Digital healthcare: Fools gold or a promised land?

2016 ◽  
Vol 33 (S1) ◽  
pp. S28-S28
Author(s):  
M. Wise
Keyword(s):  
Support Groups ◽  
Phone Call ◽  
Systematic Evaluation ◽  
Promised Land ◽  
Use Of Technology ◽  
Competing Interest ◽  
Video Calling ◽  
Health Care Application ◽  
Digital Healthcare

Digital healthcare is the use of technology to deliver healthcare. There are many facets of it. The paradigm of care at a distance e.g. a live interface is the most understood, whether it is the old fashioned analog phone call or that of todays Millenial who ‘get’ Skype or see video calling as a day to day reality.This has moved to non-live uses, asynchronous, the modern version of written communication, email, videomessage, Instagram, twitter or any one of a multitude of social media.It has progressed beyond that though to a plethora of devices, apps and cross breeds that promise to maximise your patients health, and often your practice income! Grand claims, if not ones supported by the evidence.They have broadened the range of providers from the plain vanilla (group) therapist to the Cyber support groups; from patient information sheets, to sophisticated hyperlinked, video embedded ‘hope box’, or manual on your phone. They have changed in vivo exposure from what was limited by travel time, to what is limited by the programmers imagination.Telemdecine can connect patients and providers worldwide – how can that not be an amazing promise, today's truly outstanding goal – tomorrow commonplace event.The promise of near infinite data; if only we can measure enough, we can treat better, may hold true for a physical paradigm such as mobile ECG or BP monitoring, but is it true for mental health?Science is not a door to infinite wisdom, but a rescue from unending ignorance. The evidence is that technological innovations are not a magic solution but tools widening access, they are to travel what the motorway is to the dust track. They are an equaliser in that more people can be reached than ever before–but they do not replace human skill and ability.By December 2015, 500 million smartphone users worldwide will be estimated to be using a health care application. Yet, there is no evidence of a systematic evaluation of a fraction of these apps. They may not be snake oil salesman, but has the placebo effect graduated from molecules to ones and zero's?We will explore the evidence to understand some of the promises and the realities of what was once Tomorrows World, here today.Disclosure of interestThe author has not supplied his declaration of competing interest.

Retrovirus-mediated gene transfer of human adenosine deaminase: expression of functional enzyme in murine hematopoietic stem cells in vivo

1987 ◽  
Vol 7 (10) ◽  
pp. 3459-3465
Author(s):  
B Lim ◽  
D A Williams ◽  
S H Orkin
Keyword(s):  
Adenosine Deaminase ◽  
Leukemia Virus ◽  
Hematopoietic Cells ◽  
Phosphoglycerate Kinase ◽  
Moloney Murine Leukemia Virus ◽  
Systematic Evaluation ◽  
Hematopoietic Stem ◽  
Specific Sequences

Simplified Moloney murine leukemia virus-based recombinant retrovirus vectors have been constructed which transduce human adenosine deaminase (ADA) cDNA. ADA transcription is under the control of the constitutive promoter for the human X chromosome phosphoglycerate kinase (pgk) gene. In these simplified vectors, dominant selectable markers are not included and selection is dependent on overproduction of functional ADA enzyme. Primary murine hematopoietic cells were infected with helper-free recombinant ADA virus generated from Psi-2 packaging cells. Protein analysis revealed that human ADA enzyme was expressed in progenitor-derived hematopoietic colonies in vitro and CFU-S-derived spleen colonies in vivo. Enzyme expression was dependent on transcription from the pgk promoter. ADA expression in primary murine hematopoietic cells directed by the internal promoter was not adversely affected by the presence of the Moloney virus long terminal repeat enhancer sequence. Use of these vectors allows systematic evaluation of the effects of specific sequences in recombinant retrovirus vectors on expression in primary murine hematopoietic cells in vivo.

