Left Ventricular Assist Device Adjustment Impacted by Patient Trajectory: A Qualitative Exploratory Study

Background: Left Ventricular Assist Devices (LVADs) are used as advanced therapy for advanced heart failure in order to sustain patients until a heart transplant is available (bridge to transplant, ‘BTT’) or until the end of life (destination therapy, ‘DT’). Despite the differences in treatment trajectory, BTT and DT patients are provided the same education. Currently it is unknown if the two groups compare to living with the LVAD regarding adjustment. Aims: The aim of this study was to explore LVAD patient experience, describe how patients construct the impact of the LVAD on daily life and self-care and compare the findings between BTT and DT patients. It is imperative to understand how BTT and DT LVAD recipients construct the patient experience in order to provide patient centric education for each group and promote optimal adjustment. Methods: A general qualitative methodology was conducted with purposeful sampling of 20 LVAD recipients that self-reported either BTT or DT. Transcribed interviews were coded using Atlas.ti V8. Data content was analyzed, and once redundancy was reached relevant themes were identified through content analysis from exemplars. Findings: Participants reported the overarching theme, Living with an LVAD is inconvenient, but life-sustaining. BTT and DT LVAD participants contrasted the LVAD patient experience in three phases, (1) illness perception, (2) LVAD adjustment, and (3) health aspirations. Six components were identified as important to LVAD adjustment among both groups: (1) physical ability, (2) caregiver dependence, (3) self-care, (4) roles, (5) LVAD public perception, and (6) connection. LVAD participants described differences in health aspirations based on the self-reported LVAD indication. Conclusions: BTT and DT LVAD patients experience similar adjustment to the device. Despite the inconveniences of living with the LVAD, participants are grateful for the extended life. If faced with having to live with the LVAD for the remainder of life a majority of participants reported that it would not bother them, or they would be able to adjust. Increased knowledge regarding BTT and DT patient experience is required in to develop patient centric education and resources to ensure optimal LVAD adjustment

Architecting the Future U.S. Military Psychological Health Enterprise via Policy and Procedure Analysis

Although researchers suggest that a systems approach is required to make meaningful advances in the U.S. psychological health care system for service members, limited research has considered such an approach. This research uses an enterprise architecting framework to identify the system's strengths and areas for opportunity as they relate to the Ecosystem, Stakeholders, Strategy, Process, Organization, Knowledge, Information, and Infrastructure. Codifying qualitative data from publicly available U.S. Defense Health Agency and U.S. Service Branch doctrine, policy guidance, and concepts of operations, our findings indicate that the psychological health care system is strongly process-oriented and mentions a variety of key stakeholders and their roles and responsibilities in the enterprise. Potential opportunities of improvement for the system include a stronger emphasis on the development and transfer of knowledge capabilities, and a stronger information-based infrastructure.Department of Defens

Executable clinical models for acute care

Medical errors are the third leading cause of death in the U.S., after heart disease and cancer, causing at least 250,000 deaths every year. These errors are often caused by slips and lapses, which include, but are not limited to delayed diagnosis, delayed or ineffective therapeutic interventions, and unintended deviation from the best practice guidelines. These situations may occur more often in acute care settings, where the staff are overloaded, under stress, and must make quick decisions based on the best available evidence. An \textit{integrated clinical guidance system} can reduce such medical errors by helping medical staff track and assess patient state more accurately and adapt the care plan according to the best practice guidelines. However, a main prerequisite for developing a guideline system is to create computer interpretable representations of the clinical knowledge. The main focus of this thesis is to develop executable clinical models for acute care. We propose an organ-centric pathophysiology-based modeling paradigm, in which we translate the medical text into executable interactive disease and organ state machines. We formally verify the correctness and safety of the developed models. Afterward, we integrate the models into a best practice guidance system. We study the cardiac arrest and sepsis case studies to demonstrate the applicability of proposed modeling paradigm. We validate the clinical correctness and usefulness of our model-driven cardiac arrest guidance system in an ACLS training class. We have also conducted a preliminary clinical simulation of our model-driven sepsis screening system

Study protocol for the Anesthesiology Control Tower—Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: A pilot randomized controlled trial in intraoperative telemedicine [version 1; referees: 2 approved]

Background: Each year, over 300 million people undergo surgical procedures worldwide. Despite efforts to improve outcomes, postoperative morbidity and mortality are common. Many patients experience complications as a result of either medical error or failure to adhere to established clinical practice guidelines. This protocol describes a clinical trial comparing a telemedicine-based decision support system, the Anesthesiology Control Tower (ACT), with enhanced standard intraoperative care. Methods: This study is a pragmatic, comparative effectiveness trial that will randomize approximately 12,000 adult surgical patients on an operating room (OR) level to a control or to an intervention group. All OR clinicians will have access to decision support software within the OR as a part of enhanced standard intraoperative care. The ACT will monitor patients in both groups and will provide additional support to the clinicians assigned to intervention ORs. Primary outcomes include blood glucose management and temperature management. Secondary outcomes will include surrogate, clinical, and economic outcomes, such as incidence of intraoperative hypotension, postoperative respiratory compromise, acute kidney injury, delirium, and volatile anesthetic utilization. Ethics and dissemination: The ACTFAST-3 study has been approved by the Human Resource Protection Office (HRPO) at Washington University in St. Louis and is registered at clinicaltrials.gov (NCT02830126). Recruitment for this protocol began in April 2017 and will end in December 2018. Dissemination of the findings of this study will occur via presentations at academic conferences, journal publications, and educational materials

Detailed Perceptions by Health Service Providers Around EHRs: A Case Study of Australia’s e-Health Solution

The Australian government has invested heavily in the national e-health solution; namely, initially, the PCEHR, now MyHealth Record. A critical success factor is concerned with the perception and expectations of health service providers regarding the MyHealth Record. Further, it is important to understand the effect of the MyHealth Record on the patient-provider relationship, quality of care, and service providers’ views toward data security and confidentiality. The primary goal of this pilot study is to understand the health service providers’ perceptions and expectations; and thereby, predict the likely sustainability of the MyHealth Record. This has important implications in general as all OECD countries’ transition to large-scale e-health solutions

Breathing Signature as Vitality Score Index Created by Exercises of Qigong: Implications of Artificial Intelligence Tools Used in Traditional Chinese Medicine.

Rising concerns about the short- and long-term detrimental consequences of administration of conventional pharmacopeia are fueling the search for alternative, complementary, personalized, and comprehensive approaches to human healthcare. Qigong, a form of Traditional Chinese Medicine, represents a viable alternative approach. Here, we started with the practical, philosophical, and psychological background of Ki (in Japanese) or Qi (in Chinese) and their relationship to Qigong theory and clinical application. Noting the drawbacks of the current state of Qigong clinic, herein we propose that to manage the unique aspects of the Eastern 'non-linearity' and 'holistic' approach, it needs to be integrated with the Western "linearity" "one-direction" approach. This is done through developing the concepts of "Qigong breathing signatures," which can define our life breathing patterns associated with diseases using machine learning technology. We predict that this can be achieved by establishing an artificial intelligence (AI)-Medicine training camp of databases, which will integrate Qigong-like breathing patterns with different pathologies unique to individuals. Such an integrated connection will allow the AI-Medicine algorithm to identify breathing patterns and guide medical intervention. This unique view of potentially connecting Eastern Medicine and Western Technology can further add a novel insight to our current understanding of both Western and Eastern medicine, thereby establishing a vitality score index (VSI) that can predict the outcomes of lifestyle behaviors and medical conditions