The De-Identification of a Large Electronic Medical Records Database for Seco...Luk Arbuckle
Over the last decade Canada has seen extensive reforms, investments, and innovations in primary health care. The Canadian Working Group for Primary Healthcare Improvement recommended that performance reporting be a strategic priority in moving towards transforming the primary health care system. To enable scalable and sustainable performance measurement and reporting, automated data collection from electronic medical records (EMR) will be necessary. EMR data can also play an important role in adverse drug event detection and public health surveillance.
Real-World Data – What’s Next? by Michael Seewald, AstraZeneca for mHealth Is...Levi Shapiro
Presentation by Michael Seewald, Michael Seewald, Ph.D.
Global Head Evidence, AstraZeneca Biopharmaceuticals for mHealth Israel, October 19th, 2021.
Real-World Data is able to uncover local unmet medical need – Call to action to build Learning Healthcare Systems. Significant Variations in Care and Large Potential for Improvement. Real-World Data helps to benchmark efficient use of resources and detect “waste”. Healthcare systems need to address the problem of waste. But fundamental change is hard, and progress slow. Outcomes Transparency Improves ComplianceExample: Swedish myocardial infarction registry. Outcomes Transparency Improves Compliance. Example: Swedish myocardial infarction registry. Improving Outcomes and Creating Value will continue to guide Learning Healthcare Systems- enabled by RWD. Four technological trends as accelerators on our path. Empowered patients- Molecular screening and 24/7 monitoring driving a step change in diagnosis. Algorithmic decision-making: Artificial intelligence supports physician intelligence. Evidence-generating healthcare systemsLive insights on clinical efficacy from digital monitoring. 360° care delivery. Home replaces hospital via digital therapeutics and on-demand remote support. AstraZeneca Areas of Partnering Interest: (https://www.astrazeneca.com/partnering/our-areas-of-partnering-interest.html).
AMCCBS Virtual2021 Conference Takeaways Part 2Carevive
Check out Debra Wujcik's takeaways from her presentation at #AMCCBSVirtual. She talked about the benefits and crucial data that can be harnessed when using Remote Symptom Monitoring and ePRO platforms.
Visual Analytic Approaches for the Analysis of Spontaneously Reported Adverse...JMP software from SAS
This presentation was given live at JMP Discovery Summit 2012 in Cary, North Carolina, USA.More information on JMP Clinical is available at http://www.jmp.com/software/clinical/
The De-Identification of a Large Electronic Medical Records Database for Seco...Luk Arbuckle
Over the last decade Canada has seen extensive reforms, investments, and innovations in primary health care. The Canadian Working Group for Primary Healthcare Improvement recommended that performance reporting be a strategic priority in moving towards transforming the primary health care system. To enable scalable and sustainable performance measurement and reporting, automated data collection from electronic medical records (EMR) will be necessary. EMR data can also play an important role in adverse drug event detection and public health surveillance.
Real-World Data – What’s Next? by Michael Seewald, AstraZeneca for mHealth Is...Levi Shapiro
Presentation by Michael Seewald, Michael Seewald, Ph.D.
Global Head Evidence, AstraZeneca Biopharmaceuticals for mHealth Israel, October 19th, 2021.
Real-World Data is able to uncover local unmet medical need – Call to action to build Learning Healthcare Systems. Significant Variations in Care and Large Potential for Improvement. Real-World Data helps to benchmark efficient use of resources and detect “waste”. Healthcare systems need to address the problem of waste. But fundamental change is hard, and progress slow. Outcomes Transparency Improves ComplianceExample: Swedish myocardial infarction registry. Outcomes Transparency Improves Compliance. Example: Swedish myocardial infarction registry. Improving Outcomes and Creating Value will continue to guide Learning Healthcare Systems- enabled by RWD. Four technological trends as accelerators on our path. Empowered patients- Molecular screening and 24/7 monitoring driving a step change in diagnosis. Algorithmic decision-making: Artificial intelligence supports physician intelligence. Evidence-generating healthcare systemsLive insights on clinical efficacy from digital monitoring. 360° care delivery. Home replaces hospital via digital therapeutics and on-demand remote support. AstraZeneca Areas of Partnering Interest: (https://www.astrazeneca.com/partnering/our-areas-of-partnering-interest.html).
AMCCBS Virtual2021 Conference Takeaways Part 2Carevive
Check out Debra Wujcik's takeaways from her presentation at #AMCCBSVirtual. She talked about the benefits and crucial data that can be harnessed when using Remote Symptom Monitoring and ePRO platforms.
Visual Analytic Approaches for the Analysis of Spontaneously Reported Adverse...JMP software from SAS
This presentation was given live at JMP Discovery Summit 2012 in Cary, North Carolina, USA.More information on JMP Clinical is available at http://www.jmp.com/software/clinical/
BICR & Subjective Endpoints - Increasing Precision and Accuracy in Your Clin...JennyOShea
For many of today’s trials, the primary endpoint is a subjective assessment and depends on physician-rated or even patient-reported data, which means validation to the FDA and other regulatory agencies is automatically more difficult. For registration trials with subjective endpoints, blinded independent central review (BICR) of the trial data – including both images and other data such as laboratory and pathology data, autopsy reports, and physical descriptions – can be extremely valuable and may be executed through an endpoint assessment committee (EAC).
Visensia is ph
ysiological monitoring software that collates and analyses data from bedside
monitors on 5
vital signs to produce a single patient health status score. This is used for early
identification of deterior
ation that might lead to cardiac or respir
atory arrest. One prospectiv
e,
single-centre, before-and-after study found that patients monitored with Visensia had a
statistically significantly shorter a
verage dur
ation of an
y cardio-respir
atory instability and fewer
episodes of serious and persistent instability
, although changes in patient management ma
y have
influenced these findings. The Visensia software requires e
xisting ph
ysiological monitors to pro
vide
data and costs £1950 for a 1-bed perpetuity licence; individual hospital systems are priced
according to size and include installation and configur
ation charges
Using NLP and curation to make clinical data available for researchWarren Kibbe
While at Northwestern we developed a chart abstraction tool using a data mart to present EHR data to research personnel without double entry. Used in the Brain Tumor Institute. Mike Gurley did the majority of the development.
The Need for Standards to Support Electronic Clinical Decision Support and Broader Clinical Governance. Presented by: Inga HunterThe need for better clinical governance in practice management systems in NZ. Presented by: Harry Pert
A District Wide Clinical Summary - Encompassing the Notion of a Distributed Information Environment. Presented by: Jayden MacRae
Paul Coplan, VP, Johnson & Johnson_mHealth IsraelLevi Shapiro
Pesentation, October 19th, 2021: What’s Next in RWE for Medical Devices: The Art of the Possible. Presented by Paul Coplan, ScD, MBA, FISPE, Vice President, Med Device Epidemiology and RWD Sciences, Johnson & Johnson; Adjunct Professor, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine; Fellow of the International Society of Pharmacoepidemiology
- Why RWE is Important for Medical Devices: Challenges with Clinical Trials of Medical Devices (Blinding, Surgeon skill/technique, Hospital process, Product modifications, Long term Follow up, Enrolment challenges)
- Types of Real-World Data Sources (Complaints like MAUDE, Eudramed and Company Databases, Hospital Databases, Electronic Health Records, Claims, Registries, Patient surveys, Surgeon surveys, PROs, Patient Preferences, wearables, sensors, social media, Surgical videos, device generated data, radiographic images)
- FDA CDRH Report on RWE Examples for Regulatory Decisions
- J&J Med Device Epidemiology & Real-World Data Sciences
- US National Evaluation System for Health Technology (NEST)
- RWE for Safety Assessments: Cobalt in Implants and at Work and Risk of Cancer
- Summary of Cobalt Exposure and All-Site Cancer Risk, by Study Type
- Comparative Effectiveness Studies Using RWE
- Summary
a. Use of RWE is important to benefit patients globally and enhance the safety and innovation of medical devices
b. Regulators are interested in using RWE for regulatory decisions but data quality and evidence needs to be regulatory grade
c. NEST has been a useful forum to advance the use of RWE for regulatory decisions in the US
d. RWE can be used for safety assessments, regulatory decisions, comparative effectiveness research, and R&D of products
Victorian HIV Service STI Project: How simple is to ordering a blood test? Presentation given by Brian Price at the AFAO National Syphilis Forum, 23 October 2009.
Damian Fogarty on Pathology in the era of connected health: Linking patients,...Cirdan
Damian Fogarty is a Consultant Kidney Physician in the Regional Nephrology and Transplant Unit, Belfast Health and Social Care Trust. From 2010-14 was Chairman of the UK Renal Registry, an internationally recognised national audit body with many innovations and plaudits for its work. Damian has a particular interest in using routine data for quality improvement, better engagement with patient groups and the use of social media in all these areas. In this presentation at the Pathology Horizons 2015 conference of Cirdan,he discusses data analytics for pathology.
Medicare Advantage Ad - Testing Patients with IndicationsChristian Trygstad
This was created to support the use of PADnet in the Medicare Advantage space by testing patients with primary indications for peripheral artery disease
From the Archives, 2008:Clinical and Economic Advantages Implantable Defibril...David Lee Scher, MD
This presentation from 2008 discusses the most early recognized merits of remote patient monitoring as it pertained to implantable defibrillators. It was prsented at the European Cardiac Arrhythmia Society Annual Congress. These advantages of RPM can be extended to monitoring of other conditions today.
Survival guide to stem cell research and therapiesArete-Zoe, LLC
Survival guide to stem cell research and therapies provides comprehensive guidance to publicly available resource materials, libraries and registries for people who are interested in understanding currently available treatment options involving human stem cells.
Potential: The first section explains how stem cells are currently used in research, drug testing, and therapy, and how they have to be manipulated before transfer to make any treatments possible.
Classification: Origin and ability of stem cells to differentiate into different cell types determine how different types of stem cells are typically used.
Clinical Research: In this section, we will introduce the two most important registries of clinical trials: NIH registry ClinicalTrials gov and WHO International Clinical Trials Registry Platform. A project is part of this section to give students the opportunity to get hands-on experience with collecting and collating relevant information from registries and libraries, and interpretation of the findings. Real-time interactive sessions are included to allow students to ask questions and offer additional guidance.
Patient Demand: In this section, we briefly introduce challenges relating to marketing claims, objective outcome measures, advertising strategies, and patient autonomy.
Regulatory and Legal Framework: Stem cell therapies are regulated differently in various countries around the world. In this section, we will focus on regulations that govern stem cell research and therapies in the U.S. and in the European Union. Policies on stem cell research are driven by ethical concerns relating to research that utilizes human embryos. China recently announced new ethical guidelines and new rules for its stem cell clinics, regulating both trials and treatments.
Professional Societies: The last section explains the role of professional societies in stem cell research and therapies.
What's Next in RWE_Amy Rudolph_Novartis_mHealth IsraelLevi Shapiro
Overview of the
- Healthcare ecosystem complexity increasing rapidly
- Pharma industry is facing a crisis: trends shaping the industry
- RWE complements RCTs and captures implementation of innovation
- RWE is one component of the integrated evidence needed for stakeholders
- Integrated Evidence: Optimizing patient access
- Integrated Evidence: Label expansion
- Maximizing the value of data requires a scalable platform and expertise
Market report on the opportunities in the Norwegian healthcare market, prepared for the Team Finland Digital Hospitals growth program by Fintra in partnership with Oslo Medtech.
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Medina JA. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
BICR & Subjective Endpoints - Increasing Precision and Accuracy in Your Clin...JennyOShea
For many of today’s trials, the primary endpoint is a subjective assessment and depends on physician-rated or even patient-reported data, which means validation to the FDA and other regulatory agencies is automatically more difficult. For registration trials with subjective endpoints, blinded independent central review (BICR) of the trial data – including both images and other data such as laboratory and pathology data, autopsy reports, and physical descriptions – can be extremely valuable and may be executed through an endpoint assessment committee (EAC).
Visensia is ph
ysiological monitoring software that collates and analyses data from bedside
monitors on 5
vital signs to produce a single patient health status score. This is used for early
identification of deterior
ation that might lead to cardiac or respir
atory arrest. One prospectiv
e,
single-centre, before-and-after study found that patients monitored with Visensia had a
statistically significantly shorter a
verage dur
ation of an
y cardio-respir
atory instability and fewer
episodes of serious and persistent instability
, although changes in patient management ma
y have
influenced these findings. The Visensia software requires e
xisting ph
ysiological monitors to pro
vide
data and costs £1950 for a 1-bed perpetuity licence; individual hospital systems are priced
according to size and include installation and configur
ation charges
Using NLP and curation to make clinical data available for researchWarren Kibbe
While at Northwestern we developed a chart abstraction tool using a data mart to present EHR data to research personnel without double entry. Used in the Brain Tumor Institute. Mike Gurley did the majority of the development.
The Need for Standards to Support Electronic Clinical Decision Support and Broader Clinical Governance. Presented by: Inga HunterThe need for better clinical governance in practice management systems in NZ. Presented by: Harry Pert
A District Wide Clinical Summary - Encompassing the Notion of a Distributed Information Environment. Presented by: Jayden MacRae
Paul Coplan, VP, Johnson & Johnson_mHealth IsraelLevi Shapiro
Pesentation, October 19th, 2021: What’s Next in RWE for Medical Devices: The Art of the Possible. Presented by Paul Coplan, ScD, MBA, FISPE, Vice President, Med Device Epidemiology and RWD Sciences, Johnson & Johnson; Adjunct Professor, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine; Fellow of the International Society of Pharmacoepidemiology
- Why RWE is Important for Medical Devices: Challenges with Clinical Trials of Medical Devices (Blinding, Surgeon skill/technique, Hospital process, Product modifications, Long term Follow up, Enrolment challenges)
- Types of Real-World Data Sources (Complaints like MAUDE, Eudramed and Company Databases, Hospital Databases, Electronic Health Records, Claims, Registries, Patient surveys, Surgeon surveys, PROs, Patient Preferences, wearables, sensors, social media, Surgical videos, device generated data, radiographic images)
- FDA CDRH Report on RWE Examples for Regulatory Decisions
- J&J Med Device Epidemiology & Real-World Data Sciences
- US National Evaluation System for Health Technology (NEST)
- RWE for Safety Assessments: Cobalt in Implants and at Work and Risk of Cancer
- Summary of Cobalt Exposure and All-Site Cancer Risk, by Study Type
- Comparative Effectiveness Studies Using RWE
- Summary
a. Use of RWE is important to benefit patients globally and enhance the safety and innovation of medical devices
b. Regulators are interested in using RWE for regulatory decisions but data quality and evidence needs to be regulatory grade
c. NEST has been a useful forum to advance the use of RWE for regulatory decisions in the US
d. RWE can be used for safety assessments, regulatory decisions, comparative effectiveness research, and R&D of products
Victorian HIV Service STI Project: How simple is to ordering a blood test? Presentation given by Brian Price at the AFAO National Syphilis Forum, 23 October 2009.
Damian Fogarty on Pathology in the era of connected health: Linking patients,...Cirdan
Damian Fogarty is a Consultant Kidney Physician in the Regional Nephrology and Transplant Unit, Belfast Health and Social Care Trust. From 2010-14 was Chairman of the UK Renal Registry, an internationally recognised national audit body with many innovations and plaudits for its work. Damian has a particular interest in using routine data for quality improvement, better engagement with patient groups and the use of social media in all these areas. In this presentation at the Pathology Horizons 2015 conference of Cirdan,he discusses data analytics for pathology.
Medicare Advantage Ad - Testing Patients with IndicationsChristian Trygstad
This was created to support the use of PADnet in the Medicare Advantage space by testing patients with primary indications for peripheral artery disease
From the Archives, 2008:Clinical and Economic Advantages Implantable Defibril...David Lee Scher, MD
This presentation from 2008 discusses the most early recognized merits of remote patient monitoring as it pertained to implantable defibrillators. It was prsented at the European Cardiac Arrhythmia Society Annual Congress. These advantages of RPM can be extended to monitoring of other conditions today.
Survival guide to stem cell research and therapiesArete-Zoe, LLC
Survival guide to stem cell research and therapies provides comprehensive guidance to publicly available resource materials, libraries and registries for people who are interested in understanding currently available treatment options involving human stem cells.
Potential: The first section explains how stem cells are currently used in research, drug testing, and therapy, and how they have to be manipulated before transfer to make any treatments possible.
Classification: Origin and ability of stem cells to differentiate into different cell types determine how different types of stem cells are typically used.
Clinical Research: In this section, we will introduce the two most important registries of clinical trials: NIH registry ClinicalTrials gov and WHO International Clinical Trials Registry Platform. A project is part of this section to give students the opportunity to get hands-on experience with collecting and collating relevant information from registries and libraries, and interpretation of the findings. Real-time interactive sessions are included to allow students to ask questions and offer additional guidance.
Patient Demand: In this section, we briefly introduce challenges relating to marketing claims, objective outcome measures, advertising strategies, and patient autonomy.
Regulatory and Legal Framework: Stem cell therapies are regulated differently in various countries around the world. In this section, we will focus on regulations that govern stem cell research and therapies in the U.S. and in the European Union. Policies on stem cell research are driven by ethical concerns relating to research that utilizes human embryos. China recently announced new ethical guidelines and new rules for its stem cell clinics, regulating both trials and treatments.
Professional Societies: The last section explains the role of professional societies in stem cell research and therapies.
What's Next in RWE_Amy Rudolph_Novartis_mHealth IsraelLevi Shapiro
Overview of the
- Healthcare ecosystem complexity increasing rapidly
- Pharma industry is facing a crisis: trends shaping the industry
- RWE complements RCTs and captures implementation of innovation
- RWE is one component of the integrated evidence needed for stakeholders
- Integrated Evidence: Optimizing patient access
- Integrated Evidence: Label expansion
- Maximizing the value of data requires a scalable platform and expertise
Market report on the opportunities in the Norwegian healthcare market, prepared for the Team Finland Digital Hospitals growth program by Fintra in partnership with Oslo Medtech.
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Medina JA. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
Experiencias y percepción de la atención integral de los pacientes con cáncer. Oriol Díaz de Bustamante I. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Sánchez de Toledo J. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Ortiz H. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
Multidisciplinary care: a perspective from diagnosis and treatment of rare cancers. Casali P. Technical Conference: Multidisciplinary Care in Cancer as a model of health care quality (Madrid: Ministry of Health and Social Policy, 2010)
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Barnadas A. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
Experiencias y percepción de la atención integral de los pacientes con cáncer. Moreno Marín P. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
Christopher Chute, MD, DrPH
Chair, Division of Biomedical Informatics
Mayo Clinic
Presentation “Strategies for the ICD-10 Transition”
Participants will have an understanding of the background and implications of three key areas:
∙ How Meaningful Use standards impact ACO operations and success
∙ What role will the new ICD-10 play in providers understanding their practice and outcomes
∙ What are the future directions in ICD-11 and beyond Meaningful Use Phase 3
Overview of Healthcare IT Security including research based statistics and leveraging best practices to ensure sustainability and compliance for providers
Update on the Adoption and Utilization of Emerging Precision Medicine Biomark...Andrew Aijian
In this 2nd wave of our precision oncology pulse survey, we explore how recent clinical, commercial, and regulatory events have impacted the adoption of emerging precision oncology biomarkers and diagnostic tools. We also examine the key technological trends likely to impact the landscape in the near-mid term.
