Sharing Digital Health Information

An in-depth study on attitudes and activation processes of My UNC Chart at UNC Health Care. UNC Health Care is a non-profit, integrated health care system owned by the State of North Carolina. UNC Health Care consists of multiple hospitals and ambulatory care (outpatient) clinics, as well as clinical programs in the UNC School of Medicine. The UNC Practice Quality and Innovation (PQI) team works with ambulatory care settings to improve patient “experiences and outcomes, operational processes, and business performance.” The goal of PQI is to make sure patients have adequate access to appropriate care. One of the areas of focus in achieving this goal is use of an online health portal known as My UNC Chart. The online patient portal is important because it helps improve patient engagement and allows patients to become active partners in their health.Master of Science in Public Healt

Suppression of inflammation by low-dose methotrexate is mediated by adenosine A(2A )receptor but not A(3 )receptor activation in thioglycollate-induced peritonitis

Prior studies demonstrate that adenosine, acting at one or more of its receptors, mediates the anti-inflammatory effects of methotrexate in animal models of both acute and chronic inflammation. Both adenosine A(2A )and A(3 )receptors contribute to the anti-inflammatory effects of methotrexate treatment in the air pouch model of inflammation, and the regulation of inflammation by these two receptors differs at the cellular level. Because different factors may regulate inflammation at different sites we examined the effect of low-dose weekly methotrexate treatment (0.75 mg/kg/week) in a model of acute peritoneal inflammation in adenosine A(2A )receptor knockout mice and A(3 )receptor knockout mice and their wild-type littermates. Following intraperitoneal injection of thioglycollate there was no significant difference in the number or type of leukocytes, tumor necrosis factor alpha (TNF-α) and IL-10 levels that accumulated in the thioglycollate-induced peritoneal exudates in adenosine A(2A )knockout mice or wild-type control mice. In contrast, there were more leukocytes, TNF-α and IL-10 in the exudates of the adenosine A(3 )receptor-deficient mice. Low-dose, weekly methotrexate treatment increased the adenosine concentration in the peritoneal exudates of all mice studied, and reduced the leukocyte accumulation in the wild-type mice and A(3 )receptor knockout mice but not in the A(2A )receptor knockout mice. Methotrexate reduced exudate levels of TNF-α in the wild-type mice and A(3 )receptor knockout mice but not the A(2A )receptor knockout mice. More strikingly, IL-10, a critical regulator of peritoneal inflammation, was increased in the methotrexate-treated wild-type mice and A(3 )knockout mice but decreased in the A(2A )knockout mice. Dexamethasone, an agent that suppresses inflammation by a different mechanism, was similarly effective in wild-type mice, A(2A )mice and A(3 )knockout mice. These findings provide further evidence that adenosine is a potent regulator of inflammation that mediates the anti-inflammatory effects of methotrexate. Moreover, these data provide strong evidence that the anti-inflammatory effects of methotrexate and adenosine are mediated by different receptors in different inflammatory loci, an observation that may explain why inflammatory diseases of some organs but not of other organs respond to methotrexate therapy

EXAMINING THE RELATION BETWEEN MARKET VALUE AND CO2 EMISSION: STUDY OF INDIAN FIRMS

In the present era, sustainable business practices have become an important metric for measuring the organisational effectiveness. Shareholders have added sustainability as an important dimension of firms’ performance and consider it as value relevant for determining the market value of any company. Given the premises, present study examines the impact of CO2 emission on the market value of the firm (measured by market-to-book value ratio and Tobin’s Q ratio) in the context of a developing country. Current study is based on panel data of 230 firm-year observations collected from the annual report of Carbon Disclosure Project (CDP) and annual report of sample companies. Using panel least square regression analysis, the findings indicate significant adverse impact of CO2 emission on the firm value. In other words, shareholders assign negative value to higher discharge of carbon dioxide and reflect the same by lowering the market value of shares. Further, the results are checked for robustness using generalised method of moments (GMM) and the conclusions are found coinciding. Present findings have important implications for regulatory authorities, policy makers, and practicing managers

DEVELOPMENT AND VALIDATION OF RP-HPLC METHOD FOR DETERMINATION OF HYDROCHLOROTHIAZIDE, OLMESARTAN MEDOXOMIL AND THEIR RELATED SUBSTANCES IN COMBINED TABLET DOSAGE FORM

