scholarly journals Implementation of a non-emergent medical transportation programme at an integrated health system

2021 ◽  
Vol 28 (1) ◽  
pp. e100417
Author(s):  
Patrick G Lyons ◽  
Brett A Ramsey ◽  
Michael Welker ◽  
Megan Guinn ◽  
Janice K Ernest ◽  
...  
Keyword(s):  
Stakeholder Engagement ◽  
De Novo ◽  
Hybrid Approach ◽  
Healthcare Delivery ◽  
Baseline Data ◽  
First Year ◽  
Patient Needs ◽  
Solution System ◽  
Integrated Healthcare ◽  
Prior State

ObjectivesTo implement a unified non-emergency medical transportation (NEMT) service across a large integrated healthcare delivery network.MethodsWe assessed needs among key organisational stakeholders, then reviewed proposals. We selected a single NEMT vendor best aligned with organisational priorities and implemented this solution system-wide.ResultsOur vendor’s hybrid approach combined rideshares with contracted vehicles able to serve patients with equipment and other needs. After 6195 rides in the first year, we observed shorter wait times and lower costs compared with our prior state.DiscussionEssential lessons included (1) understanding user and patient needs, (2) obtaining complete, accurate and comprehensive baseline data and (3) adapting existing workflows—rather than designing de novo—whenever possible.ConclusionsOur implementation of a single-vendor NEMT solution validates the need for NEMT at large healthcare organisations, geographical challenges to establishing NEMT organisation-wide, and the importance of baseline data and stakeholder engagement.

scholarly journals Dravet syndrome associated mutations in GABRA1, GABRB2 and GABRG2 define the genetic landscape of defects of GABAA receptors

2021 ◽  
Author(s):  
Ciria C Hernandez ◽  
XiaoJuan Tian ◽  
Ningning Hu ◽  
Wangzhen Shen ◽  
Mackenzie A Catron ◽  
...  
Keyword(s):  
Gabaa Receptor ◽  
De Novo ◽  
Epileptic Encephalopathy ◽  
Dravet Syndrome ◽  
First Year ◽  
Genes Encoding ◽  
Genetic Landscape ◽  
Clonic Seizures ◽  
Trafficking Defects ◽  
First Year Of Life

Abstract Dravet syndrome is a rare, catastrophic epileptic encephalopathy that begins in the first year of life, usually with febrile or afebrile hemiclonic or generalized tonic-clonic seizures followed by status epilepticus. De novo variants in genes that mediate synaptic transmission such as SCN1A and PCDH19 are often associated with Dravet syndrome. Recently, GABAA receptor subunit genes (GABRs) encoding α1 (GABRA1), β3 (GABRB3) and γ2 (GABRG2), but not β2 (GABRB2) or β1 (GABRB1), subunits are frequently associated with Dravet syndrome or Dravet syndrome-like phenotype. We performed next generation sequencing on 870 patients with Dravet syndrome and identified nine variants in three different GABRs. Interestingly, the variants were all in genes encoding the most common GABAA receptor, the α1β2γ2 receptor. Mutations in GABRA1 (c.644T>C, p.L215P; c.640C>T, p.R214C; c.859G>A; V287I; c.641G>A, p.R214H) and GABRG2 (c.269C>G, p.T90R; c.1025C>T, p.P342L) presented as de novo cases, while in GABRB2 two variants were de novo (c.992T>C, p.F331S; c.542A>T, p.Y181F) and one was autosomal dominant and inherited from the maternal side (c.990_992del, p.330_331del). We characterized the effects of these GABR variants on GABAA receptor biogenesis and channel function. We found that defects in receptor gating were the common deficiency of GABRA1 and GABRB2 Dravet syndrome variants, while mainly trafficking defects were found with the GABRG2 (c.269C>G, p.T90R) variant. It seems that variants in α1 and β2 subunits are less tolerated than in γ2 subunits, since variant α1 and β2 subunits express well but were functionally deficient. This suggests that all of these GABR variants are all targeting GABR genes that encode the assembled α1β2γ2 receptor, and regardless of which of the three subunits are mutated, variants in genes coding for α1, β2 and γ2 receptor subunits make them candidate causative genes in the pathogenesis of Dravet syndrome.

scholarly journals Standard induction with basiliximab versus no induction in low immunological risk kidney transplant recipients: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Aziza Ajlan ◽  
Hassan Aleid ◽  
Tariq Zulfiquar Ali ◽  
Hala Joharji ◽  
Khalid Almeshari ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Double Blind ◽  
Donor Specific Antibodies

Abstract Background Induction therapy with IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent in low immunological risk kidney transplant recipients. However, the role of IL2-RA in the setting of tacrolimus-based immunosuppression has not been fully investigated. Aims To compare different induction therapeutic strategies with 2 doses of basiliximab vs. no induction in low immunologic risk kidney transplant recipients as per KFSHRC protocol. Methods Prospective, randomized, double blind, non-inferiority, controlled clinical trial Expected outcomes 1. Primary outcomes: Biopsy-proven acute rejection within first year following transplant 2. Secondary outcomes: a. Patient and graft survival at 1 year b. eGFR at 6 months and at 12 months c. Emergence of de novo donor-specific antibodies (DSAs) Trial registration The study has been prospectively registered at clinicaltrials.gov (NTC: 04404127). Registered on 27 May 2020.

scholarly journals Integrating healthcare and research genetic data empowers the discovery of 28 novel developmental disorders

2019 ◽  
Author(s):  
Joanna Kaplanis ◽  
Kaitlin E. Samocha ◽  
Laurens Wiel ◽  
Zhancheng Zhang ◽  
Kevin J. Arvai ◽  
...  
Keyword(s):  
Developmental Disorders ◽  
De Novo ◽  
Genetic Data ◽  
Statistical Test ◽  
Integrated Healthcare ◽  
Protein Coding ◽  
Protein Coding Genes ◽  
Clinical Diagnostic ◽  
Simulation Based

SummaryDe novo mutations (DNMs) in protein-coding genes are a well-established cause of developmental disorders (DD). However, known DD-associated genes only account for a minority of the observed excess of such DNMs. To identify novel DD-associated genes, we integrated healthcare and research exome sequences on 31,058 DD parent-offspring trios, and developed a simulation-based statistical test to identify gene-specific enrichments of DNMs. We identified 285 significantly DD-associated genes, including 28 not previously robustly associated with DDs. Despite detecting more DD-associated genes than in any previous study, much of the excess of DNMs of protein-coding genes remains unaccounted for. Modelling suggests that over 1,000 novel DD-associated genes await discovery, many of which are likely to be less penetrant than the currently known genes. Research access to clinical diagnostic datasets will be critical for completing the map of dominant DDs.

scholarly journals Acute nonlymphocytic leukemia following etoposide and cisplatin combination chemotherapy for advanced non-small-cell carcinoma of the lung

Blood ◽  
1987 ◽  
Vol 70 (5) ◽  
pp. 1412-1417 ◽  
Author(s):  
MJ Ratain ◽  
LS Kaminer ◽  
JD Bitran ◽  
RA Larson ◽  
MM Le Beau ◽  
...  
Keyword(s):  
Combination Chemotherapy ◽  
Advanced Nsclc ◽  
De Novo ◽  
Cumulative Risk ◽  
Late Complications ◽  
Small Cell ◽  
First Year ◽  
Acute Nonlymphocytic Leukemia ◽  
Acute Monoblastic Leukemia ◽  
High Doses

