Challenges of systematic reviewing integrative health care.

This article is based on an extensive review of integrative medicine (IM) and integrative health care (IHC). Since there is no general agreement of what constitutes IM/IHC, several major problems were identified that make the review of work in this field problematic. In applying the systematic review methodology, we found that many of those captured articles that used the term integrative medicine were in actuality referring to adjunctive, complementary, or supplemental medicine. The objective of this study was to apply a sensitivity analysis to demonstrate how the results of a systematic review of IM and IHC will differ according to what inclusion criteria is used based on the definition of IM/IHC. By analyzing 4 different scenarios, the authors show that, due to unclear usage of these terms, results vary dramatically, exposing an inconsistent literature base for this field

Acquisition, Distribution and Perspectives of Healthcare Information in Complementary and Alternative Medicines (CAM)

Merged with duplicate record 10026.1/2500 on 06.20.2017 by CS (TIS)From April 2001 until September 2005 1 worked as a Pilkington research fellow at the Department of Complementary Medicine, University of Exeter, which in 2002 was integrated as a unit of the Peninsula Medical School. All the publications presented here have been carried out during my time of employment in this post at the Complementary Medicine Unit of the Peninsula Medical School in Exeter, United Kingdom. During the first few months of my research post in 2001 1 recognized the importance of the Internet as a tool to obtain healthcare information. Under the supervision of Professor Edzard Ernst, director of CAM, I carried out five Internet surveys, of which I collected and summarized the data and drafted the first version of the manuscripts, which were then finalized by Professor Ernst's comments: * Health risks over the Internet: advice offered by'medical herbalists' to a pregnant woman. * Reflexologists' responses to a patient with abdominal pain -a survey on Internet advice. * Internet advice by acupuncturists -a risk factor for cardiovascular patients? * Are asthma sufferers at risk when consulting chiropractors over the Internet? * Aspects of MMR / MMR vaccination advice over the Internet

Levosimendan for the prevention of acute organ dysfunction in sepsis

BACKGROUND Levosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis. METHODS We conducted a double-blind, randomized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis. Patients were randomly assigned to receive a blinded infusion of levosimendan (at a dose of 0.05 to 0.2 μg per kilogram of body weight per minute) for 24 hours or placebo in addition to standard care. The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28 (scores for each of five systems range from 0 to 4, with higher scores indicating more severe dysfunction; maximum score, 20). Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events. RESULTS The trial recruited 516 patients; 259 were assigned to receive levosimendan and 257 to receive placebo. There was no significant difference in the mean (±SD) SOFA score between the levosimendan group and the placebo group (6.68±3.96 vs. 6.06±3.89; mean difference, 0.61; 95% confidence interval [CI], −0.07 to 1.29; P=0.053). Mortality at 28 days was 34.5% in the levosimendan group and 30.9% in the placebo group (absolute difference, 3.6 percentage points; 95% CI, −4.5 to 11.7; P=0.43). Among patients requiring ventilation at baseline, those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days (hazard ratio, 0.77; 95% CI, 0.60 to 0.97; P=0.03). More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia (3.1% vs. 0.4%; absolute difference, 2.7 percentage points; 95% CI, 0.1 to 5.3; P=0.04). CONCLUSIONS The addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia. (Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others; LeoPARDS Current Controlled Trials number, ISRCTN12776039.

An exploratory study of the role of emotion regulation and emotional intelligence in compassion satisfaction and fatigue among doctors and nurses

