Jefferson Digital Commons quarterly report: April-June 2019

This quarterly report includes: Articles CREATE Day Presentations Dissertations From the Archives Grand Rounds and Lectures House Staff Quality Improvement and Patient Safety Posters JCIPE Student Hotspotting Posters Journals and Newsletters MPH Capstone Presentations Posters Sigma Xi Research Day What People are Saying About the Jefferson Digital Common

Building Medical Homes in State Medicaid and CHIP Programs

Presents strategies, best practices, and lessons learned from ten states' efforts to advance the medical home model of comprehensive and coordinated care in Medicaid and Children's Health Insurance Programs in order to improve quality and contain costs

IoMT innovations in diabetes management: Predictive models using wearable data

Diabetes Mellitus (DM) represents a metabolic disorder characterized by consistently elevated blood glucose levels due to inadequate pancreatic insulin production. Type 1 DM (DM1) constitutes the insulin-dependent manifestation from disease onset. Effective DM1 management necessitates daily blood glucose monitoring, pattern recognition, and cognitive prediction of future glycemic levels to ascertain the requisite exogenous insulin dosage. Nevertheless, this methodology may prove imprecise and perilous. The advent of groundbreaking developments in information and communication technologies (ICT), encompassing Big Data, the Internet of Medical Things (IoMT), Cloud Computing, and Machine Learning algorithms (ML), has facilitated continuous DM1 management monitoring. This investigation concentrates on IoMT-based methodologies for the unbroken observation of DM1 management, thereby enabling comprehensive characterization of diabetic individuals. Integrating machine learning techniques with wearable technology may yield dependable models for forecasting short-term blood glucose concentrations. The objective of this research is to devise precise person-specific short-term prediction models, utilizing an array of features. To accomplish this, inventive modeling strategies were employed on an extensive dataset comprising glycaemia-related biological attributes gathered from a large-scale passive monitoring initiative involving 40 DM1 patients. The models produced via the Random Forest approach can predict glucose levels within a 30-minute horizon with an average error of 18.60 mg/dL for six-hour data, and 26.21 mg/dL for a 45-minute prediction horizon. These findings have also been corroborated with data from 10 Type 2 DM patients as a proof of concept, thereby demonstrating the potential of IoMT-based methodologies for continuous DM monitoring and management.Funding for open Access charge: Universidad de Málaga / CBUA. Plan Andaluz de Investigación, Desarrollo e Innovación (PAIDI), Junta de Andalucía, Spain. María Campo-Valera is grateful for postdoctoral program Margarita Salas – Spanish Ministry of Universities (financed by European Union – NextGenerationEU). The authors would like to acknowledge project PID2022-137461NB-C32 financed by MCIN/AEI/10.13039/501100011033/FEDER(“Una manera de hacer Europa”), EU

Improving personalized elderly care: an approach using cognitive agents to better assist elderly people

Tesis por compendio de publicaciones[ES]El envejecimiento de la población a nivel global es una constante cada vez más presente en el día a día y las consecuencias derivadas de este problema son cada vez más impactantes para el correcto funcionamiento y estructuración de la sociedad. En este contexto, hablamos de consecuencias a nivel de crecimiento económico, estilos de vida (y jubilación), relaciones familiares, recursos disponibles por el gobierno a la franja etaria más anciana e inevitablemente la prevalencia de enfermedades crónicas. Es ante esta realidad que surge la necesidad de desarrollo y promoción de estrategias eficaces en el acompañamiento, prevención y estímulo al envejecimiento activo y saludable de la población para garantizar que las personas ancianas continúen teniendo un papel relevante en la sociedad en lugar de someterse al aislamiento y fácil deterioro de las capacidades físicas, cognitivas, emocionales y sociales. De esta forma, tiene todo el sentido aprovechar todos los desarrollos tecnológicos verificados en los últimos años, principalmente en lo que se refiere a avances en las áreas de dispositivos móviles, inteligencia artificial y sistemas de monitoreo y crear soluciones capaces de brindar apoyo diariamente al recopilar datos e indicadores del estado de salud y, en respuesta, proporcionar diversas acciones personalizadas que motiven la adopción de mejores hábitos de salud y medios para lograr este envejecimiento activo y saludable. El desafío consiste en motivar a esta población a conciliar su día a día con el interés y la voluntad de utilizar aplicaciones y sistemas que brinden este apoyo personalizado. Algunas de las abordajes recientemente explorados en la literatura con este objetivo y que han alcanzado resultados prometedores se basan en la utilización de técnicas de gamificación e incentivo al cumplimiento de desafíos a nivel de salud (como si la persona estuviera jugando un juego) y la utilización de interacciones personalizadas con objetos (ya sean físicos como robots o virtuales como avatares) capaces de brindar feedback más personal, creando así una conexión más cercana entre ambas entidades. El trabajo aquí presentado combina estas ideas y resulta en un enfoque inteligente para la promoción del bienestar de la población anciana a través de un sistema de cuidados de salud personalizado. Este sistema incorpora diversas técnicas de gamificación para la promoción de mejores hábitos y comportamientos, y la utilización de un asistente virtual cognitivo capaz de entender las necesidades e intereses del usuario para posibilitar un feedback e interacción personalizados con el fin de ayudar y motivar al cumplimiento de los diferentes desafíos y objetivos que se identifiquen. El enfoque propuesto fue validado a través de un estudio con 12 usuarios ancianos y se lograron resultados significativos en términos de usabilidad, aceptación y efectos de salud. Específicamente, los resultados obtenidos permiten respaldar la importancia y el efecto positivo de combinar técnicas de gamificación e interacción con un asistente virtual cognitivo que traduzca el progreso del estado de salud del usuario, ya que se lograron mejoras significativas en los resultados de salud después de la intervención. Además, los resultados de usabilidad obtenidos mediante la cumplimentación de un cuestionario de usabilidad confirmaron la buena adhesión a el enfoque presentado. Estos resultados validan la hipótesis de la investigación estudiada en el desarrollo de esta disertación

