Why Primary Care Practices Should Become Digital Health Information Hubs for their Patients

Background: Two interesting health care trends are currently occurring: 1) patient-facing technologies, such as personal health records, patient portals, and mobile health apps, are being adopted at rapid rates, and 2) primary care, which includes family practice, is being promoted as essential to reducing health care costs and improving health care outcomes. While these trends are notable and commendable, both remain subject to significant fragmentation and incentive misalignments, which has resulted in significant data coordination and value generation challenges. In particular, patient-facing technologies designed to increase care coordination, often fall prey to the very digital fragmentation issues they are supposed to overcome. Additionally, primary care providers are treating patients that may have considerable health information histories, but generating a single view of such multi-source data is nearly impossible. Discussion: We contribute to this debate by proposing that primary care practices become digital health information hubs for their patients. Such hubs would offer health data coordination in a medically professional setting with the benefits of expert, trustworthy advice coupled with active patient engagement. We acknowledge challenges including: costs, information quality and provenance, willingness-to-share information and records, willingness-to-use (by both providers and patients), primary care scope creep, and determinations of technical and process effectiveness. Even with such potential challenges, we strongly believe that more debate is needed on this topic prior to full implementation of various health information technology incentives and reform programs currently being designed and enacted throughout the world. Ultimately, if we do not provide a meaningful way for the full spectrum of health information to be used by both providers and patients, especially early in the health care continuum, effectively improving health outcomes may remain elusive. Summary: We view the primary care practice as a central component of digital information coordination, especially when considering the current challenges of digital health information fragmentation. Given these fragmentation issues and the emphasis on primary care as central to improving health and lower overall health care costs, we suggest that primary care practices should embrace their evolving role and should seek to become digital health information hubs for their patients

Randomised placebo-controlled cross-over study examining the role of anamorelin in mesothelioma (The ANTHEM study): Rationale and protocol

Introduction Cachexia is common in malignant mesothelioma (MM); half of patients have malnutrition and low skeletal muscle mass. Malnourished patients have worse quality of life (QoL). Weight loss is strongly associated with poor survival. Anamorelin is an oral ghrelin receptor agonist that improves appetite, body weight and QoL in advanced cancer. The aim of this study is to examine the efficacy of anamorelin in improving appendicular skeletal muscle mass (ASM) and patient-reported outcomes in patients with MM with cachexia. Methods and analysis A single-centre, phase II, randomised, placebo-controlled cross-over pilot study with 28-day treatment periods and 3-day washout. Forty patients will be randomised. Primary outcome is change in ASM relative to height measured by dual energy X-ray absorptiometry at end of period 1. Secondary outcomes include cancer-specific and cachexia-related QoL, objective physical activity, dietary intake and adverse events. Eligible patients will have confirmed MM, Eastern Cooperative Oncology Group 0-2, expected survival \u3e 3 months and cachexia (defined as \u3e 5% weight loss in 6 months or body mass index \u3c 20 kg/m 2 with weight loss \u3e2%). Ethics and dissemination Ethical approval has been granted. Results will be reported in peer-reviewed publications. Trial registration number Australian New Zealand Clinical Trials Registry (U1111-1240-6828). © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ

Stan obecny w rozpoznawaniu i leczeniu złożonych przetok odbytniczych (CPF) w chorobie Leśniowskiego-Crohna (CD) w Polsce — na podstawie badania pt. „Schematy postępowania terapeutycznego u pacjentów ze złożonymi przetokami w przebiegu choroby Leśniowskie

WSTĘP: Złożona przetoka odbytu (CPF) jest chorobą stanowiącą poważne wyzwanie zarówno terapeutyczne, jak i społeczne z perspektywy pacjentów oraz ich rodzin. Głównym problemem jest konieczność zapewnienia chorym dostępu do skoordynowanej opieki, w której kluczową rolę odgrywa współpraca gastroenterologów oraz chirurgów, między innymi ze względu na wysoki odsetek niepowodzeń leczenia standardowego, prowadzącego do konieczności zastosowania rozwiązań chirurgicznych. Celem badania było uzyskanie informacji na temat obecnej praktyki postępowania z CPF w Polsce i zidentyfikowanie zwyczajów terapeutycznych lekarzy zajmujących się leczeniem chorych z CPF. MATERIAŁ I METODY: Badanie przeprowadzono od lutego do kwietnia 2018 roku i składało się z dwóch części: bezpośrednich wywiadów z lekarzami (30 gastroenterologów i 15 chirurgów) oraz analizy dokumentacji medycznej 75 pacjentów z CPF, którzy nie odpowiedzieli na standardowe leczenie, przy czym od momentu wprowadzenia kolejnego rzutu leczenia po niepowodzeniu terapii standardowej minął przynajmniej rok, ale nie więcej niż 5 lat. WYNIKI: Nie zidentyfikowano jednego, ustandaryzowanego schematu postępowania. Leczenie pacjentów z CPF, a także rola leczenia chirurgicznego różni się w zależności od wielkości i doświadczenia ośrodka medycznego. Przeprowadzona analiza dokumentacji medycznej dotyczącej 75 pacjentów pokazała, że u 41% chorych zastosowano wyłącznie leczenie farmakologiczne, natomiast u 59% leczenie farmakologiczne i chirurgiczne. Czas leczenia farmakologicznego od początku terapii do decyzji o zastosowaniu kolejnej linii leczenia w grupie łącznej wynosił średnio 12,3 miesiąca. W przypadku pacjentów leczonych chirurgicznie, średni czas od rozpoczęcia farmakologicznego leczenia CPF do decyzji o leczeniu chirurgicznym, wynosił 10–18 tygodni. WNIOSKI: Obecnie w Polsce brakuje ujednoliconego algorytmu postępowania u chorych z CPF oraz szeroko stosowanego standardu skoordynowanej opieki nad tymi chorymi. Widoczna jest pilna potrzeba wypracowania nowego paradygmatu terapeutycznego skupiającego się na zapewnieniu kompleksowej opieki chorym oraz wzmocnieniu w tym aspekcie znaczenia współpracy pomiędzy gastroenterologami oraz chirurgami

COVID 19:Seroprevalence and vaccine responses in UK dental care professionals

Dental care professionals (DCPs) are thought to be at enhanced risk of occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, robust data to support this from large-scale seroepidemiological studies are lacking. We report a longitudinal seroprevalence analysis of antibodies to SARS-CoV-2 spike glycoprotein, with baseline sampling prior to large-scale practice reopening in July 2020 and follow-up postimplementation of new public health guidance on infection prevention control (IPC) and enhanced personal protective equipment (PPE). In total, 1,507 West Midlands DCPs were recruited into this study in June 2020. Baseline seroprevalence was determined using a combined IgGAM enzyme-linked immunosorbent assay and the cohort followed longitudinally for 6 mo until January/February 2021 through the second wave of the coronavirus disease 2019 pandemic in the United Kingdom and vaccination commencement. Baseline seroprevalence was 16.3%, compared to estimates in the regional population of 6% to 7%. Seropositivity was retained in over 70% of participants at 3- and 6-mo follow-up and conferred a 75% reduced risk of infection. Nonwhite ethnicity and living in areas of greater deprivation were associated with increased baseline seroprevalence. During follow-up, no polymerase chain reaction–proven infections occurred in individuals with a baseline anti–SARS-CoV-2 IgG level greater than 147.6 IU/ml with respect to the World Health Organization international standard 20-136. After vaccination, antibody responses were more rapid and of higher magnitude in those individuals who were seropositive at baseline. Natural infection with SARS-CoV-2 prior to enhanced PPE was significantly higher in DCPs than the regional population. Natural infection leads to a serological response that remains detectable in over 70% of individuals 6 mo after initial sampling and 9 mo from the peak of the first wave of the pandemic. This response is associated with protection from future infection. Even if serological responses wane, a single dose of the Pfizer-BioNTech 162b vaccine is associated with an antibody response indicative of immunological memory

A novel isolator-based system promotes viability of human embryos during laboratory processing

In vitro fertilisation (IVF) and related technologies are arguably the most challenging of all cell culture applications. The starting material is a single cell from which one aims to produce an embryo capable of establishing a pregnancy eventually leading to a live birth. Laboratory processing during IVF treatment requires open manipulations of gametes and embryos, which typically involves exposure to ambient conditions. To reduce the risk of cellular stress, we have developed a totally enclosed system of interlinked isolator-based workstations designed to maintain oocytes and embryos in a physiological environment throughout the IVF process. Comparison of clinical and laboratory data before and after the introduction of the new system revealed that significantly more embryos developed to the blastocyst stage in the enclosed isolator-based system compared with conventional open-fronted laminar flow hoods. Moreover, blastocysts produced in the isolator-based system contained significantly more cells and their development was accelerated. Consistent with this, the introduction of the enclosed system was accompanied by a significant increase in the clinical pregnancy rate and in the proportion of embryos implanting following transfer to the uterus. The data indicate that protection from ambient conditions promotes improved development of human embryos. Importantly, we found that it was entirely feasible to conduct all IVF-related procedures in the isolator-based workstations

VERTEX: A Compendium of Research and Design

From the foreword: Vertex was organized to showcase some of the UNLV School of Architecture’s most prominent areas of strength. Our multidisciplinary design foundation program is the initial building block that instills in students an ethos of systematic inquiry through making. Appropriately structured processes of experimentation and production using a variety of tools and media help students develop significant spatial understandings through the sequential act of drawing and making. The spatial understandings developed in the design foundation, supplemented by a culture of inquiry through making that is cultivated in our design studios, prepare our students to creatively engage in a rigorous study of relevant disciplinary subjects that range from the design of arid environments to hospitality, and from building technologies (including design-build) to healthcare interior design. Note: The written sections of the book are featured in Digital Scholarship@UNLV. The complete volume may be purchased at the Buy this book link abovehttps://digitalscholarship.unlv.edu/vertex/1000/thumbnail.jp

The prescription and monitoring of conventional synthetic disease-modifying anti-rheumatic drugs:British Society for Rheumatology guideline scope

This guideline will provide up-to-date, evidence-based recommendations on the safe use of non-biologic DMARDs, also called conventional synthetic DMARDs (csDMARD), across the full spectrum of autoimmune rheumatic diseases. The guideline will update the guideline published in 2017 and will be expanded to include people of all ages. Updated information on the monitoring of DMARDs and vaccinations will be included. The guideline will be developed using the methods and processes described in the British Society for Rheumatology’s ‘Creating clinical guidelines: our protocol’, updated 2023

Measuring the predictability of life outcomes with a scientific mass collaboration.

How predictable are life trajectories? We investigated this question with a scientific mass collaboration using the common task method; 160 teams built predictive models for six life outcomes using data from the Fragile Families and Child Wellbeing Study, a high-quality birth cohort study. Despite using a rich dataset and applying machine-learning methods optimized for prediction, the best predictions were not very accurate and were only slightly better than those from a simple benchmark model. Within each outcome, prediction error was strongly associated with the family being predicted and weakly associated with the technique used to generate the prediction. Overall, these results suggest practical limits to the predictability of life outcomes in some settings and illustrate the value of mass collaborations in the social sciences