Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is dependency. Our project proposal aims to enhance medication safety in the elderly. It requires a multidisciplinary approach and patient-centred care focusing on benzodiazepine deprescribing using the 3Es model of Educating, Empowering, and Engaging. The education starts with patients, providers, and the community about benzodiazepine adverse effects on the elderly and provides alternative approaches for symptoms management.
The AHSN Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing Problematic Polypharmacy in Haringey Care Homes, can be viewed here.
For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/
Predicting Patient Adherence: Why and HowCognizant
To contain costs and improve healthcare outcomes, players across the value chain must apply advanced analytics to measure and understand patients’ failure to follow treatment therapies, and to then determine effective remedial action. This white paper lays out a framework for enabling patient adherence management and some general prescriptions on how to convert lofty concepts to meaningful action.
My talk at the Scientific Research Day of Medical colleges, UQU
5 March 2019
where I presented my publication (Patient-Centered Pharmacovigilance: A review)
Description This is a continuation of the health promotion pro.docxmecklenburgstrelitzh
Description
This is a continuation of the health promotion program proposal, part one, which you submitted previously. Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
Directions
For this assignment add criteria 5-8 as detailed below:
5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. ( 3 paragraph. You may use bullets if appropriate).
6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1 paragraph).
7. Provide a detailed plan for evaluation for each outcome. (1 paragraph).
8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph).
9. Conclude the paper with a Conclusion paragraph. Don’t type the word “Conclusion”. Here you will share your insights about this strategy and your expectations regarding achieving your goals. (1 paragraph).
Paper Requirements
Your assignment should be 3 pages (excluding title page, references, and appendices), following APA standards.
Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion.
Please add this section to the PART 1 ATTACHED , must be one document for the entire work, AGAIN this 4 pages you will do now, please add it to the PART 1 ATTACHED, add references for this section and put them properly in APA style with the previously in the PART 1.
[removed]
Running head: CONGESTIVE HEART FAILURE Page 2
Patients with Congestive Heart failure and Increased Readmission Rates
Florida National University
NGR 6638
Professor Alexander Garcia Salas DNP, MSN, ARNP, FNP-C
Congestive heart failure (CHF), which affects millions of people, especially the elderly, is a significant and expanding public health concern. According to research, CHF accounts for between 12 and 15 million office visits and 6.5 million inpatient days annually (Hollier, 2021). Unfortunately, this approach leads to disease progression and rehospitalizations for many CHF patients because of insufficient care, unclear discharge instructions, and a lack of follow-up visits. These higher rehospitalization rates are driving up expenses and indicating that existing care strategies for CHF are not the most effective. Therefore, evidence-based t.
Great article on how to integrate machine learning and optimization technique.
One group of researchers was able to reduce heart failure readmissions by 35% by combining machine learning and decision science technique, see "Data-driven decisions for reducing readmissions for heart failure: general methodology and case study" (Bayati, et. al., 2014).
The AHSN Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing Problematic Polypharmacy in Haringey Care Homes, can be viewed here.
For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/
Predicting Patient Adherence: Why and HowCognizant
To contain costs and improve healthcare outcomes, players across the value chain must apply advanced analytics to measure and understand patients’ failure to follow treatment therapies, and to then determine effective remedial action. This white paper lays out a framework for enabling patient adherence management and some general prescriptions on how to convert lofty concepts to meaningful action.
My talk at the Scientific Research Day of Medical colleges, UQU
5 March 2019
where I presented my publication (Patient-Centered Pharmacovigilance: A review)
Description This is a continuation of the health promotion pro.docxmecklenburgstrelitzh
Description
This is a continuation of the health promotion program proposal, part one, which you submitted previously. Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
Directions
For this assignment add criteria 5-8 as detailed below:
5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. ( 3 paragraph. You may use bullets if appropriate).
6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1 paragraph).
7. Provide a detailed plan for evaluation for each outcome. (1 paragraph).
8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph).
9. Conclude the paper with a Conclusion paragraph. Don’t type the word “Conclusion”. Here you will share your insights about this strategy and your expectations regarding achieving your goals. (1 paragraph).
Paper Requirements
Your assignment should be 3 pages (excluding title page, references, and appendices), following APA standards.
Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion.
Please add this section to the PART 1 ATTACHED , must be one document for the entire work, AGAIN this 4 pages you will do now, please add it to the PART 1 ATTACHED, add references for this section and put them properly in APA style with the previously in the PART 1.