Role of online technology and social networking site at workplace

2017 ◽  
Vol 41 (S1) ◽  
pp. s494-s494
Author(s):  
H. Gupta
Keyword(s):  
Internet Use ◽  
Social Networking Site ◽  
Personal Hygiene ◽  
Cross Sectional ◽  
Online Technology ◽  
Use Of Technology ◽  
Pornography Use ◽  
Pornography Addiction ◽  
Private Sector Organizations ◽  
Competing Interest

BackgroundInternet use has affected the pattern of working style at the workplace. Recent years have seen an increased use of online activities (especially pornography/gaming) at the workplace. It has been shown to affect productivity at the workplace. There is a dearth of literature from the Indian context in this area.AimThis study was conducted to explore the pattern of pornography use& gaming at the workplace and its dysfunctions. Setting and design: The present study was a cross-sectional prospective studyMaterials and methodsThe objective of the study was to assess the pattern of pornography use at the workplace. Five hundred employees having experience of Internet use for more than a year of various government/private sector organizations in Bengaluru were assessed using background data sheet, DSM V criteria, Internet addiction test & pornography addiction screening instrument. Users who were unwilling to participate were excluded from the study.ResultsSeven to nine percent reported preference for Internet to work, meals, personal hygiene, sleep, and interaction with family members and effects on productivity. Three to four percent have excessive use of pornography & game.ConclusionsThe present study has implications for evolving psychoeducational modules for the promotion of healthy use of technology.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Digi-HTA: Health technology assessment framework for digital healthcare services

2019 ◽  
Vol 11 (4) ◽  
Author(s):  
Jari Haverinen ◽  
Niina Keränen ◽  
Petra Falkenbach ◽  
Anna Maijala ◽  
Timo Kolehmainen ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
State Of The Art ◽  
Health Technology ◽  
Healthcare Services ◽  
The State ◽  
Systematic Evaluation ◽  
Health Technologies ◽  
Digital Healthcare ◽  
And Robotics

Health technology assessment (HTA) refers to the systematic evaluation of the properties, effects, and/or impacts of health technology. The main purpose of the assessment is to inform decisionmakers in order to better support the introduction of new health technologies. New digital healthcare solutions like mHealth, artificial intelligence (AI), and robotics have brought with them a great potential to further develop healthcare services, but their introduction should follow the same criteria as that of other healthcare methods. They must provide evidence-based benefits and be safe to use, and their impacts on patients and organizations need to be clarified. The first objective of this study was to describe the state-of-the-art HTA methods for mHealth, AI, and robotics. The second objective of this study was to evaluate the domains needed in the assessment. The final aim was to develop an HTA framework for digital healthcare services to support the introduction of novel technologies into Finnish healthcare. In this study, the state-of-the-art HTA methods were evaluated using a literature review and interviews. It was noted that some good practices already existed, but the overall picture showed that further development is still needed, especially in the AI and robotics fields. With the cooperation of professionals, key aspects and domains that should be taken into account to make fast but comprehensive assessments were identified. Based on this information, we created a new framework which supports the HTA process for digital healthcare services. The framework was named Digi-HTA.

Abstract TP288: Overcoming Obstacles Making People Healthy (OOMPH): A Patient Centered Post Discharge Follow-up Program for Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jonathan Muller ◽  
Barbara Gatton ◽  
Linda Fox ◽  
Joseph A Bove ◽  
Johanna Donovan Turner ◽  
...  
Keyword(s):  
Support Groups ◽  
Medical Information ◽  
Patient Adherence ◽  
Hospital Readmissions ◽  
Phone Call ◽  
Stroke Patients ◽  
Post Discharge ◽  
Phone Calls ◽  
Stroke Support Groups

