WorldWideScience

Sample records for network ctn001-002 patients

  1. Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network

    Directory of Open Access Journals (Sweden)

    Bruce Burchett

    2010-12-01

    Full Text Available Li-Tzy Wu1,2, Walter Ling3, Bruce Burchett1, Dan G Blazer1,2, Jack Shostak2, George E Woody41Department of Psychiatry and Behavioral Sciences, School of Medicine, 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; 3David Geffen School of Medicine, NPI/Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA; 4Department of Psychiatry, School of Medicine, University of Pennsylvania and Treatment Research Institute, Philadelphia, PA, USAPurpose: Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study examined clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation.Methods: The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002. Patients were recruited from 12 addiction treatment programs across the nation. Gender and racial/ethnic differences in addiction severity, human immunodeficiency virus (HIV risk, and quality of life were examined.Results: Women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems and report poorer health-related quality of life and functioning. Whites and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were

  2. Social networking among upper extremity patients.

    Science.gov (United States)

    Rozental, Tamara D; George, Tina M; Chacko, Aron T

    2010-05-01

    Despite their rising popularity, the health care profession has been slow to embrace social networking sites. These are Web-based initiatives, designed to bring people with common interests or activities under a common umbrella. The purpose of this study is to evaluate social networking patterns among upper extremity patients. A total of 742 anonymous questionnaires were distributed among upper extremity outpatients, with a 62% response rate (462 were completed). Demographic characteristics (gender, age, level of education, employment, type of health insurance, and income stratification) were defined, and data on computer ownership and frequency of social networking use were collected. Social network users and nonusers were compared according to their demographic and socioeconomic characteristics. Our patient cohort consisted of 450 patients. Of those 450 patients, 418 had a high school education or higher, and 293 reported a college or graduate degree. The majority of patients (282) were employed at the time of the survey, and income was evenly distributed among U.S. Census Bureau quintiles. A total of 349 patients reported computer ownership, and 170 reported using social networking sites. When compared to nonusers, social networking users were younger (pnetworking use. Most users (n = 114) regularly visit a single site. Facebook was the most popular site visited (n=142), followed by MySpace (n=28) and Twitter (n=16). Of the 450 upper extremity patients in our sample, 170 use social networking sites. Younger age, higher level of education, and computer ownership were associated with social networking use. Physicians should consider expanding their use of social networking sites to reach their online patient populations. Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Architecture for networked electronic patient record systems.

    Science.gov (United States)

    Takeda, H; Matsumura, Y; Kuwata, S; Nakano, H; Sakamoto, N; Yamamoto, R

    2000-11-01

    There have been two major approaches to the development of networked electronic patient record (EPR) architecture. One uses object-oriented methodologies for constructing the model, which include the GEHR project, Synapses, HL7 RIM and so on. The second approach uses document-oriented methodologies, as applied in examples of HL7 PRA. It is practically beneficial to take the advantages of both approaches and to add solution technologies for network security such as PKI. In recognition of the similarity with electronic commerce, a certificate authority as a trusted third party will be organised for establishing networked EPR system. This paper describes a Japanese functional model that has been developed, and proposes a document-object-oriented architecture, which is-compared with other existing models.

  4. Impairment of attention networks in patients with untreated hyperthyroidism.

    Science.gov (United States)

    Yuan, Lili; Tian, Yanghua; Zhang, Fangfang; Dai, Fang; Luo, Li; Fan, Jin; Wang, Kai

    2014-06-27

    Attention disorders are common symptoms in patients with untreated hyperthyroidism. Nevertheless, it is unknown whether they represent a global attention deficit or selective impairment of attention networks. Thirty-seven patients with hyperthyroidism were recruited and underwent the Attention Network Test (ANT), which provided measures of three independent attention networks (alerting, orienting and executive control), before being treated with methimazole. This study demonstrated that patients with untreated hyperthyroidism had significant deficits in the alerting and executive control networks. Interestingly, a significant positive association was also found between T4 level and the value of the executive network in patients with hyperthyroidism. These results suggest that the patients with hyperthyroidism may not just exist a specific impairment of attention networks, and there was some relationship between the level of T4, not T3 or TSH, and the value of the executive control network in patients with hyperthyroidism. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Online Social Networks - Opportunities for Empowering Cancer Patients.

    Science.gov (United States)

    Mohammadzadeh, Zeinab; Davoodi, Somayeh; Ghazisaeidi, Marjan

    2016-01-01

    Online social network technologies have become important to health and apply in most health care areas. Particularly in cancer care, because it is a disease which involves many social aspects, online social networks can be very useful. Use of online social networks provides a suitable platform for cancer patients and families to present and share information about their medical conditions, address their educational needs, support decision making, and help to coping with their disease and improve their own outcomes. Like any other new technologies, online social networks, along with many benefits, have some negative effects such as violation of privacy and publication of incorrect information. However, if these effects are managed properly, they can empower patients to manage cancer through changing behavioral patterns and enhancing the quality of cancer patients lives This paper explains some application of online social networks in the cancer patient care process. It also covers advantages and disadvantages of related technologies.

  6. Social networks of patients with psychosis: a systematic review.

    Science.gov (United States)

    Palumbo, Claudia; Volpe, Umberto; Matanov, Aleksandra; Priebe, Stefan; Giacco, Domenico

    2015-10-12

    Social networks are important for mental health outcomes as they can mobilise resources and help individuals to cope with social stressors. Individuals with psychosis may have specific difficulties in establishing and maintaining social relationships which impacts on their well-being and quality of life. There has been a growing interest in developing social network interventions for patients with psychotic disorders. A systematic literature review was conducted to investigate the size of social networks of patients with psychotic disorders, as well as their friendship networks. A systematic electronic search was carried out in MEDLINE, EMBASE and PsychINFO databases using a combination of search terms relating to 'social network', 'friendship' and 'psychotic disorder'. The search identified 23 relevant papers. Out of them, 20 reported patient social network size. Four papers reported the mean number of friends in addition to whole network size, while three further papers focused exclusively on the number of friends. Findings varied substantially across the studies, with a weighted mean size of 11.7 individuals for whole social networks and 3.4 individuals for friendship networks. On average, 43.1 % of the whole social network was composed of family members, while friends accounted for 26.5 %. Studies assessing whole social network size and friendship networks of people with psychosis are difficult to compare as different concepts and methods of assessment were applied. The extent of the overlap between different social roles assessed in the networks was not always clear. Greater conceptual and methodological clarity is needed in order to help the development of effective strategies to increase social resources of patients with psychosis.

  7. Social network in patient safety: Social media visibility

    Directory of Open Access Journals (Sweden)

    Azucena Santillán García

    2011-11-01

    Full Text Available Internet social network (social media is a powerful communication tool, and its use is expanding significantly. This paper seeks to know the current state of visibility in online social networks of active citizen talking about patient safety. This is an observational cross-sectional study whose target population is the websites Facebook, Twitter and Tuenti in Spain. By three consecutive cuts social profiles were found using the searching terms “seguridad+paciente” and “safety+patient”. There were found 5 profiles on Facebook that met the search criteria, 6 on Twitter and none were found on Tuenti. It is concluded that although there is evidence of the rise of social networking, citizen network involved in patient safety appears not to be significantly represented within the social networks examined.

  8. Patient informed governance of distributed research networks: results and discussion from six patient focus groups.

    Science.gov (United States)

    Mamo, Laura A; Browe, Dennis K; Logan, Holly C; Kim, Katherine K

    2013-01-01

    Understanding how to govern emerging distributed research networks is essential to their success. Distributed research networks aggregate patient medical data from many institutions leaving data within the local provider security system. While much is known about patients' views on secondary medical research, little is known about their views on governance of research networks. We conducted six focus groups with patients from three medical centers across the U.S. to understand their perspectives on privacy, consent, and ethical concerns of sharing their data as part of research networks. Participants positively endorsed sharing their health data with these networks believing that doing so could advance healthcare knowledge. However, patients expressed several concerns regarding security and broader ethical issues such as commercialism, public benefit, and social responsibility. We suggest that network governance guidelines move beyond strict technical requirements and address wider socio-ethical concerns by fully including patients in governance processes.

  9. Factors affecting the cerebral network in brain tumor patients.

    Science.gov (United States)

    Heimans, Jan J; Reijneveld, Jaap C

    2012-06-01

    Brain functions, including cognitive functions, are frequently disturbed in brain tumor patients. These disturbances may result from the tumor itself, but also from the treatment directed against the tumor. Surgery, radiotherapy and chemotherapy all may affect cerebral functioning, both in a positive as well as in a negative way. Apart from the anti-tumor treatment, glioma patients often receive glucocorticoids and anti-epileptic drugs, which both also have influence on brain functioning. The effect of a brain tumor on cerebral functioning is often more global than should be expected on the basis of the local character of the disease, and this is thought to be a consequence of disturbance of the cerebral network as a whole. Any network, whether it be a neural, a social or an electronic network, can be described in parameters assessing the topological characteristics of that particular network. Repeated assessment of neural network characteristics in brain tumor patients during their disease course enables study of the dynamics of neural networks and provides more insight into the plasticity of the diseased brain. Functional MRI, electroencephalography and especially magnetoencephalography are used to measure brain function and the signals that are being registered with these techniques can be analyzed with respect to network characteristics such as "synchronization" and "clustering". Evidence accumulates that loss of optimal neural network architecture negatively impacts complex cerebral functioning and also decreases the threshold to develop epileptic seizures. Future research should be focused on both plasticity of neural networks and the factors that have impact on that plasticity as well as the possible role of assessment of neural network characteristics in the determination of cerebral function during the disease course.

  10. Queueing network model for obstetric patient flow in a hospital.

    Science.gov (United States)

    Takagi, Hideaki; Kanai, Yuta; Misue, Kazuo

    2016-03-03

    A queueing network is used to model the flow of patients in a hospital using the observed admission rate of patients and the histogram for the length of stay for patients in each ward. A complete log of orders for every movement of all patients from room to room covering two years was provided to us by the Medical Information Department of the University of Tsukuba Hospital in Japan. We focused on obstetric patients, who are generally hospitalized at random times throughout the year, and we analyzed the patient flow probabilistically. On admission, each obstetric patient is assigned to a bed in one of the two wards: one for normal delivery and the other for high-risk delivery. Then, the patient may be transferred between the two wards before discharge. We confirm Little's law of queueing theory for the patient flow in each ward. Next, we propose a new network model of M/G/ ∞ and M/M/ m queues to represent the flow of these patients, which is used to predict the probability distribution for the number of patients staying in each ward at the nightly census time. Although our model is a very rough and simplistic approximation of the real patient flow, the predicted probability distribution shows good agreement with the observed data. The proposed method can be used for capacity planning of hospital wards to predict future patient load in each ward.

  11. Wireless sensor networks for monitoring physiological signals of multiple patients.

    Science.gov (United States)

    Dilmaghani, R S; Bobarshad, H; Ghavami, M; Choobkar, S; Wolfe, C

    2011-08-01

    This paper presents the design of a novel wireless sensor network structure to monitor patients with chronic diseases in their own homes through a remote monitoring system of physiological signals. Currently, most of the monitoring systems send patients' data to a hospital with the aid of personal computers (PC) located in the patients' home. Here, we present a new design which eliminates the need for a PC. The proposed remote monitoring system is a wireless sensor network with the nodes of the network installed in the patients' homes. These nodes are then connected to a central node located at a hospital through an Internet connection. The nodes of the proposed wireless sensor network are created by using a combination of ECG sensors, MSP430 microcontrollers, a CC2500 low-power wireless radio, and a network protocol called the SimpliciTI protocol. ECG signals are first sampled by a small portable device which each patient carries. The captured signals are then wirelessly transmitted to an access point located within the patients' home. This connectivity is based on wireless data transmission at 2.4-GHz frequency. The access point is also a small box attached to the Internet through a home asynchronous digital subscriber line router. Afterwards, the data are sent to the hospital via the Internet in real time for analysis and/or storage. The benefits of this remote monitoring are wide ranging: the patients can continue their normal lives, they do not need a PC all of the time, their risk of infection is reduced, costs significantly decrease for the hospital, and clinicians can check data in a short time.

