1,002 research outputs found
Health intelligence: Discovering the process model using process mining by constructing Start-to-End patient journeys
Archived with the publisher's permission. Copyright © 2014, Australian Computer Society, Inc.
This paper appeared at the Australasian Workshop on
Health Informatics and Knowledge Management (HIKM
2014), Auckland, New Zealand. Conferences in Research
and Practice in Information Technology (CRPIT), Vol.
153. J. Warren and K. Gray, Eds. Reproduction for
academic, not-for profit purposes permitted provided this
text is included.Australian Public Hospitals are continually engaged in
various process improvement activities to improve patient
care and to improve hospital efficiency as the demand for
service intensifies. As a consequence there are many
initiatives within the health sector focusing on gaining
insight into the underlying health processes which are
assessed for compliance with specified Key Performance
Indicators (KPIs). Process Mining is classified as a
Business Intelligence (BI) tool. The aim of process
mining activities is to gain insight into the underlying
process or processes. The fundamental element needed
for process mining is a historical event log of a process.
Generally, these event logs are easily sourced from
Process Aware Information Systems (PAIS). Simulation
is widely used by hospitals as a tool to study the complex
hospital setting and for prediction. Generally, simulation
models are constructed by ‘hand’. This paper presents a
novel way of deriving event logs for health data in the
absence of PAIS. The constructed event log is then used
as an input for process mining activities taking advantage
of existing process mining algorithms aiding the
discovery of knowledge of the underlying processes
which leads to Health Intelligence (HI). One such output
of process mining activity, presented in this paper, is the
discovery of process model for simulation using the
derived event log as an input for process mining by
constructing start-to-end patient journey. The study was
undertaken using data from Flinders Medical Centre to
gain insight into patient journeys from the point of
admission to the Emergency Department (ED) until the
patient is discharged from the hospital.
Gaining insight from patient journey data using process-oriented analysis approach
Hospitals are continually struggling to cater for the increasing demand for inpatient services. This is due to increased population, aging, and the rising incidence of chronic diseases associated with modern life. The high demand for hospital services leads to unpredictable bed availability, longer waiting period for acute admission, difficulties in keeping planned admission, stressed hospital staff, undesirable patient and family experience, as well as unclear long term impact on health care capacity. This study aims to derive some correlation between various factors contributing to ward occupancy rate and operation efficiency. The aim is also to discover the inpatient flow process model proposing to use process mining techniques combined with data analysis to depict the relationships among inpatients, wards and Length of Stay (LOS) in an effort to gain insight into factors that could be focused to relieve access block. Open source process mining software - ProM is used for this study. The study is done in collaboration with Flinders Medical Centre (FMC) using data from their Patient Journey Database as case study
Analysing homogenous patient journeys to assess quality of care for patients admitted outside of their ‘home-ward’
This study is the first to explore the quality of care based on the outlier or the inlier status of patients for a large heterogeneous General Medicine (GM) service at a busy public hospital. The study compared the quality of care between ward outliers and ward inliers based on a homogenous group of patients using Two-step clustering method. Contrary to common perception, ward outliers had overall shorter Length of Stay (LOS) than ward inliers. The study also was unable to support the perception of shorter LOS in the outlier group being associated with higher in-hospital mortality. The study confirmed that overall the outliers received inferior quality of care as discharge summaries for the outliers were delayed and more outliers were re-admitted within 7 days of discharge in comparison to the inliers
Economic evaluation of an extended nutritional intervention in older Australian hospitalized patients: a randomized controlled trial
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBackground
Prevalence of malnutrition in older hospitalized patients is 30%. Malnutrition is associated with poor clinical outcomes in terms of high morbidity and mortality and is costly for hospitals. Extended nutrition interventions improve clinical outcomes but limited studies have investigated whether these interventions are cost-effective.
Methods
In this randomized controlled trial, 148 malnourished general medical patients ≥60 years were recruited and randomized to receive either an extended nutritional intervention or usual care. Nutrition intervention was individualized and started with 24 h of admission and was continued for 3 months post-discharge with a monthly telephone call whereas control patients received usual care. Nutrition status was confirmed by Patient generated subjective global assessment (PG-SGA) and health-related quality of life (HRQoL) was measured using EuroQoL 5D (EQ-5D-5 L) questionnaire at admission and at 3-months follow-up. A cost-effectiveness analysis was conducted for the primary outcome (incremental costs per unit improvement in PG-SGA) while a cost-utility analysis (CUA) was undertaken for the secondary outcome (incremental costs per quality adjusted life year (QALY) gained).
Results
Nutrition status and HRQoL improved in intervention patients. Mean per included patient Australian Medicare costs were lower in intervention group compared to control arm (by 2956 to 13,882 versus 838 versus 1000 per unit improvement in PG-SGA was > 98% while it was 78% at a willingness to pay $50,000 per QALY gained.
Conclusion
This health economic analysis suggests that the use of extended nutritional intervention in older general medical patients is likely to be cost-effective in the Australian health care setting in terms of both primary and secondary outcomes
Angle-Resolved Photoelectron Spectroscopy and Scanning Tunnelling Spectroscopy Studies of the Endohedral Fullerene Li@C60
M. S., E. B., J. O. F. T. and E. E. B. C. gratefully acknowledge financial support from the Leverhulme Foundation (RPF-298 “PES of hollow nanomaterials”). M. S. and H. J. C. acknowledge the financial support of EPSRC DTP studentships (EP/M508214/1 and EP/N509644/1). R. S. acknowledges financial support from the Scottish Funding Council through SRD-Grant (HRO7003). The work of FR and BM is supported by the Fonds de la Recherche Fondamentale Collective (#T.0132.16 and J.0012.18) and by the U.S. Department of Energy (DOE), Office of Science, Basic Energy Sciences (BES) under Award # DE-SC0012628. BM and FR thank the Fonds National de la Recherche (FRS.FNRS, Belgium) for its support. Computational resources were provided by Consortium des équipements de calcul intensif (CECI, FNRS 2.5020.11).Gas phase photoelectron spectroscopy (Rydberg Fingerprint Spectroscopy), TDDFT calculations and low temperature STM studies are combined to provide detailed information on the properties of the diffuse, low-lying Rydberg-like SAMO states of isolated Li@C60 endohedral fullerenes. The presence of the encapsulated Li is shown by the calculations to produce a significant distortion of the lowest-lying S- and P-SAMOs that is dependent on the position of the Li inside the fullerene cage. Under the high temperature conditions of the gas phase experiments, the Li is mobile and able to access different positions within the cage. This is accounted for in the comparison with theory that shows a very good agreement of the photoelectron angular distributions, allowing the symmetry of the observed SAMO states to be identified. When adsorbed on a metal substrate at low temperature, a strong interaction between the low-lying SAMOs and the metal substrate moves these states to energies much closer to the Fermi energy compared to the situation for empty C60 while the Li remains frozen in an off-centre position.Publisher PDFPeer reviewe
Opposing effects of rheumatoid arthritis and low dose prednisolone on arginine metabolomics
This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (Oct 2017) in accordance with the publisher’s archiving policyBackground and aims
The effects of low dose prednisolone on circulating markers of endothelial function, the arginine metabolites asymmetric dimethyl arginine (ADMA), mono methyl arginine (MMA), and homoarginine, are uncertain. We assessed whether patients with rheumatoid arthritis have perturbations in arginine metabolite concentrations that are reversed by low dose prednisolone.
Methods
Eighteen rheumatoid arthritis patients who had not taken prednisolone for >6 months (non-glucocorticoid (GC) users), 18 rheumatoid arthritis patients taking continuous oral prednisolone (6.5 ± 1.8 mg/day) for >6 months (GC users) and 20 healthy controls were studied. Fasting plasma concentrations of ADMA, MMA, and homoarginine were measured by ultra-performance liquid-chromatography. Baseline data from non-GC users were compared with healthy controls to assess the effect of rheumatoid arthritis. The change in arginine metabolites in non-GC users after 7 days of prednisolone (6 mg/day) was used to assess the acute effects of prednisolone. Baseline data from non-GC users were compared with GC users to assess the chronic effects of prednisolone.
Results
Non-GC users had higher ADMA (0.59 ± 0.03 vs. 0.47 ± 0.01 μM, p = 0.004) and MMA concentrations (0.10 ± 0.01 vs. 0.05 ± 0.00 μM, p < 0.001) than controls. The only change with acute prednisolone was a reduction in homoarginine (1.23 ± 0.06 vs. 1.08 ± 0.06 μM, p = 0.04) versus baseline. GC users had lower concentrations of ADMA (0.51 ± 0.02 vs. 0.59 ± 0.03 μM, p = 0.03) than non-GC users.
Conclusions
Rheumatoid arthritis patients have higher concentrations of ADMA and MMA, inhibitors of endothelial function. Chronic, but not acute, prednisolone therapy is associated with a lower ADMA concentration, suggesting a salutary effect of long-term glucocorticoid treatment on endothelial function
Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial
© Cuzick et al. Open Access article distributed under the terms of CC BY.http://dx.doi.org/10.1016/S1470-2045(14)71171-
Hundreds of variants clustered in genomic loci and biological pathways affect human height
Most common human traits and diseases have a polygenic pattern of inheritance: DNA sequence variants at many genetic loci influence the phenotype. Genome-wide association (GWA) studies have identified more than 600 variants associated with human traits, but these typically explain small fractions of phenotypic variation, raising questions about the use of further studies. Here, using 183,727 individuals, we show that hundreds of genetic variants, in at least 180 loci, influence adult height, a highly heritable and classic polygenic trait. The large number of loci reveals patterns with important implications for genetic studies of common human diseases and traits. First, the 180 loci are not random, but instead are enriched for genes that are connected in biological pathways (P = 0.016) and that underlie skeletal growth defects (P < 0.001). Second, the likely causal gene is often located near the most strongly associated variant: in 13 of 21 loci containing a known skeletal growth gene, that gene was closest to the associated variant. Third, at least 19 loci have multiple independently associated variants, suggesting that allelic heterogeneity is a frequent feature of polygenic traits, that comprehensive explorations of already-discovered loci should discover additional variants and that an appreciable fraction of associated loci may have been identified. Fourth, associated variants are enriched for likely functional effects on genes, being over-represented among variants that alter amino-acid structure of proteins and expression levels of nearby genes. Our data explain approximately 10% of the phenotypic variation in height, and we estimate that unidentified common variants of similar effect sizes would increase this figure to approximately 16% of phenotypic variation (approximately 20% of heritable variation). Although additional approaches are needed to dissect the genetic architecture of polygenic human traits fully, our findings indicate that GWA studies can identify large numbers of loci that implicate biologically relevant genes and pathways.
Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial
Background
Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy
- …