What do clinicians want? Interest in integrative health services at a North Carolina academic medical center

BACKGROUND: Use of complementary medicine is common, consumer driven and usually outpatient focused. We wished to determine interest among the medical staff at a North Carolina academic medical center in integrating diverse therapies and services into comprehensive care. METHODS: We conducted a cross sectional on-line survey of physicians, nurse practitioners and physician assistants at a tertiary care medical center in 2006. The survey contained questions on referrals and recommendations in the past year and interest in therapies or services if they were to be provided at the medical center in the future. RESULTS: Responses were received from 173 clinicians in 26 different departments, programs and centers. There was strong interest in offering several specific therapies: therapeutic exercise (77%), expert consultation about herbs and dietary supplements (69%), and massage (66%); there was even stronger interest in offering comprehensive treatment programs such as multidisciplinary pain management (84%), comprehensive nutritional assessment and advice (84%), obesity/healthy lifestyle promotion (80%), fit for life (exercise and lifestyle program, 76%), diabetes healthy lifestyle promotion (73%); and comprehensive psychological services for stress management, including hypnosis and biofeedback (73%). CONCLUSION: There is strong interest among medical staff at an academic health center in comprehensive, integrated services for pain, obesity, and diabetes and in specific services in fitness, nutrition and stress management. Future studies will need to assess the cost-effectiveness of such services, as well as their financial sustainability and impact on patient satisfaction, health and quality of life

ATHENA: A knowledge-based hybrid backpropagation-grammatical evolution neural network algorithm for discovering epistasis among quantitative trait Loci

<p>Abstract</p> <p>Background</p> <p>Growing interest and burgeoning technology for discovering genetic mechanisms that influence disease processes have ushered in a flood of genetic association studies over the last decade, yet little heritability in highly studied complex traits has been explained by genetic variation. Non-additive gene-gene interactions, which are not often explored, are thought to be one source of this "missing" heritability.</p> <p>Methods</p> <p>Stochastic methods employing evolutionary algorithms have demonstrated promise in being able to detect and model gene-gene and gene-environment interactions that influence human traits. Here we demonstrate modifications to a neural network algorithm in ATHENA (the Analysis Tool for Heritable and Environmental Network Associations) resulting in clear performance improvements for discovering gene-gene interactions that influence human traits. We employed an alternative tree-based crossover, backpropagation for locally fitting neural network weights, and incorporation of domain knowledge obtainable from publicly accessible biological databases for initializing the search for gene-gene interactions. We tested these modifications <it>in silico </it>using simulated datasets.</p> <p>Results</p> <p>We show that the alternative tree-based crossover modification resulted in a modest increase in the sensitivity of the ATHENA algorithm for discovering gene-gene interactions. The performance increase was highly statistically significant when backpropagation was used to locally fit NN weights. We also demonstrate that using domain knowledge to initialize the search for gene-gene interactions results in a large performance increase, especially when the search space is larger than the search coverage.</p> <p>Conclusions</p> <p>We show that a hybrid optimization procedure, alternative crossover strategies, and incorporation of domain knowledge from publicly available biological databases can result in marked increases in sensitivity and performance of the ATHENA algorithm for detecting and modelling gene-gene interactions that influence a complex human trait.</p

Models of care in palliative medicine

© 2014 Springer-Verlag Berlin Heidelberg. All rights reserved. In resource-rich countries, chronic complex diseases have largely replaced acute causes of disability and death. There is now a need for every clinician to be able to take a palliative approach. This is defined as the ability to deal with key elements of clinical care for someone who has a progressive illness that is likely to lead to death and their caregivers. The key elements of a palliative approach are access; collaborative interdisciplinary team-based care; defining the goals of care; evaluating the net effect of any treatments or interventions addressing, where relevant, issues of withholding and withdrawing treatment; determining preferred place of care and, separately, the preferred place at the time of death; and managing care transitions. For patients, there is evidence of improved symptom control, better met needs, better satisfaction with care and better quality of dying and improved comfort in the last 2 weeks of life. Having relinquished their roles, caregivers for people at the end of life who have used specialist palliative care services had better long-term survival and were better able to adjust to their changed circumstances. Specialist palliative care services are also associated with better met caregiver needs, improved satisfaction with care and less caregiver anxiety. For health systems, benefits include reduced inpatient stays, fewer presentations to the emergency department and reduced overall costs. Patient-defined areas of importance include the ability to carry out one's affairs as the end-of-life approaches, resolving relationship issues and being involved in decision-making. Specialist supportive and palliative care has services which are charged with providing team-based clinical care to people with the most complex end-of-life care needs and their families, as well as and consultative support for colleagues providing care where the patient or family have less complex needs. Ensuring all people have access to best palliative care is dependent upon an on going committment to ensuring that: There is adequate education at an undergraduate, postgraduate and post-registration level; and high-quality research that continues to refine the evidence base for clinical care that is offered; and health services are structured to optimally deliver these services