The Prescription Opioid Epidemic: an Evidence-Based Approach

A group of experts, led by researchers at the Johns Hopkins Bloomberg School of Public Health, issued this report aimed at stemming the prescription opioid epidemic, a crisis that kills an average of 44 people a day in the U.S. The report calls for changes to the way medical students and physicians are trained, prescriptions are dispensed and monitored, first responders are equipped to treat overdoses, and those with addiction are identified and treated. The report grew out of discussions that began last year at a town hall co-hosted by the Bloomberg School and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation. The recommendations were developed by professionals from medicine, pharmacy, injury prevention and law. Patient representatives, insurers and drug manufacturers also participated in developing the recommendations. The report breaks its recommendations into seven categories:Prescribing GuidelinesPrescription Drug Monitoring Programs (PDMPs)Pharmacy Benefit Managers (PBMs) and PharmaciesEngineering Strategies (i.e., packaging)Overdose Education and Naloxone Distribution ProgramsAddiction TreatmentCommunity-Based Prevention Strategie

Medthings AS – a break-through innovation with the handling of medication

Master’s in Applied and Commercial Biotechnology. Inland Norway University of Applied Sciences, Faculty of Applied Ecology, Agriculture Sciences and Biotechnology.Patients depend on medicines to maintain health, prevent illness, manage chronic ailments and treat/improve disease conditions. However, there are growing reports indicating the misuse of medicines (not taken on time, skipped dosage, irregular or improper dosage) causing a great deal of challenge to the health sector. The major challenge lies with the elderly people (above 75 years) who often tends to forget their medications or are not adhered to it. At present, changing demography with a high number of elderly people and providing them quality health services is the biggest challenge. People aged 80 years or over use an average of 5.8 prescription drugs per person. The global spending on medicine reached 1.2 trillion U.S. dollars in 2018 and is set to exceed 1.5 trillion dollars by 2023, while the global automatic pill dispenser machine market accounted for 1,755 million dollars in 2016 and is estimated to reach 3,023 million dollars by 2023. Studies suggests that 25% of the emergency rooms are alone filled with patients taking wrong medications making it the cause of majority of the deaths and involving an expenditure of $10.30 billion annually. Several losses of life can be avoided if intake of medicine can be controlled. In addition, there is a huge medicine wastage due to unused/expired or skipped dosage. In 2019, Swedish pharmacies collected over 1,300 tonnes of medicinal residues (Wallêr, 2019), affecting the economy and well and the nature. Medicine management plays a very vital role in order to ensure the correct intake of medicine. Several approaches, from nurses to automated robots have been sought to ensure the correct use of medicines but none of them have been able to turn out completely effective. The variety of automated pill dispensers in the market with multiple functionality and features lack one thing or the other. Although every dispenser is produced with the aim of dispensing the correct medicine at the correct time with accurate dose, it fails to ensure whether the medicine is actually taken or just thrown away. This thesis was written with a purpose to investigate the specific needs for medicine management using Mobili 1) and to suggest a market entry strategy for it in the Swedish market. Several articles and literature reviews were considered to gather background knowledge on this issue and some primary data were collected through personal communications with 10 concerned persons. Furthermore, business analysis tools were also used to study the market and the target customers and to know about the competitors. Overall, an image that despite a hefty number of pill dispensers in the market, the exact number of them used at present and their comparison based on the price was not clear. An important finding was that although not quite great, but still there is possibility of entrance and success for Mobili with the target group of people above 75 years with chronic ailment and multi drugs prescriptions, or young age group with daily supplement intake having a busy schedule requiring reminder. Although there was a conflict of thoughts on the benefits and trustworthiness of the pill dispensers, yet the literature suggested that the elderlies are quite familiar with the technology and the health professionals also praise such automated pill dispensers. 1) An innovative and modern pill dispenser system produced by Medthings AS, Norwa

