scholarly journals Digital Measures That Matter to Patients: A Framework to Guide the Selection and Development of Digital Measures of Health

2020 ◽  
Vol 4 (3) ◽  
pp. 69-77 ◽  
Author(s):  
Christine Manta ◽  
Bray Patrick-Lake ◽  
Jennifer C. Goldsack
Keyword(s):  
Patient Engagement ◽  
Selection Process ◽  
Clinical Care ◽  
High Quality ◽  
Digital Medicine ◽  
Touch Point ◽  
Health Concept ◽  
Measurement Selection ◽  
Health And Disease ◽  
Traditional Assessments

<b><i>Background:</i></b> With the rise of connected sensor technologies, there are seemingly endless possibilities for new ways to measure health. These technologies offer researchers and clinicians opportunities to go beyond brief snapshots of data captured by traditional in-clinic assessments, to redefine health and disease. Given the myriad opportunities for measurement, how do research or clinical teams know what they <i>should</i> be measuring? Patient engagement, early and often, is paramount to thoughtfully selecting what is most important. Regulators encourage stakeholders to have a patient focus but actionable steps for continuous engagement are not well defined. Without patient-focused measurement, stakeholders risk entrenching digital versions of poor traditional assessments and proliferating low-value tools that are ineffective, burdensome, and reduce both quality and efficiency in clinical care and research. <b><i>Summary:</i></b> This article synthesizes and defines a sequential framework of core principles for selecting and developing measurements in research and clinical care that are meaningful for patients. We propose next steps to drive forward the science of high-quality patient engagement in support of measures of health that matter in the era of digital medicine. <b><i>Key Messages:</i></b> All measures of health should be meaningful, regardless of the product’s regulatory classification, type of measure, or context of use. To evaluate meaningfulness of signals derived from digital sensors, the following four-level framework is useful: Meaningful Aspect of Health, Concept of Interest, Outcome to be measured, and Endpoint (exclusive to research). Incorporating patient input is a dynamic process that requires more than a single, transactional touch point but rather should be conducted continuously throughout the measurement selection process. We recommend that developers, clinicians, and researchers reevaluate processes for more continuous patient engagement in the development, deployment, and interpretation of digital measures of health.

scholarly journals DEVELOPMENT OF FIELD CROP SEED PRODUCTION IN RUSSIA

2020 ◽  
Vol 8 (3) ◽  
pp. 81-85
Author(s):  
Artem Lukomec
Keyword(s):  
Food Security ◽  
Seed Production ◽  
Production System ◽  
Selection Process ◽  
Biological Properties ◽  
Field Crop ◽  
High Quality ◽  
Main Condition ◽  
Field Crops ◽  
High Quality Seed

Seed production of field crops plays a key role in ensuring food security of the country and is a continuation of the selection process, a necessary link for the development and maintenance of the variety. In seed production, the main object is a variety that is genetically close to each other a certain group of plants, homogeneous in morphological and biological properties. The finish of high-quality seed production is seeds with good varietal and sowing qualities. The main condition for effective production of field crops is a well-established seed production system, which is a set of functionally interconnected structures engaged in the production of elite and reproductive seeds. Seed production of field crops solves two main tasks: variety exchange and variety renewal. When a variety is changed, one zoned variety is replaced by another with more valuable economic characteristics. During variety renewal, varietal seeds in farms are replaced with seeds of the same varieties, but of higher reproductions. Usually, seeds for cereals and legumes are updated every 3-4 years, for millet - every 2 years, for sunflower - annually. The main goal of seed production of field crops is to maintain a set of characteristics of the variety, its most valuable qualities and economic indicators.

Machine Learning Approaches to Retrieve High-Quality, Clinically Relevant, Evidence from the Biomedical Literature: A Systematic Review (Preprint)

2021 ◽  
Author(s):  
Wael Abdelkader ◽  
Tamara Navarro ◽  
Rick Parrish ◽  
Chris Cotoi ◽  
Federico Germini ◽  
...  
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Strong Evidence ◽  
Clinical Care ◽  
Biomedical Literature ◽  
Supervised Machine Learning ◽  
Machine Learning Techniques ◽  
Learning Approaches ◽  
High Quality ◽  
Applied Machine Learning

