Abstract 296: Characteristics Of Ambulatory Cardiovascular Patients In India: Findings From The First 18,000+ Patient Encounters In The PINNACLE India Outpatient Registry

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Nathan T Glusenkamp ◽  
Purvez Grant ◽  
Ganesh Kumar ◽  
Nirmala Castellino ◽  
Rahul Gupta ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Vital Signs ◽  
Performance Measure ◽  
Patient Records ◽  
Normal Range ◽  
Electronic Data Collection ◽  
Cardiovascular Patients ◽  
Lipid Panel ◽  
The Us ◽  
Outpatient Departments

Background: In India, patients usually are responsible for medical records, carrying them to ambulatory clinic visits. Little is known about the characteristics of cardiovascular (CV) patients visiting Indian hospital outpatient departments (OPDs), as this information is not collected or analyzed in a standardized fashion. Methods: We used paper scanners along with an electronic data collection tool to systematically collect CV patient records in hospital OPDs. Standardized data definitions were used for all elements, including demographics, vital signs, and lab values. We normalized and analyzed the data collected, producing totals, means, medians, and standard deviations for all element values. Results: We collected 18,804 CV patient encounters in the OPDs of two tertiary facilities in Maharastra state from 2/12 to10/12. Of 18,622 records with gender recorded, 12,386 were male (66.5%). Only 22% of records were for patients over age of 65. Mean age was 57, the same mean age for males. Mean age for females was 54. Systolic blood pressure (BP) was documented in 8,481 (45%) of patient visits. Diastolic BP was documented in 8,477 (45%) patient visits. Mean systolic BP was 130, with a standard deviation of ± 18. Mean diastolic BP was 81 ± 9. Most BPs were high, with 6,651 (78%) greater than 120. Hypertension diagnoses could be applied to 2,566 (30%) of the encounters with a systolic BP over 140 documented. Ejection fraction (EF) was present in 857 patient encounter records (4.5%). Most EFs (704) fell within the normal range of ≥ 50%. Mean ejection fraction was 56% ± 11. For EFs outside normal range, 74 were mildly reduced (an EF of 40-49%), 57 moderately reduced (26-29%) and 22 severely reduced (≤ 25%). Complete lipid panel, consisting of values for total cholesterol, HDL, LDL, and triglycerides, was present in 594 patient records (3.2%). LDL values were present in 601 encounter records, with mean LDL of 101 mg/dL ± 35. 288 LDL values were over 100 mg/dL, the upper bound of optimal range. Conclusion: Indian ambulatory CV patients appear to be younger and more heavily male than outpatient CV populations in the US. Opportunity remains for increased documentation, allowing for performance measure generation.

Simplified rat intubation using a new oropharyngeal intubation wedge

2000 ◽  
Vol 89 (5) ◽  
pp. 1766-1770 ◽  
Author(s):  
I-Ming Jou ◽  
Ya-Ting Tsai ◽  
Ching-Lin Tsai ◽  
Ming-Ho Wu ◽  
Han-Yu Chang ◽  
...  
Keyword(s):  
Low Cost ◽  
Vital Signs ◽  
Upper Airway ◽  
Postmortem Examination ◽  
Normal Range ◽  
Special Equipment ◽  
Vocal Cords ◽  
Oropharyngeal Cavity ◽  
Series Of Experiments ◽  
Proper Setting

Our new oropharyngeal intubation wedge made from a plastic 3-ml syringe has been used successfully for the expansion of the oropharyngeal cavity and visualization of vocal cords for endotracheal intubation in the rat. All the animals we used tolerated the intubation and ventilation procedures in a series of experiments. After the proper setting of the respirator, vital signs were maintained within normal range. The postmortem examination and measurements in the upper airway confirmed that the endotracheal tube was properly sited and also demonstrated the precise size of the device that should be used. The main advantages of this method include low cost, simplicity, and reliability. Furthermore, because no expensive, elaborate, difficult-to-operate, or hard-to-get special equipment is needed, this technique can be used in every laboratory.

scholarly journals Ultrasound assessment of heart remodelling affected by therapeutic hypothermia and MSC on myocardial infarction model

2020 ◽  
Vol 28 (3) ◽  
pp. 222-240
Author(s):  
M. O. Chyzh ◽  
A. O. Manchenko ◽  
A. V. Trofimova ◽  
I. V. Belochkina
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Therapeutic Hypothermia ◽  
Left Coronary Artery ◽  
Left Ventricular ◽  
Control Group ◽  
Normal Range ◽  
Allogeneic Mscs

