Optimization of Automated Dispensing Machines and Justifying Cost Neutralization for Nurse-Link and Pharmogistics Implementation

OBJECTIVE: The use of automated dispensing machines (ADM) continues to evolve and is an increasingly prevalent component of the medication-use process in health care organizations today. The rapid development of technology applications in health care, including ADM, has raised concerns about cost, patient safety and access to medications. At WPAHS, there were concerns regarding nursing inefficiencies in patient care as it became necessary to take additional steps, increased lines during busy med-pass times, additional phone calls and delay in care. Also, concerns within the Pharmacy department of not being able to track inventory of medications on hand, especially when medication shortages were at the high point. There was a need to evaluate and optimize current technology and look into additional resources available to provide safe and quality care to our patients. METHOD: Knowledge portal’s Key Performance Indicators (KPIs) were used for inventory management as part of the Pyxis optimization. Knowledge portal was also used to collect data, generate reports and monitor trends on Pyxis usage for the past year. A business plan, part of the Performance Improvement Plan (PIP) was created to justify the cost of system-wide implementation of Nurse-Link and Pharmogistics. RESULTS: Eighteen machines at AGH and two machines at WPH were identified to be removed based on lower usage. Cost savings justification of $40,690.13 at year 1 and$85,080.00 thereafter annually was projected. Increase in the Vend-to-refill ratio and decrease in the stock-out percentages in three out of four machines post optimization was observed. Eighteen non-emergent medications were removed from all four machines and ten new medications were added to all four machines. CONCLUSION/PUBLIC HEALTH SIGNIFICANCE: A “how to guide” to optimize Pyxis machines was created to optimize inventory, lower waste of expired medications and increase efficiency along with the justification of cost neutralization for Nurse-Link and Pharmogistics implementation. Implementation of Nurse-Link and Pharmogistics can significantly improve nursing and pharmacy efficiencies, transform safe patient care at bedside, drive to lean process and improve the complexity of medication administration, inventory, re-fill and ordering processes. Rising health care costs with shifting reimbursement structure in United States compels institutions to provide higher quality patient care at lower cost. By evaluating and optimizing current technology and investing in additional resources such as Nurse-Link and Pharmogistics allows WPAHS to provide a quality and cost effective care to our patients

Comprehensive analysis of the transcriptional landscape of the human FMR1 gene reveals two new long noncoding RNAs differentially expressed in Fragile X syndrome and Fragile X-associated tremor/ataxia syndrome

The majority of the human genome is transcribed but not translated, giving rise to noncoding RNAs (ncRNAs), including long ncRNAs (lncRNAs, >200 nt) that perform a wide range of functions in gene regulation. The Fragile X mental retardation 1 (FMR1) gene is a microsatellite locus that in the general population contains <55 CGG repeats in its 5′-untranslated region. Expansion of this repeat region to a size of 55-200 CGG repeats, known as premutation, is associated with Fragile X tremor and ataxia syndrome (FXTAS). Further expansion beyond 200 CGG repeats, or full mutation, leads to FMR1 gene silencing and results in Fragile X syndrome (FXS). Using a novel technology called “Deep-RACE”, which combines rapid amplification of cDNA ends (RACE) with next generation sequencing, we systematically interrogated the FMR1 gene locus for the occurrence of novel lncRNAs. We discovered two transcripts, FMR5 and FMR6. FMR5 is a sense lncRNA transcribed upstream of the FMR1 promoter, whereas FMR6 is an antisense transcript overlapping the 3′ region of FMR1. FMR5 was expressed in several human brain regions from unaffected individuals and from full and premutation patients. FMR6 was silenced in full mutation and, unexpectedly, in premutation carriers suggesting abnormal transcription and/or chromatin remodeling prior to transition to the full mutation. These lncRNAs may thus be useful as biomarkers, allowing for early detection and therapeutic intervention in FXS and FXTAS. Finally we show that FMR5 and FMR6 are expressed in peripheral blood leukocytes and propose future studies that correlate lncRNA expression with clinical outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00439-013-1356-6) contains supplementary material, which is available to authorized users

Study of the cases of severe acute maternal morbidity at a tertiary care centre

Background: Reduction in the maternal morbidity has been the key strategy towards achievement of Millennium Development Goal. Despite exhaustive measures at all levels, the decline has been slow. WHO in 2007 established a technical working group to identify cases of severe acute maternal morbidity. It served dual goals to identify the causes and pointing out delays leading to SAMM. SAMM is now an established superior indicator of surviving women’s health and allows uniform comparisons. The present study was conducted with an aim to identify cases of SAMM at our centre. The objective is to determine the frequency of maternal near miss and conduct an epidemiological survey.Methods: This retrospective study was conducted in the department of Obstetrics and Gynecology and ICU of School of Medical Sciences and Research, Greater Noida, from November 2014 to October 2017. All the cases identified as SAMM, as per WHO 2009 criteria (modified according to the local protocol), were included in the study.  Results: During the study period there were a total of 2252 delivery, out of which 2051 were live births. There were 123 SAMM cases and 47 were excluded out of study. So, study was done on 76 cases of SAMM, and on 11 maternal deaths in the study period. Calculated MNM incidence ratio was 37.05 per 1000 live births. A mortality index of 12.64% was calculated. MNM to maternal death ratio was 6.9:1. Major identifiable cause for SAMM was hypertension (35.5%)), followed by haemorrhage (18.4%). Haematologic system was the commonest organ system involved. 67.8% of the admissions were done in critical condition.Conclusions: Maternal mortality and SAMM cases shared characteristics, and study of SAMM cases can provide an insight into the causative etiology and give time for early intervention

Predicting symptom severity and contagiousness of respiratory viral infections

This work aims at predicting the symptom severity and contagiousness of a person infected with respiratory virus, using time series gene expression data. Four different respiratory viruses were studied – RSV, H1N1, H3N2 and Rhinovirus. Predictive models were built for each virus for each time point. Partial least squares discriminant analysis was used for feature selection and random forest was used for classification. Certain genes were identified as biomarkers in distinguishing the subjects. Gene enrichment analysis was performed on the differentially expressed genes. Prediction accuracy values were high even when expression data from early time points were analyzed. Significant genes were detected as early as 5 and 10 hours post infection, as compared to prior work that did so at 29 hours post infection. The potential biomarkers obtained with the proposed approach need to be investigated further

Comparison of Three Targeted Enrichment Strategies on the SOLiD Sequencing Platform

Despite the ever-increasing throughput and steadily decreasing cost of next generation sequencing (NGS), whole genome sequencing of humans is still not a viable option for the majority of genetics laboratories. This is particularly true in the case of complex disease studies, where large sample sets are often required to achieve adequate statistical power. To fully leverage the potential of NGS technology on large sample sets, several methods have been developed to selectively enrich for regions of interest. Enrichment reduces both monetary and computational costs compared to whole genome sequencing, while allowing researchers to take advantage of NGS throughput. Several targeted enrichment approaches are currently available, including molecular inversion probe ligation sequencing (MIPS), oligonucleotide hybridization based approaches, and PCR-based strategies. To assess how these methods performed when used in conjunction with the ABI SOLID3+, we investigated three enrichment techniques: Nimblegen oligonucleotide hybridization array-based capture; Agilent SureSelect oligonucleotide hybridization solution-based capture; and Raindance Technologies' multiplexed PCR-based approach. Target regions were selected from exons and evolutionarily conserved areas throughout the human genome. Probe and primer pair design was carried out for all three methods using their respective informatics pipelines. In all, approximately 0.8 Mb of target space was identical for all 3 methods. SOLiD sequencing results were analyzed for several metrics, including consistency of coverage depth across samples, on-target versus off-target efficiency, allelic bias, and genotype concordance with array-based genotyping data. Agilent SureSelect exhibited superior on-target efficiency and correlation of read depths across samples. Nimblegen performance was similar at read depths at 20× and below. Both Raindance and Nimblegen SeqCap exhibited tighter distributions of read depth around the mean, but both suffered from lower on-target efficiency in our experiments. Raindance demonstrated the highest versatility in assay design

Prosthetic rehabilitation of a partially amputated finger using a customized ring-wire substructure

Defects of fingers or hands due to congenital reasons or trauma can be a catastrophic setback to an individual physically, emotionally, and psychologically. An artificial finger prosthesis is a lucrative option to camouflage such defects. The anatomy of the residual stump of the defect is of extreme importance and will dictate the mode of retention to be used, and the level of esthetics one can expect. Despite the availability of the advanced skills, best of materials, and laboratory support, sometimes, the anatomy of the defect may be a hindrance in furnishing a better prosthesis. This case report describes a cost-effective and simple approach of rehabilitation of a partially amputated finger with bulbous distal anatomy using a custom-made ring-wire substructure and maxillofacial silicone, thereby striking a balance between adequate retention and optimal esthetics

Intel Logistics - Designing Cost-Effective Distribution Strategies for Intel's Proposed Ultra Low-Cost PC Chip Line

Of the five finalists, the winning team included Siddharth Coelho-Prabhu, Arpit Dharia, Akshay Kotak, Jason Kumar, Shyam Mehta, and Ranjini Ragunathan with adviser John Vande Vate who worked on a project with Intel titled, Designing Cost-Effective Distribution Strategies for Intel's Proposed Ultra Low-cost PC Chip Line. The aim of this project was to provide Intel with strategic intuition of the cost-effective distribution of its proposed Ultra Low-cost PC chips. Given the strategic nature of the project the team designed a model that made minimal parametric assumptions, modeling inventory using Brownian motion. The team then developed a set of decision-mailing tools that illustrate the relationships between demand conditions and transportation rates, supply strategies, systems performance and bottom line costs.Best of Senior Design Spring 2008 Finalist Presentations.Runtime: 19:40Vande Vate, Joh