Projecting the Community Pharmacy into Home Health Care: An IS Perspective

Community pharmacies deliver accessible and personalized health care to populations worldwide. Provision of medicine therapy is central to this business but the continuous interactions with clients in their homes is problematic. This paper models an ecosystem of wellness for community pharmacies and presents five generations of smart pharmaceutical care systems (SPCS) for home interventions. Our project follows the design science research paradigm and is supported in an extensive review of 56 recent information systems papers. Two key challenges of Health 5.0 are addressed: digital medication management and sustainable medicine use. SPCS reveal potential to change the business model of community pharmacies. However, spanning the pharmacy boundaries with digital technologies requires (1) socio-technical strategies to differentiate their offer, (2) technologies tailored to the needs of each client, (3) collective intelligence production in medicine supply chains, and (4) humanized telecare

Dispensador automático de medicação inovador e orientado para o futuro para adultos sénior

The population is getting older due to higher life expectancy and lower birth rates. Medication is becoming a bigger part of older adults’ lives. However, as all people do, it is easy to forget to take medication. This forgetfulness can bring a lot of consequences, specially in older adults. This is because of their more fragile health and the complexities in their medication, resulting in lower quality of life and higher number of hospital visits. Non adherence to medication is cause by 3 main factors: patient factors, medication factors and health care providers factors. These intertwine adding to the complexity of the problem, however they can be fixed. Technological solutions were developed along the years, some academically and some are available in the current market. Nevertheless, as all solution, there is always room for improvement. This document sets out to collect the needs of older adults regarding their medication and review current developed systems, in order to idealize an innovative system capable of meeting the needs of older adults while improving current systems. This took a systematic approach, mixing adequate product development methodologies, linear and more traditional, State-Gate, and cyclical and more innovative, Lean. This resulted in a idealization of a future proof system that tries to tackle the non adherence problem as whole. From this idealization it was possible to develop and build a prototype that demonstrates its main functionalities.A população está a envelhecer devido a um acréscimo na esperança de vida e a um decréscimo nas taxas de natalidade. Assim, a medicação está a tornar-se uma parte cada vez mais prevalente em adultos sénior. No entanto, como acontece com a população em geral, é fácil esquecer-se de tomar a medicação. Este esquecimento pode trazer muitas consequências, especialmente em adultos sénior. Isso se deve à sua saúde fragilizada e às complexidades inerente à sua medicação, resultando numa menor qualidade de vida e um maior número de visitas hospitalares. A não adesão à terapêutica é o resultado de 3 fatores principais: fatores do paciente, fatores da medicação e fatores dos prestadores de cuidados de saúde. Estes entrelaçam-se adicionando à complexidade do problema, porém podem ser corrigidos. Soluções tecnológicas foram desenvolvidas ao longo dos anos, algumas academicamente e outras estão disponíveis no mercado atual. No entanto, como todas as soluções, há sempre margem para melhorias. Este documento recolhe as necessidades dos adultos sérnio, em relação à sua medicação, e revê os sistemas desenvolvidos até ao momento,com o objetivo de idealizar um sistema inovador capaz de reponder às necessidades dos adultos sénior, construindo sobre os sistemas atuais. Para isso tomou-se uma abordagem sistemática, adaptando metodologias adequadas de desenvolvimento de produto, lineares e mais tradicionais, State-Gate, e cíclicas e mais inovadoras, Lean. Isto resultou na idealização de um sistema orientado para o futuro que tenta abordar o problema da não adesão à terapêutica como um todo. A partir desta idealização foi possível desenvolver e construir um protótipo que demonstrasse suas principais funcionalidadesMestrado em Engenharia Mecânic

A framework for development of android mobile electronic prescription transfer applications in compliance with security requirements mandated by the Australian healthcare industry