Aim: To explore relationships between emotion management strategies (ER), emotional intelligence (EI), and compassion satisfaction (CS) and fatigue (CF) in doctors and nurses at a large National Health Service (NHS) Hospital in the United Kingdom (UK).Objective: To identify predicting variable(s) for compassion satisfaction and fatigue in doctors and nurses.Method: Four hundred and eighty-seven participants completed questionnaires assessing six possible explanatory variables for compassion satisfaction and fatigue: (i) intrapersonal EI (ii) interpersonal EI, (iii) cognitive reappraisal, (iv) cognitive fusion, (v) expressive suppression, and (vi) emotional contagion. Two open-ended questionnaire items assessed the best and worst aspects of doctors and nurses’ roles that might be associated with emotional stress and potentially influence CS and CF. Data Analysis: Descriptive statistics, correlations, regression, and mediation analysis were undertaken. The two open-ended items were analysed using content analysis. Results: Only cognitive reappraisal and intra-personal EI predicted CS positively and CF negatively. Intra-personal EI was the stronger predictor. It predicted CS (β = .29, p < .001) and CF (β = - .35, p < .001) versus cognitive reappraisal CS (β = .27, p < .001) and CF (β = - .15, p < .001). Intrapersonal EI also partially mediated relationships between cognitive reappraisal and CS (b = .59, BCI .298, .927) and between cognitive reappraisal and CF (b = -.72, BCI -1.099, -.378). Content analysis of the two open-ended questionnaire items demonstrated that 54% of the enjoyable aspects of participants’ roles related to direct patient care/contact, while 60% of the least enjoyable aspects related to workplace stress, bureaucracy, lack of support and resources, and workplace politics. This provides contextual support for the main quantitative findings above, and reiterates the importance of supporting development of intrapersonal emotional intelligence skills which does help enhance reappraisal strategies required to manage undesirable effects of workplace stressors like negative emotions e.g. anger or anxiety, that can influence CS and CF. Conclusion: Intrapersonal EI represents an important target variable for possible psychological interventions aimed at enhancing CS and reducing CF in doctors and nurses in clinical settings

Use of low-dose oral theophylline as an adjunct to inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease: study protocol for a randomised controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and health-care costs. An incomplete response to the anti-inflammatory effects of inhaled corticosteroids is present in COPD. Preclinical work indicates that 'low dose' theophylline improves steroid responsiveness. The Theophylline With Inhaled Corticosteroids (TWICS) trial investigates whether the addition of 'low dose' theophylline to inhaled corticosteroids has clinical and cost-effective benefits in COPD. METHOD/DESIGN: TWICS is a randomised double-blind placebo-controlled trial conducted in primary and secondary care sites in the UK. The inclusion criteria are the following: an established predominant respiratory diagnosis of COPD (post-bronchodilator forced expiratory volume in first second/forced vital capacity [FEV1/FVC] of less than 0.7), age of at least 40 years, smoking history of at least 10 pack-years, current inhaled corticosteroid use, and history of at least two exacerbations requiring treatment with antibiotics or oral corticosteroids in the previous year. A computerised randomisation system will stratify 1424 participants by region and recruitment setting (primary and secondary) and then randomly assign with equal probability to intervention or control arms. Participants will receive either 'low dose' theophylline (Uniphyllin MR 200 mg tablets) or placebo for 52 weeks. Dosing is based on pharmacokinetic modelling to achieve a steady-state serum theophylline of 1-5 mg/l. A dose of theophylline MR 200 mg once daily (or placebo once daily) will be taken by participants who do not smoke or participants who smoke but have an ideal body weight (IBW) of not more than 60 kg. A dose of theophylline MR 200 mg twice daily (or placebo twice daily) will be taken by participants who smoke and have an IBW of more than 60 kg. Participants will be reviewed at recruitment and after 6 and 12 months. The primary outcome is the total number of participant-reported COPD exacerbations requiring oral corticosteroids or antibiotics during the 52-week treatment period. DISCUSSION: The demonstration that 'low dose' theophylline increases the efficacy of inhaled corticosteroids in COPD by reducing the incidence of exacerbations is relevant not only to patients and clinicians but also to health-care providers, both in the UK and globally. TRIAL REGISTRATION: Current Controlled Trials ISRCTN27066620 was registered on Sept. 19, 2013, and the first subject was randomly assigned on Feb. 6, 2014