Chapter 4 Electronic Health RecordsRobert Hoyt MDVishnu Moh.docxrobertad6
Chapter 4: Electronic Health Records
Robert Hoyt MD
Vishnu Mohan MD
After reading this chapter the reader should be able to:
State the definition and history of electronic health records (EHRs)
Describe the limitations of paper-based health records
Identify the benefits of electronic health records
List the key components of an electronic health record
Describe the ARRA-HITECH programs to support EHRs
Describe the benefits and challenges of computerized order entry and clinical decision support systems
State the obstacles to purchasing, adopting and implementing an electronic health record
Enumerate the steps to adopt and implement an EHR
Learning Objectives
2
There is no topic in health informatics as important, yet controversial, as the electronic health record (EHR)
In spite of fledgling EHRs being around for the past 35-40 years they are still controversial in the eyes of many
Due to the federal government reimbursement programs for EHR use by physicians and hospitals, EHRs are now part of the healthcare landscape
Some of the famous early EHRs are listed on the next slide
Introduction
The Problem Oriented Medical Information System (PROMIS)
American Rheumatism Association Medical Information System (ARAMIS)
Regenstrief Medical Record System (RMRS)
Summary Time Oriented Record (STOR)
Health Evaluation Through Logical Processing (HELP)
Computer Stored Ambulatory Record (COSTAR)
De-Centralized Hospital Computer Program (DHCP)—forerunner of VistA (Veterans Health Administration)
Early EHRs
Electronic Health Record: “An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization”
While the “experts” can debate the difference between EHR and EMR, we will not and will stick with EHR throughout the textbook and slides
Definition
Paper records are severely limited: less legible, more difficult to retrieve, store and share and unstructured data. Also, electronic records less likely to be missing and available 24/7 from multiple locations. Paper records do not permit clinical decision support
Need for improved efficiency and productivity: clinicians are more productive if charts are available and retrieval of results is faster. EHR access from home while on call helps productivity
Quality of care and patient safety: the factors already described in last two bullets plus clinical decision support, quality reports and secure messaging as part of an EHR
Why do we need EHRs?
Public expectations: EHRs may increase patient satisfaction through faster results, messaging, patient portals, electronic patient education, e-prescribing and online scheduling
Governmental expectations: federal government considers EHR to be transformational and hence why they support reimbursement for u.
Experiencias y percepción de la atención integral de los pacientes con cáncer. Fisas Armengol A. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Ferro T. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Díaz Mediavilla J. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Ignacio A. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
The power of lifestyle interventions to prevent cardiovascular diseases. Tuomilehto J. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).
Alcohol and chronic diseases: complex relations. Guillemont J. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).
Risk Assessment and Management of Cardiovascular Diseases - an English Approach. Lynam E. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).
Cardiovascular disease inequalities: causes and consequences. Capewell S. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).
Addressing cardiovascular disease at EU level: tangible plans for the future. Hübel M. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).
The impact of eHealth on Healthcare Professionals and Organisations: The Impact of ICT at Kaiser Permanente. Wiesenthal A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
The impact of eHealth on Healthcare Professionals and Organisations: A National Perspective. Eccles S. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
The impact of eHealth on Healthcare Professionals and Organisations: Health Information Management Systems in Modern Health Care. Shemer J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
The impact of eHealth on Healthcare Professionals and Organisations: e-health and Healthcare Organization. Piqué J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Just-in-time Decision Support for Improving and Optimising Professional Practices. Geissbühler A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
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
1. eHealth Reality in North
America
David E. Garets,
President & CEO, HIMSS Analytics
Executive Vice President, HIMSS
2. Expectations, Limits, and Barriers
for EMRs in U.S.