The effect of tualang honey in chronic exposure of high cholesterol diet in animal model

Introduction: Hyperlipidaemia accompanies chronic renal disease either as a consequence of the renal dysfunction or as part of generalized metabolic derangements. The aim of this study was to determine the effects of tualang honey (TH) on the kidneys of animal model with chronic exposure to high cholesterol diet. Materials and method: Twenty Sprague-Dawley rats were divided into two groups, the high cholesterol diet (12% CD (n= 16) and standard diet (SD) (n=4) and were fed for 12 weeks. After 12 weeks, the rats in the 12% CD group were subsequently divided into four groups. The first group was continued with only 12% CD while the other 3 groups in addition to the 12% CD, they were given TH treatment at different concentrations (1.2, 2.4 and 3.0 g/kg/day) for 4 weeks. Biochemical analysis of lipid profile and renal function were performed at the end of the experiment. The animals were sacrificed and the kidneys were harvested for histological examination. Results: In the 12 weeks HCD group, the serum cholesterol, LDL-c and creatinine levels were significantly higher) compared to that of the SD group. All groups with the tualang honey treatment had significant reduction in the LDL-c, triglyceride and creatinine levels. Histological examination of the kidney tissues of the HCD and HCD+TH groups at 16 weeks revealed segmental mesangial proliferation of some glomeruli with focal mesangial matrix expansion. No areas of periglomerular and peritubular fibrosis were observed. Conclusion: Tualang honey supplementation of animal model with chronic exposure to high cholesterol diet improved the renal function hence suggesting the its renoprotective effect. However, there were no changes seen in the histology of the kidneys . Additionally, tualang honey showed improvement in the LDL-c and triglyceride levels indicating its lipid lowering activities

Navigating Healthcare Science Student Learning and Engagement Through Implementation of a Virtual Classroom

Objective. This study explored whether virtual classrooms can be utilized to facilitate student learning and engagement. Background. University students and their learning approaches undergo constant changes, mainly due to advances in technology. Therefore, student expectations are continuously shifting. Although technology allows easier access to learning material, students still depend on a structured learning environment facilitated by an instructor to receive and process the correct information. Methods. A virtual classroom developed and housed in Second Life was used to deliver a week-long course on health promotion. Thirty students from different healthcare science programs participated in the study. After a 15-minute live orientation session, participants explored the classroom for a week, completed a short quiz, and described their experience using a survey. The quiz was completed via Canvas while Qualtrics was used to capture student experience. SPSS v.26.0 was utilized to run correlation and cluster analyses. Results. Hierarchical cluster analysis was completed in order to identify groups of students that had similar characteristics. The results partitioned students into three clusters characterized by quiz score, belief in difficulty of the content and technology. Correlation analysis revealed that students who perceived the course content as challenging also expressed that the control devices interfered with performance within the virtual classroom; r(22)=0.473, pConclusion. 82% of the participants believed that the Second Life platform can serve as an alternative to supplement occasional live student engagement and learning. Grants. This study was funded by the HPD Research Grant at Nova Southeastern University

The prevalence of depression among secondary school students of Kuantan, Pahang, Malaysia.

Introduction: Depression is a curable debilitating illness that becomes a leading cause of morbidity and mortality globally. The prevalence of depression is underrecognized among adolescents. The study is conducted to determine the prevalence of depression among secondary school students of Kuantan Malaysia. Materials and method: We conduct a quantitative cross-sectional study. A population of 414 students from two urban schools, two rural schools, and one international school will participate in the study. The assessment tool used is the Malaysian version of Depression, Anxiety and Stress Scale 21 (DASS 21). Data will be analyzed using SPSS version 21 (SPSS IBM, New York, USA). Factors associated with depressive symptoms will be analyzed using multi Variate logistic regression analysis. Results: Prevalence of depression in Kuantan, Malaysia will be compared to the same international trends. Conclusion: Our study can determine and compare the prevalence of depression in different categories. Education and early interventions of depressed adolescents will add extra value of the projec

Automated telephone communication systems for preventive healthcare and management of long-term conditions

Background Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone’s touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. Objectives To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. Search methods We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. Selection criteria Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. Data collection and analysis We used standard Cochrane methods to select and extract data and to appraise eligible studies. Main results We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty). For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening. Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data. The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use. Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/ substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers. Only four trials (3%) reported adverse events, and it was unclear whether these were related to the intervention

Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain