RH-RT: A Data Analytics Framework for Reducing Wait Time at Emergency Departments and Centres for Urgent Care

This is the author accepted manuscript. The final version is available from IEEE via the DOI in this recordRight Hospital – Right Time (RH-RT) is the conceptualization of the use of descriptive, predictive and prescriptive analytics with real-time data from Accident & Emergency (A&E)/Emergency Departments (ED) and centers for urgent care; its objective is to derive maximum value from wait time data by using data analytics techniques, and making them available to both patients and healthcare organizations. The paper presents an architecture for the implementation of RH-RT that is specific to the authors’ current work on a digital platform (NHSquicker) that makes available live waiting time from multiple centers of urgent care (e.g., A&E/ED, Minor Injury Units) in Devon and Cornwall. The focus of the paper is on the development of a Hybrid Systems Model (HSM) comprising of healthcare business intelligence, forecasting techniques and computer simulation. The contribution of the work is the conceptual RH-RT framework and its implementation architecture that relies on near real-time data from NHSquicker.Torbay Medical Research FundEconomic and Social Research Council (ESRC)Torbay Medical Research FundAcademic Health Science Networ

Genome-wide association analyses identify new Brugada syndrome risk loci and highlight a new mechanism of sodium channel regulation in disease susceptibility

Brugada syndrome (BrS) is a cardiac arrhythmia disorder associated with sudden death in young adults. With the exception of SCN5A, encoding the cardiac sodium channel NaV1.5, susceptibility genes remain largely unknown. Here we performed a genome-wide association meta-analysis comprising 2,820 unrelated cases with BrS and 10,001 controls, and identified 21 association signals at 12 loci (10 new). Single nucleotide polymorphism (SNP)-heritability estimates indicate a strong polygenic influence. Polygenic risk score analyses based on the 21 susceptibility variants demonstrate varying cumulative contribution of common risk alleles among different patient subgroups, as well as genetic associations with cardiac electrical traits and disorders in the general population. The predominance of cardiac transcription factor loci indicates that transcriptional regulation is a key feature of BrS pathogenesis. Furthermore, functional studies conducted on MAPRE2, encoding the microtubule plus-end binding protein EB2, point to microtubule-related trafficking effects on NaV1.5 expression as a new underlying molecular mechanism. Taken together, these findings broaden our understanding of the genetic architecture of BrS and provide new insights into its molecular underpinnings

Increasing Enrollment of Cardiac Rehabilitation for Eligible Patients in the Outpatient Setting: A Toolkit

Background: Heart disease is the leading cause of death worldwide. It is responsible for serious cardiac events that can be fatal. When a patient experiences one cardiac event, they are more likely to have a second event. Therefore, secondary prevention programs such as cardiac rehabilitation (CR) have been proven to reduce mortality in these patients and enhance quality of life; however, they are severely underutilized. Purpose: The purpose of this integrative review and DNP project was to educate outpatient providers about the immense value of cardiac rehabilitation to eligible patients and develop a toolkit targeted to help providers recognize eligible patients, educate them and expedite enrollment. Methods: An educational intervention was virtually presented with a pre- and post-survey completed by 9 staff members of an outpatient cardiology office. Feedback was collected to determine efficacy of the presentation, change in provider perceptions, and the utility of the toolkit. Data was input into Excel and SPSS to determine statistical significance and organization of feedback. Results: By using the Health Belief Model as a framework, the Wilcoxon Signed Ranks Test determined that there was statistically significant (p=0.026) increase in perceived seriousness, susceptibility, and benefit after the educational intervention indicating that participants’ attitudes and beliefs about the importance of cardiac rehabilitation (CR) and can be affected with education, leading to the increased interest in improving referral rates for eligible patients. Conclusion: This project should serve as a tool to continue to educate outpatient providers of the value of CR, while the toolkit may be utilized to expedite enrollment and help reach national goals of increasing cardiac rehabilitation participation to 70%

Healthcare Group Purchasing Organizations: Who’s Really Saving? An Empirical Investigation of Hospital Characteristics That Influence Supply Expense for Healthcare GPO Members

Healthcare Group Purchasing Organizations (HGPOs) can aggregate purchasing volume and leverage this power to influence supply and service expenses for its members. However, all HGPO members do not realize corresponding value across the board, which could be due to hospital characteristics that impact organizational structure positioning some members to better leverage the resources of the HGPO. This empirical investigation is a quantitative study that examines healthcare provider characteristics associated with influencing supply expense ratio (SER%) for HGPO members that employs the Economies of Scale Theory (EST) as a conceptual framework. EST suggests that increased size and output of the HGPO, decreases the operating cost per purchase venture thereby decreasing the purchase spend for the HGPO member. Utilization of HGPO contracts is a prime example of the EST and is expected to influence supply expense for its members, legitimizing the need to investigate other factors driving SER% and the differentiation seen amongst members. Prior research has shown that certain hospital characteristics can positively or negatively influence the operations and organizational structure of the hospital warranting the focus on this factor (Armansingham et al, 2008). Using two years of supply expense data for 2162 healthcare providers in the U.S, this study investigated whether specific HGPO member characteristics such as (demographic, descriptive, utilization and service-type designation.) can influence the members SER%. This model not only adds pragmatic findings concerning influencers of hospital expense for HGPO members, it also presents a reliable and replicable model for healthcare supply chain researchers and practitioners to further determine how the effective use of HGPOs can be maximized. The strategic design and implementation of this study will provide healthcare supply chain executives, healthcare policy and reform researchers and hospital administrators with new leads of research areas aimed at decreasing the problem of rising healthcare expenditures in the U.S

Sleep Apnea – Recent Updates

Sleep apnea is highly prevalent and underdiagnosed. It is associated with multiple medical conditions including cardiac dysrhythmia, stroke, hypertension, diabetes and congestive heart failure. In the last few decades, advances in diagnosis and treatment of sleep apnea have been robust. In this review, we will emphasize primarily developments in the area of sleep apnea that occurred in the past 5 years. These include changes in the nomenclature of sleep apnea in the International Classification in Sleep Disorders (ICSD)-3, physiologic approach of treating sleep apnea, eligibility for CPAP (continuous positive airway pressure) treatment, home sleep testing (HST), sleep apnea in pregnancy, updates in oral device treatment and other emerging concepts on sleep apnea

Improving Online Education Using Big Data Technologies

In a world in full digital transformation, where new information and communication technologies are constantly evolving, the current challenge of Computing Environments for Human Learning (CEHL) is to search the right way to integrate and harness the power of these technologies. In fact, these environments face many challenges, especially the increased demand for learning, the huge growth in the number of learners, the heterogeneity of available resources as well as the problems related to the complexity of intensive processing and real-time analysis of data produced by e-learning systems, which goes beyond the limits of traditional infrastructures and relational database management systems. This chapter presents a number of solutions dedicated to CEHL around the two big paradigms, namely cloud computing and Big Data. The first part of this work is dedicated to the presentation of an approach to integrate both emerging technologies of the big data ecosystem and on-demand services of the cloud in the e-learning field. It aims to enrich and enhance the quality of e-learning platforms relying on the services provided by the cloud accessible via the internet. It introduces distributed storage and parallel computing of Big Data in order to provide robust solutions to the requirements of intensive processing, predictive analysis, and massive storage of learning data. To do this, a methodology is presented and applied which describes the integration process. In addition, this chapter also addresses the deployment of a distributed e-learning architecture combining several recent tools of the Big Data and based on a strategy of data decentralization and the parallelization of the treatments on a cluster of nodes. Finally, this article aims to develop a Big Data solution for online learning platforms based on LMS Moodle. A course recommendation system has been designed and implemented relying on machine learning techniques, to help the learner select the most relevant learning resources according to their interests through the analysis of learning traces. The realization of this system is done using the learning data collected from the ESTenLigne platform and Spark Framework deployed on Hadoop infrastructure

Data Segmentation in Electronic Health Information Exchange: Policy Considerations and Analysis

The issue of whether and, if so, to what extent patients should have control over the sharing or withholding of their health information represents one of the foremost policy challenges related to electronic health information exchange. It is widely acknowledged that patients\u27 health information should flow where and when it is needed to support the provision of appropriate and high-quality care. Equally significant, however, is the notion that patients want their needs and preferences to be considered in the determination of what information is shared with other parties, for what purposes, and under what conditions. Some patients may prefer to withhold or sequester certain elements of health information, often when it is deemed by them (or on their behalf) to be sensitive, whereas others may feel strongly that all of their health information should be shared under any circumstance. This discussion raises the issue of data segmentation, which we define for the purposes of this paper as the process of sequestering from capture, access or view certain data elements that are perceived by a legal entity, institution, organization, or individual as being undesirable to share. This whitepaper explores key components of data segmentation, circumstances for its use, associated benefits and challenges, various applied approaches, and the current legal environment shaping these endeavors

The Public Health Exposome: A Population-Based, Exposure Science Approach to Health Disparities Research

The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level disparities. The public health exposome is presented as a universal exposure tracking framework for integrating complex relationships between exogenous and endogenous exposures across the lifespan from conception to death. It uses a social-ecological framework that builds on the exposome paradigm for conceptualizing how exogenous exposures “get under the skin”. The public health exposome approach has led our team to develop a taxonomy and bioinformatics infrastructure to integrate health outcomes data with thousands of sources of exogenous exposure, organized in four broad domains: natural, built, social, and policy environments. With the input of a transdisciplinary team, we have borrowed and applied the methods, tools and terms from various disciplines to measure the effects of environmental exposures on personal and population health outcomes and disparities, many of which may not manifest until many years later. As is customary with a paradigm shift, this approach has far reaching implications for research methods and design, analytics, community engagement strategies, and research training

CPA\u27s guide to medical, dental and other healthcare practices;

CD-ROM files converted to PDF and included after main texthttps://egrove.olemiss.edu/aicpa_guides/1128/thumbnail.jp

Toward a Discourse Community for Telemedicine: A Domain Analytic View of Published Scholarship

In the past 20 years, the use of telemedicine has increased, with telemedicine programs increasingly being conducted through the Internet and ISDN technologies. The purpose of this dissertation is to examine the discourse community of telemedicine. This study examined the published literature on telemedicine as it pertains to quality of care, defined as correct diagnosis and treatment (Bynum and Irwin 2011). Content analysis and bibliometrics were conducted on the scholarly discourse, and the most prominent authors and journals were documented to paint and depict the epistemological map of the discourse community of telemedicine. A taxonomy based on grounded research of scholarly literature was developed and validated against other existing taxonomies. Telemedicine has been found to increase the quality and access of health care and decrease health care costs (Heinzelmann, Williams, Lugn and Kvedar 2005 and Wootton and Craig 1999). Patients in rural areas where there is no specialist or patients who find it difficult to get to a doctor’s office benefit from telemedicine. Little research thus far has examined scholarly journals in order to aggregate and analyze the prevalent issues in the discourse community of telemedicine. The purpose of this dissertation is to empiricallydocument the prominent topics and issues in telemedicine by examining the related published scholarly discourse of telemedicine during a snapshot in time. This study contributes to the field of telemedicine by offering a comprehensive taxonomy of the leading authors and journals in telemedicine, and informs clinicians, librarians and other stakeholders, including those who may want to implement telemedicine in their institution, about issues telemedicine