[removed]
Running head: CONGESTIVE HEART FAILURE Page 2
Patients with Congestive Heart failure and Increased Readmission Rates
Florida National University
NGR 6638
Professor Alexander Garcia Salas DNP, MSN, ARNP, FNP-C
Congestive heart failure (CHF), which affects millions of people, especially the elderly, is a significant and expanding public health concern. According to research, CHF accounts for between 12 and 15 million office visits and 6.5 million inpatient days annually (Hollier, 2021). Unfortunately, this approach leads to disease progression and rehospitalizations for many CHF patients because of insufficient care, unclear discharge instructions, and a lack of follow-up visits. These higher rehospitalization rates are driving up expenses and indicating that existing care strategies for CHF are not the most effective. Therefore, evidence-based t.
Great article on how to integrate machine learning and optimization technique.
One group of researchers was able to reduce heart failure readmissions by 35% by combining machine learning and decision science technique, see "Data-driven decisions for reducing readmissions for heart failure: general methodology and case study" (Bayati, et. al., 2014).
V O L U M E 3 4 - N U M B E R 4 - F A L L 2 0 1 6 187FEATURE ART.docxkdennis3
V O L U M E 3 4 , N U M B E R 4 , F A L L 2 0 1 6 187
F E
A T
U R
E A
R T
IC L
E
Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting Kristen L. Marjama, JoAnn S. Oliver, and Jennifer Hayes
Diabetes is the seventh leading cause of death in the United States, burdening society with
high costs for treatment and placing increased demand on the health care system (1). According to the 2014 National Diabetes Statistics Report, an estimated 29.1 million people in the United States have diabetes, and 8.1 million of them are undiagnosed (2). The lack of screening for early identification of patients at risk for type 2 diabetes is a significant clin- ical problem. Health care providers (HCPs) need to be aware of the in- creasing diabetes burden and to pri- oritize the screening of patients who may be at risk. Screening for risk can aid in both efforts to prevent the development of diabetes and early management of the disease to reduce complications. Clinical trials have demonstrated that type 2 diabetes can be delayed or prevented through life- style modification or pharmacother- apy for people at increased risk (3).
In order to reduce risk for those at risk of developing diabetes, screen- ing is a priority that will raise patient
awareness. Many patients are not aware of their risk for type 2 dia- betes until they receive a confirmed diagnosis from their HCP. There are numerous health care settings in which screenings can be imple- mented, including but not limited to primary care practices, urgent care centers, hospital emergency depart- ments, and retail health clinics.
Retail clinics are located in retail supermarket and pharmacy chains to provide high-quality, affordable, and easily accessible health care services for communities. A true measure of quality in retail clinics is their degree of adherence to several measures iden- tified in the Healthcare Effectiveness Data and Information Set (4). Services in this type of setting may include treatment of acute episodic conditions, physical examinations, vaccinations, health screenings, and prevention and management of chronic conditions (5). Retail clinics provide services to patients with or without insurance or a primary care “home.†Patients’ visits to a retail clinic afford the opportunity to assess
■IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association’s Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail cli.
Patient Data Collection Methods. Retrospective Insights.QUESTJOURNAL
Introduction: Multiple classic and modern data collection techniques are presented in the current paper, but only a mix of them provides the appropriate approach to address patient safety problems. The current study aims to reveal the data collection methods applied worldwide. Materials and Methods: All scientific sources of the current article were identified mainly by research on Internet. The matching words used in the search of materials are “data collection methods”, “hospital reporting systems”, “incident reporting systems”, “patient events”, “patient reported data”. Relevant articles and studies covering the 2003-2016 timeframe were selected as a reference. Results: Various data collection procedures are available worldwide. During several years of research, it was concluded that a significant number of patient studies use the following patient data collection methods: retrospective record review, record review of current inpatients, staff interview of current inpatients and nominal group technique based consensus method. Conclusion: New trends in data collection techniques are also discussed, as they reveal the potential of the electronic environment. Future insights on this topic should consider the standardization of different data collection methods in order to improve data comparability aspects.
The Increasing Importance of Patient Reported Outcomes and the Patient Voice ...Covance
Over the past few years there has been a paradigm shift in the overall approach to pharmacovigilance from that of pure safety analysis to overall benefit-risk evaluation of products. **Disclaimer: This article was previously published. Sciformix is now a Covance company.