BACKGROUND The rapid growth of the biomedical literature makes identifying strong evidence a time-consuming task. Applying machine learning to the process could be a viable solution that limits effort while maintaining accuracy. OBJECTIVE To summarize the nature and comparative performance of machine learning approaches that have been applied to retrieve high-quality evidence for clinical consideration from the biomedical literature. METHODS We conducted a systematic review of studies that applied machine learning techniques to identify high-quality clinical articles in the biomedical literature. Multiple databases were searched to July 2020. Extracted data focused on the applied machine learning model, steps in the development of the models, and model performance. RESULTS From 3918 retrieved studies, 10 met our inclusion criteria. All followed a supervised machine learning approach and applied, from a limited range of options, a high-quality standard for the training of their model. The results show that machine learning can achieve a sensitivity of 95% while maintaining a high precision of 86%. CONCLUSIONS Applying machine learning to distinguish studies with strong evidence for clinical care has the potential to decrease the workload of manually identifying these. The evidence base is active and evolving. Reported methods were variable across the studies but focused on supervised machine learning approaches. Performance may improve by applying more sophisticated approaches such as active learning, auto-machine learning, and unsupervised machine learning approaches.

Biomarkers of pain in infants and children

2021 ◽  
pp. 412-421
Author(s):  
Naama Rotem-Kohavi ◽  
Susanne Brummelte ◽  
Kenneth D. Craig ◽  
Tim F. Oberlander
Keyword(s):  
Stress Reactivity ◽  
Life Experience ◽  
Physiological Stress ◽  
Clinical Care ◽  
Infants And Children ◽  
Developmental Changes ◽  
Motor Disabilities ◽  
Reflecting Function ◽  
Health And Disease ◽  
In Infants And Children

Biomarkers are commonly used in clinical care and research as indicators of diseases and physiological states. Preferably, a biomarker should be readily accessible, low in cost, easy to interpret, highly specific, and sensitive to health and disease. Owing to the complexity of the pain system, no unidimensional reliable biomarker for pain has been identified that meets all of these criteria to date. In children, neurologically dependent developmental changes, maturation of physiological stress reactivity systems, and life experience add additional layers of complexity to the use of biomarkers of pain. Nevertheless, readily available and reliable biomarkers reflecting function of the pain system would greatly enhance timely and appropriate understanding and treatment of pain, especially in infants and children with communication, cognitive, and motor disabilities. This chapter examines currently available pain-related biomarkers, their use, and limitations.

Volume management as a key dimension of a high-quality PD prescription

2020 ◽  
Vol 40 (3) ◽  
pp. 282-292 ◽  
Author(s):  
Angela Yee-Moon Wang ◽  
Jie Dong ◽  
Xiao Xu ◽  
Simon Davies
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Clinical Care ◽  
Small Sample ◽  
Volume Status ◽  
Volume Control ◽  
High Quality ◽  
Volume Management ◽  
Residual Kidney Function

Background: Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for “High-quality PD prescription” necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. Methods: A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted. Results: There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only “practice points” were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care. Conclusions: High-quality goal-directed PD prescription should include volume management as one of the key dimensions.

scholarly journals Systems Biology and Kidney Disease

2020 ◽  
Vol 15 (5) ◽  
pp. 695-703 ◽  
Author(s):  
Jennifer A. Schaub ◽  
Habib Hamidi ◽  
Lalita Subramanian ◽  
Matthias Kretzler
Keyword(s):  
Systems Biology ◽  
Molecular Mechanisms ◽  
Kidney Diseases ◽  
Clinical Care ◽  
Treatment Options ◽  
Cell Types ◽  
Current State ◽  
Health And Disease ◽  
National Databases ◽  
Different Cell Types

The kidney is a complex organ responsible for maintaining multiple aspects of homeostasis in the human body. The combination of distinct, yet interrelated, molecular functions across different cell types make the delineation of factors associated with loss or decline in kidney function challenging. Consequently, there has been a paucity of new diagnostic markers and treatment options becoming available to clinicians and patients in managing kidney diseases. A systems biology approach to understanding the kidney leverages recent advances in computational technology and methods to integrate diverse sets of data. It has the potential to unravel the interplay of multiple genes, proteins, and molecular mechanisms that drive key functions in kidney health and disease. The emergence of large, detailed, multilevel biologic and clinical data from national databases, cohort studies, and trials now provide the critical pieces needed for meaningful application of systems biology approaches in nephrology. The purpose of this review is to provide an overview of the current state in the evolution of the field. Recent successes of systems biology to identify targeted therapies linked to mechanistic biomarkers in the kidney are described to emphasize the relevance to clinical care and the outlook for improving outcomes for patients with kidney diseases.

scholarly journals Budgeting of non-commercial clinical trials: development of a budget tool by a public funding agency

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hilde Nevens ◽  
Jillian Harrison ◽  
France Vrijens ◽  
Leen Verleye ◽  
Nelle Stocquart ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Selection Process ◽  
Necessary Condition ◽  
Funding Agency ◽  
Published Data ◽  
Close Monitoring ◽  
High Quality ◽  
Cost Drivers ◽  
Pragmatic Clinical Trials

Abstract Background Investigator-led multicentre randomised trials are essential to generate evidence on the optimal use of medical interventions. These non-commercial trials are often hampered by underfunding, which may lead to difficulties in gathering a team with the necessary expertise, a delayed trial start, slow recruitment and even early trial discontinuation. As a new public funder of pragmatic clinical trials, the KCE Trials programme was committed to correctly pay all trial activities in order to assure timely delivery of high-quality trial results. As no appropriate trial budget tool was readily publicly available that took into account the costs for the sponsor as well as the costs for participating sites, we developed a tool to make the budgeting of a clinical trial efficient, transparent and fair across applicants. Methods All trial-related activities of the sponsor and sites were categorised, and cost drivers were identified. All elements were included in a spreadsheet tool allowing the sponsor team to calculate in detail the various activities of a clinical trial and to appreciate the budget impact of specific cost drivers, e.g. a delay in recruitment. Hourly fees by role were adapted from published data. Fixed amounts per activity were developed when appropriate. Results This publicly available tool has already been used for 17 trials funded since the start of the KCE Trials programme in 2016, and it continues to be used and improved. This budget tool is used together with additional risk-reducing measures such as a multistep selection process with advance payments, a recruitment feasibility check by sponsor and funder, a close monitoring of study progress and a milestone-based payment schedule with the last payment made when the manuscript is submitted. Conclusions The budget tool helps the KCE Trials programme to answer relevant research questions in a timely way, within budget and with high quality, a necessary condition to achieve impact of this programme for patients, clinical practice and healthcare payers.

scholarly journals An Interprofessional Education Project to Address Veterans’ Healthcare Needs

2016 ◽  
Vol 6 (1) ◽  
pp. 1 ◽  
Author(s):  
Jane Peterson ◽  
Margaret Brommelsiek ◽  
Sarah Knopf Amelung
Keyword(s):  
Interprofessional Education ◽  
Clinical Care ◽  
Quality Care ◽  
Primary Care Clinic ◽  
Military Culture ◽  
Team Approach ◽  
High Quality ◽  
Care Clinic ◽  
High Quality Care ◽  
Healthcare Needs

Background/Objective: The number of veterans and their families seeking healthcare and support within civilian communities is increasing worldwide. There is a need for healthcare providers to provide sensitive, comprehensive care for veterans with both physical and behavioral health conditions. Many civilian providers are unfamiliar with veterans’ issues and need training on military culture and combat experiences in order to provide compassionate, high quality care. An interprofessional (IPE) course to increase health professional students’ understanding of military culture and the associated health problems of veterans was implemented and evaluated. Methods: An 8-week IPE immersion course was offered for students with clinical experience at a Veterans’ Health primary care clinic and a didactic component. The class content included military culture, behavioral and physical health disorders common among veterans, and the related behavioral and pharmacological treatments. Faculty-led discussions with students in IPE teams used veteran-focused case studies and standardized patients to prepare students to work in IPE teams in the clinical care of veterans. Results: This educational project was evaluated using quantitative surveys and qualitative reflection questions and focus groups. Students scored high for readiness for interprofessional learning pre-course. Post-course students reported valuing the team approach to veterans care and students engaged in high levels of communication and collaboration within the team. Students’ knowledge scores increased related to understanding of military culture and their patient advocate role. Conclusions: Students learned about military culture and the provision of humanistic, high quality care for military veterans in this clinical and didactic immersion IPE course.

Adolescent Psychiatry Services

1995 ◽  
Vol 166 (3) ◽  
pp. 306-310 ◽  
Author(s):  
Tony Jaffa
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Adolescent Psychiatry ◽  
Clinical Care ◽  
Psychiatric Services ◽  
High Quality ◽  
History Of ◽  
The Uk ◽  
The Way

BackgroundThe way in which psychiatric services for adolescents in the UK are developing will be affected by recent changes in the organisation of the National Health Service.MethodThe history of these services, and the different opportunities for development are reviewed.ResultsWays in which high-quality clinical care can still be provided are indicated.ConclusionAdolescent psychiatric services should be judged on their ability to provide such care, not merely on their ability to survive.

An Evaluation Of The Supplier Selection And Evaluation Process In Zimbabwean Universities

2012 ◽  
Vol 6 ◽  
Author(s):  
Bongani Mushanyuri
Keyword(s):  
Supplier Selection ◽  
Selection Process ◽  
Low Cost ◽  
Evaluation Process ◽  
High Quality ◽  
Alternative Source ◽  
Environmental Criteria ◽  
Process Strategy ◽  
Strategic Consideration

Supplier  selection  and  evaluation  is  fast  becoming  animportant strategic consideration in purchasing and supply.Suppliers  play  an  influential  role  to  the  overall  success  of the  buying  organisation.  Nowadays,  supplier  selection  is firmly  positioned  as  an  alternative  source  for  competitive advantage  for  organisations  with  regards  to  offering  low cost,  high  quality  products  and  services  or  achieving reliability  to  customers.  As  organisations  become  more dependent  on  suppliers,  the  direct  and  indirect consequences of poor decision making on supplier selection will  become  more  critical.  With  the  increasingly  important role of suppliers in supply chain management, the selection process strategy has changed; other than scanning a series of pricelists only, qualitative, quantitative and environmental criteria have now been incorporated into the process.

Providing oncologic care with access to clinical trials to an underserved and minority population: The Mayo Clinic/Indian Health Service experience.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 79-79
Author(s):  
Donald W. Northfelt ◽  
Chara Chamie ◽  
Farhia Omar ◽  
Janet Okamoto ◽  
Timothy Mathews ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Health Service ◽  
Cancer Patients ◽  
Mayo Clinic ◽  
Clinical Care ◽  
Indian Health Service ◽  
Cancer Clinical Trials ◽  
High Quality ◽  
Indian Health

79 Background: Novel mechanisms are needed to provide high quality oncologic clinical care and clinical trial access to underserved and minority populations (UMP). UMP are underrepresented in cancer clinical trials, thus limiting the generalizability of the research. As a National Cancer Institute-Comprehensive Cancer Center, Mayo Clinic has the responsibility to ensure that its cancer care reaches a diverse patient population. Mayo Clinic in Arizona developed a clinical oncology practice in collaboration with the US Indian Health Service at Phoenix Indian Medical Center (PIMC), in part to address these needs. The relationship between Mayo and PIMC is invaluable and serves a crucial need in the community. The Mayo consultants serve as staff physicians in the “Oncology Center of Excellence” at PIMC and see 100 – 200 tribal members annually with new diagnoses of cancer or blood disorders. Being onsite at PIMC allows Mayo consultants to integrate seamlessly into the wider PIMC practice. Methods: Descriptive demographic data from the MCA-PIMC clinical practice were obtained from the PIMC practice database 2008 - 2017. Enrollment of MCA-PIMC patients into MCA cancer clinical trials were prospectively enumerated. Results: Between the time period of 2008-2017, 356 breast cancer patients and 259 colorectal cancer patients were seen by Mayo Clinic oncologists and the PIMC nurse practitioner. During the period of 2016-2017, there were 13 clinical trial referrals from PIMC with 8 of those patients being enrolled in Mayo cancer clinical trials. Conclusions: High quality oncologic clinical care can be provided via unique collaborations between academic oncology program and UMP-focused care provider. This mechanism allows access to cancer clinical trial opportunities for UMP. Prior to the established partnership, there were no Native American patients referred to clinical trials from PIMC, showing the critical pathway that has been forged. Importantly, this is the only known program of its kind in the country. By imbedding the cancer provider in the community, we are able to build trust with the underserved community and create a pathway to a quality care and clinical research.

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