  12. Disrupted Brain Functional Network Architecture in Chronic Tinnitus Patients.

    Science.gov (United States)

    Chen, Yu-Chen; Feng, Yuan; Xu, Jin-Jing; Mao, Cun-Nan; Xia, Wenqing; Ren, Jun; Yin, Xindao

    2016-01-01

    Resting-state functional magnetic resonance imaging (fMRI) studies have demonstrated the disruptions of multiple brain networks in tinnitus patients. Nonetheless, several studies found no differences in network processing between tinnitus patients and healthy controls (HCs). Its neural bases are poorly understood. To identify aberrant brain network architecture involved in chronic tinnitus, we compared the resting-state fMRI (rs-fMRI) patterns of tinnitus patients and HCs. Chronic tinnitus patients (n = 24) with normal hearing thresholds and age-, sex-, education- and hearing threshold-matched HCs (n = 22) participated in the current study and underwent the rs-fMRI scanning. We used degree centrality (DC) to investigate functional connectivity (FC) strength of the whole-brain network and Granger causality to analyze effective connectivity in order to explore directional aspects involved in tinnitus. Compared to HCs, we found significantly increased network centrality in bilateral superior frontal gyrus (SFG). Unidirectionally, the left SFG revealed increased effective connectivity to the left middle orbitofrontal cortex (OFC), left posterior lobe of cerebellum (PLC), left postcentral gyrus, and right middle occipital gyrus (MOG) while the right SFG exhibited enhanced effective connectivity to the right supplementary motor area (SMA). In addition, the effective connectivity from the bilateral SFG to the OFC and SMA showed positive correlations with tinnitus distress. Rs-fMRI provides a new and novel method for identifying aberrant brain network architecture. Chronic tinnitus patients have disrupted FC strength and causal connectivity mostly in non-auditory regions, especially the prefrontal cortex (PFC). The current findings will provide a new perspective for understanding the neuropathophysiological mechanisms in chronic tinnitus.

  13. Social network of family caregivers of disabled and dependent patients

    Directory of Open Access Journals (Sweden)

    Cintia Hitomi Yamashita

    2014-08-01

    Full Text Available Cross-sectional study that used the Social Network Index and the genogram to assess the social network of 110 family caregivers of dependent patients attended by a Home Care Service in São Paulo, Brazil. Data were analyzed using the test U of Mann-Whitney, Kruskal-Wallis and Spearman correlation. Results were considered statistically significant when p<0,05. Few caregivers participated in activities outside the home and the average number of people they had a bond was 4,4 relatives and 3,6 friends. Caregivers who reported pain and those who had a partner had higher average number of relatives who to trust. The average number of friends was higher in the group that reported use of medication for depression. Total and per capita incomes correlated with the social network. It was found that family members are the primary caregiver’s social network.

  14. MobiHealth: Ambulant Patient Monitoring Over Public Wireless Networks

    NARCIS (Netherlands)

    Konstantas, D.; van Halteren, Aart; Bults, Richard G.A.; Wac, K.E.; Jones, Valerie M.; Widya, I.A.; Herzog, Rainer

    2004-01-01

    The use of health BANs together with advanced wireless communications enables remote management of chronic conditions and detection of health emergencies whilst maximising patient mobility. MobiHealth1,2 has developed a generic Body Area Network (BAN) for healthcare and an m-health service platform.

  15. Altered brain network centrality in depressed Parkinson's disease patients.

    Science.gov (United States)

    Lou, Yuting; Huang, Peiyu; Li, Dan; Cen, Zhidong; Wang, Bo; Gao, Jixiang; Xuan, Min; Yu, Hualiang; Zhang, Minming; Luo, Wei

    2015-11-01

    Depression is a relatively common and serious nonmotor symptom of Parkinson's disease (PD), which reduces the quality of patients' life. Although disturbances in some related brain networks have been reported, the pathophysiology of depression in PD is still unclear. Here, we aim to investigate whole-brain functional connectivity patterns in depressed PD patients. We recruited 17 PD patients diagnosed with major depressive disorder, 17 PD patients without depression, and 17 healthy control subjects. Resting-state functional MRI and eigenvector centrality mapping were used to identify functional connectivity alterations among these groups. Results showed that depressed PD patients had decreased functional connectivity in the left dorsolateral prefrontal cortex and right superior temporal gyrus and increased functional connectivity in the right posterior cingulate cortex, compared to nondepressed patients. In addition, there was a significant negative correlation between functional connectivity and depression scores in the posterior cingulate cortex. This study suggests that functional connectivity changes in certain nodes of brain networks might contribute to depression in patients with PD. © 2015 International Parkinson and Movement Disorder Society.

  16. Patient Health Monitoring Using Wireless Body Area Network

    Directory of Open Access Journals (Sweden)

    Hsu Myat Thwe

    2015-06-01

    Full Text Available Abstract Nowadays remote patient health monitoring using wireless technology plays very vigorous role in a society. Wireless technology helps monitoring of physiological parameters like body temperature heart rate respiration blood pressure and ECG. The main aim of this paper is to propose a wireless sensor network system in which both heart rate and body temperature ofmultiplepatients can monitor on PC at the same time via RF network. The proposed prototype system includes two sensor nodes and receiver node base station. The sensor nodes are able to transmit data to receiver using wireless nRF transceiver module.The nRF transceiver module is used to transfer the data from microcontroller to PC and a graphical user interface GUI is developed to display the measured data and save to database. This system can provide very cheaper easier and quick respondent history of patient.

  17. SPECIFICITY OF COMMUNICATION DOCTOR – PATIENT, ONLINE, THROUGH SOCIAL NETWORKS

    Directory of Open Access Journals (Sweden)

    Florin-Alexandru LUCA

    2014-12-01

    Full Text Available A survey in 2013 of Division Market Research Group Rentrop Straton Romanian-German - "state services and private clinics. Comparative Analysis ", highlights the fact that into urban population in Romania, the internet is the most popular source of information on health services. According to the survey, 81.9% of respondents use the Internet to find out about the best doctors available to them. Preferences of respondents to the online environment as the main source of information translates into ease of access and the possibility of interaction, but also trust recommendations based on personal experiences, recommendations can be found through discussion forums, mostly or comments left on pages on social networking sites. In the present study we try to emphasize the specificity of communication physician - patient online through social networks.

  18. Social Media for Networking, Professional Development, and Patient Engagement.

    Science.gov (United States)

    Markham, Merry Jennifer; Gentile, Danielle; Graham, David L

    2017-01-01

    Social media has become an established method of communication, and many physicians are finding these interactive tools and platforms to be useful for both personal and professional use. Risks of social media, or barriers to its use, include perceived lack of time, privacy concerns, and the risk of damage to one's reputation by unprofessional behavior. Of the social media platforms, Twitter has become favored by physicians and other health care professionals. Although one of the most obvious uses of social media is for rapid dissemination and receipt of information, oncologists are finding that social media is important for networking through blogs, Facebook, and Twitter. These platforms also have potential for providing opportunities for professional development, such as finding collaborators through networking, participation in Twitter journal clubs, and participating in online case-based tumor boards. Social media can also be used for patient engagement, such as through participation in tweet chats. There is emerging data that patient engagement through these platforms may lead to improvement in some health-related outcomes; however, data are sparse for oncology-specific outcomes. Efforts are underway to determine how to assess how social media engagement impacts health outcomes in oncology patients.

  19. Social networking in online support groups for health: how online social networking benefits patients.

    Science.gov (United States)

    Chung, Jae Eun

    2014-01-01

    An increasing number of online support groups (OSGs) have embraced the features of social networking. So far, little is known about how patients use and benefit from these features. By implementing the uses-and-gratifications framework, the author conducted an online survey with current users of OSGs to examine associations among motivation, use of specific features of OSG, and support outcomes. Findings suggest that OSG users make selective use of varied features depending on their needs, and that perceptions of receiving emotional and informational support are associated more with the use of some features than others. For example, those with strong motivation for social interaction use diverse features of OSG and make one-to-one connections with other users by friending. In contrast, those with strong motivation for information seeking limit their use primarily to discussion boards. Results also show that online social networking features, such as friending and sharing of personal stories on blogs, are helpful in satisfying the need for emotional support. The present study sheds light on online social networking features in the context of health-related OSGs and provides practical lessons on how to improve the capacity of OSGs to serve the needs of their users.

  20. Socioeconomic analysis of patient-centric networks: effects of patients and hospitals' characteristics and network structure on hospitalization costs.

    Science.gov (United States)

    Abbasi, Alireza; Uddin, Shahadat; Hossain, Liaquat

    2012-06-01

    Improving operations and delivery of cost-effective healthcare services is considered to be an important area of investigation due to the challenges in allocation of resources in meeting the increasing cost of health care for the twenty-first century. To date, appropriate mechanisms for systematic evaluation of hospital operations and its impact of the delivery of cost-effective healthcare services are lacking. This is, perhaps, the first study, which focuses on using large insurance claims data to develop a social network-based model for exploring the effect of patient-doctor tie strength and patient socio-demographic factors for exploring the social structure of operations and delivery of cost-effective healthcare services. We suggest that delivery of cost-effective healthcare services and operation is embedded within the social structure of hospitals. By exploring the mode of hospital operations in terms of their patient-centric care network, we are able to develop a better understanding of the operation and delivery of cost-effective healthcare services.

  1. Patient-Centered Network of Learning Health Systems: Developing a resource for clinical translational research.

    Science.gov (United States)

    Finney Rutten, L J; Alexander, A; Embi, P J; Flores, G; Friedman, C; Haller, I V; Haug, P; Jensen, D; Khosla, S; Runger, G; Shah, N D; Winden, T; Roger, V L

    2017-02-01

    The Learning Health System Network clinical data research network includes academic medical centers, health-care systems, public health departments, and health plans, and is designed to facilitate outcomes research, pragmatic trials, comparative effectiveness research, and evaluation of population health interventions. The Learning Health System Network is 1 of 13 clinical data research networks assembled to create, in partnership with 20 patient-powered research networks, a National Patient-Centered Clinical Research Network. Herein, we describe the Learning Health System Network as an emerging resource for translational research, providing details on the governance and organizational structure of the network, the key milestones of the current funding period, and challenges and opportunities for collaborative science leveraging the network.

  2. Neural network adapted to wound cell analysis in surgical patients.

    Science.gov (United States)

    Viljanto, Jouko; Koski, Antti

    2011-01-01

    Assessment of the real state of wound healing of closed surgical wounds is uncertain both clinically and from conventional laboratory tests. Therefore, a novel approach based on early analysis of exactly timed wound cells, computerized further with an artificial neural network, was developed. At the end of routine surgery performed on 481 children under 18 years of age, a specific wound drain Cellstick™ was inserted subcutaneously between the wound edges to harvest wound cells. The Cellsticks™ were removed from 1 to 50 hours, mainly at hour 3 or 24 postsurgery. Immediately, the cellular contents were washed out using a pump constructed for the purpose. After cytocentrifugation, the cells were stained and counted differentially. Based on their relative proportions at selected time intervals, an artificial self-organizing neural map was developed. This was further transformed to a unidirectional linear graph where each node represents one set of relative cell quantities. As early as 3 hours, but more precisely 24 hours after surgery, the location of the nodes on this graph showed individually the patients' initial speed of wound inflammatory cell response. Similarly, timed Cellstick™ specimens from new surgical patients could be analyzed, computerized, and compared with these node values to assess their initial speed in wound inflammatory cell response. Location of the node on the graph does not express the time lapse after surgery but the speed of wound inflammatory cell response in relation to that of other patients. © 2011 by the Wound Healing Society.

  3. Classifying patient portal messages using Convolutional Neural Networks.

    Science.gov (United States)

    Sulieman, Lina; Gilmore, David; French, Christi; Cronin, Robert M; Jackson, Gretchen Purcell; Russell, Matthew; Fabbri, Daniel

    2017-10-01

    Patients communicate with healthcare providers via secure messaging in patient portals. As patient portal adoption increases, growing messaging volumes may overwhelm providers. Prior research has demonstrated promise in automating classification of patient portal messages into communication types to support message triage or answering. This paper examines if using semantic features and word context improves portal message classification. Portal messages were classified into the following categories: informational, medical, social, and logistical. We constructed features from portal messages including bag of words, bag of phrases, graph representations, and word embeddings. We trained one-versus-all random forest and logistic regression classifiers, and convolutional neural network (CNN) with a softmax output. We evaluated each classifier's performance using Area Under the Curve (AUC). Representing the messages using bag of words, the random forest detected informational, medical, social, and logistical communications in patient portal messages with AUCs: 0.803, 0.884, 0.828, and 0.928, respectively. Graph representations of messages outperformed simpler features with AUCs: 0.837, 0.914, 0.846, 0.884 for informational, medical, social, and logistical communication, respectively. Representing words with Word2Vec embeddings, and mapping features using a CNN had the best performance with AUCs: 0.908 for informational, 0.917 for medical, 0.935 for social, and 0.943 for logistical categories. Word2Vec and graph representations improved the accuracy of classifying portal messages compared to features that lacked semantic information such as bag of words, and bag of phrases. Furthermore, using Word2Vec along with a CNN model, which provide a higher order representation, improved the classification of portal messages. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. The role of personal social networks in risk assessment and management of forensic psychiatric patients

    NARCIS (Netherlands)

    Pomp, L.; Spreen, M.; Boegarts, S.; Völker, B.G.M.

    2010-01-01

    Social network factors are usually not accounted for in the clinical practice of risk assessment/management.This article introduces a social network analysis as an instrument to systematically chart the relationships and personal networks of forensic psychiatric patients. During the period 2005 to

  5. Abnormal activity of default mode network in GERD patients

    National Research Council Canada - National Science Library

    Sun, Huihui; Chen, Ying; Zhao, Xiaohu; Wang, Xiangbin; Jiang, Yuanxi; Wu, Ping; Tang, Yinhan; Meng, Qingwei; Xu, Shuchang

    2013-01-01

    ...). However, most studies were focused on the possible functions of perceptual processing related network during task status, little attention has been paid to default mode network, which has been...

  6. The role of personal social networks in risk assessment and management of forensic psychiatric patients

    OpenAIRE

    Pomp, L.; Spreen, M.; Bogaerts, S.; Völkel, B.

    2010-01-01

    Social network factors are usually not accounted for in the clinical practice of risk assessment/management.This article introduces a social network analysis as an instrument to systematically chart the relationships and personal networks of forensic psychiatric patients. During the period 2005 to 2007, the so-called Forensic Social Network Analysis (FSNA) was developed in a Dutch forensic psychiatric hospital. A case study describes the FSNA concepts and shows the benefits of using FSNA as a...

  7. 78 FR 48691 - Food and Drug Administration Patient Network Annual Meeting; Demystifying Food and Drug...

    Science.gov (United States)

    2013-08-09

    ... of: The FDA Patient Network Web site--A new, patient-centered Web site that contains educational... Representatives as Special Government Employees in appropriate Agency meetings with medical product sponsors and...

  8. Assessing Social Networks in Patients with Psychotic Disorders: A Systematic Review of Instruments.

    Science.gov (United States)

    Siette, Joyce; Gulea, Claudia; Priebe, Stefan

    2015-01-01

    Evidence suggests that social networks of patients with psychotic disorders influence symptoms, quality of life and treatment outcomes. It is therefore important to assess social networks for which appropriate and preferably established instruments should be used. To identify instruments assessing social networks in studies of patients with psychotic disorders and explore their properties. A systematic search of electronic databases was conducted to identify studies that used a measure of social networks in patients with psychotic disorders. Eight instruments were identified, all of which had been developed before 1991. They have been used in 65 studies (total N of patients = 8,522). They assess one or more aspects of social networks such as their size, structure, dimensionality and quality. Most instruments have various shortcomings, including questionable inter-rater and test-retest reliability. The assessment of social networks in patients with psychotic disorders is characterized by a variety of approaches which may reflect the complexity of the construct. Further research on social networks in patients with psychotic disorders would benefit from advanced and more precise instruments using comparable definitions of and timescales for social networks across studies.

  9. Social networks enabled coordination model for cost management of patient hospital admissions.

    Science.gov (United States)

    Uddin, Mohammed Shahadat; Hossain, Liaquat

    2011-09-01

    In this study, we introduce a social networks enabled coordination model for exploring the effect of network position of "patient," "physician," and "hospital" actors in a patient-centered care network that evolves during patient hospitalization period on the total cost of coordination. An actor is a node, which represents an entity such as individual and organization in a social network. In our analysis of actor networks and coordination in the healthcare literature, we identified that there is significant gap where a number of promising hospital coordination model have been developed (e.g., Guided Care Model, Chronic Care Model) for the current healthcare system focusing on quality of service and patient satisfaction. The health insurance dataset for total hip replacement (THR) from hospital contribution fund, a prominent Australian Health Insurance Company, are analyzed to examine our proposed coordination model. We consider network attributes of degree, connectedness, in-degree, out-degree, and tie strength to measure network position of actors. To measure the cost of coordination for a particular hospital, average of total hospitalization expenses for all THR hospital admissions is used. Results show that network positions of "patient," "physician," and "hospital" actors considering all hospital admissions that a particular hospital has have effect on the average of total hospitalization expenses of that hospital. These results can be used as guidelines to set up a cost-effective healthcare practice structure for patient hospitalization expenses. © 2011 National Association for Healthcare Quality.

  10. QoS-based management of biomedical wireless sensor networks for patient monitoring.

    Science.gov (United States)

    Abreu, Carlos; Miranda, Francisco; Ricardo, Manuel; Mendes, Paulo Mateus

    2014-01-01

    Biomedical wireless sensor networks are a key technology to support the development of new applications and services targeting patient monitoring, in particular, regarding data collection for medical diagnosis and continuous health assessment. However, due to the critical nature of medical applications, such networks have to satisfy demanding quality of service requirements, while guaranteeing high levels of confidence and reliability. Such goals are influenced by several factors, where the network topology, the limited throughput, and the characteristics and dynamics of the surrounding environment are of major importance. Harsh environments, as hospital facilities, can compromise the radio frequency communications and, consequently, the network's ability to provide the quality of service required by medical applications. Furthermore, the impact of such environments on the network's performance is hard to manage due to its random and unpredictable nature. Consequently, network planning and management, in general or step-down hospital units, is a very hard task. In such context, this work presents a quality of service based management tool to help healthcare professionals supervising the network's performance and to assist them managing the admission of new sensor nodes (i.e., patients to be monitored) to the biomedical wireless sensor network. The proposed solution proves to be a valuable tool both, to detect and classify potential harmful variations in the quality of service provided by the network, avoiding its degradation to levels where the biomedical signs would be useless; and to manage the admission of new patients to the network.

  11. Aberrant functional connectivity of default-mode network in type 2 diabetes patients

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Ying; Jiao, Yun; Chen, Hua-Jun; Ding, Jie; Luo, Bing; Peng, Cheng-Yu; Ju, Sheng-Hong; Teng, Gao-Jun [Medical School of Southeast University, Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Nanjing, Jiangsu (China)

    2015-11-15

    Type 2 diabetes mellitus is associated with increased risk for dementia. Patients with impaired cognition often show default-mode network disruption. We aimed to investigate the integrity of a default-mode network in diabetic patients by using independent component analysis, and to explore the relationship between network abnormalities, neurocognitive performance and diabetic variables. Forty-two patients with type 2 diabetes and 42 well-matched healthy controls were included and underwent resting-state functional MRI in a 3 Tesla unit. Independent component analysis was adopted to extract the default-mode network, including its anterior and posterior components. Z-maps of both sub-networks were compared between the two groups and correlated with each clinical variable. Patients showed increased connectivity around the medial prefrontal cortex in the anterior sub-network, but decreased connectivity around the posterior cingulate cortex in the posterior sub-network. The decreased connectivity in the posterior part was significantly correlated with the score on Complex Figure Test-delay recall test (r = 0.359, p = 0.020), the time spent on Trail-Making Test-part B (r = -0.346, p = 0.025) and the insulin resistance level (r = -0.404, p = 0.024). Dissociation pattern in the default-mode network was found in diabetic patients, which might provide powerful new insights into the neural mechanisms that underlie the diabetes-related cognitive decline. (orig.)

  12. Epilepsy is related to theta band brain connectivity and network topology in brain tumor patients

    Directory of Open Access Journals (Sweden)

    Douw Linda

    2010-08-01

    Full Text Available Abstract Background Both epilepsy patients and brain tumor patients show altered functional connectivity and less optimal brain network topology when compared to healthy controls, particularly in the theta band. Furthermore, the duration and characteristics of epilepsy may also influence functional interactions in brain networks. However, the specific features of connectivity and networks in tumor-related epilepsy have not been investigated yet. We hypothesize that epilepsy characteristics are related to (theta band connectivity and network architecture in operated glioma patients suffering from epileptic seizures. Included patients participated in a clinical study investigating the effect of levetiracetam monotherapy on seizure frequency in glioma patients, and were assessed at two time points: directly after neurosurgery (t1, and six months later (t2. At these time points, magnetoencephalography (MEG was recorded and information regarding clinical status and epilepsy history was collected. Functional connectivity was calculated in six frequency bands, as were a number of network measures such as normalized clustering coefficient and path length. Results At the two time points, MEG registrations were performed in respectively 17 and 12 patients. No changes in connectivity or network topology occurred over time. Increased theta band connectivity at t1 and t2 was related to a higher total number of seizures. Furthermore, higher number of seizures was related to a less optimal, more random brain network topology. Other factors were not significantly related to functional connectivity or network topology. Conclusions These results indicate that (pathologically increased theta band connectivity is related to a higher number of epileptic seizures in brain tumor patients, suggesting that theta band connectivity changes are a hallmark of tumor-related epilepsy. Furthermore, a more random brain network topology is related to greater vulnerability to

  13. Stroke Social Network Scale: development and psychometric evaluation of a new patient-reported measure

    OpenAIRE

    Northcott, S.; Hilari, K.

    2013-01-01

    Objective: To describe the development and psychometric evaluation of a new patient-reported measure which assesses a person’s social network in the first six months post stroke. Although it is known that the social networks of those with stroke and aphasia are vulnerable to change, there is currently no social network scale that has been validated for this population.\\ud \\ud Design and Setting: Repeated measures psychometric study, evaluating internal consistency, construct validity, and res...

  14. Synthesize, optimize, analyze, repeat (SOAR): Application of neural network tools to ECG patient monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Watrous, R.; Towell, G.; Glassman, M.S. [Siemens Corporate Research, Princeton, NJ (United States)

    1995-12-31

    Results are reported from the application of tools for synthesizing, optimizing and analyzing neural networks to an ECG Patient Monitoring task. A neural network was synthesized from a rule-based classifier and optimized over a set of normal and abnormal heartbeats. The classification error rate on a separate and larger test set was reduced by a factor of 2. When the network was analyzed and reduced in size by a factor of 40%, the same level of performance was maintained.

  15. Impaired small-world network efficiency and dynamic functional distribution in patients with cirrhosis.

    Directory of Open Access Journals (Sweden)

    Tun-Wei Hsu

    Full Text Available Hepatic encephalopathy (HE is a complex neuropsychiatric syndrome and a major complication of liver cirrhosis. Dysmetabolism of the brain, related to elevated ammonia levels, interferes with intercortical connectivity and cognitive function. For evaluation of network efficiency, a 'small-world' network model can quantify the effectiveness of information transfer within brain networks. This study aimed to use small-world topology to investigate abnormalities of neuronal connectivity among widely distributed brain regions in patients with liver cirrhosis using resting-state functional magnetic resonance imaging (rs-fMRI. Seventeen cirrhotic patients without HE, 9 with minimal HE, 9 with overt HE, and 35 healthy controls were compared. The interregional correlation matrix was obtained by averaging the rs-fMRI time series over all voxels in each of the 90 regions using the automated anatomical labeling model. Cost and correlation threshold values were then applied to construct the functional brain network. The absolute and relative network efficiencies were calculated; quantifying distinct aspects of the local and global topological network organization. Correlations between network topology parameters, ammonia levels, and the severity of HE were determined using linear regression and ANOVA. The local and global topological efficiencies of the functional connectivity network were significantly disrupted in HE patients; showing abnormal small-world properties. Alterations in regional characteristics, including nodal efficiency and nodal strength, occurred predominantly in the association, primary, and limbic/paralimbic regions. The degree of network organization disruption depended on the severity of HE. Ammonia levels were also significantly associated with the alterations in local network properties. Results indicated that alterations in the rs-fMRI network topology of the brain were associated with HE grade; and that focal or diffuse lesions

  16. The ART of Social Networking: How SART member clinics are connecting with patients online

    Science.gov (United States)

    OMURTAG, Kenan; JIMENEZ, Patricia T.; RATTS, Valerie; ODEM, Randall; COOPER, Amber R.

    2013-01-01

    Objective To study and describe the use of social networking websites among SART member clinics Design Cross-sectional study Setting University Based Practice Patients Not Applicable Interventions Not Applicable Main Outcome Measure Prevalence of social networking websites among SART member clinics and evaluation of content, volume and location (i.e mandated state, region) using multivariate regression analysis Results 384 SART registered clinics and 1,382 social networking posts were evaluated. Of the clinics, 96% have a website and 30% link to a social networking website. The majority of clinics (89%) with social networking websites were affiliated with non-academic centers. Social networking posts mostly provide information (31%) and/or advertise (28%), while the remaining offer support (19%) or are irrelevant (17%) to the target audience. Only 5% of posts involved patients requesting information. Clinic volume correlates with the presence of a clinic website and a social networking website (pnetworking website like Facebook, Twitter and/or a Web-log (“blog”). Larger volume clinics commonly host social networking websites. These sites provide new ways to communicate with patients, but clinics should maintain policies on the incorporation of social networks into practice. PMID:22088209

  17. The ART of social networking: how SART member clinics are connecting with patients online.

    Science.gov (United States)

    Omurtag, Kenan; Jimenez, Patricia T; Ratts, Valerie; Odem, Randall; Cooper, Amber R

    2012-01-01

    To study and describe the use of social networking websites among Society for Assisted Reproductive Technology (SART) member clinics. Cross-sectional study. University-based practice. Not applicable. Not applicable. Prevalence of social networking websites among SART member clinics and evaluation of content, volume, and location (i.e., mandated state, region) using multivariate regression analysis. A total of 384 SART-registered clinics and 1,382 social networking posts were evaluated. Of the clinics, 96% had a website and 30% linked to a social networking website. The majority of clinics (89%) with social networking websites were affiliated with nonacademic centers. Social networking posts mostly provided information (31%) and/or advertising (28%), and the remaining offered support (19%) or were irrelevant (17%) to the target audience. Only 5% of posts involved patients requesting information. Clinic volume correlated with the presence of a clinic website and a social networking website. Almost all SART member clinics have a website. Nearly one-third of these clinics host a social networking website such as Facebook, Twitter, and/or a blog. Large-volume clinics commonly host social networking websites. These sites provide new ways to communicate with patients, but clinics should maintain policies on the incorporation of social networks into practice. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Predicting the Survival of Gastric Cancer Patients Using Artificial and Bayesian Neural Networks

    Science.gov (United States)

    Korhani Kangi, Azam; Bahrampour, Abbas

    2018-02-26

    Introduction and purpose: In recent years the use of neural networks without any premises for investigation of prognosis in analyzing survival data has increased. Artificial neural networks (ANN) use small processors with a continuous network to solve problems inspired by the human brain. Bayesian neural networks (BNN) constitute a neural-based approach to modeling and non-linearization of complex issues using special algorithms and statistical methods. Gastric cancer incidence is the first and third ranking for men and women in Iran, respectively. The aim of the present study was to assess the value of an artificial neural network and a Bayesian neural network for modeling and predicting of probability of gastric cancer patient death. Materials and Methods: In this study, we used information on 339 patients aged from 20 to 90 years old with positive gastric cancer, referred to Afzalipoor and Shahid Bahonar Hospitals in Kerman City from 2001 to 2015. The three layers perceptron neural network (ANN) and the Bayesian neural network (BNN) were used for predicting the probability of mortality using the available data. To investigate differences between the models, sensitivity, specificity, accuracy and the area under receiver operating characteristic curves (AUROCs) were generated. Results: In this study, the sensitivity and specificity of the artificial neural network and Bayesian neural network models were 0.882, 0.903 and 0.954, 0.909, respectively. Prediction accuracy and the area under curve ROC for the two models were 0.891, 0.944 and 0.935, 0.961. The age at diagnosis of gastric cancer was most important for predicting survival, followed by tumor grade, morphology, gender, smoking history, opium consumption, receiving chemotherapy, presence of metastasis, tumor stage, receiving radiotherapy, and being resident in a village. Conclusion: The findings of the present study indicated that the Bayesian neural network is preferable to an artificial neural network for

  19. [The therapeutic drug monitoring network server of tacrolimus for Chinese renal transplant patients].

    Science.gov (United States)

    Deng, Chen-Hui; Zhang, Guan-Min; Bi, Shan-Shan; Zhou, Tian-Yan; Lu, Wei

    2011-07-01

    This study is to develop a therapeutic drug monitoring (TDM) network server of tacrolimus for Chinese renal transplant patients, which can facilitate doctor to manage patients' information and provide three levels of predictions. Database management system MySQL was employed to build and manage the database of patients and doctors' information, and hypertext mark-up language (HTML) and Java server pages (JSP) technology were employed to construct network server for database management. Based on the population pharmacokinetic model of tacrolimus for Chinese renal transplant patients, above program languages were used to construct the population prediction and subpopulation prediction modules. Based on Bayesian principle and maximization of the posterior probability function, an objective function was established, and minimized by an optimization algorithm to estimate patient's individual pharmacokinetic parameters. It is proved that the network server has the basic functions for database management and three levels of prediction to aid doctor to optimize the regimen of tacrolimus for Chinese renal transplant patients.

  20. Altered topological organization of white matter structural networks in patients with neuromyelitis optica.

    Directory of Open Access Journals (Sweden)

    Yaou Liu

    Full Text Available OBJECTIVE: To investigate the topological alterations of the whole-brain white-matter (WM structural networks in patients with neuromyelitis optica (NMO. METHODS: The present study involved 26 NMO patients and 26 age- and sex-matched healthy controls. WM structural connectivity in each participant was imaged with diffusion-weighted MRI and represented in terms of a connectivity matrix using deterministic tractography method. Graph theory-based analyses were then performed for the characterization of brain network properties. A multiple linear regression analysis was performed on each network metric between the NMO and control groups. RESULTS: The NMO patients exhibited abnormal small-world network properties, as indicated by increased normalized characteristic path length, increased normalized clustering and increased small-worldness. Furthermore, largely similar hub distributions of the WM structural networks were observed between NMO patients and healthy controls. However, regional efficiency in several brain areas of NMO patients was significantly reduced, which were mainly distributed in the default-mode, sensorimotor and visual systems. Furthermore, we have observed increased regional efficiency in a few brain regions such as the orbital parts of the superior and middle frontal and fusiform gyri. CONCLUSION: Although the NMO patients in this study had no discernible white matter T2 lesions in the brain, we hypothesize that the disrupted topological organization of WM networks provides additional evidence for subtle, widespread cerebral WM pathology in NMO.

  1. Motor imagery cognitive network after left ischemic stroke: study of the patients during mental rotation task.

    Directory of Open Access Journals (Sweden)

    Jing Yan

    Full Text Available Although motor imagery could improve motor rehabilitation, the detailed neural mechanisms of motor imagery cognitive process of stroke patients, particularly from functional network perspective, remain unclear. This study investigated functional brain network properties in each cognitive sub-stage of motor imagery of stroke patients with ischemic lesion in left hemisphere to reveal the impact of stroke on the cognition of motor imagery. Both stroke patients and control subjects participated in mental rotation task, which includes three cognitive sub-stages: visual stimulus perception, mental rotation and response cognitive process. Event-related electroencephalograph was recorded and interdependence between two different cortical areas was assessed by phase synchronization. Both global and nodal properties of functional networks in three sub-stages were statistically analyzed. Phase synchronization of stroke patients significantly reduced in mental rotation sub-stage. Longer characteristic path length and smaller global clustering coefficient of functional network were observed in patients in mental rotation sub-stage which implied the impaired segregation and integration. Larger nodal clustering coefficient and betweenness in contralesional occipitoparietal and frontal area respectively were observed in patients in all sub-stages. In addition, patients also showed smaller betweenness in ipsilesional central-parietal area in response sub-stage. The compensatory effects on local connectedness and centrality indicated the neuroplasticity in contralesional hemisphere. The functional brain networks of stroke patients demonstrated significant alterations and compensatory effects during motor imagery.

  2. Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines.

    Science.gov (United States)

    Ong, Mei-Sing; Olson, Karen L; Cami, Aurel; Liu, Chunfu; Tian, Fang; Selvam, Nandini; Mandl, Kenneth D

    2016-02-01

    Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or "doctor-shopping," contributes to the problem. To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics. A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011. Provider patient-sharing networks were modelled using social network analytics. Care team cohesion was measured using care density, defined as the ratio between the total number of patients shared by provider pairs within a patient's care team and the total number of provider pairs in the care team. Relationships within provider pairs were further quantified using a range of network metrics, including the number and proportion of patients or collaborators shared. The relationship between patient-sharing network metrics and the likelihood of multiple prescribing of benzodiazepines. Patients between the ages of 18 and 64 years who received two or more benzodiazepine prescriptions from multiple providers, with overlapping coverage of more than 14 days. A total of 5659 patients and 1448 provider pairs were included in our study. Among these, 1028 patients (18.2 %) received multiple prescriptions of benzodiazepines, involving 445 provider pairs (30.7 %). Patients whose providers rarely shared patients had a higher risk of being prescribed overlapping benzodiazepines; the median care density was 8.1 for patients who were prescribed overlapping benzodiazepines and 10.1 for those who were not (p benzodiazepines. Our findings demonstrate the importance of care team cohesion in addressing multiple-provider prescribing of controlled substances. Furthermore, we illustrate the potential of the provider network as a surveillance tool to detect and prevent adverse events that could arise due to fragmentation of care.

  3. Anticipated Ethics and Regulatory Challenges in PCORnet: The National Patient-Centered Clinical Research Network.

    Science.gov (United States)

    Ali, Joseph; Califf, Robert; Sugarman, Jeremy

    2016-01-01

    PCORnet, the National Patient-Centered Clinical Research Network, seeks to establish a robust national health data network for patient-centered comparative effectiveness research. This article reports the results of a PCORnet survey designed to identify the ethics and regulatory challenges anticipated in network implementation. A 12-item online survey was developed by leadership of the PCORnet Ethics and Regulatory Task Force; responses were collected from the 29 PCORnet networks. The most pressing ethics issues identified related to informed consent, patient engagement, privacy and confidentiality, and data sharing. High priority regulatory issues included IRB coordination, privacy and confidentiality, informed consent, and data sharing. Over 150 IRBs and five different approaches to managing multisite IRB review were identified within PCORnet. Further empirical and scholarly work, as well as practical and policy guidance, is essential if important initiatives that rely on comparative effectiveness research are to move forward.

  4. Artificial neural network: predicted vs observed survival in patients with colonic cancer.

    Science.gov (United States)

    Dolgobrodov, S G; Moore, P; Marshall, R; Bittern, R; Steele, R J C; Cuschieri, A

    2007-02-01

    An Internet-web-based artificial neural network has been developed for practicing clinical oncologists and medical researchers as part of an ongoing program designed for the implementation of advanced neural networks for prognostic estimates and eventually for management/treatment decisions in individual patients with colonic cancer. An interdisciplinary team of academic oncologists and physicists has configured and implemented a Partial Logistic Artificial Neural Network and trained it to predict cancer-related survival in patients with confirmed colorectal cancer by using a database (1,558 patients) made available for the study by the Information & Statistics Division of National Health Service Scotland. The reliability of the trained network was evaluated against Kaplan-Meier observed survival plots of a random sample of 300 patients not used in the training but forming part of the same data set. The predicted survival curves obtained as the output from the artificial neural network showed close agreement with observed actual survival rates of a cohort of 300 patients with four grades of risk of dying from the cancer within five years of diagnosis. The web-based Partial Logistic Artificial Neural Network system accurately predicts survival after staging and treatment of colonic cancer. It can be made web-accessible where it is powerful enough to serve hundreds of users simultaneously.

  5. Altered resting state networks in epileptic patients with generalized tonic-clonic seizures.

    Science.gov (United States)

    Wang, Zhengge; Lu, Guangming; Zhang, Zhiqiang; Zhong, Yuan; Jiao, Qing; Zhang, Zongjun; Tan, Qifu; Tian, Lei; Chen, Guanghui; Liao, Wei; Li, Kai; Liu, Yijun

    2011-02-16

    Recent functional magnetic resonance imaging (fMRI) studies have demonstrated that the resting state networks (RSNs) are impaired in various neuropsychiatric disorders. However, little is known about the changes in the functional architecture of the RSNs in idiopathic generalized epilepsy patients with generalized tonic-clonic seizures (GTCS). Resting state fMRI data were acquired from 16 GTCS patients and 16 healthy subjects. The data were acquired during interictal without combined EEG confirmation. Functional connectivity among the RSNs was examined using individual-based independent component analysis. Six RSNs were identified in both the GTCS and control groups. Compared with the healthy subjects, decreased functional connectivity in the self-referential, somatosensory, visual, and auditory networks, and both the decreased and increased functional connectivities in the classic default-mode and dorsal attention networks were found in the GTCS patients. Furthermore, the present study revealed a negative correlation between the seizure duration and functional connectivity changes in the medial prefrontal cortex in the GTCS patients. These results indicate that there are impairments in the RSNs and possible reorganization of the default-mode network and dorsal attention network in patients with GTCS. Our findings may also suggest that the medial prefrontal cortex and its associated network play a role in the development of GTCS. Copyright © 2010 Elsevier B.V. All rights reserved.

  6. Decreased triple network connectivity in patients with post-traumatic stress disorder

    Science.gov (United States)

    Liu, Yang; Li, Liang; Li, Baojuan; Zhang, Xi; Lu, Hongbing

    2017-03-01

    The triple network model provides a common framework for understanding affective and neurocognitive dysfunctions across multiple disorders, including central executive network (CEN), default mode network (DMN), and salience network (SN). Considering the effect of traumatic experience on post-traumatic stress disorder (PTSD), this study aims to explore the alteration of triple network connectivity in a specific PTSD induced by a single prolonged trauma exposure. With arterial spin labeling sequence, three networks were identified using independent component analysis in 10 PTSD patients and 10 healthy survivors, who experienced the same coal mining flood disaster. In PTSD patients, decreased connectivity was identified in left middle frontal gyrus of CEN, left precuneus and bilateral superior frontal gyrus of DMN, and right anterior insula of SN. The decreased connectivity in left middle frontal gyrus was identified to associate with clinical severity. These results indicated the decreased triple network connectivity, which not only supported the proposal of the triple network model, but also prompted possible neurobiology mechanism of cognitive dysfunction for this kind of PTSD.

  7. Social network composition of vascular patients and its associations with health behavior and clinical risk factors.

    Directory of Open Access Journals (Sweden)

    Naomi Heijmans

    Full Text Available This study aimed to explore linkages of patients' social network composition with health behaviors and clinical risk factors.This observational study was embedded in a project aimed at improving cardiovascular risk management (CRVM in primary care. 657 vascular patients (227 with cardiovascular disease, 380 at high vascular risk, mean age 72.4 (SD 9.4 years, were recruited as were individuals patients considered important for dealing with their disease, so called alters (n = 487. Network composition was measured with structured patient questionnaires. Both patients and alters completed questionnaires to measure health behavior (habits for physical activity, diet, and smoking. Clinical risk factors (systolic blood pressure, LDL cholesterol level, and body mass index were extracted from patients' medical records. Six logistic regression analyses, using generalized estimating equations, were used to test three hypothesized effects of network composition (having alters with healthful behaviors, without depression, and with specialized knowledge on six outcomes, adjusted for demographic, personal and psychological characteristics.Having alters with overall healthful behavior was related to healthful patient diet (OR 2.14, 95%CI: 1.52-3.02. Having non-smoking alters in networks was related to reduced odds for patient smoking (OR 0.17, 95%CI: 0.05-0.60. No effects of presence of non-depressed alters were found. Presence of alters with specialized knowledge on CVRM was inversely related to healthful diet habits of patients (OR 0.47, 95%CI 0.24-0.89. No significant associations between social network composition and clinical risk factors were found.Diet and smoking, but not physical exercise and clinical risk factors, were associated with social network composition of patients with vascular conditions. In this study of vascular patients, controlling for both personal and psychological factors, fewer network influences were found compared to previous

  8. A managed clinical network for cardiac services: set-up, operation and impact on patient care

    Directory of Open Access Journals (Sweden)

    Karen E. Hamilton

    2005-09-01

    Full Text Available Purpose: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were

  9. A managed clinical network for cardiac services: set-up, operation and impact on patient care

    Science.gov (United States)

    E StC Hamilton, Karen; M Sullivan, Frank; T Donnan, Peter; Taylor, Rex; Ikenwilo, Divine; Scott, Anthony; Baker, Chris; Wyke, Sally

    2005-01-01

    Abstract Purpose To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not

  10. Patient referral patterns and the spread of hospital-acquired infections through national health care networks.

    Directory of Open Access Journals (Sweden)

    Tjibbe Donker

    2010-03-01

    Full Text Available Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA, are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2004 to measure the connectedness between hospitals. This allowed us to reconstruct the network of hospitals in the Netherlands. We used mathematical models to assess the effect of different patient referral patterns on the potential spread of hospital-acquired infections between hospitals, and between categories of hospitals (University medical centers, top clinical hospitals and general hospitals. University hospitals have a higher number of shared patients than teaching or general hospitals, and are therefore more likely to be among the first to receive colonized patients. Moreover, as the network is directional towards university hospitals, they have a higher prevalence, even when infection control measures are equally effective in all hospitals. Patient referral patterns have a profound effect on the spread of health care-associated infections like hospital-acquired MRSA. The MRSA prevalence therefore differs between hospitals with the position of each hospital within the health care network. Any comparison of MRSA rates between hospitals, as a benchmark for hospital hygiene, should therefore take the position of a hospital within the network into account.

  11. Predicting post-treatment survivability of patients with breast cancer using Artificial Neural Network methods.

    Science.gov (United States)

    Wang, Tan-Nai; Cheng, Chung-Hao; Chiu, Hung-Wen

    2013-01-01

    In the last decade, the use of data mining techniques has become widely accepted in medical applications, especially in predicting cancer patients' survival. In this study, we attempted to train an Artificial Neural Network (ANN) to predict the patients' five-year survivability. Breast cancer patients who were diagnosed and received standard treatment in one hospital during 2000 to 2003 in Taiwan were collected for train and test the ANN. There were 604 patients in this dataset excluding died not in breast cancer. Among them 140 patients died within five years after their first radiotherapy treatment. The artificial neural networks were created by STATISTICA(®) software. Five variables (age, surgery and radiotherapy type, tumor size, regional lymph nodes, distant metastasis) were selected as the input features for ANN to predict the five-year survivability of breast cancer patients. We trained 100 artificial neural networks and chose the best one to analyze. The accuracy rate is 85% and area under the receiver operating characteristic (ROC) curve is 0.79. It shows that artificial neural network is a good tool to predict the five-year survivability of breast cancer patients.

  12. Increased interictal visual network connectivity in patients with migraine with aura.

    Science.gov (United States)

    Tedeschi, Gioacchino; Russo, Antonio; Conte, Francesca; Corbo, Daniele; Caiazzo, Giuseppina; Giordano, Alfonso; Conforti, Renata; Esposito, Fabrizio; Tessitore, Alessandro

    2016-02-01

    To evaluate the resting-state visual network functional connectivity in patients with migraine with aura and migraine without aura during the interictal period. Using resting-state functional magnetic resonance imaging, the resting-state visual network integrity was investigated in 20 patients with migraine with aura, 20 age- and sex-matched patients with migraine without aura and 20 healthy controls. Voxel-based morphometry and diffusion tensor imaging were used to assess whether between-groups differences in functional connectivity were dependent on structural or microstructural changes. Resting-state functional magnetic resonance imaging data showed that patients with migraine with aura, compared to both patients with migraine without aura and healthy controls, had a significant increased functional connectivity in the right lingual gyrus within the resting-state visual network (p aura exhibit an altered resting-state visual network connectivity. These results support the hypothesis of an extrastriate cortex involvement, centred in the lingual gyrus, a brain region related to mechanisms underlying the initiation and propagation of the migraine aura. This resting-state functional magnetic resonance imaging finding may represent a functional biomarker that could differentiate patients experiencing the aura phenomenon from patients with migraine without aura, even between migraine attacks. © International Headache Society 2015.

  13. Bluetooth-based sensor networks for remotely monitoring the physiological signals of a patient.

    Science.gov (United States)

    Zhang, Ying; Xiao, Hannan

    2009-11-01

    Integrating intelligent medical microsensors into a wireless communication network makes it possible to remotely collect physiological signals of a patient, release the patient from being tethered to monitoring medical instrumentations, and facilitate the patient's early hospital discharge. This can further improve life quality by providing continuous observation without the need of disrupting the patient's normal life, thus reducing the risk of infection significantly, and decreasing the cost of the hospital and the patient. This paper discusses the implementation issues, and describes the overall system architecture of our developed Bluetooth sensor network for patient monitoring and the corresponding heart activity sensors. It also presents our approach to developing the intelligent physiological sensor nodes involving integration of Bluetooth radio technology, hardware and software organization, and our solutions for onboard signal processing.

  14. Social network composition of vascular patients and its associations with health behavior and clinical risk factors

    Science.gov (United States)

    Heijmans, Naomi; van Lieshout, Jan; Wensing, Michel

    2017-01-01

    Background This study aimed to explore linkages of patients’ social network composition with health behaviors and clinical risk factors. Methods/Design This observational study was embedded in a project aimed at improving cardiovascular risk management (CRVM) in primary care. 657 vascular patients (227 with cardiovascular disease, 380 at high vascular risk), mean age 72.4 (SD 9.4) years, were recruited as were individuals patients considered important for dealing with their disease, so called alters (n = 487). Network composition was measured with structured patient questionnaires. Both patients and alters completed questionnaires to measure health behavior (habits for physical activity, diet, and smoking). Clinical risk factors (systolic blood pressure, LDL cholesterol level, and body mass index) were extracted from patients’ medical records. Six logistic regression analyses, using generalized estimating equations, were used to test three hypothesized effects of network composition (having alters with healthful behaviors, without depression, and with specialized knowledge) on six outcomes, adjusted for demographic, personal and psychological characteristics. Results Having alters with overall healthful behavior was related to healthful patient diet (OR 2.14, 95%CI: 1.52–3.02). Having non-smoking alters in networks was related to reduced odds for patient smoking (OR 0.17, 95%CI: 0.05–0.60). No effects of presence of non-depressed alters were found. Presence of alters with specialized knowledge on CVRM was inversely related to healthful diet habits of patients (OR 0.47, 95%CI 0.24–0.89). No significant associations between social network composition and clinical risk factors were found. Discussion Diet and smoking, but not physical exercise and clinical risk factors, were associated with social network composition of patients with vascular conditions. In this study of vascular patients, controlling for both personal and psychological factors, fewer network

  15. Positron Emission Tomography Reveals Abnormal Topological Organization in Functional Brain Network in Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Qiu eXiangzhe

    2016-05-01

    Full Text Available Recent studies have demonstrated alterations in the topological organization of structural brain networks in diabetes mellitus (DM. However, the DM-related changes in the topological properties in functional brain networks are almost unexplored so far. We therefore used fluoro-D-glucose positron emission tomography (FDG-PET data to construct functional brain networks of 73 DM patients and 91 sex- and age-matched normal controls (NCs, followed by a graph theoretical analysis. We found that both DM patients and NCs had a small-world topology in functional brain network. In comparison to the NC group, the DM group was found to have significantly lower small-world index, lower normalized clustering coefficients and higher normalized shortest path length. Moreover, for diabetic patients, the nodal centrality was significantly reduced in the right rectus, the right cuneus, the left middle occipital gyrus, and the left postcentral gyrus, and it was significantly increased in the orbitofrontal region of the left middle frontal gyrus, the left olfactory region, and the right paracentral lobule. Our results demonstrated that the diabetic brain was associated with disrupted topological organization in the functional PET network, thus providing the functional evidence for the abnormalities of brain networks in DM.

  16. Taking data seriously: the value of actor-network theory in rethinking patient experience data.

    Science.gov (United States)

    Desai, Amit; Zoccatelli, Giulia; Adams, Mary; Allen, Davina; Brearley, Sally; Rafferty, Anne Marie; Robert, Glenn; Donetto, Sara

    2017-04-01

    Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention to patient experience data as having agency in particular hospital interactions allows us to better trace how and in what circumstances data lead (or fail to lead) to quality improvement.

  17. Graph Analysis of Functional Brain Networks in Patients with Mild Traumatic Brain Injury

    Science.gov (United States)

    van der Horn, Harm J.; Liemburg, Edith J.; Scheenen, Myrthe E.; de Koning, Myrthe E.; Spikman, Jacoba M.; van der Naalt, Joukje

    2017-01-01

    Mild traumatic brain injury (mTBI) is one of the most common neurological disorders worldwide. Posttraumatic complaints are frequently reported, interfering with outcome. However, a consistent neural substrate has not yet been found. We used graph analysis to further unravel the complex interactions between functional brain networks, complaints, anxiety and depression in the sub-acute stage after mTBI. This study included 54 patients with uncomplicated mTBI and 20 matched healthy controls. Posttraumatic complaints, anxiety and depression were measured at two weeks post-injury. Patients were selected based on presence (n = 34) or absence (n = 20) of complaints. Resting-state fMRI scans were made approximately four weeks post-injury. High order independent component analysis resulted in 89 neural components that were included in subsequent graph analyses. No differences in graph measures were found between patients with mTBI and healthy controls. Regarding the two patient subgroups, degree, strength, local efficiency and eigenvector centrality of the bilateral posterior cingulate/precuneus and bilateral parahippocampal gyrus were higher, and eigenvector centrality of the frontal pole/ bilateral middle & superior frontal gyrus was lower in patients with complaints compared to patients without complaints. In patients with mTBI, higher degree, strength and eigenvector centrality of default mode network components were related to higher depression scores, and higher degree and eigenvector centrality of executive network components were related to lower depression scores. In patients without complaints, one extra module was found compared to patients with complaints and healthy controls, consisting of the cingulate areas. In conclusion, this research extends the knowledge of functional network connectivity after mTBI. Specifically, our results suggest that an imbalance in the function of the default mode- and executive network plays a central role in the interaction

  18. Graph Analysis of Functional Brain Networks in Patients with Mild Traumatic Brain Injury.

    Directory of Open Access Journals (Sweden)

    Harm J van der Horn

    Full Text Available Mild traumatic brain injury (mTBI is one of the most common neurological disorders worldwide. Posttraumatic complaints are frequently reported, interfering with outcome. However, a consistent neural substrate has not yet been found. We used graph analysis to further unravel the complex interactions between functional brain networks, complaints, anxiety and depression in the sub-acute stage after mTBI. This study included 54 patients with uncomplicated mTBI and 20 matched healthy controls. Posttraumatic complaints, anxiety and depression were measured at two weeks post-injury. Patients were selected based on presence (n = 34 or absence (n = 20 of complaints. Resting-state fMRI scans were made approximately four weeks post-injury. High order independent component analysis resulted in 89 neural components that were included in subsequent graph analyses. No differences in graph measures were found between patients with mTBI and healthy controls. Regarding the two patient subgroups, degree, strength, local efficiency and eigenvector centrality of the bilateral posterior cingulate/precuneus and bilateral parahippocampal gyrus were higher, and eigenvector centrality of the frontal pole/ bilateral middle & superior frontal gyrus was lower in patients with complaints compared to patients without complaints. In patients with mTBI, higher degree, strength and eigenvector centrality of default mode network components were related to higher depression scores, and higher degree and eigenvector centrality of executive network components were related to lower depression scores. In patients without complaints, one extra module was found compared to patients with complaints and healthy controls, consisting of the cingulate areas. In conclusion, this research extends the knowledge of functional network connectivity after mTBI. Specifically, our results suggest that an imbalance in the function of the default mode- and executive network plays a central role in the

  19. Graph Analysis of Functional Brain Networks in Patients with Mild Traumatic Brain Injury.

    Science.gov (United States)

    van der Horn, Harm J; Liemburg, Edith J; Scheenen, Myrthe E; de Koning, Myrthe E; Spikman, Jacoba M; van der Naalt, Joukje

    2017-01-01

    Mild traumatic brain injury (mTBI) is one of the most common neurological disorders worldwide. Posttraumatic complaints are frequently reported, interfering with outcome. However, a consistent neural substrate has not yet been found. We used graph analysis to further unravel the complex interactions between functional brain networks, complaints, anxiety and depression in the sub-acute stage after mTBI. This study included 54 patients with uncomplicated mTBI and 20 matched healthy controls. Posttraumatic complaints, anxiety and depression were measured at two weeks post-injury. Patients were selected based on presence (n = 34) or absence (n = 20) of complaints. Resting-state fMRI scans were made approximately four weeks post-injury. High order independent component analysis resulted in 89 neural components that were included in subsequent graph analyses. No differences in graph measures were found between patients with mTBI and healthy controls. Regarding the two patient subgroups, degree, strength, local efficiency and eigenvector centrality of the bilateral posterior cingulate/precuneus and bilateral parahippocampal gyrus were higher, and eigenvector centrality of the frontal pole/ bilateral middle & superior frontal gyrus was lower in patients with complaints compared to patients without complaints. In patients with mTBI, higher degree, strength and eigenvector centrality of default mode network components were related to higher depression scores, and higher degree and eigenvector centrality of executive network components were related to lower depression scores. In patients without complaints, one extra module was found compared to patients with complaints and healthy controls, consisting of the cingulate areas. In conclusion, this research extends the knowledge of functional network connectivity after mTBI. Specifically, our results suggest that an imbalance in the function of the default mode- and executive network plays a central role in the interaction

  20. Disrupted Control Network Connectivity in Abstinent Patients with Alcohol Dependence

    OpenAIRE

    Kim, Siekyeong; Im, Sungjin; Lee, Jeonghwan; Lee, Sang-Gu

    2017-01-01

    Objective Alcohol causes damage to the brain and is associated with various functional impairments. However, much of the brain damage can be reversed by abstaining for enough time. This study aims to investigate the patterns and degrees of brain function in abstinent patients with alcohol dependence by using resting-state functional connectivity. Methods 26 male patients with alcohol dependence (alcohol group) and 28 age-matched male healthy volunteers (control group) were recruited from a me...

  1. Altered brain network measures in patients with primary writing tremor

    Energy Technology Data Exchange (ETDEWEB)

    Lenka, Abhishek; Jhunjhunwala, Ketan Ramakant [National Institute of Mental Health and Neurosciences, Department of Clinical Neurosciences, Bangalore, Karnataka (India); National Institute of Mental Health and Neurosciences (NIMHANS), Department of Neurology, Bangalore, Karnataka (India); Panda, Rajanikant; Saini, Jitender; Bharath, Rose Dawn [National Institute of Mental Health and Neurosciences, Department of Neuroimaging and Interventional Radiology, Bangalore, Karnataka (India); Yadav, Ravi; Pal, Pramod Kumar [National Institute of Mental Health and Neurosciences (NIMHANS), Department of Neurology, Bangalore, Karnataka (India)

    2017-10-15

    Primary writing tremor (PWT) is a rare task-specific tremor, which occurs only while writing or while adopting the hand in the writing position. The basic pathophysiology of PWT has not been fully understood. The objective of this study is to explore the alterations in the resting state functional brain connectivity, if any, in patients with PWT using graph theory-based analysis. This prospective case-control study included 10 patients with PWT and 10 age and gender matched healthy controls. All subjects underwent MRI in a 3-Tesla scanner. Several parameters of small-world functional connectivity were compared between patients and healthy controls by using graph theory-based analysis. There were no significant differences in age, handedness (all right handed), gender distribution (all were males), and MMSE scores between the patients and controls. The mean age at presentation of tremor in the patient group was 51.7 ± 8.6 years, and the mean duration of tremor was 3.5 ± 1.9 years. Graph theory-based analysis revealed that patients with PWT had significantly lower clustering coefficient and higher path length compared to healthy controls suggesting alterations in small-world architecture of the brain. The clustering coefficients were lower in PWT patients in left and right medial cerebellum, right dorsolateral prefrontal cortex (DLPFC), and left posterior parietal cortex (PPC). Patients with PWT have significantly altered small-world brain connectivity in bilateral medial cerebellum, right DLPFC, and left PPC. Further studies with larger sample size are required to confirm our results. (orig.)

  2. Altered default mode network activity in patient with anxiety disorders: An fMRI study

    Energy Technology Data Exchange (ETDEWEB)

    Zhao Xiaohu [Imaging Department of Tong Ji Hospital of Tong Ji University, Shanghai 200065 (China) and Bio-X lab, Department of Physics, Zhe Jiang University, Hangzhou 310027 (China)], E-mail: xhzhao999@263.net; Wang Peijun [Imaging Department of Tong Ji Hospital of Tong Ji University, Shanghai 200065 (China)], E-mail: tongjipjwang@vip.sina.com; Li Chunbo [Department of Psychiatry, Tong Ji Hospital of Tong Ji University, Shanghai 200065 (China)], E-mail: licb@mail.tongji.edu.cn; Hu Zhenghui [Department of Electrical and Engineering, Hong Kong University of Science and Technology, Hong Kong (China)], E-mail: eezhhu@ust.hk; Xi Qian [Imaging Department of Tong Ji Hospital of Tong Ji University, Shanghai 200065 (China)], E-mail: 96125007@sina.com.cn; Wu Wenyuan [Department of Psychiatry, Tong Ji Hospital of Tong Ji University, Shanghai 200065 (China)], E-mail: wuwy@mail.tongji.edu.cn; Tang Xiaowei [Bio-X lab, Department of Physics, Zhe Jiang University, Hangzhou 310027 (China)], E-mail: tangxw@zju.edu.cn

    2007-09-15

    Anxiety disorder, a common mental disorder in our clinical practice, is characterized by unprovoked anxiety. Medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC), which closely involved in emotional processing, are critical regions in the default mode network. We used functional magnetic resonance imaging (fMRI) to investigate whether default mode network activity is altered in patients with anxiety disorder. Ten anxiety patients and 10 healthy controls underwent fMRI while listening to emotionally neutral words alternating with rest (Experiment 1) and threat-related words alternating with emotionally neutral words (Experiment 2). In Experiment 1, regions of deactivation were observed in patients and controls. In Experiment 2, regions of deactivation were observed only in patients. The observed deactivation patterns in the two experiments, which included MPFC, PCC, and inferior parietal cortex, were similar and consistent with the default model network. Less deactivation in MPFC and greater deactivation in PCC were observed for patients group comparing to controls in Experiment 1. Our observations suggest that the default model network is altered in anxiety patients and dysfunction in MPFC and PCC may play an important role in anxiety psychopathology.

  3. Determining of prognostic factors in gastric cancer patients using artificial neural networks.

    Science.gov (United States)

    Biglarian, Akbar; Hajizadeh, Ebrahim; Kazemnejad, Anoshirvan; Zayeri, Farid

    2010-01-01

    The aim of this study is to determine diagnostic factors for Iranian gastric cancer patients and their importance using artificial neural network and Weibull regression models. This study was a historical cohort study with data gathered from 436 registered gastric cancer patients who underwent surgery between 2002 and 2007 at the Taleghani Hospital (a referral center for gastrointestinal cancers), Tehran, Iran. In order to determine risk factors and their importance, neural network and Weibull regression models were used. The Weibull regression analysis showed that lymph node metastasis and histopathology of tumor were selected as important variables. Based on the neural network model, staging, lymph node metastasis, histopathology of tumor, metastasis, and age at diagnosis were selected as important variables. The true prediction of neural network was 82.6%, and for the Weibull regression model, 75.7%. The present study showed that the neural network model is a more powerful tool in determining the important variables for gastric cancer patients compared to Weibull regression model. Therefore, this model is recommended for determining of risk factors of such patients.

  4. HIV testing among patients infected with Neisseria gonorrhoeae: STD Surveillance Network, United States, 2009-2010.

    Science.gov (United States)

    Bradley, Heather; Asbel, Lenore; Bernstein, Kyle; Mattson, Melanie; Pathela, Preeti; Mohamed, Mukhtar; Samuel, Michael C; Schwebke, Jane; Stenger, Mark; Tabidze, Irina; Zenilman, Jonathan; Dowell, Deborah; Weinstock, Hillard

    2013-03-01

    We used data from the STD Surveillance Network to estimate HIV testing among patients being tested or treated for gonorrhea. Of 1,845 gonorrhea-infected patients identified through nationally notifiable disease data, only 51% were tested for HIV when they were tested or treated for gonorrhea. Among the 10 geographic sites in this analysis, the percentage of patients tested for HIV ranged from 22-63% for men and 20-79% for women. Nearly 33% of the un-tested patients had never been previously HIV-tested. STD clinic patients were more likely to be HIV-tested than those in other practice settings.

  5. Characterization of physiological networks in sleep apnea patients using artificial neural networks for Granger causality computation

    Science.gov (United States)

    Cárdenas, Jhon; Orjuela-Cañón, Alvaro D.; Cerquera, Alexander; Ravelo, Antonio

    2017-11-01

    Different studies have used Transfer Entropy (TE) and Granger Causality (GC) computation to quantify interconnection between physiological systems. These methods have disadvantages in parametrization and availability in analytic formulas to evaluate the significance of the results. Other inconvenience is related with the assumptions in the distribution of the models generated from the data. In this document, the authors present a way to measure the causality that connect the Central Nervous System (CNS) and the Cardiac System (CS) in people diagnosed with obstructive sleep apnea syndrome (OSA) before and during treatment with continuous positive air pressure (CPAP). For this purpose, artificial neural networks were used to obtain models for GC computation, based on time series of normalized powers calculated from electrocardiography (EKG) and electroencephalography (EEG) signals recorded in polysomnography (PSG) studies.

  6. Resting-state brain networks in patients with Parkinson's disease and impulse control disorders.

    Science.gov (United States)

    Tessitore, Alessandro; Santangelo, Gabriella; De Micco, Rosa; Giordano, Alfonso; Raimo, Simona; Amboni, Marianna; Esposito, Fabrizio; Barone, Paolo; Tedeschi, Gioacchino; Vitale, Carmine

    2017-09-01

    To investigate intrinsic neural networks connectivity changes in Parkinson's disease (PD) patients with and without impulse control disorders (ICD). Fifteen patients with PD with ICD (ICD+), 15 patients with PD without ICD (ICD-) and 24 age and sex-matched healthy controls (HC) were enrolled in the study. To identify patients with and without ICD and/or punding, we used the Minnesota Impulsive Disorders Interview (MIDI) and a clinical interview based on diagnostic criteria for each symptom. All patients underwent a detailed neuropsychological evaluation. Whole brain structural and functional imaging was performed on a 3T GE MR scanner. Statistical analysis of functional data was completed using BrainVoyager QX software. Voxel-based morphometry (VBM) was used to test whether between-group differences in resting-state connectivity were related to structural abnormalities. The presence of ICD symptoms was associated with an increased connectivity within the salience and default-mode networks, as well as with a decreased connectivity within the central executive network (p < .05 corrected). ICD severity was correlated with both salience and default mode networks connectivity changes only in the ICD+ group. VBM analysis did not reveal any statistically significant differences in local grey matter volume between ICD+ and ICD- patients and between all patients and HC (p < .05. FWE). The presence of a disrupted connectivity within the three core neurocognitive networks may be considered as a potential neural correlate of ICD presence in patients with PD. Our findings provide additional insights into the mechanisms underlying ICD in PD, confirming the crucial role of an abnormal prefrontal-limbic-striatal homeostasis in their development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Network analysis of patient flow in two UK acute care hospitals identifies key sub-networks for A&E performance.

    Directory of Open Access Journals (Sweden)

    Daniel M Bean

    Full Text Available The topology of the patient flow network in a hospital is complex, comprising hundreds of overlapping patient journeys, and is a determinant of operational efficiency. To understand the network architecture of patient flow, we performed a data-driven network analysis of patient flow through two acute hospital sites of King's College Hospital NHS Foundation Trust. Administration databases were queried for all intra-hospital patient transfers in an 18-month period and modelled as a dynamic weighted directed graph. A 'core' subnetwork containing only 13-17% of all edges channelled 83-90% of the patient flow, while an 'ephemeral' network constituted the remainder. Unsupervised cluster analysis and differential network analysis identified sub-networks where traffic is most associated with A&E performance. Increased flow to clinical decision units was associated with the best A&E performance in both sites. The component analysis also detected a weekend effect on patient transfers which was not associated with performance. We have performed the first data-driven hypothesis-free analysis of patient flow which can enhance understanding of whole healthcare systems. Such analysis can drive transformation in healthcare as it has in industries such as manufacturing.

  8. Development of a neural network for prediction of glucose concentration in type 1 diabetes patients.

    Science.gov (United States)

    Pappada, Scott M; Cameron, Brent D; Rosman, Paul M

    2008-09-01

    A major difficulty in the management of diabetes is the optimization of insulin therapies to avoid occurrences of hypoglycemia and hyperglycemia. Many factors impact glucose fluctuations in diabetes patients, such as insulin dosage, nutritional intake, daily activities and lifestyle (e.g., sleep-wake cycles and exercise), and emotional states (e.g., stress). The overall effect of these factors has not been fully quantified to determine the impact on subsequent glycemic trends. Recent advances in diabetes technology such as continuous glucose monitoring (CGM) provides significant sources of data, such that quantification may be possible. Depending on the CGM technology utilized, the sampling frequency ranges from 1-5 min. In this study, an intensive electronic diary documenting the factors previously described was created. This diary was utilized by 18 patients with insulin-dependent diabetes mellitus in conjunction with CGM. Utilizing this dataset, various neural network models were constructed to predict glucose in these diabetes patients while varying the predictive window from 50-180 min. The predictive capability of each neural network within the fully trained dataset was analyzed as well as the predictive capabilities of the neural networks on unseen data. Neural network models were created using NeuroSolutions software with variable predictive windows of 50, 75, 100, 120, 150, and 180 min. Neural network models were trained using patient datasets ranging from 11-17 patients and evaluated on patient data not included in the neural network formulation. Performance analysis was completed for the neural network models using MATLAB. Performance measures include the calculation of the mean absolute difference percent overall and at hypoglycemic and hyperglycemic extremes, and the percentage of hypoglycemic and hyperglycemic occurrences were predicted. Overall, the neural network models perform adequately at predicting at normal (>70 and or =180 mg/dl); however

  9. Disturbed small-world networks and neurocognitive function in frontal lobe low-grade glioma patients.

    Directory of Open Access Journals (Sweden)

    Qingling Huang

    Full Text Available BACKGROUND: Brain tumor patients often associated with losses of the small-world configuration and neurocognitive functions before operations. However, few studies were performed on the impairments of frontal lobe low-grade gliomas (LGG after tumor resection using small-world network features. METHODOLOGY/PRINCIPAL FINDINGS: To detect differences in the whole brain topology among LGG patients before and after operation, a combined study of neurocognitive assessment and graph theoretical network analysis of fMRI data was performed. We collected resting-state fMRI data of 12 carefully selected frontal lobe LGG patients before and after operation. We calculated the topological properties of brain functional networks in the 12 LGG, and compared with 12 healthy controls (HCs. We also applied Montreal Cognitive Assessment (MoCA in a subset of patients (n = 12, including before and after operation groups and HCs (n = 12. The resulting functional connectivity matrices were constructed for all 12 patients, and binary network analysis was performed. In the range of 0.05 ≤ Kcos t ≤ 0.35, the functional networks in preoperative LGG and postoperative one both fitted the definition of small-worldness. We proposed Knet = 0.20 as small-world network interval, and the results showed that the topological properties were found to be disrupted in the two LGG groups, meanwhile the global efficiency increased and the local efficiency decreased. Lnet in the two LGG groups both were longer than HCs. Cnet in the LGG groups were smaller than HCs. Compared with the Hcs, MoCA in the two LGG groups were lower than HCs with significant difference, and the disturbed networks in the LGG were negatively related to worse MoCA scores. CONCLUSIONS: Disturbed small-worldness preperty in the two LGG groups was found and widely spread in the strength and spatial organization of brain networks, and the alterated small-world network may be responsible for cognitive

  10. The networked patient : Sharing data to improve health?

    NARCIS (Netherlands)

    Heerings, M.

    2014-01-01

    For diabetes type 1 the development towards stricter regulation of blood-glucose levels is associated with lower risk of long term complications (such as neuropathy, nephropathy, retinopathy, cardiovascular disease). A stricter regulation changes disease management practices of patients and health

  11. Characterizing structure connectivity correlation with the default mode network in Alzheimer's patients and normal controls

    Science.gov (United States)

    Guo, Jia; Xu, Peng; Song, Chao; Yao, Li; Zhao, Xiaojie

    2012-03-01

    Magnetic resonance diffusion tensor imaging (DTI) is a kind of effective measure to do non-invasive investigation on brain fiber structure at present. Studies of fiber tracking based on DTI showed that there was structural connection of white matter fiber among the nodes of resting-state functional network, denoting that the connection of white matter was the basis of gray matter regions in functional network. Nevertheless, relationship between these structure connectivity regions and functional network has not been clearly indicated. Moreover, research of fMRI found that activation of default mode network (DMN) in Alzheimer's disease (AD) was significantly descended, especially in hippocampus and posterior cingulated cortex (PCC). The relationship between this change of DMN activity and structural connection among functional networks needs further research. In this study, fast marching tractography (FMT) algorithm was adopted to quantitative calculate fiber connectivity value between regions, and hippocampus and PCC which were two important regions in DMN related with AD were selected to compute white matter connection region between them in elderly normal control (NC) and AD patient. The fiber connectivity value was extracted to do the correlation analysis with activity intensity of DMN. Results showed that, between PCC and hippocampus of NC, there exited region with significant high connectivity value of white matter fiber whose performance has relatively strong correlation with the activity of DMN, while there was no significant white matter connection region between them for AD patient which might be related with reduced network activation in these two regions of AD.