Objective: Development of RP-HPLC method for determination of Hydrochlorothiazide (HCTZ), Olmesartan medoxomil (OLM) and their related substances in combined tablet dosage form and validation of the developed method. Methods: Gradient mobile phase system was used for estimation of drug contents and their related substances. Mobile phase A contained the mixture of Acetonitrile and 15 mM Phosphate buffer (pH adjusted to 3.4 with orthophosphoric acid) in the ratio of 20:80. Mobile phase B contained the same mixture in the ratio of 80:20. Chromatographic separation was carried out at the mobile phase flow rate of 0.8 mL/min using C18 Phenomenax inplace of Enable (250 × 4.6 mm) 5 μm column and detection was made at 254 nm. Results: The linearity of developed method was tested in the range of 62.5-187.5 μg/mL for Hydrochlorothiazide, 100-300 μg/mL for Olmesartan medoxomil, 1-1.8 μg/mL for Hydrochlorothiazide. The % recovery was found to be 99.88-100.67 % (HCTZ), 99.14-99.91 % (OLM), 99.11-100.71% (HCTZ-IMP) and 98.13-100.83% (OLM-IMP). The assay of marketed formulation was found to be 99.78% (HCTZ) and 99.26% (OLM). Conclusion: A simple, precise and accurate RP-HPLC method was developed for determination of Hydrochlorothiazide, Olmesartan medoxomil and their related substances

A study of relation between primary open angle glaucoma and type II diabetes mellitus

Background: Primary open angle glaucoma has been characterized by its adult onset, IOP >21mmHg at some point in the course of the disease, open angles on gonioscopy, glaucomatous visual field changes and glaucomatous optic nerve damage. POAG is a multi-factorial disease such as age, black race, positive family history, high myopia etc. Diabetes mellitus has also been considered as one of the risk factors, but no major study has been conducted to provide tangible proof.Methods: This cross sectional, case control study was conducted to determine whether diabetes stands as a risk factor in development of glaucoma. The selected patients were divided into 3 groups based on inclusion and exclusion criteria. They were subjected to complete ocular examination including gonioscopy and perimetry.Results: The 16 patients from 50 of the diabetic group (28%) were found to have POAG. The p value was <0.005 which was statistically significant. Also, no correlation was found between blood sugar and IOP levels in these patients.Conclusions: These data show a significant correlation between diabetes and glaucoma. Further studies are warranted to determine its actual role in pathogenesis of glaucoma

Diagnosis and staging of lung carcinoma with CT scan and its histopathological correlation

Background: Lung cancer is the most common cancer worldwide. Hence, timely diagnosis and accurate staging of the carcinoma is critical for the treatment and prognosis. So, this study was performed to evaluate the role of CT scan in diagnosis and staging of lung cancer.Methods: This was a prospective and observational study carried out over one and half years at a tertiary care hospital. The patients found to have abnormalities on chest X-ray suggestive of carcinoma were included in the study. Pre and post contrast CT scans were performed. Individual patient biopsies were done for histopathological staging.Results: Most patients belonged to 41-50 years age group with male preponderance (81.33%). Habit of smoking was prevalent among the lung cancer patients. Almost all masses (92%) showed heterogeneous contrast enhancement on CT. Additionally, there were calcifications, cavitation, hilar enlargement, pleural invasion, mediastinal lymphadenopathy and contiguous bone involvement. Adenocarcinoma was the most common (46.66%) form of cancer followed by squamous cell carcinoma (42.66%). For histopathological diagnosis, majority of patients (73.33%) were diagnosed using CT guided biopsy. In the remaining patients, USG guided biopsy or fibreoptic bronchoscopy were performed. The most common lobe affected by bronchogenic carcinoma was right upper lobe. The most common site of metastasis was pleura (22.66%) followed by bone (17.33%). Majority of the patients (41.33%) presented with TNM stage IV.Conclusions: CT scan as a modality for detection and staging of bronchogenic carcinoma is superior to chest radiograph. CT guided FNAC has a high success rate in evaluation of lung carcinoma.

Optimization of Medication Delivery Robot Use Using Lean Methodology in a Veterans Affairs Academic Medical Center

PURPOSE: The purpose of the retrospective process improvement study was to optimize the functionality of four upgraded medication delivery robots (MDRs) in the inpatient pharmacy of the Michael E. DeBakey Veterans Affairs Medical Center from a previous state of two robots. The primary endpoint was to reduce medication delivery time to the nursing units. Secondary endpoints include the volume of missing doses and cost-savings post implementation. METHODS: Our pharmacy technology project management incorporated principles of lean and six sigma methodologies to refine value-added processes and eliminate any waste. We assessed medication delivery times and missing doses reports by pharmacy shift, by time and day of week and by nursing unit destinations of the previous two robots before implementation of the new upgraded MDRs. Nursing staff from various units and pharmacy staff on various shifts completed a voice of customer survey to determine strengths, weaknesses, opportunities and threats (SWOT) of the previous two MDRs. Using data from previous robot use and the SWOT analysis, a taskforce of pharmacy managers, staff pharmacists, pharmacy technicians, a nurse, and a systems redesign facilitator convened weekly between November 2013 and February 2014 to determine optimal use of the four new upgraded medication delivery robots. The committee executed the Plan-Do-Study-Act model to conduct pilot projects that refined robot parking spots, increased robot use, scheduled timed deliveries, and allocated specific robots for certain nursing units or medications. The committee evaluated medication delivery time reports and feedback from pharmacy and nursing staff one week after each implemented pilot project to assess if the piloted idea met the intent of reducing delivery time without negatively impacting staff work-load. RESULTS: Pilot project efforts reduced average delivery time to nursing units from 34 minutes and 43 seconds (std dev 19 mins, 15 seconds) to 27 minutes and 39 seconds (std dev 15 mins, 40 seconds). In addition to medication delivery time, a 0.12% change in missing doses was observed, which equates to 3,539 fewer missing doses per year (p<0.0005). The investment of 4 new robots was fully paid for the tenth fiscal year after implementation via FTE salary-savings (equivalent to 1.5 FTE) generated from the additional mileage traveled by the 2 added robots, the repurposing of 1 IV room pharmacy delivery technician FTE, and time savings from the reduction in missing dose volume. When quantified, these factors demonstrated financial gains that surpassed the steep upfront costs of implementation. CONCLUSION: In conclusion, the use of Lean and six-sigma methodologies facilitated the optimization of the four new medication delivery robots in the MEDVAMC inpatient pharmacy. Pilot efforts yielded time savings for time to medication delivery. As the first study to be conducted in a VA setting, this research contributes to the current body of literature on medication delivery robots in that it supplies targeted interventions to optimize MDR use and is the first of its kind to quantify cost savings on missing doses as a secondary benefit. DISCLOSURES: None.Pharmacy, College o

Spectrum of Radiological Findings in Leptospirosis on Chest Radiograph and Ultrasonography-Study during Epidemics in South Gujarat Region of India

Introduction: Leptospirosis is an acute generalised infectious disease caused by any of the group of spirochetes of the genus Leptospira. The disease can involve many organs mainly liver, central nervous system, kidneys, skeletal muscle, and lungs. Diagnosis can be done on the basis of epidemiological, clinical and laboratory features. As the disease has varied manifestations, it is frequently misdiagnosed even in areas of high prevalence. A delay in diagnosis can leads to severe form of disease and development of its complications. Aim: To find out involvement of thoracic and abdominal organs in each and every patient with the help of chest radiographs and Ultrasonography (USG) of abdomen and thorax. Also, to put together the radiological spectrum of pulmonary manifestations, and other system involvement in leptospirosis during epidemics in south Gujarat region and their role in early diagnosis and follow up of patients. Materials and Methods: Study was carried out for 3 years. Total 380 patients of suspected leptospirosis were referred during epidemic during months of July to October in year 2008, 2009 and 2010 for confirmation of diagnosis and management. Total 275 patients were confirmed for leptospirosis by serological test (ELISA) during first and second week of illness which was included in our study. All 275 patients were evaluated with chest radiographs and ultrasound of chest and abdomen. Those patients which are clinically suspected for leptospirosis but were serologically negative were excluded. Results: Out of 275 confirmed patients of leptospirosis, 54 patients had signs of pulmonary haemorrhage on chest radiograph (19.65%). Out of these 54 patients 50 (which accounts 92% of pulmonary hemorrhage patients and 18% of total 275 patients) died due to severe pulmonary haemorrhage and respiratory distress. Pleural effusion was diagnosed on X-ray chest in 10 patients but it was found in 68 patients on USG. Signs of acute renal disease were found on USG of abdomen in 124 patients (45%). Hepatic involvement was found in 192 patients while 68 patients had multi organ involvement (24.7%). Changes of acute pancreatitis were noted in 11 patients while 16 patients had pericardial effusion and 198 patients had ascites. Conclusion: Chest radiograph and USG study of each and every patient suspected of leptospirosis has got definite role in confirming different organ involvement and thus helps us in early diagnosis, planning treatment and for judgement of prognosis. As it is non-invasive and easily available procedure, it is also helpful for follow-up after treatment