• Expectations:
• Widespread adoption of acute care and ambulatory EMRs, and
“meaningful use” – via first time ever financial incentives and
requirements from the federal government, increasingly
stringent over 3 phases starting this calendar year.
• Interoperable exchange of summary patient data among acute
care and ambulatory providers, payers, health registries, and
patients via health information exchanges
• Limits:
• Perverse incentives – hospitals and physicians get paid for
helping people once they’re sick as opposed to keeping people
healthy
• Hospitals compete against each other – medical arms wars –
most health systems don’t have good economies of scale in IT
3. Expectations, Limits, and Barriers
for EMRs in U.S.
• Barriers:
• Clinician adoption – lack of change management strategies
• Lack of pan-America standards adoption
• Money is tight, in both operating and capital budgets
• There’s a 40,000 – 60,000 person shortage of qualified,
experienced health IT professionals
• Potentially 35% of hospitals have “too far to go” to earn Phase
1 incentives.
4. 2005-2009 US EMR Adoption Model Trends
2005 2009
Final Final
Complete EMR; CCD transactions to share data; Data
Stage 7 warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.7%
Physician documentation (structured templates), full
Stage 6 CDSS (variance & compliance), full R-PACS 0.0% 1.6%
Stage 5 Closed loop medication administration .001% 3.8%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 2.5% 7.4%
Nursing/clinical documentation (flow sheets), CDSS
Stage 3 (error checking), PACS available outside Radiology
10.0% 50.9%
CDR, Controlled Medical Vocabulary,
Stage 2 CDS, may have Document Imaging; HIE capable
48.8% 16.9%
Stage 1 Ancillaries – Lab, Rad, Pharmacy – All Installed 19.6% 7.2%
Stage 0 All Three Ancillaries Not Installed 18.4% 11.5%
Source: HIMSS AnalyticsTM Database N = 3,816/5,235
5. Expectations, Limits, and Barriers
for EMRs/EPRs in Canada
• Expectations:
• Widespread adoption of physician/primary care clinic EMRs
• Obligation to make minimal data available to all patients –
lab/radiology diagnostic results, drug history
• Minimizing number of EMR platforms in most provinces
• Limits:
• Full acute care implementations at a few selected sites
• Extensive rural environment precludes practicality of complete
paperless EMRs in most population centers.
6. Expectations, Limits, and Barriers
for EMRs/EPRs in Canada
• Barriers:
• Clinician adoption remains a challenge
• Canada has yet to adopt HL7 CCD standards
• EMR strategies remain intra-provincial
• Emphasis by Canada Health Infoway on pan-Canadian
PHR
• Economic restrictions due to large deficits
7. 2009 Canadian/U.S. Comparison
CDN US
Final Final
Complete EMR; CCD transactions to share data; Data
Stage 7 warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.7%
Physician documentation (structured templates), full
Stage 6 CDSS (variance & compliance), full R-PACS 0.2% 1.6%
Stage 5 Closed loop medication administration 0.0% 3.8%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 1.1% 7.4%
Nursing/clinical documentation (flow sheets), CDSS
Stage 3 (error checking), PACS available outside Radiology
28.8% 50.9%
CDR, Controlled Medical Vocabulary,
Stage 2 CDS, may have Document Imaging; HIE capable
22.7% 16.9%
Stage 1 Ancillaries – Lab, Rad, Pharmacy – All Installed 11.7% 7.2%
Stage 0 All Three Ancillaries Not Installed 35.6% 11.5%
Source: HIMSS AnalyticsTM Database N = 660/5,235
8. IT Spending in U.S. hospitals
• Projected 2009
spending:
• $27.5B -
$30.41B
• Actual 2009
spending:
• $28.03B