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RIS...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive
and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be
useful for selecting treatments because they directly predict the response to a treatment. The latter are used
to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease.
Current intelligent systems can be a solution for transferring advancements in molecular biology into
practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis
of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating
domain knowledge in predictive and prognostic models for personalized treatment. Our personalized
medicine support system provides the needed support in complex decisions and can be incorporated into a
treatment guide for selecting molecular targeted therapies.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RIS...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive
and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be
useful for selecting treatments because they directly predict the response to a treatment. The latter are used
to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease.
Current intelligent systems can be a solution for transferring advancements in molecular biology into
practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis
of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating
domain knowledge in predictive and prognostic models for personalized treatment. Our personalized
medicine support system provides the needed support in complex decisions and can be incorporated into a
treatment guide for selecting molecular targeted therapies.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RI...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be useful for selecting treatments because they directly predict the response to a treatment. The latter are used to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease. Current intelligent systems can be a solution for transferring advancements in molecular biology into practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating domain knowledge in predictive and prognostic models for personalized treatment. Our personalized medicine support system provides the needed support in complex decisions and can be incorporated into a treatment guide for selecting molecular targeted therapies.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RIS...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive
and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be
useful for selecting treatments because they directly predict the response to a treatment. The latter are used
to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease.
Current intelligent systems can be a solution for transferring advancements in molecular biology into
practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis
of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating
domain knowledge in predictive and prognostic models for personalized treatment. Our personalized
medicine support system provides the needed support in complex decisions and can be incorporated into a
treatment guide for selecting molecular targeted therapies.
Just Text Me Using SMS Technology forCollaborative Patient .docxcroysierkathey
Just Text Me: Using SMS Technology for
Collaborative Patient Mood Charting
By April C. Foreman, Chris Hall, Karen Bone, Je�rey Cheng and Adam Kaplin |
September 26, 2011
Abstract
Summary: Mood 24/7 is an innovation in traditional mood charting using text messaging
technology. Mood 24/7 allows the user to collect mood data in a standardized text message
format, receives optional 160-character annotations from users in addition to their daily
mood ratings, and securely stores user response data on a protected server. Adopting this
strategy for monitoring mental health symptoms may be one way to increase patient
engagement and accuracy in reporting mood symptoms.
Keywords: Mental health, depression, mood tracking, HIT, SMS, texting, patient
engagement.
Citation: Foreman AC, Hall C, Bone K, Cheng J, Kaplin A. Just text me: using SMS technology
for collaborative patient mood charting. J Participat Med. 2011 Sept 26; 3:e45.
Published: September 26, 2011.
Competing Interests: Chris Hall leads the product and business development of Mood 24/7
as Director, Clinical Platforms at HealthCentral. Adam Kaplin is entitled to a share of royalty
received by the University on sales of products used in the study described in this article,
Under a licensing agreement between The HealthCentral Network Inc., and Johns Hopkins
University. The terms of this arrangement are being managed by Johns Hopkins University
in accordance with its con�ict of interest policies.
Introduction
Depressed mood and “mood swings” are common complaints from patients in both medical
and behavioral health care settings. A common intervention for patients expressing these
symptoms is to advise them to monitor their mood, often using a Likert scale. The usual
clinical practice of mood monitoring uses a simple paper chart that patients can complete
on a daily basis. Based on a subjective rating scale, patients can chart (and clinicians can
monitor) the progression of patients’ mood changes over time.[1]
Transforming the Culture of Patient Care
UU aa
DonateDonate
https://participatorymedicine.org/journal/author/acforeman/
https://participatorymedicine.org/journal/author/chall/
https://participatorymedicine.org/journal/author/kbone/
https://participatorymedicine.org/journal/author/jcheng/
https://participatorymedicine.org/journal/author/akaplin/
https://participatorymedicine.org/
https://participatorymedicine.org/donate/
High reliability and validity of subjective mood rating has been demonstrated over the past
forty years.[2] For example, longitudinal charting of a single scale for subjective mood rating
has been shown to correlate highly with other more elaborate rating scales such as the
Hamilton, Beck, and Zung rating scales for depression. When patients can rate their moods
consistently, and remember to bring them to their appointments, these charts can provide
highly valuable clinical information. This information is useful for the patient, clinicians, and
other members of a ...