This thesis investigates mobile electronic transfer of prescription (ETP) in compliance with the security requirements mandated by the Australian healthcare industry and proposes a framework for the development of an Android mobile electronic prescription transfer application. Furthermore, and based upon the findings and knowledge from constructing this framework, another framework is also derived for assessing Android mobile ETP applications for their security compliance. The centralised exchange model-based ETP solution currently used in the Australian healthcare industry is an expensive solution for on-going use. With challenges such as an aging population and the rising burden of chronic disease, the cost of the current ETP solution’s operational infrastructure is certain to rise in the future. In an environment where it is increasingly beneficial for patients to engage in and manage their own information and subsequent care, this current solution fails to offer the patient direct access to their electronic prescription information. The current system also fails to incorporate certain features that would dramatically improve the quality of the patient’s care and safety, i.e. alerts for the patient’s drug allergies, harmful dosage and script expiration. Over a decade old, the current ETP solution was essentially designed and built to meet legislation and regulatory requirements, with change-averting its highest priority. With little, if any, provision for future growth and innovation, it was not designed to cater to the needs of the ETP process. This research identifies the gap within the current ETP implementation (i.e. dependency on infrastructure, significant on-going cost and limited availability of the patient’s medication history) and proposes a framework for building a secure mobile ETP solution on the Android mobile operating system platform which will address the identified gap. The literature review part of this thesis examined the significance of ETP for the nation’s larger initiative to provide an improved and better maintainable healthcare system. The literature review also revealed the stance of each jurisdiction, from legislative and regulatory perspectives, in transitioning to the use of a fully electronic ETP solution. It identified the regulatory mandates of each jurisdiction for ETP as well as the security standards by which the current ETP implementation is iii governed so as to conform to those regulatory mandates. The literature review part of the thesis essentially identified and established how the Australian healthcare industry’s various prescription-related legislations and regulations are constructed, and the complexity of this construction for eTP. The jurisdictional regulatory mandates identified in the literature review translate into a set of security requirements. These requirements establish the basis of the guiding framework for the development of a security-compliant Android mobile ETP application. A number of experimentations were conducted focusing on the native security features of the Android operating system, as well as wireless communication technologies such as NFC and Bluetooth, in order to propose an alternative mobile ETP solution with security assurance comparable to the current ETP implementation. The employment of a proof-of-concept prototype such as this alongside / coupled with a series of iterative experimentations strengthens the validity and practicality of the proposed framework. The first experiment successfully proved that the Android operating system has sufficient encryption capabilities, in compliance with the security mandates, to secure the electronic prescription information from the data at rest perspective. The second experiment indicated that the use of NFC technology to implement the alternative transfer mechanism for exchanging electronic prescription information between ETP participating devices is not practical. The next iteration of the experimentation using Bluetooth technology proved that it can be utilised as an alternative electronic prescription transfer mechanism to the current approach using the Internet. These experiment outcomes concluded the partial but sufficient proofof- concept prototype for this research. Extensive document analysis and iterative experimentations showed that the framework constructed by this research can guide the development of an alternative mobile ETP solution with both comparable security assurance to and better access to the patient’s medication history than the current solution. This alternative solution would present no operational dependence upon infrastructure and its associated, ongoing cost to the nation’s healthcare expenditure. In addition, use of this mobile ETP alternative has the potential to change the public’s perception (i.e. acceptance from regulatory and security perspectives) of mobile healthcare solutions, thereby paving the way for further innovation and future enhancements in eHealth

Assessment of ambient assisted living systems for patients with mild cognitive impairment

According to the World Health Organization, about 50 million people worldwide suffer from dementia. Ten million new cases added every year. Mild Cognitive Impairment (MCI) affects more than 15% of the population aged 65. Technological solutions, such as smart home technology with ubiquitous computing devices, 24/7 telemedical observation and support can alleviate the growing problem and lower pressure on the healthcare system. This approach is also preferable for homecare patients in distant and rural areas. MCI patients are mostly home-based. Ambient Assisted Living (AAL) systems provide tools for automatic registration of vital signs and other medically and socially important information. AAL system for MCI patients is a logical answer to the problem. At the same time, many of the proposed AAL systems are proprietary, technically complicated and have a high price tag for implementation and service. Also, some proposed technical solutions not entirely reflect the opinion of healthcare stakeholders. The current study was proposed as a way to bridge the possible differences in the positions. An online anonymous questionnaire for healthcare professionals was created to prove or disprove the number of interconnected hypotheses about the necessity and feasibility of AAL system for MCI patients. The main focus was made on the hypotheses: "There is necessity of AAL systems for the healthcare" and "AAL systems are capable of providing assistance for patients with Mild Cognitive Impairment". The questionnaire was presented to more than three hundred potential respondents. Around a hundred and twenty agreed to fill it, and sixty completed the whole questionnaire. Results were analyzed to produce some directions guideline for future technical applications of AAL systems for MCI patients and future research. Descriptive statistics show support for the implementation of general AAL and variants for MCI patients. Comparative analysis of ordinal data for specific groups of respondents is done with help of non-parametric tests. Mann–Whitney–Wilcoxon test and Kruskal-Wallis test are applied. Table questions results are analyzed with chisquare for frequency tables. Group analysis demonstrated relative positive uniformity in of responses in the support of AAL of MCI patients.Segundo a Organização Mundial da Saúde, cerca de 50 milhões de pessoas em todo o mundo sofrem de demência. Dez milhões de novos casos adicionados a cada ano. O comprometimento cognitivo leve (MCI) afeta mais de 15% da população com 65 anos. Soluções tecnológicas, como tecnologia de casa inteligente com dispositivos de computação onipresentes, observação e suporte telemédico 24 horas por dia, 7 dias por semana, podem aliviar o problema crescente e diminuir a pressão sobre o sistema de saúde. Essa abordagem também é preferível para pacientes de cuidados domiciliares em áreas distantes e rurais. Os pacientes com CCL são, em sua maioria, domiciliares. Os sistemas Ambient Assisted Living (AAL) fornecem ferramentas para registro automático de sinais vitais e outras informações médicas e socialmente importantes. O sistema AAL para pacientes com MCI é uma resposta lógica para o problema. Ao mesmo tempo, muitos dos sistemas AAL propostos são proprietários, tecnicamente complicados e têm um alto preço para implementação e serviço. Além disso, algumas soluções técnicas propostas não refletem inteiramente a opinião das partes interessadas na área da saúde. O presente estudo foi proposto como forma de colmatar as possíveis diferenças nas posições. Um questionário anônimo online para profissionais de saúde foi criado para comprovar ou refutar o número de hipóteses interligadas sobre a necessidade e viabilidade do sistema AAL para pacientes com CCL. O foco principal foi feito nas hipóteses: "Há necessidade de sistemas de AAL para a saúde" e "Os sistemas de AAL são capazes de prestar assistência a pacientes com Comprometimento Cognitivo Leve". O questionário foi apresentado a mais de trezentos respondentes potenciais. Cerca de cento e vinte concordaram em preenchê-lo e sessenta preencheram todo o questionário. Os resultados foram analisados para produzir algumas diretrizes para futuras aplicações técnicas de sistemas AAL para pacientes com MCI e pesquisas futuras. Estatísticas descritivas mostram suporte para a implementação de AAL geral e variantes para pacientes com CCL. A análise comparativa de dados ordinais para grupos específicos de respondentes é feita com a ajuda de testes não paramétricos. Aplicam-se os testes de Mann-Whitney-Wilcoxon e Kruskal-Wallis. Os resultados das questões da tabela são analisados com qui-quadrado para tabelas de frequência. A análise do grupo demonstrou relativa uniformidade positiva nas respostas no suporte de AAL de pacientes com CCL.Selon l'Organisation mondiale de la santé, environ 50 millions de personnes dans le monde souffrent de démence. Dix millions de nouveaux cas ajoutés chaque année. Les troubles cognitifs légers (MCI) touchent plus de 15 % de la population âgée de 65 ans. Les solutions technologiques, telles que la technologie de la maison intelligente avec des appareils informatiques omniprésents, l'observation et le soutien télémédicaux 24 heures sur 24, 7 jours sur 7, peuvent atténuer le problème croissant et réduire la pression sur le système de santé. Cette approche est également préférable pour les patients en soins à domicile dans les régions éloignées et rurales. Les patients MCI sont pour la plupart à domicile. Les systèmes Ambient Assisted Living (AAL) fournissent des outils pour l'enregistrement automatique des signes vitaux et d'autres informations importantes sur le plan médical et social. Le système AAL pour les patients MCI est une réponse logique au problème. Dans le même temps, bon nombre des systèmes AAL proposés sont propriétaires, techniquement compliqués et ont un prix élevé pour la mise en oeuvre et le service. De plus, certaines solutions techniques proposées ne reflètent pas entièrement l'opinion des acteurs de santé. L'étude actuelle a été proposée comme un moyen de combler les différences possible dans les positions. Un questionnaire anonyme en ligne destiné aux professionnels de la santé a été créé pour prouver ou réfuter le nombre d'hypothèses interconnectées sur la nécessité et la faisabilité du système AAL pour les patients MCI. L'accent a été mis principalement sur les hypothèses: "Il existe une nécessité de systèmes AAL pour les soins de santé" et "Les systèmes AAL sont capables de fournir une assistance aux patients atteints de troubles cognitifs légers". Le questionnaire a été présenté à plus de trois cents répondants potentiels. Environ cent vingt ont accepté de le remplir, et soixante ont rempli tout le questionnaire. Les résultats ont été analysés pour produire des lignes directrices pour les futures applications techniques des systèmes AAL pour les patients MCI et l'avenir de la recherche. Les statistiques descriptives montrent un soutien à la mise en oeuvre de l'AAL général et des variantes pour les patients MCI. L'analyse comparative des données ordinales pour des groupes spécifiques de répondants est effectuée à l'aide de tests non paramétriques. Le test de Mann-Whitney-Wilcoxon et le test de Kruskal-Wallis sont appliqués. Les résultats des questions de tableau sont analysés avec le chi carré pour les tableaux de fréquence. L'analyse de groupe a démontré une uniformité positive relative dans les réponses à l'appui de l'AAL des patients MCI