Background and Purpose: At least 12% of stroke patients are readmitted to a hospital within 30 days of discharge. We know that patients hospitalized for other conditions are less likely to be readmitted within 30 days if they are seen by their PCP shortly after discharge. However, less than a third of patients in the New York metropolitan area admitted for heart failure, heart attacks, and pneumonia see their PCP within 14 days after discharge and nearly 40% of patients do not adhere to their prescribed regimen. In the case of cerebrovascular diseases, outpatient follow-up may prevent the majority of avoidable readmissions. The purpose of this project is to identify and reduce unnecessary, unplanned hospital readmissions after stroke. Our goal is to encourage patient adherence to prescribed medication and other therapies, as well as to ensure timely follow-up with their PCP. Methods: Stroke and transient ischemic attack (TIA) patients with a disposition of either home or short-term rehabilitation are visited and offered enrollment. Participants are given a kit which includes a personalized binder (to manage essential medical information) and a 28-slot pill box. Each patient then receives 3 phone call interviews at 7, 21 and 32 days after discharge. The aim of the phone calls is to identify obstacles to compliance with treatment regimen and follow-up care. Results: From January 2015 to June 2016, 247 patients were enrolled and followed up. Within 30 days of discharge, 10% were readmitted and 50% of all readmissions occurred within the first 7 days. Of those readmitted, 19% were due to an injury from physical therapy. Data from follow-up phone calls revealed that 83% were taking all prescribed medications, 89% had completed a follow-up with any physician, 69% were using the binder, and 61% had done all three. Conclusions: While we have not enrolled enough patients to see a statistically significant reduction in readmissions, our interviews showed that weather, depression, as well as a lack of insurance, family support, and a home health aide are all determinants on how patients will follow their prescribed regimen. The results of this study have allowed us to begin implementing stroke support groups and pre-discharge follow-up appointment scheduling.

Cortical oscillations to measure anti-epileptic drug activity in clinical trials

2021 ◽  
Author(s):  
Andrea Biondi ◽  
Lorenzo Rocchi ◽  
Viviana Santoro ◽  
Gregory Beatch ◽  
Pierre Rossini ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Brain Activity ◽  
Systematic Evaluation ◽  
Alpha Power ◽  
Brain Oscillations ◽  
Cortical Oscillations ◽  
Anti Epileptic Drug ◽  
Beta Power ◽  
Gamma Power

Abstract The frequency analysis of electroencephalographic (EEG) activity, either spontaneous or evoked by transcranial magnetic stimulation (TMS-EEG), is a powerful tool to investigate changes in brain activity and excitability following the administration of antiepileptic drugs (AEDs). However, a systematic evaluation of the effect of AEDs on spontaneous and TMS-induced brain oscillations has not yet been provided. We studied the effects of lamotrigine, levetiracetam, and of a novel potassium channel opener (XEN1101) on TMS-induced and spontaneous brain oscillations in a group of healthy volunteers. Levetiracetam suppressed TMS-induced theta, alpha and beta power, whereas lamotrigine increased TMS-induced alpha power. XEN1101 decreased TMS-induced delta, theta and beta power. Resting-state EEG showed a decrease of theta band power after lamotrigine intake. Levetiracetam increased theta, beta and gamma power, while XEN1101 produced an increase of delta, theta, beta and gamma power. Different AEDs induce specific patterns of power changes in spontaneous and TMS-induced brain oscillations. Spontaneous and TMS-induced cortical oscillations represent a powerful tool to characterize the effect of AEDs on in vivo brain activity. Spectral fingerprints of specific AEDs should be further investigated to provide robust and objective biomarkers of biological effect in human clinical trials.

scholarly journals Development of Functional Screens for Dietary Angiogenesis Inhibitors

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 321-321
Author(s):  
James Dunleavey ◽  
St Brad Croix ◽  
Nancy Emenaker ◽  
Jessica Dunleavey
Keyword(s):  
Mouse Models ◽  
National Cancer Institute ◽  
Systematic Evaluation ◽  
Angiogenic Potential ◽  
Angiogenesis Inhibition ◽  
Sprouting Angiogenesis ◽  
In Vivo Testing ◽  
Dietary Agents

Abstract Objectives We sought to develop a workflow to evaluate the anti-angiogenic potential of dietary agents in a stringent, systemic manner: 1) in vitro inhibition of angiogenesis, 2) in vivo testing of normal angiogenesis inhibition, and 3) in vivo testing of tumor prevention. Methods We used a tiered workflow for assessment of anti-angiogenic potential of dietary compounds, beginning with cell culture methods, moving to high-throughput D. rerio angiogenesis modeling and finally mouse models of angiogenesis and tumor development to identify potent dietary agents which block tumor angiogenesis. Results We identified quercetin dihydrate as an orally available inhibitor of angiogenesis and our lead candidate for further evaluation for chemoprevention of angiogenesis. Quercetin blocked in vitro sprouting angiogenesis, and displayed a dose-dependent reduction in sprouting angiogenesis in the tail regeneration model in zebrafish. Finally, quercetin implanted at reported physiologic levels blocked blood vessel growth in mouse models of angiogenesis. Conclusions We describe a workflow for systematic evaluation of dietary compounds in increasing complexity models for stringent, systematic evaluation of angiogenesis inhibition. These multi-model approaches allow for filtering of pan-assay interference compounds (PAINS) prior to in vivo screening. This workflow identified quercetin as a potent inhibitor of angiogenesis which warrants further study for chemoprevention through diet. Funding Sources National Cancer Institute Division of Cancer Prevention, National Cancer Institute Center for Cancer Research.

