be re-run, stopped or altered for improved educational value. This creates a learning environment where multiple options can be practiced and cognitive or psychomotor skills mastered.Simulation-based education has been proven to be effective in industry, aviation, the military and healthcare. There are a plethora of publications describing its application in healthcare in the areas of emergency management, procedural skills, obstetrics, surgery, teamwork & communication. Little has been published on its use in chronic disease management.So why do it? In some applications, like this interactive computer-based simulation program, it is efficient & cost effective…Case-based simulations provide a context for learningPeople are more likely to remember learning and replicate in real-world situations.Provides chart encounters of simulated patients in a primary care environment.Simulation depicts some aspect of reality where the learner can identify and study the effects of change.
The design of the intervention concentrated on four elements described in more detail below: 1. A comprehensive library of case scenarios of patients with type 1 and type 2 diabetes.A team of experts that included physicians proficient in current diabetes guidelines and treatment, a professor of medical physiology, and a professor of decision-making science collaborated regularly to design a clinical content map of diabetes management that would comprehensively address care skills deemed important for resident providers to learn. Table 1 is a list of the learning principles that emerged on the map within the domains of glycemia, lipids, blood pressure, and safety and monitoring. Next, 18 cases were developed with initialized scenarios and patient states that would facilitate provider learning pertaining to all learning topics on the clinical content map.2. An interactive web-based interface display for providers to manage the simulated cases. A web-based interface was designed to mimic an electronic health record. It allowed for complex medical scenarios to come alive through narrative and information displayed in the patient’s “chart,” and for users to perform multiple clinical functions such as review the chart history, prescribe medications, start and adjust insulin with each meal and at bedtime, order labs and diagnostic tests such as electrocardiograms, chest x-rays and sleep studies, make referrals, give patient advice, view self-monitored blood sugar (SMBG) results and change SMBG frequency, and schedule phone or visit follow-up at any desired frequency. See figure 1 for a screen shot of the interface.3. A physiologic model (or engine) to calculate effects of provider actions.Formulas derived from published literature and clinical experts were modeled to compute physiologic responses to provider actions. For example, the simulated patient’s blood sugar state was represented by 8 self-monitored blood sugar (SMBG) values or “patient states” throughout the day. Short and long-acting Insulin and oral drug effects were based on pharmacokinetic curves that distribute the SMBG effects of the drugs over time. Other clinical states that were modeled included blood pressure, pulse, weight, lipids, renal function, potassium, microalbuminuria, depression, drug and behavioral adherence. The collection of patient clinical state predictors were stacked in a predefined way and could be added to in a plug and play fashion to extend to new domains and patient states. The simulation engine was developed using a Java application running on Linux servers, and the data was stored in an Oracle Database. 3. A physiologic model (or engine) to calculate effects of provider actions.Formulas derived from published literature and clinical experts were modeled to compute physiologic responses to provider actions. For example, the simulated patient’s blood sugar state was represented by 8 self-monitored blood sugar (SMBG) values or “patient states” throughout the day. Short and long-acting Insulin and oral drug effects were based on pharmacokinetic curves that distribute the SMBG effects of the drugs over time. Other clinical states that were modeled included blood pressure, pulse, weight, lipids, renal function, potassium, microalbuminuria, depression, drug and behavioral adherence. The collection of patient clinical state predictors were stacked in a predefined way and could be added to in a plug and play fashion to extend to new domains and patient states. The simulation engine was developed using a Java application running on Linux servers, and the data was stored in an Oracle Database.
Example of a patient with type 2 diabetes of 5 years duration
Knowledge test was completed by 52% of early and 78% late intervention participants
We ran an analysis looking at change in these questions from baseline to follow up (to account for the higher ratings on self-efficacy at baseline in the intervention group compared to the control group) and had similar findings. Everything remained significantly improved in the intervention group.
simCare: 57 consented docs and 2000 of their patients. 2001. Better glycemic control and reductions in risky prescribing of metformin in patients with renal impairment-DM inertia: 41 consenting docsand 3000 patients, Conducted 2006-07, better mean A1c and higher % of patients at goal. Costs trended lower -$71 per patient relative to non-intervention patients.