Knowledge discovery on the integrative analysis of electrical and mechanical dyssynchrony to improve cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) is a standard method of treating heart failure by coordinating the function of the left and right ventricles. However, up to 40% of CRT recipients do not experience clinical symptoms or cardiac function improvements. The main reasons for CRT non-response include: (1) suboptimal patient selection based on electrical dyssynchrony measured by electrocardiogram (ECG) in current guidelines; (2) mechanical dyssynchrony has been shown to be effective but has not been fully explored; and (3) inappropriate placement of the CRT left ventricular (LV) lead in a significant number of patients. In terms of mechanical dyssynchrony, we utilize an autoencoder to extract new predictive features from nuclear medicine images, characterizing local mechanical dyssynchrony and improving the CRT response rate. Although machine learning can identify complex patterns and make accurate predictions from large datasets, the low interpretability of these black box methods makes it difficult to integrate them with clinical decisions made by physicians in the healthcare setting. Therefore, we use visualization techniques to enable physicians to understand the physical meaning of new features and the reasoning behind the clinical decisions made by the artificial intelligent model. For electrical dyssynchrony, we use short-time Fourier transform (STFT) to transform one-dimensional waveforms into two-dimensional frequency-time spectra. And transfer learning is used to leverage the knowledge learned from a large arrhythmia ECG dataset of related medical conditions to improve patient selection for CRT with limited data. This improves prediction accuracy, reduces the time and resources required, and potentially leads to better patient outcomes. Furthermore, an innovative approach is proposed for using three-dimensional spatial VCG information to describe the characteristics of electrical dyssynchrony, locate the latest activation site, and combine it with the latest mechanical contraction site to select the optimal LV lead position. In addition, we apply deep reinforcement learning to the decision-making problem of CRT patients. We investigate discrete state space/specific action space models to find the best treatment strategy, improve the reward equation based on the physician\u27s experience, and learn the approximation of the best action-value function that can improve the treatment policy used by clinicians and provide interpretability

Multilevel Weighted Support Vector Machine for Classification on Healthcare Data with Missing Values

This work is motivated by the needs of predictive analytics on healthcare data as represented by Electronic Medical Records. Such data is invariably problematic: noisy, with missing entries, with imbalance in classes of interests, leading to serious bias in predictive modeling. Since standard data mining methods often produce poor performance measures, we argue for development of specialized techniques of data-preprocessing and classification. In this paper, we propose a new method to simultaneously classify large datasets and reduce the effects of missing values. It is based on a multilevel framework of the cost-sensitive SVM and the expected maximization imputation method for missing values, which relies on iterated regression analyses. We compare classification results of multilevel SVM-based algorithms on public benchmark datasets with imbalanced classes and missing values as well as real data in health applications, and show that our multilevel SVM-based method produces fast, and more accurate and robust classification results.Comment: arXiv admin note: substantial text overlap with arXiv:1503.0625

The Bulletin: Sidney Kimmel Medical College at Thomas Jefferson University, Volume 67, Issue 2, Spring/Summer 2018

This issue includes: Exposure: Michael Weinstein, MD \u2794, had a plan to take his own life; now he is back to living it Medical School 2.0: JeffMD - A New Way to Train Physicians 25 Years of JeffHOPE Clinics: Student Volunteers Shape Patients\u27 Lives - and Their Own Caring for the Most Vulnerable a Moral, Ethical, Medical Responsibility : Jefferson\u27s Latina Women\u27s Clinic Dispenses Care and Compassion The Dean\u27s Column Findings: New Look at Eye\u27s Immune Status Home at Last: A message from Elizabeth Dale Endowed Professorships Time Capsule On Campus Feeling all the Bumps: Jefferson Oncologist Looks at the World from Behind a Camera Drawing on Many Mikes: Intern Uses Art to Apply the Adage Physician Heal Thyself Class Notes In Memoriam By the Number

SWOSU Research and Scholarly Activity Fair 2016

Welcome to the Twenty-Third SWOSU Research and Scholarly Activity Fair! On display today are 117 presentations involving 187 student researchers, writers, presenters, and artists, and 45 faculty sponsors encompassing scholarly activity from the SWOSU School of Nursing and the SWOSU Departments of Art, Communication, and Theatre; Biological Sciences; Business & Computer Science; Chemistry and Physics; Education; Engineering Technology; Language and Literature; Music; Pharmaceutical Sciences; Psychology; and Social Sciences. In addition, there are poster presentations from the Western Technology Center Biomedical Academy