scholarly journals Racemization and isomerization of type I collagen C-telopeptides in human bone and soft tissues: assessment of tissue turnover

2000 ◽  
Vol 345 (3) ◽  
pp. 481-485 ◽  
Author(s):  
Evelyne GINEYTS ◽  
Paul A. C. CLOOS ◽  
Olivier BOREL ◽  
Laurent GRIMAUD ◽  
Pierre D. DELMAS ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Type I Collagen ◽  
Soft Tissues ◽  
Systematic Evaluation ◽  
Specific Marker ◽  
Type I ◽  
Aspartic Acid Residue ◽  
Post Translational Modifications ◽  
High Degree

Urinary excretion of the type I collagen C-telopeptide (CTx) has been shown to be a sensitive index of the rate of bone resorption. The human type I collagen sequence A1209HDGGR1214 of CTx can undergo racemization of the aspartic acid residue Asp1211 and isomerization of the bond between this residue and Gly1212. These spontaneous non-enzymic chemical reactions takes place in vivo in bone, and the degree of racemization and isomerization of CTx molecules may be an index of the biological age and the remodelling of bone. The aim of the present study was to investigate the degree of racemization and isomerization of type I collagen in human connective soft tissues, in order to estimate the rate of collagen turnover in adult tissues and compare it with that of bone. We also performed a systematic evaluation of the pyridinium cross-link content in adult human tissues. Using antibodies raised against the different CTx forms, we found that bone and dermis are the tissues that show most racemization and isomerization. The type I collagen of arteries, lung, intestine, kidney, skeletal muscle and heart shows significantly less racemization and isomerization than that of bone, suggesting that these soft tissues have a faster turnover than bone. We also found that pyridinoline and, to a lesser degree, deoxypyridinoline are distributed throughout the different tissues investigated. Because bone type I collagen is characterized by a high degree of both racemization/isomerization and deoxypyridinoline cross-linking, the concomitant assessment of these two post-translational modifications is likely to result in a highly specific marker of bone resorption.

Long-Term Planning and Legal Issues

2018 ◽  
Author(s):  
Michael Ellis
Keyword(s):  
Special Needs ◽  
Support Groups ◽  
Text Message ◽  
Legal Issues ◽  
Phone Call ◽  
Specific Situation ◽  
Financial Decisions ◽  
Legal Advice ◽  
Children With Asd

Please be aware that I am not an attorney and the following information should not be considered legal advice. The information contained in this chapter is what I have learned as a parent of a child with autism spectrum disorder (ASD) and as a doctor trying to help those with ASD navigate complex legal and financial decisions. I recommend all parents of children with ASD develop a relationship with a licensed attorney with experience in special needs in their jurisdiction. As this chapter details, there are many different legal issues you and your child may encounter as your child matures into adulthood. Having an attorney who is familiar with your specific situation and your child can be very reassuring should legal needs arise. If you have the financial capacity to place some funds in a retainer with an attorney so that they are available any time you need for a quick e-mail, phone call, or text message, it is often worth the expense and peace of mind. Parents can usually locate attorneys with experience in special needs by contacting their local bar associations, many of which maintain formal referral programs. Also, many autism support groups maintain lists of attorneys who specialize in various aspects of the law relevant to children with ASD. Your child’s medical providers may also be able to provide referrals. If you are like most parents of a child with ASD, you are over­whelmed with even the thought of long-term planning. You are likely thinking, “It is hard enough making it day by day, let alone considering long-term planning.” The truth is that most of us avoid thinking of the future because it is too frightening and uncertain. There is also little guidance from healthcare professionals on this very complex issue. However, much relief can be found in achieving a plan for your child’s future. Do not wait. It is important to talk with a financial planner when your child is young.

Development of Renal Calculi and Imatinib Therapy in CML: Is There an Association?.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4551-4551
Author(s):  
Tapan Saikia ◽  
Nandini Hazarika ◽  
Boman Dhabhar
Keyword(s):  
Mineral Metabolism ◽  
Renal Calculi ◽  
Imatinib Therapy ◽  
Systematic Evaluation ◽  
Abdominal Ultrasonography ◽  
Biochemical Evaluation ◽  
Parathyroid Dysfunction ◽  
Renal Tubular ◽  
Calcium And Phosphate Metabolism

Abstract Reports are accumulating regarding the altered bone and mineral metabolism caused by imatinib (IM) therapy (Berman E, et al 2006 NEJM). This probably occurs through in vivo inhibition of PDGF receptors. It has been proposed that prolonged use of IM may cause some potentially serious metabolic pathological disorders. Compensatory rise in parathyroid hormone level may cause renal pathologies in these patients. In this observational study we came across a few patients on imatinib therapy for CML who experienced prolonged dyspepsia, abdominal and bone pain (suggestive of groans, moans, bones and stones features) and abdominal ultrasonography revealed renal calculi. This has led to collection of clinical data. So far, no systematic evaluation with radiological or biochemical have been undertaken in our cohort of 177 of CML on imatinib therapy. At the time of this report we have noted development of renal calculi (all symptomatic) in 7 patients of CML on imatinib therapy. All these patients have been on imatinib therapy 400 mg daily for more than 1 month before symptoms developed. In all but one, no surgical intervention has been necessary so far. Biochemical evaluation for altered bone metabolism revealed hyperphosphatemia in one and normal in another. Analysis of renal stone in one showed a composition of calcium phosphate and oxalate. Imatinib was not discontinued but reduced to 300 mg in 3 patients. It is possible that prolonged use of IM may alter calcium and phosphate metabolism leading to renal calculi formation. The proposed mechanisms could be, interference with bone and mineral metabolism coupled with parathyroid dysfunction which in turn leads to renal tubular abnormalities or availability of excess oxalate for intestinal absorption brought about by low calcium ingestion. Well designed cohort studies may throw more light in this area.

The role of the gut microbiota in mood and behaviour. Whether psychobiotics can become an alternative in therapy in psychiatry?

2016 ◽  
Vol 33 (S1) ◽  
pp. S26-S26 ◽  
Author(s):  
S. Van Hemert ◽  
W. Marlicz ◽  
P. Szachta ◽  
E. Pekelharing ◽  
G. Ormel ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Response To Therapy ◽  
Human Trial ◽  
Pain Anxiety ◽  
Gut Barrier Function ◽  
Psychiatric Disturbances ◽  
Competing Interest

IntroductionNovel research concepts based on therapies aiming to modulate intestinal microbiota are emerging. The evidence is mounting that gut-brain axis plays an important role in the development of mood and depressive disorders [1]. The similarities between blood brain barrier (BBB) and gut vascular barrier (GVB) and their role in chronic diseases have been recently unraveled [2]. Especially convincing data come from animal models, where administration of probiotics and antibiotics in germ and pathogen free mice showed beneficial role in the regulation of behavior, cognition, pain, anxiety and mood.Aims and resultsBased on available data as well as on studies looking at the effect of multispecies probiotics (Ecologic® Barrier containing B.bifidumW23, B.lactisW52, L.acidophilusW37, L.brevisW63, L.caseiW56, L.salivariusW24, L.lactisW19, L.lactisW58) on cognitive reactivity to sad mood in healthy volunteers [3] we designed the human trial aiming to compare microbiome alterations and response to therapy in patients with depression and schizophrenia. Moreover, in vitro and in vivo data support the notion that multispecies probiotics are capable of improving gut barrier function [4] and may alleviate disorders affecting mood and depressive-like behavior. We postulate that therapies modulating the microbiome-gut-brain axis warrant further investigations.ConclusionMultispecies probiotics have the potential to influence the gut-brain axis and alleviate mental disorders. Ongoing clinical study in patients with depression and schizophrenia will help to further unravel the role of gut-brain axis in the treatment of patients with psychiatric disturbances.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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