Strategic facilities management system in relation with building performance; the significance and relationship

Healthcare design frequently involves complex concepts that are difficult to measure and evaluate because the building require a modern, quality, functional and therapeutic environment. For this specific reason, facilities management has become a very important support system to ensure smoothness in healthcare business. Facilities management in healthcare building is a complicated system involving multiple layers of administrative division and sub-divisions. Building performance such as building impact, function and quality prove to have significant impact on strategic facilities management. This paper will do an extensive review of strategic healthcare business management as a holistic approach and examine how facilities management can effectively manage their division with consideration and understanding of building performance. The correlation between strategic facilities management and building performance will be identified and a framework for strategic FM system with regards to building performance will be developed

Application of Multifocal Electroretinogram in Early Detection of Inner Retinal Changes in Experimental Glaucoma

Purpose: Glaucoma is a multifactorial disease that causes structural and functional damage to retinal ganglion cells (RGCs) and their axons (retinal nerve fiber layer, RNFL). Early diagnosis is critical to preserving vision. The electroretinogram (ERG) is a noninvasive technique of assessing retinal function. The goal of this dissertation was to explore the utility of two ERG techniques (multifocal, mfERG and full field) in detecting early functional changes and to compare the changes with early structural changes in retina and optic nerve head (ONH) in an experimental model of glaucoma. Methods: All experiments were conducted on nonhuman primates (Mucaca Mulatta). In Experiment 1, using a slow sequence mfERG protocol, the stimulus consisted of a 19 hexagon array subtending angles of 35o X 34o on the retina. The protocol was modified by adding up to six initial focal flashes in a 30 frame sequence to increase the amplitude of the multifocal photopic negative response (mfPhNR). mfPhNR and multifocal oscillatory potentials (mfOPs) using the modified mfERG protocol were recorded in experimental (Exp) and fellow control (Con) eyes of seven monkeys with unilateral experimental glaucoma. Structural measures including RNFL thickness (RNFLT), macular ganglion cell inner plexiform layer thickness (m-GCIPLT) and deep ONH structures, minimum rim width (MRW) and anterior lamina cribrosa depth (ALCSD) were obtained concurrently. All parameters were measured globally (g) and locally (sectoral, s and macular, m). Time points of first significant changes in structural and functional measures were compared. In Experiment 2, mfPhNR was measured from a slow sequence protocol with a 103 hexagon array and a m-sequence of one focal flash followed by 14 dark frames (F14). Time points of change in the mfPhNR-F14 were compared with the corresponding structural changes and with mfPhNRs from Experiment 1. In Experiment 3, longitudinal changes in the full field PhNR (FF-PhNR) were measured and the time point of change in the FF-PhNR amplitude was compared with the structural measures. Results: Experiment 1: mfPhNR amplitude increased with increasing number of focal frames and saturated at 5 focal frames (F30-5), corresponding to an approximate duration of 53 ms. In Exp eyes, mfERG measures showed early reductions as cumulative IOP increased. g-mfPhNR amplitude was linearly related to MRW (R2=0.66, P<0.01) and ALCSD (R2=0.54, P<0.01) but showed an exponential relationship with g-RNFLT (R2=0.58, P<0.01). ONH structural changes either preceded or coincided with functional losses (mfPhNR) and g-RNFLT was the last parameter to change (K-M survival, P<0.05, log rank test). Reductions in m-mfPhNR amplitude occurred prior to m-GCIPL thinning in half of the monkeys. s-RNFL showed thinning prior to g-RNFL (P<0.05, paired t-test). Experiment 2: The coefficient of variation (CV) was significantly lower for the F30-5 (9.1%) protocol compared to the F14 (14.1 %) (P<0.05, paired t test). In Exp eyes, the mfPhNR-F14 amplitude changed early along with the ONH measures but prior to RNFL thinning. Time points for changes in the mfPhNR amplitudes from the two mfERG protocols were similar. Experiment 3: Early reduction in FF-PhNR amplitude occurred concurrently with the ONH changes but prior to g-RNFL and m-GCIPL thinning (P<0.05, log rank test). Time points for changes in mfPhNR-F30 and FF-PhNR were similar. Conclusion: Functional changes in mfPhNR and FF-PhNR amplitudes and changes in the ONH structures (MRW and ALCSD) occurred prior to structural changes in the inner retina (RNFLT and m-GCIPLT) in experimental glaucoma. Local RNFLT showed changes prior to global. While the FF-ERG can be used as a screening tool to detect early functional changes, mfERG can used to track changes in function related to local structural changes in the inner retina in glaucoma.Optometry, College o

Use of EPIC EMR for Early Identification and Management of Patients at Risk of Cardiac Implantable Electronic Device (CIED) Infection

Objectives Aim of our project was early identification of 100% of patients with a CIED IMPLANT presenting with bacteremia Process involves use of EPIC EMR to automatically identify patients with positive blood cultures Traditionally, cardiologists are alerted by the care team using the CONSULT system for management of these patients EPIC EMR as an adjunct to the CONSULT syste

Pathways to care for people with dementia in India: an exploratory study using case vignettes

Background: Limited evidence exists on how people living with dementia and their family/unpaid carers navigate care and support in India. Aim: This study used case vignettes to illustrate likely pathways to care for dementia, from receiving a diagnosis to long-term support, in India and to highlight gaps and challenges associated with current care provision for persons living with dementia. Methods: As part of the Strengthening Responses to Dementia in Developing Countries (STRiDE) project, and to contribute to an analysis of dementia care policies and systems in India, case vignettes were used to illustrate the diverse situations that people with dementia and their families may experience when seeking care in the Indian context. Eight hypothetical, but realistic cases of people with dementia were created by a multi-disciplinary team with experience in dementia care in India, to map out the likely care journeys of each case. Results: Investigating eight diverse care trajectories of people living with dementia highlighted important patterns relevant to the Indian context. We identified delays in dementia diagnosis to be attributed to low awareness of dementia among the general public and medical professionals in addition to a critical shortage of specialist services involved in facilitating dementia diagnosis. Post-diagnosis, support was recognized as limited and associated with considerable out-of-pocket (OOP) costs. Families primarily provide long-term care for people with dementia till end of life. Conclusions and Recommendations: Several steps need to be taken in order to improve dementia care in India. Increasing dementia awareness among both medical professionals and general public is essential. Shortages in dementia specialists can be addressed in part through appropriate task shifting. Lastly, more research is needed to develop evidence-based community interventions to support informal care provision for persons with dementia in India

Experiences of people with dementia and their caregivers during the COVID-19 pandemic in India: a mixed-methods study

Background The COVID-19 pandemic has unprecedented consequences for the management of chronic diseases such as dementia. However, limited evidence exists on the condition of persons with dementia and their caregivers during the pandemic in lower-middle-income countries (LMICs). The study aimed to provide insights into the experiences of persons with dementia and their families during the early phases of the pandemic in India. Methods This study adopted a mixed-method approach. One hundred and four persons with dementia and their caregivers were evaluated via telephone using validated instruments and a semi-structured interview guide. We used the quantitative data collected to establish a baseline, whereas qualitative data were analysed thematically. Results The study revealed that persons with dementia and their caregivers experienced difficulties during the pandemic, which included worsening of behaviour, problems in accessing care, disruptions in functional activities and struggles in enforcing infection prevention contributing to caregiver distress. An important finding that emerged was the unchanging reality of caregiving for families. The relative success of the public health response to the COVID-19 pandemic contrasted with the lack of awareness and formal support for dementia. Conclusions The COVID-19 pandemic has exposed the vulnerabilities of persons with dementia and their caregivers. This calls for a collaborative reframing of medical care and public health policies to address dementia care

Common folate gene variant, MTHFR C677T, is associated with brain structure in two independent cohorts of people with mild cognitive impairment☆

A commonly carried C677T polymorphism in a folate-related gene, MTHFR, is associated with higher plasma homocysteine, a well-known mediator of neuronal damage and brain atrophy. As homocysteine promotes brain atrophy, we set out to discover whether people carrying the C677T MTHFR polymorphism which increases homocysteine, might also show systematic differences in brain structure. Using tensor-based morphometry, we tested this association in 359 elderly Caucasian subjects with mild cognitive impairment (MCI) (mean age: 75 ± 7.1 years) scanned with brain MRI and genotyped as part of Alzheimer's Disease Neuroimaging Initiative. We carried out a replication study in an independent, non-overlapping sample of 51 elderly Caucasian subjects with MCI (mean age: 76 ± 5.5 years), scanned with brain MRI and genotyped for MTHFR, as part of the Cardiovascular Health Study. At each voxel in the brain, we tested to see where regional volume differences were associated with carrying one or more MTHFR ‘T’ alleles. In ADNI subjects, carriers of the MTHFR risk allele had detectable brain volume deficits, in the white matter, of up to 2–8% per risk T allele locally at baseline and showed accelerated brain atrophy of 0.5–1.5% per T allele at 1 year follow-up, after adjusting for age and sex. We replicated these brain volume deficits of up to 5–12% per MTHFR T allele in the independent cohort of CHS subjects. As expected, the associations weakened after controlling for homocysteine levels, which the risk gene affects. The MTHFR risk variant may thus promote brain atrophy by elevating homocysteine levels. This study aims to investigate the spatially detailed effects of this MTHFR polymorphism on brain structure in 3D, pointing to a causal pathway that may promote homocysteine-mediated brain atrophy in elderly people with MCI

Common folate gene variant, MTHFR C677T, is associated with brain structure in two independent cohorts of people with mild cognitive impairment

AbstractA commonly carried C677T polymorphism in a folate-related gene, MTHFR, is associated with higher plasma homocysteine, a well-known mediator of neuronal damage and brain atrophy.As homocysteine promotes brain atrophy, we set out to discover whether people carrying the C677T MTHFR polymorphism which increases homocysteine, might also show systematic differences in brain structure.Using tensor-based morphometry, we tested this association in 359 elderly Caucasian subjects with mild cognitive impairment (MCI) (mean age: 75±7.1years) scanned with brain MRI and genotyped as part of Alzheimer's Disease Neuroimaging Initiative. We carried out a replication study in an independent, non-overlapping sample of 51 elderly Caucasian subjects with MCI (mean age: 76±5.5years), scanned with brain MRI and genotyped for MTHFR, as part of the Cardiovascular Health Study. At each voxel in the brain, we tested to see where regional volume differences were associated with carrying one or more MTHFR ‘T’ alleles.In ADNI subjects, carriers of the MTHFR risk allele had detectable brain volume deficits, in the white matter, of up to 2–8% per risk T allele locally at baseline and showed accelerated brain atrophy of 0.5–1.5% per T allele at 1year follow-up, after adjusting for age and sex. We replicated these brain volume deficits of up to 5–12% per MTHFR T allele in the independent cohort of CHS subjects.As expected, the associations weakened after controlling for homocysteine levels, which the risk gene affects. The MTHFR risk variant may thus promote brain atrophy by elevating homocysteine levels.This study aims to investigate the spatially detailed effects of this MTHFR polymorphism on brain structure in 3D, pointing to a causal pathway that may promote homocysteine-mediated brain atrophy in elderly people with MCI

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation