Correcting Bias in Survival Probabilities for Partially Monitored Populations via Integrated Models

(1) Background: Integrated models of primary care deliver the comprehensive and preventative approach needed to identify and manage frailty in older people. Seniors’ Community Hub (SCH) was developed to deliver person-centered, evidence-informed, coordinated, and integrated care services to older community dwelling adults living with frailty. This paper aims to describe the SCH model, and to present patient-oriented results of the pilot. (2) Methods: SCH was piloted in an academic clinic with six family physicians. Eligible patients were community dwelling, 65 years of age and older, and considered to be at risk of frailty (eFI > 0.12). Health professionals within the clinic received training in geriatrics and interprofessional teamwork to form the SCH team working with family physicians, patients and caregivers. The SCH intervention consisted of a team-based multi-domain assessment with person-centered care planning and follow-up. Patient-oriented outcomes (EQ-5D-5L and EQ-VAS) and 4-metre gait speed were measured at initial visit and 12 months later. (3) Results: 88 patients were enrolled in the pilot from April 2016–December 2018. No statistically significant differences in EQ-5D-5L/VAS or the 4-metre gait speed were detected in 38 patients completing the 12-month assessment. (4) Conclusions: Future larger scale studies of longer duration are needed to demonstrate impacts of integrated models of primary care on patient-oriented outcomes for older adults living with frailty.

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The Effect of Perioral Scan and Artificial Skin Markers on the Accuracy of Virtual Dentofacial Integration: Stereophotogrammetry Versus Smartphone Three-Dimensional Face-Scanning

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010229 ◽

2020 ◽

Vol 18 (1) ◽

pp. 229

Author(s):

Hang-Nga Mai ◽

Du-Hyeong Lee

Keyword(s):

Three Dimensional ◽

Laser Scanner ◽

Statistical Analyses ◽

Integrated Models ◽

Image Integration ◽

Positional Accuracy ◽

Significant Difference ◽

Face Scanning ◽

Scanning Systems ◽

Dimensional Face

This study evaluated the effects of different matching methods on the accuracy of dentofacial integration in stereophotogrammetry and smartphone face-scanning systems. The integration was done (N = 30) with different matching areas (n = 10), including teeth image only (TO), perioral area without markers (PN) and with markers (PM). The positional accuracy of the integrated models was assessed by measuring the midline linear deviations and incisal line canting between the experimental groups and laser scanner-based reference standards. Kruskal–Wallis and Mann–Whitney U tests were used for statistical analyses (α = 0.05). The PM method exhibited the smallest linear deviations in both systems; while the highest deviations were found in the TO in stereophotogrammetry; and in PN in smartphone. For the incisal line canting; the canting degree was the lowest in the PM method; followed by that in the TO and the PN in both systems. Although stereophotogrammetry generally exhibited higher accuracy than the smartphone; the two systems demonstrated no significant difference when the perioral areas were used for matching. The use of perioral scans with markers enables accurate dentofacial image integration; however; cautions should be given on the accuracy of the perioral image obtained without the use of markers.

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“It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00213-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Elizabeth C. Saunders ◽

Sarah K. Moore ◽

Olivia Walsh ◽

Stephen A. Metcalf ◽

Alan J. Budney ◽

...

Keyword(s):

Qualitative Study ◽

The United States ◽

Opioid Use Disorder ◽

Integrated Treatment ◽

Medical Setting ◽

Integrated Models ◽

Opioid Use ◽

Medical Settings ◽

Psychosocial Services ◽

Treatment Models

Abstract Background Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. Methods This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. Results While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). Conclusions Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all.

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Information technology support for integrated supply chain modeling

Human Systems Management ◽

10.3233/hsm-2008-27102 ◽

2008 ◽

Vol 27 (1) ◽

pp. 3-13

Author(s):

Charu Chandra ◽

Jānis Grabis

Keyword(s):

Decision Making ◽

Information Technology ◽

Supply Chain ◽

Process Modeling ◽

Service Oriented Architecture ◽

Model Development ◽

Integrated Models ◽

Supply Chain Modeling ◽

Decision Making Models ◽

Integrated Supply Chain

Multiple interrelated decision-making models are frequently used in supply chain modeling. Model integration is a precondition for efficient development and utilization of these models. This paper discusses use of modern information technology (IT) techniques and methods for integration of supply chain decision-making models. The overall approach to using IT at various stages of model development is presented. Data and process modeling techniques are used to developed semi-formalized representation of integrated models. These models support integration of decision-making components with other parts of supply chain information system. Process modeling is also used to describe interrelationships among multiple decision-making models. This representation is used as the basis for implementation of integrated models. The service-oriented architecture is proposed as an implementation platform. The presented discussion serves as the basis for further developments in developing integrated supply chain decision-making models.