Ulcerative Colitis with Aseptic Abscesses Controlled by Vedolizumab: A Case R...pateldrona
Aseptic abscesses (AAs) are neutrophilic infiltrative lesions that often coincide with systemic inflammatory disorders such as inflammatory bowel diseases (IBD). According to recent literature, medical therapies in IBD with AAs include corticosteroid, immunosuppressants and anti-TNFα biologics.
Prevalence and Determinants of Distress Among Residents During COVID Crisispateldrona
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
More Related Content
Similar to Deprescribing of Benzodiazepines in the Elderly Using A 3Es Model: A Patient Centered Approach
V O L U M E 3 4 - N U M B E R 4 - F A L L 2 0 1 6 187FEATURE ART.docxkdennis3
V O L U M E 3 4 , N U M B E R 4 , F A L L 2 0 1 6 187
F E
A T
U R
E A
R T
IC L
E
Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting Kristen L. Marjama, JoAnn S. Oliver, and Jennifer Hayes
Diabetes is the seventh leading cause of death in the United States, burdening society with
high costs for treatment and placing increased demand on the health care system (1). According to the 2014 National Diabetes Statistics Report, an estimated 29.1 million people in the United States have diabetes, and 8.1 million of them are undiagnosed (2). The lack of screening for early identification of patients at risk for type 2 diabetes is a significant clin- ical problem. Health care providers (HCPs) need to be aware of the in- creasing diabetes burden and to pri- oritize the screening of patients who may be at risk. Screening for risk can aid in both efforts to prevent the development of diabetes and early management of the disease to reduce complications. Clinical trials have demonstrated that type 2 diabetes can be delayed or prevented through life- style modification or pharmacother- apy for people at increased risk (3).
In order to reduce risk for those at risk of developing diabetes, screen- ing is a priority that will raise patient
awareness. Many patients are not aware of their risk for type 2 dia- betes until they receive a confirmed diagnosis from their HCP. There are numerous health care settings in which screenings can be imple- mented, including but not limited to primary care practices, urgent care centers, hospital emergency depart- ments, and retail health clinics.
Retail clinics are located in retail supermarket and pharmacy chains to provide high-quality, affordable, and easily accessible health care services for communities. A true measure of quality in retail clinics is their degree of adherence to several measures iden- tified in the Healthcare Effectiveness Data and Information Set (4). Services in this type of setting may include treatment of acute episodic conditions, physical examinations, vaccinations, health screenings, and prevention and management of chronic conditions (5). Retail clinics provide services to patients with or without insurance or a primary care “home.†Patients’ visits to a retail clinic afford the opportunity to assess
■IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association’s Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail cli.
Patient Data Collection Methods. Retrospective Insights.QUESTJOURNAL
Introduction: Multiple classic and modern data collection techniques are presented in the current paper, but only a mix of them provides the appropriate approach to address patient safety problems. The current study aims to reveal the data collection methods applied worldwide. Materials and Methods: All scientific sources of the current article were identified mainly by research on Internet. The matching words used in the search of materials are “data collection methods”, “hospital reporting systems”, “incident reporting systems”, “patient events”, “patient reported data”. Relevant articles and studies covering the 2003-2016 timeframe were selected as a reference. Results: Various data collection procedures are available worldwide. During several years of research, it was concluded that a significant number of patient studies use the following patient data collection methods: retrospective record review, record review of current inpatients, staff interview of current inpatients and nominal group technique based consensus method. Conclusion: New trends in data collection techniques are also discussed, as they reveal the potential of the electronic environment. Future insights on this topic should consider the standardization of different data collection methods in order to improve data comparability aspects.
The Increasing Importance of Patient Reported Outcomes and the Patient Voice ...Covance
Over the past few years there has been a paradigm shift in the overall approach to pharmacovigilance from that of pure safety analysis to overall benefit-risk evaluation of products. **Disclaimer: This article was previously published. Sciformix is now a Covance company.
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RIS...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive
and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be
useful for selecting treatments because they directly predict the response to a treatment. The latter are used
to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease.
Current intelligent systems can be a solution for transferring advancements in molecular biology into
practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis
of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating
domain knowledge in predictive and prognostic models for personalized treatment. Our personalized
medicine support system provides the needed support in complex decisions and can be incorporated into a
treatment guide for selecting molecular targeted therapies.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RIS...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive
and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be
useful for selecting treatments because they directly predict the response to a treatment. The latter are used
to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease.