Combination chemotherapy is frequently used in the therapy of advanced non-small-cell lung cancer (NSCLC), but late complications are rarely recognized because of the short survival of most patients. Of 119 patients with advanced NSCLC treated with cisplatin and other drugs, four patients developed acute nonlymphocytic leukemia (ANLL). All four patients received etoposide and cisplatin with or without vindesine. Leukemia was diagnosed at 13, 19, 28, and 35 months after start of treatment. Three patients had morphologic and/or cytogenetic features of acute leukemia with significant monoblastic involvement; the fourth patient had trilineage dysplasia and cytogenetic abnormalities more commonly associated with therapy-related leukemia. Detailed analysis of the subgroup who survived longer than 1 year (24 patients) suggests that high cumulative doses of etoposide are leukemogenic; the median etoposide dose was 6,795 mg/m2 (first year only) in the four leukemic patients compared with 3,025 mg/m2 in the 20 nonleukemic patients (P less than .01). The rate of ANLL was 0.30 per person-year after the first year (95% confidence limits 0.11 to 0.90), with a cumulative risk of 15% +/- 11% at 2 years, and 44% +/- 24% at 2.5 years. We conclude that high doses of etoposide are potentially leukemogenic, and can induce a syndrome with features of acute monoblastic leukemia de novo that is distinct from other secondary leukemias.

Pediatric Telepsychiatry as Innovation in Healthcare Delivery

2011 ◽  
pp. 2044-2056
Author(s):  
Katherine M. Boydell ◽  
Tiziana Volpe ◽  
Antonio Pignatiello
Keyword(s):  
Rural Communities ◽  
Clinical Education ◽  
Healthcare Service ◽  
Knowledge Exchange ◽  
Healthcare Delivery ◽  
Mental Healthcare ◽  
Children And Youth ◽  
Integrated Healthcare ◽  
Knowledge Translation And Exchange

Although a great deal has been written about the potential for telemedicine to increase access to care, applications in paediatrics are sparse. This chapter details how one paediatric telepsychiatry program has facilitated the creation of integrated healthcare solutions in patient psychiatric care for children and youth in remote and rural communities. It demonstrates how the telepsychiatry model of healthcare service delivery has improved access, enhanced capacity, and promoted knowledge exchange in rural communities. A case study is used to highlight theoretical and empirical research on the value of televideo information technology in mental healthcare and its impact on the healthcare stakeholders who utilize this technology. An overview of the clinical, education, and evaluation components of the program is outlined, with a focus on knowledge translation and exchange as the underpinning foundation to the success of the program.

Cardiovascular Deaths among CAPD Patients

1983 ◽  
Vol 3 (3_suppl) ◽  
pp. 23-26 ◽  
Author(s):  
George Wu
Keyword(s):  
Heart Disease ◽  
De Novo ◽  
Plasma Cholesterol ◽  
Hypertensive Heart Disease ◽  
Cardiovascular Complications ◽  
First Year ◽  
Antihypertensive Medications ◽  
Significant Difference ◽  
Artery Disease ◽  
Similar Risk

Forty-four of the 508 CAPD patients in Toronto died of cardiovascular complications during the period september 1977 -October 1982. More than 80% of these patients had evidence of ischemic or hypertensive heart disease before commencement of CAPD. The survival of CAPD patients, who were free of cardiac problems before starting CAPD, was significantly better than those who had angina pectoris, myocardial infarction or cardiomegaly at the onset of CAPD. The de novo incidence of ischemic heart disease in patients between ages 40 and 59 (n = 70) was 8.8% at the end of the first year, and 15%() at the end of the second year. These figures were comparable to those reported for hemodialysis patients but worse than those in nonuremic patients with similar risk factors. After starting CAPD, 68.2% of the initially hypertensive patients became normotensive without taking any medication, and 25.8%() became normotensive with a reduced dose of antihypertensive medications. There was no statistically significant difference between the mean fasting plasma cholesterol and triglyceride levels of patients with and those without coronary artery disease.

scholarly journals Gestational Thyrotoxicosis, Antithyroid Drug Use and Neonatal Outcomes Within an Integrated Healthcare Delivery System

Thyroid ◽  
2015 ◽  
Vol 25 (6) ◽  
pp. 698-705 ◽  
Author(s):  
Joan C. Lo ◽  
Scott A. Rivkees ◽  
Malini Chandra ◽  
Joel R. Gonzalez ◽  
James J. Korelitz ◽  
...  
Keyword(s):  
Drug Use ◽  
Delivery System ◽  
Healthcare Delivery ◽  
Antithyroid Drug ◽  
Neonatal Outcomes ◽  
Healthcare Delivery System ◽  
Integrated Healthcare
Sign in / Sign up

Export Citation Format

Share Document