Automated Tracking of Hand Hygiene Stages

The European Centre for Disease Prevention and Control (ECDC) estimates that 2.5 millioncases of Hospital Acquired Infections (HAIs) occur each year in the European Union. Handhygiene is regarded as one of the most important preventive measures for HAIs. If it is implemented properly, hand hygiene can reduce the risk of cross-transmission of an infection in the healthcare environment. Good hand hygiene is not only important for healthcare settings. Therecent ongoing coronavirus pandemic has highlighted the importance of hand hygiene practices in our daily lives, with governments and health authorities around the world promoting goodhand hygiene practices. The WHO has published guidelines of hand hygiene stages to promotegood hand washing practices. A significant amount of existing research has focused on theproblem of tracking hands to enable hand gesture recognition. In this work, gesture trackingdevices and image processing are explored in the context of the hand washing environment.Hand washing videos of professional healthcare workers were carefully observed and analyzedin order to recognize hand features associated with hand hygiene stages that could be extractedautomatically. Selected hand features such as palm shape (flat or curved); palm orientation(palms facing or not); hand trajectory (linear or circular movement) were then extracted andtracked with the help of a 3D gesture tracking device - the Leap Motion Controller. These fea-tures were further coupled together to detect the execution of a required WHO - hand hygienestage,Rub hands palm to palm, with the help of the Leap sensor in real time. In certain conditions, the Leap Motion Controller enables a clear distinction to be made between the left andright hands. However, whenever the two hands came into contact with each other, sensor data from the Leap, such as palm position and palm orientation was lost for one of the two hands.Hand occlusion was found to be a major drawback with the application of the device to this usecase. Therefore, RGB digital cameras were selected for further processing and tracking of the hands. An image processing technique, using a skin detection algorithm, was applied to extractinstantaneous hand positions for further processing, to enable various hand hygiene poses to be detected. Contour and centroid detection algorithms were further applied to track the handtrajectory in hand hygiene video recordings. In addition, feature detection algorithms wereapplied to a hand hygiene pose to extract the useful hand features. The video recordings did not suffer from occlusion as is the case for the Leap sensor, but the segmentation of one handfrom another was identified as a major challenge with images because the contour detectionresulted in a continuous mass when the two hands were in contact. For future work, the datafrom gesture trackers, such as the Leap Motion Controller and cameras (with image processing)could be combined to make a robust hand hygiene gesture classification system

Next generation supply chains: making the right decisions about digitalisation

This white paper is based on research carried out by the IfM’s Centre for International Manufacturing and insights emerging from our work with industrial partners. In it we share our latest findings to help global companies consider their digital supply chain strategies