Current intelligent systems can be a solution for transferring advancements in molecular biology into
practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis
of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating
domain knowledge in predictive and prognostic models for personalized treatment. Our personalized
medicine support system provides the needed support in complex decisions and can be incorporated into a
treatment guide for selecting molecular targeted therapies.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RI...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be useful for selecting treatments because they directly predict the response to a treatment. The latter are used to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease. Current intelligent systems can be a solution for transferring advancements in molecular biology into practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating domain knowledge in predictive and prognostic models for personalized treatment. Our personalized medicine support system provides the needed support in complex decisions and can be incorporated into a treatment guide for selecting molecular targeted therapies.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RIS...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive
and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be
useful for selecting treatments because they directly predict the response to a treatment. The latter are used
to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease.
Current intelligent systems can be a solution for transferring advancements in molecular biology into
practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis
of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating
domain knowledge in predictive and prognostic models for personalized treatment. Our personalized
medicine support system provides the needed support in complex decisions and can be incorporated into a
treatment guide for selecting molecular targeted therapies.
Just Text Me Using SMS Technology forCollaborative Patient .docxcroysierkathey
Just Text Me: Using SMS Technology for
Collaborative Patient Mood Charting
By April C. Foreman, Chris Hall, Karen Bone, Je�rey Cheng and Adam Kaplin |
September 26, 2011
Abstract
Summary: Mood 24/7 is an innovation in traditional mood charting using text messaging
technology. Mood 24/7 allows the user to collect mood data in a standardized text message
format, receives optional 160-character annotations from users in addition to their daily
mood ratings, and securely stores user response data on a protected server. Adopting this
strategy for monitoring mental health symptoms may be one way to increase patient
engagement and accuracy in reporting mood symptoms.
Keywords: Mental health, depression, mood tracking, HIT, SMS, texting, patient
engagement.
Citation: Foreman AC, Hall C, Bone K, Cheng J, Kaplin A. Just text me: using SMS technology
for collaborative patient mood charting. J Participat Med. 2011 Sept 26; 3:e45.
Published: September 26, 2011.
Competing Interests: Chris Hall leads the product and business development of Mood 24/7
as Director, Clinical Platforms at HealthCentral. Adam Kaplin is entitled to a share of royalty
received by the University on sales of products used in the study described in this article,
Under a licensing agreement between The HealthCentral Network Inc., and Johns Hopkins
University. The terms of this arrangement are being managed by Johns Hopkins University
in accordance with its con�ict of interest policies.
Introduction
Depressed mood and “mood swings” are common complaints from patients in both medical
and behavioral health care settings. A common intervention for patients expressing these
symptoms is to advise them to monitor their mood, often using a Likert scale. The usual
clinical practice of mood monitoring uses a simple paper chart that patients can complete
on a daily basis. Based on a subjective rating scale, patients can chart (and clinicians can
monitor) the progression of patients’ mood changes over time.[1]
Transforming the Culture of Patient Care
UU aa
DonateDonate
https://participatorymedicine.org/journal/author/acforeman/
https://participatorymedicine.org/journal/author/chall/
https://participatorymedicine.org/journal/author/kbone/
https://participatorymedicine.org/journal/author/jcheng/
https://participatorymedicine.org/journal/author/akaplin/
https://participatorymedicine.org/
https://participatorymedicine.org/donate/
High reliability and validity of subjective mood rating has been demonstrated over the past
forty years.[2] For example, longitudinal charting of a single scale for subjective mood rating
has been shown to correlate highly with other more elaborate rating scales such as the
Hamilton, Beck, and Zung rating scales for depression. When patients can rate their moods
consistently, and remember to bring them to their appointments, these charts can provide
highly valuable clinical information. This information is useful for the patient, clinicians, and
other members of a ...
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Syringoma is a benign eccrine sweat gland tumor affecting mostly females at puberty projected with multiple soft papules usually 1-2 mm in diameter. During puberty, syringoma appears among females; it is presented as multiple soft papules, 1-2 mm in diameter, as a benign eccrine sweat gland tumor. The sites of predilection are lower eyelids, and cheeks. The regions of tendency are cheeks and lower eyelids. Syringoma of the vulvar is a rare disorder few cases of which have been reported in literature.
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Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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2. of patients above 60 have low literacy, and it’s a major barrier
to communication with the healthcare provider [5]. Low-literate
patients in the USA described serious and widespread communi-
cation difficulties with their health providers [6]. The assessment
tool is called the test of functional health literacy assessment and
it is proposed to be utilized by pharmacists or their assistants [7].
Patient apprehension was identified as a major barrier in 1/3 of
patients tested with low functional health literacy [8].
3. Rationale for Deprescribing
The three rationales for deprescribing of benzodiazepines are inap-
propriate prescribing, re-prescribing and the risk of morbidity and
mortality. Retrospective database reports from the Netherlands
and Norway revealed a prevalence of 20-25% inappropriate ben-
zodiazepine prescription in the elderly [9, 10] and according to the
2002 Beers criteria, inappropriate prescription is about 26 % [10].
About 50% of physicians renew benzodiazepine prescription due
to patient dependency [11].
4. Subject Community and Its Health System
It is important to define the health system and the community to
establish stakeholders and assess infrastructure. The stakeholders
in our proposal are the patient, the caregiver, the prescriber, the
pharmacist, and the community (Figure 1). Our community would
include those who would be involved in the care of the elderly
including care facilities for seniors.
5. Intervention Model
Our study population will be more than or equal to 65 years on
benzodiazepines medication for at least a month. We will exclude
centers with no computerized system, walk-in clinics that cannot
arrange follow-up and emergency rooms. We decided to do a be-
fore and after study design to collect retrospective and prospective
data for ethical reasons (Figure 2).
The intervention will be focusing on stakeholders using the 3Es
model for Education, Empowerment and Engagement (Figure 3).
The patient and their caregivers will receive one-on-one education
from the provider using clinical motivation behavioural techniques
to empower and engage in deprescribing. The prescriber will ac-
cess the deprescribing algorithm and computerized system to alert
for deprescribing and offer an alternative. The community will
have an outreach program that focuses on education and a depre-
scribing campaign. The project group will provide feedback to the
stakeholders at the end (Figure 2).
Figure 1: Stakeholders
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3. Figure 2: Intervention Model
Figure 3: 3Es using patient centered approach.
6. Implementation
The implementation will be in six phases (Figure 4), starting with
the screening phase based on inclusion and exclusion criteria, then
the enrollment phase by either phone or visit. The assessment
phase will involve functional assessment, review of all patient's
medication, indications for benzodiazepine, and literacy assess-
ment.
The empowerment and education phase will be for both patients
and caregivers using motivational, behavioural intervention and
the community thought outreach education program. For the eval-
uation phase, patients will be booked visits as per the deprescrib-
ing algorithm and at six months. The final phase will be two-way
feedback for and from stakeholders. A computerized system will
be used to alert for deprescribing, suggest alternatives and track
changes.
7. Protocol
The algorithm (Figure 5) can be found using this link: Benzodiaz-
epine & Drug (BZRA) Deprescribing Algorithm.
The protocol, an evidence-based practice guideline created by the
deprescribing group that we will use in our project.
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5. Figure 5: Benzodiazepine deprescribing algorithm from deprescribing.org.
8. Evaluation and Assessment
We will look at the number of patients off medication and dose
reduction percentage at six months as our primary outcomes for
evaluation. The goal is to reach at least a 50 % reduction. Sec-
ondary outcomes that will be measured are the number of falls
and severity (those requiring a hospital visit and admission surgi-
cal intervention or movement from initial place of residence to a
higher level of care facility), the number of alternative medications
prescribed, episodes of aggressive behaviour, mental status, and
aspiration pneumonia.
The data assessment we are measuring is both qualitative and
quantitative data. The qualitative data include age (range and
mode), history of falls on benzodiazepines, cognitive assessment,
sex, fall severity, aspiration pneumonia, functional status, comor-
bidities, patient satisfaction, patient literacy, medications history,
and stakeholder’s feedback.
The quantitative data include some metrics focusing on primary
and secondary outcomes, as shown in (Table 1).
Table 1: Quantitative data and goals.
Quantitative data Goal
No. of patients on benzo at enrollment 100%
No. of patients off benzo at 6 months ≥ 50%
No. of falls reduced
No. of patients requiring alternative prescription for sleep/anxiety Few
Episodes of aggressive behaviour Reduced
Symptoms recurrence Reduced
Time for intervention 30-60 min
Benzo: benzodiazepine, F: female, Hx: history, M:male, MOCA:Montreal Cognitive Assessment, No.: numbers.
9. Scale and Feasibility
For scalability and feasibility, we looked at 5 elements:
1. Given the importance and rationale of deprescribing benzodiaz-
epine in the elderly, we anticipate the effect on improving safety
and quality measures. This will make the 3Es project reachable to
more communities and be adopted for its importance.
2. Education is key to perform the intervention for both provider
and patient and to set up an outreach program for awareness of the
benzodiazepine effect on the elderly.
3. Resources need to include training and infrastructure to incor-
porate algorithm and alert systems and personnel and support per-
sonal for the outreach program.
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6. 4. The implementation cost will save patients and the healthcare
system money due to reducing unwanted side effects.
5. The system, once it's programmed, will be easily implemented,
and data and feedback can be collected.
10. Discussion
The proposal is unique in using 3Es for Educate, Empower and
Engage. Patient care is a central approach. The problem we are
addressing is important and relates to medication safety in the el-
derly. Challenges include implementation during the COVID pan-
demic, language barrier and literacy.
The limitations include the study design, given the lack of a direct
comparator group and potentially finding low literacy that might
interfere with implementing the intervention. Also, lack of incen-
tive and time-consuming intervention might need additional sup-
port staff to administer. The study period is short, and to make
cultural and system changes will require buying from health and
provisional authorities and time.
As an alternative approach, we might consider cluster randomiza-
tion. However, due to the importance of deprescribing benzodiaz-
epine in the elderly, we wanted to offer equal chances to people
enrolled in the study since side effects are well established and the
problem of dependency and re-prescribing. The other modification
we might consider is implementing an educational curriculum for
deprescribing to a residency program for awareness and behaviour
change.
11. Acknowledgment
We want to acknowledge the deprescribing.org group and the au-
thors of Benzodiazepine & Z-Drug (BZRA) Deprescribing Algo-
rithm for the algorithm and using their material. We also want to
acknowledge Dr. Alhussaini for articulating and presenting our
work.
References
1. Palmaro A, Dupouy J, Lapeyre-Mestre M. Benzodiazepines and risk
of death: results from two large cohort studies in France and UK.
Eur Neuropsychopharmacol. 2015; 25(10): 1566-1577.
2. Markota M, Rummans TA, Bostwick JM, Lapid MI. Benzodiaze-
pine Use in Older Adults: Dangers, Management, and Alternative
Therapies. Mayo Clin Proc. 2016; 91(11): 1632-1639.
3. Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan
KM, Marra CA. Meta-analysis of the impact of 9 medication classes
on falls in elderly persons. Arch Intern Med. 2009; 169(21): 1952-
60.
4. Miles S, Davis T. Patients who can’t read: implications for the health
care system. JAMA. 1995; 274: 1719-20.
5. Williams MV, Parker RM, Baker DW. Inadequate functional health
literacy among patients at two public hospitals. JAMA. 1995;
274:1677-82.
6. Baker DW, Parker RM, Williams MV. The health care experience of
patients with low literacy. Arch Fam Med. 1996; 5: 329-34.
7. Parker RM, Baker DW, Williams MV, Nurss JR. The test of func-
tional health literacy in adults: a new instrument for measuring pa-
tients’ literacy skills. J Gen Intern Med. 1995; 10: 537-41.
8. Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame
and health literacy: the unspoken connection. Patient Educ Counsel.
1996; 27: 33-9.
9. Brekke M, Rognstad S, Straand J, Furu K, Gjelstad S, Bjørner T.
Pharmacologically inappropriate prescriptions for elderly patients
in general practice: how common? Baseline data from the Prescrip-
tion Peer Academic Detailing (Rx-PAD) study. Scand J Prim Health
Care. 2008; 26(2): 80-5.
10. Van der Hooft CS, Jong GW, Dieleman JP. Inappropriate drug pre-
scribing in older adults: the updated 2002 Beers criteria – a popula-
tion-based cohort study. Br J Clin Pharmacol. 2005; 60(2): 137-144.
11. Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Re-
duction of inappropriate benzodiazepine prescriptions among older
adults through direct patient education: the EMPOWER cluster ran-
domized trial. JAMA Intern Med. 2014; 174(6): 890-8.
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