Background. Late seeking medical advice, limited number of cardiac surgery hospitals and conservative treatment, which does not seem to be always efficacious, trigger the search for new, more effective mode therapy of acute myocardial infarction (MI). Recently, mesenchymal stromal cells (MSCs) have come into sharp focus of scientists due to the prospects for clinical use. On the other hand, multicenter studies have proved that therapeutic hypothermia (TH) has neuro- and cardioprotective effects, and it is administered as one of the urgent methods in providing primary health care. Purpose. Providing and analyzing ultrasonography (US) of rat hearts with experimental MI in order to determine the nature of heart remodelling under combined use of TH and introducing allogeneic MSCs. Materials and methods. The study involved 90 outbred white rats weighing 240–270 g. Myocardial infarction was reproduced by ligating the descending branch of the left coronary artery on the border of the upper and middle third of the vessel. Therapeutic hypothermia was performed in a cold chamber, 60 minutes long. The local skin temperature of the neck area was maintained at +4 оC, while the rectal and tympanic temperature decreased to + 25 оC. A suspension of allogeneic cryopreserved MSCs of the placenta with a concentration of 1.2 × × 106 cells/ml was administered once intravenously through v. saphena magna. Heart sonography was carried out by means of «Сономед 500» («СПЕКТРОМЕД», Russia) ultrasound scanner in B- and M-mode using a linear sensor 7.5L38 with frequency of 7.5 MHz. Results and discussion. The control group with experimental MI showed significantly suppressed function of the left ventricle (LV). It resulted in decreasing stroke volume (SV) and cardiac output (CO) and on the whole indicated reduced ejection fraction (EF) to 46.04 %, that was 35 % less than the corresponding normal range. According to the values of relative wall thickness (RWT) and left ventricular mass (LVM) on day 7 and day 30 after ligating the left coronary artery, LV remodelling was proceeding via eccentric mode of LV alteration. Therapeutic hypothermia was not able to completely stop the pathophysiological processes associated with coronary ligation. EF was not significantly different from the control group, and was 51.08 ± ± 2.68 %. On day 7 of the experiment, heart remodelling in this group was proceeding according to the normal geometry model, and on day 30 – according to the eccentric model. In spite of the volume overload causing post-infarction extension of the left ventricular cavity, in the group with applying MSCs, on day 7 there was a compensatory increase of the stroke volume, 1.8 times over compared to the group with normal range values and 2.3 over compared to the control group. The ejection fraction was 17 % less than the normal range, but statistically significantly higher than the corresponding indicator of the control group of this observation period. Heart remodelling after applying allogeneic MSCs associated with MI at all stages of observation was proceeding by eccentric LV hypertrophy. Аfter therapeutic hypothermia and applying MSCs associated with experimental myocardial infarction on day 7 and day 30, the group recorded the best values of echo params of LV anatomical structures, indicating no dilatation along with occuring moderate myocardial hypertrophy. The ejection fraction showed the best outcome, i. e. 58.78 %, while LV remodelling was minimal, occurring according to normal heart geometry. Conclusions. Applying echocardiography in rats is a very informative diagnosis method which makes it possible to describe the type of structural and functional remodelling of the myocardium associated infarction at early and late observation stages. The ultrasound study showed that the closest to the normal range was the group of animals exposed to therapeutic hypothermia and MSC transplantation. According to LVM and RWT values, in the rats of that group on day 7 and day 30 of the experiment, LV remodelling was characterized by normal geometry.

Abstract 17027: Generalizability of the US FDA Label for Dapagliflozin to Patients With Heart Failure With Reduced Ejection Fraction in the GWTG-HF Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muthiah Vaduganathan ◽  
Stephen Greene ◽  
Shuaiqi Zhang ◽  
maria v grau-sepulveda ◽  
Adam D Devore ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ejection Fraction ◽  
Care Facility ◽  
Eligibility Criteria ◽  
Discharge Data ◽  
Reduced Ejection Fraction ◽  
Type 2 Dm ◽  
The Us ◽  
Us Fda

Background: In May 2020, dapagliflozin was approved by the US FDA as the first SGLT-2 inhibitor for HF with reduced ejection fraction (HFrEF) based on the pivotal DAPA-HF trial. Limited data are available characterizing its generalizability to US clinical practice. Methods: We studied patients with HFrEF (≤40%) hospitalized at 406 sites in the Get With The Guidelines (GWTG)-HF registry admitted between Jan 2014 - Sept 2019. We excluded patients who left against medical advice, transferred to an acute care facility or to hospice, or had missing critical data. We applied the FDA label (excluding eGFR<30 mL/min/1.73 m 2 , dialysis, or type 1 DM) and eligibility criteria of DAPA-HF to the GWTG-HF registry sample. Results: Among 154,714 patients hospitalized with HFrEF, 125,497 (81.1%) would be candidates for dapagliflozin under the FDA label. Across 355 sites with ≥10 hospitalizations, median proportion of FDA label candidates was 81.1% (77.8%-84.6%). This proportion was similar across all study years (80.4-81.7%) and higher among those without type 2 DM than with type 2 DM (85.5% vs. 75.6%). Among GWTG-HF participants, the most frequent reason for not meeting the FDA label was eGFR<30 mL/min/1.73 m 2 (n=28,605). Among patients with available paired admission and discharge data, 14.2% had eGFR<30 mL/min/1.73 m 2 at both time points, while 3.8% developed eGFR<30 mL/min/1.73 m 2 by discharge. While there were more women, more Black patients, and less Asian patients in GWTG-HF, clinical characteristics were qualitatively similar between DAPA-HF trial and GWTG-HF registry participants. Compared with the DAPA-HF trial cohort, there was lower use of evidence-based HF therapies among GWTG-HF patients ( Table ). Conclusions: These data from a large, contemporary US hospitalized HF registry suggest that 4 out of 5 patients with HFrEF (with or without type 2 DM) would be candidates for initiation of dapagliflozin, and support its broad generalizability to US clinical practice.

The practices of performance management and low performers in the US Federal Government

2019 ◽  
Vol 41 (4) ◽  
pp. 417-433
Author(s):  
Hyung-Woo Lee ◽  
Dong-Young Rhee
Keyword(s):  
Regression Analysis ◽  
Performance Management ◽  
Federal Government ◽  
Performance Measure ◽  
News Article ◽  
Multinomial Regression ◽  
Cross Sectional ◽  
Content Type ◽  
The Us ◽  
Us Federal Government

Purpose Addressing low performers has been an important issue for government. The purpose of this paper is to examine what practices of performance management are effective in reducing the proportion of low performers in the US federal government. Design/methodology/approach The authors conducted the binary logit regression analysis and multinomial regression analysis. Findings Analyzing the Merit Principle Survey 2016, the authors found that the dismissal of low performing employees and the formal performance improvement plan (PIP) is the most effective in reducing the proportion of low performers. To the contrary, the within-grade-increase did not have a significant influence on the proportion of low performers. Moreover, using the performance appraisal for the purpose of reassigning employees to the position that better match employees’ talent increased the number of low performers in work units. Research limitations/implications Research limitations are as follows. First, the performance measure for this study was the percentage of employees rated as unsuccessful. Second, the pseudo-R2 indicated that the proposed model explained only the small, albeit significant, portion of the total variance in employee performance. Lastly, this study used a cross-sectional research design that may impede the validity of inference of causalities. Practical implications According to a recent news article (Rein, 2018), Trump signed an executive order that limits the stable benefits associated with government employment such as, limiting pay associated with union work and negotiating more stringent union contracts. These measures are largely aimed at eliminating low performing employees rather than attempting to improve their performances through carefully designed training programs. Although removing low performers may be an option, the results indicate that providing assistance in order to develop employee knowledge and skills through the PIP have a comparable impact on reducing low performers. Originality/value These findings imply that the use of performance evaluation for developmental or sanctioning purpose is more effective than reassignment or incentive purpose.

Fade to Black: Importation and Counterfeit Drugs

2006 ◽  
Vol 32 (2-3) ◽  
pp. 279-323 ◽  
Author(s):  
Bryan A. Liang
Keyword(s):  
Quality Of Life ◽  
Prescription Drugs ◽  
Prescription Medications ◽  
Health Statistics ◽  
Counterfeit Drugs ◽  
Hospital Outpatient ◽  
The Us ◽  
Outpatient Departments ◽  
Outpatient Settings

Americans rely extensively upon prescription medications to maintain health and quality of life. According to the National Center for Health Statistics, in 2002, at least 1.5 billion drugs were prescribed to patients in physician offices, 196 million in US emergency departments, and 140 million in outpatient settings. Almost two-thirds of visits to physician offices and hospital outpatient departments had at least one drug associated with the visit, and 7% of visits had five or more drugs. In 2004, US pharmacies dispensed over 3.5 billion prescriptions to patients. Estimates indicate that annual expenditures for prescription drugs in the US top $230 billion dollars each year—and there is every indication that these numbers will only increase.

The Role of Performance Measure Noise in Mediating the Relation between Task Complexity and Outsourcing

2010 ◽  
Vol 22 (1) ◽  
pp. 75-102 ◽  
Author(s):  
Ge Bai ◽  
Freddy Coronado ◽  
Ranjani Krishnan
Keyword(s):  
Performance Measures ◽  
Transaction Cost Economics ◽  
Task Complexity ◽  
Performance Measure ◽  
For Profit ◽  
Mediating Role ◽  
Outpatient Departments ◽  
Incentive Contracting ◽  
External Vendors

ABSTRACT: This paper examines the effect of task complexity on a firm’s decision to outsource and the mediating role of performance measure noise. Using insights from agency and transaction cost economics theories, we predict that task complexity reduces the extent of outsourcing of the task. We further predict that one reason for the negative relation between task complexity and outsourcing is that task complexity increases the noise in performance measures. Noisy performance measures introduce problems in incentive contracting with external vendors and, hence, decrease the extent of outsourcing. Data from 305 inpatient and 1,255 ancillary and outpatient departments of for-profit hospitals provide support for our prediction that performance measure noise mediates the relation between task complexity and outsourcing.

scholarly journals A Review on Wearable and Contactless Sensing for COVID-19 With Policy Challenges

2021 ◽  
Vol 2 ◽  
Author(s):  
Sagar Suresh Kumar ◽  
Kia Dashtipour ◽  
Qammer H. Abbasi ◽  
Muhammad A. Imran ◽  
Wasim Ahmad
Keyword(s):  
Patient Monitoring ◽  
Vital Signs ◽  
Risk Groups ◽  
Developed Countries ◽  
Cross Infection ◽  
Remote Patient Monitoring ◽  
Healthcare Facilities ◽  
Emergency Situations ◽  
The Us ◽  
Remote Patient

The COVID-19 pandemic has affected more than 100 million people worldwide, with around 500,000 cases reported daily. This has led to the overwhelming of healthcare systems even in developed countries such as the US, UK, etc. Remote monitoring of COVID-19 patients with non-serious symptoms can help reduce the burden on healthcare facilities and make them available for high risk groups and the seriously affected. The pandemic has accelerated the demand for the remote patient monitoring (RPM) technologies, and the market is expected to reach 2.14 billion in 2027 from the value of 786.4 million in 2019. In RPM programs, there are two types of sensors that can be used: wearable and contactless. The former, which is currently more widely used, is not only more obtrusive and uncomfortable, but can also lead to cross-infection through patient contact. These two types of technologies are discussed and compared for each vital sign. In the respiratory system, the vital signs are the respiratory rate (RR) and oxygen saturation (SpO2), while for the latter, they are the heart rate/rhythm and the blood pressure (BP). Then, the discussion is broadened to policy level changes needed to expedite the use of such technologies for remote patient monitoring (RPM) in the world. Around 80% of countries' RPM programs are either informal or in a pilot phase, and thus lack policies and an established regulatory framework to implement their programs. The various policies needed to initiate, deliver, and reimburse RPM programs during emergency situations and outbreaks are discussed. Finally, technologies such as contactless systems, robotics, and Internet-of-things (IoT) that will revolutionize healthcare in the future by reducing the interaction between physicians and patients and cross-infection are discussed.

scholarly journals EP11 Using machine learning to recover unrecorded prehospital data

2021 ◽  
Vol 38 (9) ◽  
pp. A5.3-A6
Author(s):  
Thilo Reich ◽  
Adam Bancroft ◽  
Marcin Budka
Keyword(s):  
Machine Learning ◽  
Random Forest ◽  
Vital Signs ◽  
Machine Learning Algorithms ◽  
Free Text ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Minority Class ◽  
South Central ◽  
Tree Classifier

BackgroundThe recording practices, of electronic patient records for ambulance crews, are continuously developing. South Central Ambulance Service (SCAS) adapted the common AVPU-scale (Alert, Voice, Pain, Unresponsive) in 2019 to include an option for ‘New Confusion’. Progressing to this new AVCPU-scale made comparisons with older data impossible. We demonstrate a method to retrospectively classify patients into the alertness levels most influenced by this update.MethodsSCAS provided ~1.6 million Electronic Patient Records, including vital signs, demographics, and presenting complaint free-text, these were split into training, validation, and testing datasets (80%, 10%, 10% respectively), and under sampled to the minority class. These data were used to train and validate predictions of the classes most affected by the modification of the scale (Alert, New Confusion, Voice).A transfer-learning natural language processing (NLP) classifier was used, using a language model described by Smerity et al. (2017) to classify the presenting complaint free-text.A second approach used vital signs, demographics, conveyance, and assessments (30 metrics) for classification. Categorical data were binary encoded and continuous variables were normalised. 20 machine learning algorithms were empirically tested and the best 3 combined into a voting ensemble combining three vital-sign based algorithms (Random Forest, Extra Tree Classifier, Decision Tree) with the NLP classifier using a Random Forest output layer.ResultsThe ensemble method resulted in a weighted F1 of 0.78 for the test set. The sensitivities/specificities for each of the classes are: 84%/ 90% (Alert), 73%/ 89% (Newly Confused) and 68%/ 93% (Voice).ConclusionsThe ensemble combining free text and vital signs resulted in high sensitivity and specificity when reclassifying the alertness levels of prehospital patients. This study demonstrates the capabilities of machine learning classifiers to recover missing data, allowing the comparison of data collected with different recording standards.

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