The document discusses methods for evaluating mobile health interventions. It describes searching various research databases to identify 486 relevant projects from the past six years, including 29 actual mobile health interventions. It outlines plans to conduct a randomized controlled trial to evaluate the impact of a mobile diabetes intervention on outcomes like HbA1c, depression, and diabetes distress over one year. It also notes challenges in operationalizing evaluations when collaborating with industry and protecting user data across different servers.
Principles of evidence based medicine.
EBM means integrating individual clinical expertise with the best available external evidence from systematic research.
Preliminary results from a survey on the use of metrics and evaluation strate...jehill3
Preliminary results from a survey on the use of metrics and evaluation strategies among mHealth projects
Patricia Mechael, Nadi Kaonga
Center for Global Health and Economic Development at the Earth Institute, Columbia University
CORE Group Spring Meeting, April 30, 2010
Principles of evidence based medicine.
EBM means integrating individual clinical expertise with the best available external evidence from systematic research.
Preliminary results from a survey on the use of metrics and evaluation strate...jehill3
Preliminary results from a survey on the use of metrics and evaluation strategies among mHealth projects
Patricia Mechael, Nadi Kaonga
Center for Global Health and Economic Development at the Earth Institute, Columbia University
CORE Group Spring Meeting, April 30, 2010
The Green Park Collaborative (GPC) has developed a new tool to help health care decision makers confidently and consistently use Real World Evidence (RWE) when making tough coverage and care choices. Called RWE Decoder, the spreadsheet-based assessment tool lets users review and evaluate all existing studies and evidence for both rigor and relevance. Informed by these factors, users can assess study quality, and generate a visual summary to help gauge the evidence under review.
Published RWE studies developed from data-rich electronic medical records or medical claims data are increasingly available from health care systems. However, the quality of this research can vary widely, and payers, clinicians and other health care decision makers often dismiss it out of hand. RWE Decoder and its associated user guide and framework, offer a thoughtful approach to helping these decision makers assess whether RWE studies address their questions and can appropriately guide their choices.
The tool, user guide, and supporting white paper are available here: https://goo.gl/AhbHUw
A presentation showcasing some of the patient recruitment challenges that I encountered as a recruitment manager as well as some of the strategies -- DIGITAL ADVERTISING -- I used to overcome them.
The challenges of our time require a strategic approach to build the drugs and devices of the future. Our broad knowledge and long-term experience allow us to provide our customers with Innovative solutions and risk management.
Comparison of registered and published intervention fidelity assessment in cl...valéry ridde
A methodologically oriented systematic review was conducted to study current practices concerning the assessment of intervention fidelity in CRTs of public health interventions conducted in LMICs.
Identifying information retrieval research for systematic reviews and other e...Patrice Chalon
Background:
To date, Cochrane has focused primarily on publishing systematic reviews of the effectiveness of healthcare interventions and subsequently reviews of diagnostic test accuracy. How to identify studies in these areas is well-described in The Cochrane Handbooks. Cochrane is considering extending its remit to evidence syntheses in other areas, such as economic evaluations, prognosis and qualitative research. Study identification has not yet received as much attention in these areas within Cochrane. Additionally, under MECIR (Methodological Expectations of Cochrane Intervention Reviews), if a Cochrane Review has specific eligibility criteria around study design to address adverse effects, economic issues or qualitative research questions, it is now mandatory that searches must be undertaken to address these issues. These areas, together with others, are covered in a new web resource, SuRe Info, produced by the Interest Sub-Group on Information Resources (IRG) of Health Technology Assessment international (HTAi).
Objective:
To present the SuRe Info resource.
Methods:
Information retrieval methods publications are identified by database searching. Publications meeting the SuRe Info inclusion criteria receive a structured abstract containing a brief critical appraisal prepared by one SuRe Info information specialist and checked by another. Key messages from the appraisals are summarized into topic-specific chapters.
Results:
SuRe Info is published as a section of the HTAi Vortal (www.sure-info.org). It has two parts:
1) chapters on general search methods common across all evidence syntheses and
2) chapters describing the methods to use when searching for specific aspects of evidence syntheses, such as adverse effects / safety and economic evaluations. Chapters summarize current research evidence with links to the structured abstracts / appraisals.
Conclusion:
SuRe Info is a new open-access web resource that provides research-based summaries relating to information retrieval for evidence synthesis including systematic reviews. It provides a valuable addition to the information provided in The Cochrane Handbooks.
Supervision, monitoring and evaluation of researchAshok Pandey
To train the health professionals on health system research proposal development,
To acquaint the participants with health research process, and
To train basic managerial skills required to manage proposed health research.
The Green Park Collaborative (GPC) has developed a new tool to help health care decision makers confidently and consistently use Real World Evidence (RWE) when making tough coverage and care choices. Called RWE Decoder, the spreadsheet-based assessment tool lets users review and evaluate all existing studies and evidence for both rigor and relevance. Informed by these factors, users can assess study quality, and generate a visual summary to help gauge the evidence under review.
Published RWE studies developed from data-rich electronic medical records or medical claims data are increasingly available from health care systems. However, the quality of this research can vary widely, and payers, clinicians and other health care decision makers often dismiss it out of hand. RWE Decoder and its associated user guide and framework, offer a thoughtful approach to helping these decision makers assess whether RWE studies address their questions and can appropriately guide their choices.
The tool, user guide, and supporting white paper are available here: https://goo.gl/AhbHUw
A presentation showcasing some of the patient recruitment challenges that I encountered as a recruitment manager as well as some of the strategies -- DIGITAL ADVERTISING -- I used to overcome them.
The challenges of our time require a strategic approach to build the drugs and devices of the future. Our broad knowledge and long-term experience allow us to provide our customers with Innovative solutions and risk management.
Comparison of registered and published intervention fidelity assessment in cl...valéry ridde
A methodologically oriented systematic review was conducted to study current practices concerning the assessment of intervention fidelity in CRTs of public health interventions conducted in LMICs.
Identifying information retrieval research for systematic reviews and other e...Patrice Chalon
Background:
To date, Cochrane has focused primarily on publishing systematic reviews of the effectiveness of healthcare interventions and subsequently reviews of diagnostic test accuracy. How to identify studies in these areas is well-described in The Cochrane Handbooks. Cochrane is considering extending its remit to evidence syntheses in other areas, such as economic evaluations, prognosis and qualitative research. Study identification has not yet received as much attention in these areas within Cochrane. Additionally, under MECIR (Methodological Expectations of Cochrane Intervention Reviews), if a Cochrane Review has specific eligibility criteria around study design to address adverse effects, economic issues or qualitative research questions, it is now mandatory that searches must be undertaken to address these issues. These areas, together with others, are covered in a new web resource, SuRe Info, produced by the Interest Sub-Group on Information Resources (IRG) of Health Technology Assessment international (HTAi).
Objective:
To present the SuRe Info resource.
Methods:
Information retrieval methods publications are identified by database searching. Publications meeting the SuRe Info inclusion criteria receive a structured abstract containing a brief critical appraisal prepared by one SuRe Info information specialist and checked by another. Key messages from the appraisals are summarized into topic-specific chapters.
Results:
SuRe Info is published as a section of the HTAi Vortal (www.sure-info.org). It has two parts:
1) chapters on general search methods common across all evidence syntheses and
2) chapters describing the methods to use when searching for specific aspects of evidence syntheses, such as adverse effects / safety and economic evaluations. Chapters summarize current research evidence with links to the structured abstracts / appraisals.
Conclusion:
SuRe Info is a new open-access web resource that provides research-based summaries relating to information retrieval for evidence synthesis including systematic reviews. It provides a valuable addition to the information provided in The Cochrane Handbooks.
Supervision, monitoring and evaluation of researchAshok Pandey
To train the health professionals on health system research proposal development,
To acquaint the participants with health research process, and
To train basic managerial skills required to manage proposed health research.
Evidence-Informed Public Health Decisions Made Easier: Take it one Step at a ...Health Evidence™
An afternoon workshop - held in partnership with the National Collaborating Centre for Methods and Tools - at the Ontario Public Health Convention April 7, 2011
Pubrica offers high quality evidence-based global research, analyses, publication, and scientific communication support services to researchers and industries across the globe. Our growing team is comprised of researchers and industry professionals working together to resolve the most critical issues facing scientific publishing.
Four strategies to upgrade clinical trial quality in this computerized world ...Pubrica
• Biostatistics Services is important for collecting, reviewing, presenting, and interpreting data in clinical research.
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Assessing the Utility of Consumer Surveysfor Improving the Q.docxfredharris32
Assessing the Utility of Consumer Surveys
for Improving the Quality of Behavioral
Health Care Services
J. Randy Koch, PhD
Alison B. Breland, PhD
Mary Nash, PhD
Karen Cropsey, PsyD
Abstract
The development and implementation of provider performance and consumer outcome measures
for behavioral health care have been growing over the last decade, presumably because they are
useful tools for improving service quality. However, the extent to which providers have successfully
used performance measurement results has not been adequately determined. To this end, two
methods were used to better understand the use of data obtained from an annual survey of
behavioral health care consumers: a cross-sectional survey of executive directors, clinical program
directors, and quality improvement directors and follow-up interviews with a subsample of survey
respondents. Results revealed information about the use of consumer survey data, factors that
facilitate and hinder the use of results, as well as respondents’ opinions about consumer survey
administration procedures. These findings provide valuable information for the application of
performance measures and, ultimately, improving consumer outcomes.
Address correspondence to Alison B. Breland, PhD, Institute for Drug and Alcohol Studies, Virginia Commonwealth
University, McGuire Hall, Rm. B08, 1112 East Clay Street( P.O. Box 980310, Richmond, VA 23298, USA. Phone: +1-804-
6282300; Fax: +1-804-8287862; E-mail: [email protected]
J. Randy Koch, PhD, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, P.O. Box 980310,
Richmond, VA, USA. Phone: +1-804-8288633; Fax: +1-804-8287862; E-mail: [email protected]
Mary Nash, PhD, School of Human and Organization Development, Fielding Graduate University, Santa Barbara, CA,
USA. Phone: +1-757-4356589; Fax: +1-757-4356589; E-mail: [email protected]
Karen Cropsey, PsyD, Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of
Medicine, Birmingham, AL, USA. Phone: +1-205-9160135; Fax: +1-205-9409258; E-mail: [email protected]
This research was performed at the Virginia Commonwealth University, Institute for Drug and Alcohol Studies, 1112 East
Clay Street, Suite B-08, Richmond, VA 23298.
Journal of Behavioral Health Services & Research, 2010. c) 2010 National Council for Community Behavioral
Healthcare.
234 The Journal of Behavioral Health Services & Research 38:2 April 2011
Introduction
Over the past decade, there has been significant growth in the development and implementation
of provider performance and consumer outcome measures for the behavioral health care field. The
Federal Substance Abuse and Mental Health Services Administration has been at the forefront in
the development of performance measures for the public behavioral health care system and has
sponsored several initiatives that have facilitated the acceptance of performance measurement as an
essential business practice, including the Mental Health ...
Paying for performance to improve the delivery of health interventions in LMICsReBUILD for Resilience
This presentation from Sophie Witter & Karin Diaconu of Queen Margaret University, UK outlines the findings from a Cochrane review undertaken by the team on paying for performance to improve the delivery of health interventions in low and middle-income countries.
Running head evaluation tool1evaluation tool6Evaluation Tool.docxcowinhelen
Running head: evaluation tool 1
evaluation tool 6Evaluation Tool
Name
University
Class
Date
Evaluation Tool
Conducting the literature review and the evaluation methodology provided an insight into PICO question (Does implementing a new unified acute and ambulatory EHR (Electronic Health Record) system in the hospital, compared to when they are not used, improve the health care quality for the patients through documentation), and obtaining important information about what needs to be considered in a research project, particularly regarding research tool. The research should consider a tool that proves to be reliable and valid. The researcher should want to know if the tool is accurate and measuring what it is intended to measure (Penfold et al., 2011). Picking the wrong tool for research would result in an incomplete result, hence problem with the evidence. Thus, subsequent researchers may not want to use the flawed methodology to conduct their research. The purpose of this paper is to describe the selected evaluation tool for the project with a rationale, to summarize the criteria used in defining evaluation success, and to develop the assessment plan.Describing the Evaluation Tool Selected for the Evaluation Project
The chosen tool for evaluation is the “Electronic Health Record End User Survey” (AHRQ, n.d.). The tool is a questionnaire that focuses on the usability of an EHR. The questionnaire is designed for the clinical staff in the ambulatory setting to evaluate the usability of an electronic health record in ambulatory care. The aim of the assessment tool is to measure the appropriateness of ambulatory care after the implementation of clinical documentation. The device involves various types of a survey that incorporate many stakeholders who ensure that the hospital adopts new technology relating to the improvement of health care within the hospital. The tool is associated with a survey tool for assessing the EHR implementation based on development initiatives guide. The EHR End User Survey measures the effectiveness realized in the hospital setup through documentation as compared to using the old system of documentation. Based on the developed PICO question that aims at evaluating the benefits that subsume the overtaken documentation. The evaluation tool captures various hospital domains including the end users feedback regarding training and competency, usefulness, usability, infrastructure, and the user support. The tool involves the validation efforts based on needs assessment, the pilot study and the analysis of the nurse respondents. The End User Survey tool based on the EHR provides questionnaire type of review where the clinical staff answer the asked questions focusing on the current state assessment and usability within the hospital. The remote documentation applicable to the new unified ambulatory system makes it easier and efficient since it increases the number o ...
PCHAlliance conducted a systematic review of published literature to gather the available data on health outcome measures, reviewing over 1,450 citations. Fifty-three randomized controlled studies and trials were selected for analysis, on topics related to mobile technologies, remote patient monitoring, web-based counseling and other personal connected health technologies. This publication aims to set an initial baseline for the current body of evidence in personal connected health in key areas, namely behavior change and self-care, remote patient monitoring, remote counseling and mental health, as well as more broadly through key condition-specific studies.
Download the paper here: http://www.pchalliance.org/personal-connected-health-state-evidence-and-call-action
Recommendations on Evidence Needed to Support Measurement Equivalence between...CRF Health
Patient-reported outcomes (PROs) are the consequences of disease and/or its treatment
as reported by the patient. The importance of PRO measures in clinical trials for new drugs, biologic
agents, and devices was underscored by the release of the US Food and Drug Administration’s draft
guidance for industry titled "Patient-Reported Outcome Measures: Use in Medical Product Development
to Support Labeling Claims." The intent of the guidance was to describe how the FDA will evaluate the
appropriateness and adequacy of PRO measures used as effectiveness endpoints in clinical trials. In
response to the expressed need of ISPOR members for further clarification of several aspects of the draft
guidance, ISPOR’s Health Science Policy Council created three task forces, one of which was charged
with addressing the implications of the draft guidance for the collection of PRO data using electronic data
capture modes of administration (ePRO). The objective of this report is to present recommendations from
ISPOR’s ePRO Good Research Practices Task Force regarding the evidence necessary to support the
comparability, or measurement equivalence, of ePROs to the paper-based PRO measures from which
they were adapted.
The NIHR Research Design Service provides support to NHS staff and academics preparing research proposals for submission to peer-reviewed funding competitions for applied health or social care research.
Slides from Society for Clinical Trials, The goal of this CTTI-sponsored project was to describe current clinical monitoring methods for a range of clinical trial types, and to explore the rationale for the use of those methods.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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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 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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. What Really Works Methods and Measures for Research & Evaluation Charlene C. Quinn [email_address] 410.706.2406
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Editor's Notes
Thank you. I’m honored to present to this group.
To understand what’s working in methods and measures for mHealth research we conducted an informal review of funded research. Not a review of what’s been published, but what’s funded, by what agencies, what investigators and what condition or disease is funded. Search sites included NIH RePORT which is if you’re not familiar with the acronym is the NIH Research Portfolio Online Reporting Tools, clinical trials.gov (registration site for clinical trials), HSRProj (site which may list funding of government funding other than NIH, foundations, payors and includes research outcomes that are health services research in addition to patient clinical outcomes). Time period for the informal search was the previous 6 years for completed or current projects. Most federally funded projects are funded 3-5 years.
486 projects identified using search terms mobile, mobile health, telehealth. 29 were actually using some aspect of mobile health in the research intervention For a range of conditions: diabetes, HIV, obesity, cancer were top on the list followed by hypertension, patient compliance, physical activity, major depression, asthma, smoking, COPD Types of mobile interventions being evaluated included mobile phone, behavioral mobile technology, peer mobile phone, texting, SMS support, internet coaching, telemedicine (terms used by study investigators.
The importance of this informal search found that there is still not much in the pipeline of major federal funding for mobile intervention. Most major publications need to have funded studies before publication. The gold standard which is sought for better or worse is NIH funding, especially in academic medical research. The needle is beginning to move and there is great opportunity for innovators, industry and academic researchers to collaborate to move the needle further. My own observations are that the fastest pace as a business and collaborative research model, is being done by the National Cancer Institute through the SBIR, STTR funding mechanism, but the majority of projects are still more genomic and or pharma based interests. SBIRs/STTRs small funding, one –two years, take as much work as the larger NIH R01s. Encouraging are recent announcements by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), Technologies for Independent Living RFA and the NIH Office of Behavioral and Social Sciences recent call for white papers. If anyone is interested in working with my team on either of these project areas, please contact me.
When we started in 2006, deciding to focus on mobile diabetes health, NIH wasn’t interested, no pilot data. Our team sought funding from state of Maryland which encourages collaboration between industry and academic researchers. Many states have these funding programs to encourage academic-bbusiness partnerships with the ultimate goal in Maryland being job creation. Maryland is called the Maryland Industrial Partnerships (MIPS); fund average about $100,000 for a one year project, can be funded for second phase. Great for start-ups to receive additional business, legal, and technology resources. For the Academic researcher MIPS gives enough funding for a decent pilot study, proof of concept, publishable. Based on our work with the first company, WellDoc, we used MIPS funds to conduct a 30 subject study, published, providing pilot data to develop other proposals for funding. The funding for the larger RCT study, direct and indirect funding, came from Maryland Carefirst Blue Cross Blue Sheild, Lifescan, Sprint, and WellDoc through a research services agreement with the University of Maryland. Our team has a current third MIPS pilot funded with TelCare, a start-up also in the mobile diabetes space.
While working on the pilot and then with the results of the WellDoc pilot study, we put together a collaboration of funders. frankly because we knew there was interest and to go through the NIH writing and review process without a guarantee of success would take too much time. We also wanted to conduct a study to attempt to address the identified gaps in the research methods, many of which still exist and were mentioned yesterday. We decided to conduct a cluster randomized clinical trial, by enrolling physician practices, randomizing at the practice level and then patients were treated and followed based on the randomization assignment of the practice. This would allow us to have treatment fidelity. We also choose to conduct the study among community primary care provider practices where 90% of diabetes care takes place. “Real world as possible”. One year intervention so that we could study whether we could achieve change in diabetes status and would the behavior be sustained.
What works in measures for RCTs can be to identify the clinical gold standard. In diabetes research it’s hemoglobin A1c a measure of how well a person’s blood glucose has been maintained for the previous 3 months. Seems obvious to study the clinical gold standard but more interesting for where mobile health field is currently may be in the secondary outcomes. Of more interest for mobile health research is to understand not only if something works but how does it work. Most persons do not go around in everyday life and say I’m diabetic and I’d like to manage my disease. Persons are more likely to say to health providers or peers, I’d like to walk more but my feet hurt (clinically diabetes may cause neuropathies which cause pain and other sensations in feet). So in our study we identified secondary measures which might provide more information along secondary outcomes. Worked with Carlos DiClemente to create a Diabetes Behavior Stages of Change measure for the study. Just fortuitous Carlos is on faculty at a sister campus and the East Coast BJ Fogg. Provider and patient satisfaction- created our own. No good tools published.
Because there was so little in the research literature, my team wrote up the design of the study, published in Contemporary Clinical Trials. I’m sure you all have that journal on your coffee table and have read it! But it puts our methods out there for all to see….and critique. The results for the primary research outcome are in manuscript review and I hope to be published soon. So I can not discuss. We’re pleased by additional analyses we’ll be able to do, including a chance to study my passion for differences in outcomes by patient age. Hugh opportunity for mobile health to impact lives of aging population. Diabetes is a low hanging fruit, 10.9 million Americans, 65 and older have diagnosed and undiagnosed diabetes. 27% of this age group, making it the highest rate among all age groups. And older adults can and will use mobile health.
Themes we observed in the mobile intervention which work and we see more of this appearing in recent literature: Including expectations of persons with the condition or disease. Provide feedback that is actionable, not just data Continuous available feedback. Persons/patients choose to use when needed Linking actionable feedback between patients and providers is crucial for long term health behavior change.
In conducting our study and launching new studies, there are challenges in operationalizing the evaluations. In one respect we criticize the paucity of scientific evaluations and lack of metrics for mobile health. However, to change this do we have the patience to go through the time involved in conducting the large randomized clinical trials, similar to what the drug industry has done for years. For those who have not been through this process, writing and reviewing an R01 takes 12-18 months minimum. Every researcher expects to have the study rejected in it’s first NIH review, even for experienced full tenured researchers and the funding is getting tighter. Most large NIH RCTs take 3-5 years and another 1-2 to publish results. Technology will always be changing. Great example is the CMS demonstration completed a few years ago-$25-30 million using a large expensive telehealth monitor in patient homes. Improved diabetes outcomes but not cost effective. Studies which involving human subjects must go through Institutional Review Board Process (IRB), includes review of HIPAA protection. Very imporant but time consuming especially if a multi-site study may have multiple IRBs with different review approaches and time frames. Evolving issue is clear understanding and agreement on where data from mobile health studies resides, is protected and who can use. We’ve gone through a lengthy process to create a data use agreement which works for the mobile health companies, my university and my team research interests. There are challenges and opportunities for the collaborations among the mobile health industry, scientific community and payors.
My pearls I’d like to leave you with is to invest in asking not only does mobile health work but how does it work. That will move the needle for the industry and for persons and providers. And , to not be shy about your innovative thinking, if you build it, they will come. Thank you. I look forward to new collaborations.