Exploring factors associated with dementia diagnosis and post-diagnosis outcomes in the Electronic Health Care Record data

Importance: A better understanding of dementia progression will yield important information for future observational studies and clinical trials which will be essential for the approval of disease-modifying therapy (DMT). The knowledge gained will also inform guidelines for the treatment and management of dementia patients and improve resource allocation. Objectives: To comprehensively characterize longitudinal cohort studies and to identify what has been studied with regards to dementia progression after diagnosis in individuals aged 65, highlight limitations, any unexplored areas and identify opportunities to help inform new observational studies and clinical trials. To study dementia patients in the electronic health records data and provide an overview of their characteristics and select research-quality cohort. Conduct a time-to-event analysis for incident dementia and its risk factors based on the results of our preliminary analysis of our data. Describe and use multi-state modeling approach to study post-dementia outcomes using hospital admission and discharge data. Methods: For the review of literature, I searched OVID-MEDLINE for longitudinal studies with human participants from April 2008 till April 2019. Studies measuring outcomes of different domains important in dementia progression (clinical, health system utilization, biomarkers) were included. Preliminary analysis was performed using primary care general practice data and hospital episode statistics data and different summary statistics were performed and looked at the comorbidities in dementia cohort in these datasets. For the time-to-event analysis we used Cox proportional hazard model to study the factors for incident dementia in diabetic patients. We chose diabetes because it was the most prevalent comorbid conditions in dementia patients in the results of literature review and in the preliminary analysis of our datasets. For the post-dementia hospitalisation, institutionalisation, and mortality of dementia patients, I used a multi-state Cox model to study these outcomes and risk factors associated simultaneously in one model. Findings: I included 100 longitudinal studies comprising >2m individuals in the literature review. Mostly they had a small sample size (57% N<500 participants), short follow-up (66% <= 3 years), and dominance of AD (85% of the total sample in the selected studies was AD and only 9% was of vascular dementia (VaD)). Studies were mainly focused on measuring cognition (69% studies), while functioning and quality of life were less commonly measured (45% and 9% studies respectively). Studies were mainly measuring outcomes at 1 to 3 different time points and the follow-ups were shorter. The percentage of incident dementia in diabetic patients during the 10-years follow-up was 18.9 cases per 1000-person years. Increasing age, female gender and diabetes duration were associated with higher risk of dementia. From the results of the multi-state model, I found that home care availability influences mortality and institutionalisation from patients own home, and they were spending less time inside hospital and therefore, their rate of in-hospital mortality was low. Increasing age, frailty, and hospital admission due to injury were associated with higher rate of institutionalisation and death. Similarly, hospital stay 12 days was associated with hospital discharge to long-term care institutions and patients who were getting re-admitted within 30 days had a higher discharge rate and because of this had higher rate of rehospitalisation and subsequent institutionalisation and increased risk of death. Conclusion and relevance: The gaps identified by this review will help researchers design better observational studies that will inform future trials more comprehensively. It also provides an alternative way to study the intricate dynamics of hospitalisation, institutionalisation and mortality using multi-state model and provide a foundation for further research with appropriate data on formal and informal home care. The work serves as a cornerstone for further research

A child that presents with an acute limp: Legg-Calvé-Perthes disease

A 6-year-old boy presented with the recent development of a right sided limp. He had no known medical conditions. On examination, the patient had limited internal/external rotation and abduction of the right hip. He walked with a non-antalgic gait and was noted to  have a positive Trendelenberg sign. Lower extremity radiographs (A) revealed flattening of the right proximal femoral epiphysis with greater than 50% collapse. Mild acetabular changes of the right hip were present; however, there was still concentric reduction of the right femoral head within the acetabulum. After a thorough discussion of management options, the patient received botulinum toxin injections along the adductor longus and gracilis muscles to resolve an adduction contracture. An arthrogram (B) demonstrated mild-moderate flattening of the femoral head with lateral femoral head extrusion, and moderate femoral-acetabular congruency. The patient was subsequently given a hip abduction orthosis for intermittent daytime and full nighttime bracing, and was instructed to continue stretching exercises daily. The parents were educated regarding the cyclical nature of the  pathology, and that the prognosis is relatively improved in younger children with the potential to still remodel. Legg-Calvé-Perthes disease describesan idiopathic avascular necrosis of the proximal femoral epiphysis. Initial therapy includes maintenance of the femoral head within the acetabulum by an abduction splint. Additionally, daily abduction stretching exercises and physical therapy are recommended. Surgical containment can be achieved by a femoral osteotomy to redirect the involved portion within the acetabulum.Pan African Medical Journal 2016; 2

Corporate Governance and the Firm’s Performance: A Managerial Perspective

Corporate governance is a system where owners of a corporation have absolutely no direct power to have a control a company whereas others i.e. directors and managers who possess no shareholding or ownership are the ones that run the corporations but are appointed by the shareholders indirectly through electoral process. This system gained negative popularity when two giant companies (Enron Xerox and Worldcom) shocked their shareholders through different illegal means. Moreover, literature suggests that there are other several examples as well in the world that highlights the problems in this form of governance mechanism. Considering the importance of this issue the study has conceptualized to explore the main issues of corporate governance exists in Pakistani scenario. It is also worth mentioning here that many prior researches are mainly focused on the role of corporate governance in enhancing financial performance of the corporations. This research is significance in two ways, first, it is focused primarily on the effects of corporate governance mechanism on management of corporations, secondly, thematic approach has been used to understand the governance system along with the issues exist and no secondary data taken to check the effects on financial growth of corporations. The top management of several corporations was interviewed in the study to understand the governance and issues exists in the country. It has been observed that many of the issues that are discussed in the literature are same whereas some new and interesting findings are also come out due to several factors e.g. work ethics, culture, family businesses etc. Finally, the study also suggests ways to improve governance mechanism especially in Pakistani environment. The results may be interesting if  future researchers step in this field and explore the field by various dimensions e.g. by adding shareholder’s perspective, incorporating creditors and taking views of the regulators. Keywords: Corporate Governance, Governance Mechanism, Financial Performance, Family Businesses

Entrepreneurial Legacy: Role of Family in Nurturing Entrepreneurial Ventures

The entrepreneurship is a wide subject and it is spread to the family ventures, which holds the major share in the business sector. This study discusses about this area of entrepreneurial legacy where the family has a significant role of their determinants on the longevity and legacy of the business. The factors like legacy, support and care from the family, mentorship from the family elders and the succession portrays the outline of the family businesses’ success ingredients. The literature supports the relationship between these factors that plays a vital role in the legacy of the entrepreneurial venture started by the idea of a family. Extensive study for this research paper will give the insights about the family’s role in the entrepreneurial ventures making it a continuing legacy through the businesses of Pakistan in the categories of small-medium enterprises (SMEs) and large business enterprises. The research method used for this is through interviews of four different family business owners, due to convenience sampling, the interviewees openly shared the data and provide the accurate insights needed to achieve the significance level of the research. This empirical study and the literature provides the evidence that the elements of family in the family business ventures acts as the success factor for the business and contributing component to the economy. Keywords: Family business, Longevity, Family Role, Entrepreneurial Venture

Application of Artificial Intelligence declarative methods for Solving Operating Room Scheduling problems in Hospital Environments

Digital health is a relatively new but already important field in which digitalization meets the need to automatically and efficiently solve problems in healthcare to improve the quality of life for patients. The need to efficiently solve some of these problems has become even more pressing due to the Covid-19 pandemic that significantly increased stress and demand on hospitals. Hospitals have long waiting lists, surgery cancellations, and even worse, resource overload—issues that negatively impact the level of patient satisfaction and the quality of care provided. Within every hospital, operating rooms (ORs) are an important unit. The Operating Room Scheduling (ORS) problem is the task of assigning patients to operating rooms, taking into account different specialties, lengths and priority scores of each planned surgery, operating room session durations, and the availability of beds for the entire length of stay both in the Intensive Care Unit and in the wards. A proper solution to the ORS problem is of primary importance for the quality of healthcare service and the satisfaction of patients in hospital environments. In this thesis, we provide several contributions to the ORS problem. We first present a solution to the problem based on Knowledge Representation and Reasoning via modeling and solving approaches using Answer Set Programming (ASP). This first basic solution builds on a previous solution but takes into account explicitly beds and ICU units because in the pandemic we understood how important and limiting they were. Moreover, we also present an ASP solution for the rescheduling problem, i.e., when the off-line schedule cannot be completed for some reasons, and a further extension where surgical teams are also considered. Another technical contribution is a second solution for the basic ORS problem with beds and an ICU unit, whose modeling departs from the guidelines previously used and shows efficiency improvements. Finally, we introduce a web framework for managing ORS problems via ASP that allows a user to insert the main parameters of the problem, solve a specific instance, and show results graphically in real time