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SurvCNN: A Discrete Time-to-Event Cancer Survival Estimation Framework Using Image Representations of Omics Data

Cancers ◽

10.3390/cancers13133106 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3106

Author(s):

Yogesh Kalakoti ◽

Shashank Yadav ◽

Durai Sundar

Keyword(s):

Discrete Time ◽

Cancer Survival ◽

Performance Metrics ◽

Downstream Processing ◽

Cancer Prognosis ◽

Precision Oncology ◽

Omics Data ◽

Time Model ◽

Survival Probabilities ◽

Image Representations

The utility of multi-omics in personalized therapy and cancer survival analysis has been debated and demonstrated extensively in the recent past. Most of the current methods still suffer from data constraints such as high-dimensionality, unexplained interdependence, and subpar integration methods. Here, we propose SurvCNN, an alternative approach to process multi-omics data with robust computer vision architectures, to predict cancer prognosis for Lung Adenocarcinoma patients. Numerical multi-omics data were transformed into their image representations and fed into a Convolutional Neural network with a discrete-time model to predict survival probabilities. The framework also dichotomized patients into risk subgroups based on their survival probabilities over time. SurvCNN was evaluated on multiple performance metrics and outperformed existing methods with a high degree of confidence. Moreover, comprehensive insights into the relative performance of various combinations of omics datasets were probed. Critical biological processes, pathways and cell types identified from downstream processing of differentially expressed genes suggested that the framework could elucidate elements detrimental to a patient’s survival. Such integrative models with high predictive power would have a significant impact and utility in precision oncology.

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Orthogeriatrics and Hip Fracture Care in the UK: Factors Driving Change to More Integrated Models of Care

Geriatrics ◽

10.3390/geriatrics3030055 ◽

2018 ◽

Vol 3 (3) ◽

pp. 55 ◽

Cited By ~ 2

Author(s):

Mark Middleton

Keyword(s):

Hip Fracture ◽

Financial Incentives ◽

Models Of Care ◽

Social Needs ◽

Medical Rehabilitation ◽

Integrated Models ◽

National Guidelines ◽

Fracture Care ◽

The Uk ◽

The Impact

In the United Kingdom (UK), approximately 80,000 hip fractures each year result in an estimated annual cost of two billion pounds in direct healthcare costs alone. Various models of care exist for collaboration between orthopaedic surgeons and geriatricians in response to the complex medical, rehabilitation, and social needs of this patient group. Mounting evidence suggests that more integrated models of orthogeriatric care result in superior quality of care indicators and clinical outcomes. Clinical governance through national guidelines, audit through the National Hip Fracture Database (NHFD), and financial incentives through the Best Practice Tariff (providing a £1335 bonus for each patient) have driven hip fracture care in the UK forward. The demanded improvement in quality indicators has increased the popularity of collaborative care models and particularly integrated orthogeriatric services. A significant fall in 30-day mortality has resulted nationally. Ongoing data collection by the NHFD will lead to greater understanding of the impact of all elements of hip fracture care including models of orthogeriatrics.

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Radiation Therapy for Stage I Primary Orbital Non-Hodgkin's Lymphomas

Tumori Journal ◽

10.1177/030089169708300509 ◽

1997 ◽

Vol 83 (5) ◽

pp. 822-825 ◽

Cited By ~ 9

Author(s):

Haldun Şükrü Erkal ◽

Meltem Serin ◽

Serpil Dizbay Sak ◽

Ahmet Çakmak

Keyword(s):

Radiation Therapy ◽

Combination Chemotherapy ◽

Disease Free Survival ◽

Stage I ◽

Entire Group ◽

Low Grade ◽

Intermediate Grade ◽

Chop Regimen ◽

Survival Probabilities ◽

Hodgkin's Lymphomas

Aims and Background The orbit is an uncommon primary site for non-Hodgkin's lymphomas (NHL), and it accounts for less than 1% of all sites of primary presentations. We report the experience of the Department of Radiation Oncology at Ankara University Faculty of Medicine with radiation therapy in treatment of patients with stage I primary orbital NHL. Methods From February 1978 through August 1993, 14 patients with stage I primary orbital NHL were treated with radiation therapy. According to the Working Formulation classification, 8 patients had low-grade and 6 had intermediate-grade lymphomas. The most commonly used radiation therapy technique was a single anterior field with a Cobalt-60 unit, delivering 40 Gy in 2 Gy daily fractions. Two patients with intermediate-grade lymphomas received the CHOP regimen following radiation therapy. Results Follow-up ranged from 0.8 to 18.3 years (median, 10.3 years). Local control was achieved in all patients. Two patients with low-grade lymphomas relapsed locally and were successfully salvaged with radiation therapy. Three patients with intermediate-grade lymphomas failed systemically. Salvage therapy consisted of combination chemotherapy for 2 of them but was unsuccessful. Overall survival probabilities at 2, 5 and 10 years were 78.6%, 61.1% and 52.4%, respectively, for the entire group of 14 patients. Overall, cause-specific and disease-free survival probabilities were higher for patients with low-grade lymphomas than for those with intermediate-grade lymphomas (P = 0.03, P = 0.03 and P = 0.06, respectively). Cataracts were observed in 9 and lacrimal disorders in 4 patients. Conclusions The study suggests that among stage I primary orbital NHL, low-grade lymphomas could be treated with radiation therapy alone, whereas combination chemotherapy could accompany radiation therapy for intermediate-grade lymphomas.

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