  12. Functional network architecture predicts psychologically mediated analgesia related to treatment in chronic knee pain patients.

    Science.gov (United States)

    Hashmi, Javeria Ali; Kong, Jian; Spaeth, Rosa; Khan, Sheraz; Kaptchuk, Ted J; Gollub, Randy L

    2014-03-12

    Placebo analgesia is an indicator of how efficiently the brain translates psychological signals conveyed by a treatment procedure into pain relief. It has been demonstrated that functional connectivity between distributed brain regions predicts placebo analgesia in chronic back pain patients. Greater network efficiency in baseline brain networks may allow better information transfer and facilitate adaptive physiological responses to psychological aspects of treatment. Here, we theorized that topological network alignments in resting state scans predict psychologically conditioned analgesic responses to acupuncture treatment in chronic knee osteoarthritis pain patients (n = 45). Analgesia was induced by building positive expectations toward acupuncture treatment with verbal suggestion and heat pain conditioning on a test site of the arm. This procedure induced significantly more analgesia after sham or real acupuncture on the test site than in a control site. The psychologically conditioned analgesia was invariant to sham versus real treatment. Efficiency of information transfer within local networks calculated with graph-theoretic measures (local efficiency and clustering coefficients) significantly predicted conditioned analgesia. Clustering coefficients in regions associated with memory, motivation, and pain modulation were closely involved in predicting analgesia. Moreover, women showed higher clustering coefficients and marginally greater pain reduction than men. Overall, analgesic response to placebo cues can be predicted from a priori resting state data by observing local network topology. Such low-cost synchronizations may represent preparatory resources that facilitate subsequent performance of brain circuits in responding to adaptive environmental cues. This suggests a potential utility of network measures in predicting placebo response for clinical use.

  13. The impact of drug use in social networks of patients with substance use and bipolar disorders.

    Science.gov (United States)

    McDonald, Leah J; Griffin, Margaret L; Kolodziej, Monika E; Fitzmaurice, Garrett M; Weiss, Roger D

    2011-01-01

    In this exploratory analysis, we assessed the effect of drug use among social-network members on recovery from drug dependence in patients with co-occurring bipolar disorder. Patients (n = 57) enrolled in a group therapy study completed assessments over 15 months. Patients with zero to one drug users in their social networks at intake had few days of drug use during treatment and follow-up, whereas those with ≥ 2 drug users had significantly more days of drug use. Multivariate analysis showed that patients who consistently named multiple drug users in their social networks had a marked increase in drug use over 15 months, while those who never or occasionally named multiple drug users had a small decline in drug use over time. Multiple drug users in social networks of treatment-seeking drug-dependent patients with co-occurring bipolar disorder may indicate poor drug use outcomes; efforts to reduce the association with drug users may be useful. This clinical trial has been registered in a public trials registry at clinicaltrials.gov (identifier is NCT00227838).  © American Academy of Addiction Psychiatry.

  14. Abnormal organization of white matter network in patients with no dementia after ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Lin Shi

    Full Text Available Structural changes after ischemic stroke could affect information communication extensively in the brain network. It is likely that the defects in the white matter (WM network play a key role in information interchange. In this study, we used graph theoretical analysis to examine potential organization alteration in the WM network architecture derived from diffusion tensor images from subjects with no dementia and experienced stroke in the past 5.4-14.8 months (N = 47, Mini-Mental Screening Examination, MMSE range 18-30, compared with a normal control group with 44 age and gender-matched healthy volunteers (MMSE range 26-30. Region-wise connectivity was derived from fiber connection density of 90 different cortical and subcortical parcellations across the whole brain. Both normal controls and patients with chronic stroke exhibited efficient small-world properties in their WM structural networks. Compared with normal controls, topological efficiency was basically unaltered in the patients with chronic stroke, as reflected by unchanged local and global clustering coefficient, characteristic path length, and regional efficiency. No significant difference in hub distribution was found between normal control and patient groups. Patients with chronic stroke, however, were found to have reduced betweenness centrality and predominantly located in the orbitofrontal cortex, whereas increased betweenness centrality and vulnerability were observed in parietal-occipital cortex. The National Institutes of Health Stroke Scale (NIHSS score of patient is correlated with the betweenness centrality of right pallidum and local clustering coefficient of left superior occipital gyrus. Our findings suggest that patients with chronic stroke still exhibit efficient small-world organization and unaltered topological efficiency, with altered topology at orbitofrontal cortex and parietal-occipital cortex in the overall structural network. Findings from this study could

  15. APOE Genotype Effects on Intrinsic Brain Network Connectivity in Patients with Amnestic Mild Cognitive Impairment.

    Science.gov (United States)

    Wang, Zan; Dai, Zhengjia; Shu, Hao; Liao, Xuhong; Yue, Chunxian; Liu, Duan; Guo, Qihao; He, Yong; Zhang, Zhijun

    2017-03-24

    Whether and how the apolipoprotein E (APOE) ε4 genotype specifically modulates brain network connectivity in patients with amnestic mild cognitive impairment (aMCI) remain largely unknown. Here, we employed resting-state ('task-free') functional MRI and network centrality approaches to investigate local (degree centrality, DC) and global (eigenvector centrality, EC) functional integrity in the whole-brain connectome in 156 older adults, including 66 aMCI patients (27 ε4-carriers and 39 non-carriers) and 90 healthy controls (45 ε4-carriers and 45 non-carriers). We observed diagnosis-by-genotype interactions on DC in the left superior/middle frontal gyrus, right middle temporal gyrus and cerebellum, with higher values in the ε4-carriers than non-carriers in the aMCI group. We further observed diagnosis-by-genotype interactions on EC, with higher values in the right middle temporal gyrus but lower values in the medial parts of default-mode network in the ε4-carriers than non-carriers in the aMCI group. Notably, these genotype differences in DC or EC were absent in the control group. Finally, the network connectivity DC values were negatively correlated with cognitive performance in the aMCI ε4-carriers. Our findings suggest that the APOE genotype selectively modulates the functional integration of brain networks in patients with aMCI, thus providing important insight into the gene-connectome interaction in this disease.

  16. Alteration of long-distance functional connectivity and network topology in patients with supratentorial gliomas

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Eun; Kim, Ho Sung; Kim, Sang Joon; Shim, Woo Hyun [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-Gu, Seoul (Korea, Republic of); Kim, Jeong Hoon [University of Ulsan College of Medicine, Department of Neurosurgery, Asan Medical Center, Seoul (Korea, Republic of)

    2016-03-15

    The need for information regarding functional alterations in patients with brain gliomas is increasing, but little is known about the functional consequences of focal brain tumors throughout the entire brain. Using resting-state functional MR imaging (rs-fMRI), this study assessed functional connectivity in patients with supratentorial brain gliomas with possible alterations in long-distance connectivity and network topology. Data from 36 patients with supratentorial brain gliomas and 12 healthy subjects were acquired using rs-fMRI. The functional connectivity matrix (FCM) was created using 32 pairs of cortical seeds on Talairach coordinates in each individual subject. Local and distant connectivity were calculated using z-scores in the individual patient's FCM, and the averaged FCM of patients was compared with that of healthy subjects. Weighted network analysis was performed by calculating local efficiency, global efficiency, clustering coefficient, and small-world topology, and compared between patients and healthy controls. When comparing the averaged FCM of patients with that of healthy controls, the patients showed decreased long-distance, inter-hemispheric connectivity (0.32 ± 0.16 in patients vs. 0. 42 ± 0.15 in healthy controls, p = 0.04). In network analysis, patients showed increased local efficiency (p < 0.05), but global efficiency, clustering coefficient, and small-world topology were relatively preserved compared to healthy subjects. Patients with supratentorial brain gliomas showed decreased long-distance connectivity while increased local efficiency and preserved small-world topology. The results of this small case series may provide a better understanding of the alterations of functional connectivity in patients with brain gliomas across the whole brain scale. (orig.)

  17. Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients

    Science.gov (United States)

    Vanhaudenhuyse, Audrey; Noirhomme, Quentin; Tshibanda, Luaba J.-F.; Bruno, Marie-Aurelie; Boveroux, Pierre; Schnakers, Caroline; Soddu, Andrea; Perlbarg, Vincent; Ledoux, Didier; Brichant, Jean-François; Moonen, Gustave; Maquet, Pierre; Greicius, Michael D.

    2010-01-01

    The ‘default network’ is defined as a set of areas, encompassing posterior-cingulate/precuneus, anterior cingulate/mesiofrontal cortex and temporo-parietal junctions, that show more activity at rest than during attention-demanding tasks. Recent studies have shown that it is possible to reliably identify this network in the absence of any task, by resting state functional magnetic resonance imaging connectivity analyses in healthy volunteers. However, the functional significance of these spontaneous brain activity fluctuations remains unclear. The aim of this study was to test if the integrity of this resting-state connectivity pattern in the default network would differ in different pathological alterations of consciousness. Fourteen non-communicative brain-damaged patients and 14 healthy controls participated in the study. Connectivity was investigated using probabilistic independent component analysis, and an automated template-matching component selection approach. Connectivity in all default network areas was found to be negatively correlated with the degree of clinical consciousness impairment, ranging from healthy controls and locked-in syndrome to minimally conscious, vegetative then coma patients. Furthermore, precuneus connectivity was found to be significantly stronger in minimally conscious patients as compared with unconscious patients. Locked-in syndrome patient’s default network connectivity was not significantly different from controls. Our results show that default network connectivity is decreased in severely brain-damaged patients, in proportion to their degree of consciousness impairment. Future prospective studies in a larger patient population are needed in order to evaluate the prognostic value of the presented methodology. PMID:20034928

  18. Brain functional networks. Correlation analysis with clinical indexes in patients with diabetic retinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Dai, Hui; Zhang, Yu; Hu, Su; Wang, Ximing; Li, Yonggang; Hu, Chunhong [The First Affiliated Hospital of Soochow University, Department of Radiology, Suzhou, Jiangsu (China); Lai, Lillian [LAC+USC Medical Center, Department of Neuroradiology, Los Angeles, CA (United States); Shen, Hailin [Suzhou Kowloon Hospital, Shanghai Jiao Tong University Medical School, Department of Radiology, Suzhou, Jiangsu (China)

    2017-11-15

    The relationship between parameters of brain functional networks and clinical indexes is unclear so far in patients with diabetic retinopathy (DR). This paper is to investigate this. Twenty-one patients with different grades of DR and 21 age- and sex-matched healthy controls were enrolled from August 2012 to September 2014. The clinical indexes recorded included DR grade, duration of diabetes, HbA1c, diabetic foot screen, fasting plasma glucose, insulin, Homa-β, Homa-IR, insulin sensitive index (ISI), Mini-Mental State Examination (MMSE), and patient sex and age. Subjects were scanned using 3-T MR with blood-oxygen-level-dependent and 3D-FSPGR sequences. MR data was analyzed via preprocessing and functional network construction, and quantified indexes of network (clustering coefficient, characteristic path length, global efficiency, degree distribution, and small worldness) were evaluated. Statistics consisted of ANOVA and correlation. There were significant differences between patients and controls among clustering coefficient, characteristic path length, degree distribution, and small worldness parameters (P < 0.05). MMSE scores negatively correlated with characteristic path length, and Hb1Ac negatively correlated with small worldness. MMSE, duration of diabetes, diabetic foot screen, fasting plasma glucose, insulin, Homa-β, Homa-IR, ISI, DR grade, and patient age, except from Hb1Ac, correlated with degree distribution in certain brain areas. Brain functional networks are altered, specifically in the areas of visual function and cognition, and these alterations may reflect the severity of visual weakness and cognitive decline in DR patients. Moreover, the brain networks may be affected both by long-standing and instant clinical factors. (orig.)

  19. Position statement on the role of healthcare professionals, patient organizations and industry in European Reference Networks

    NARCIS (Netherlands)

    Hollak, C.E.M.; Biegstraaten, M.; Baumgartner, M.R.; Belmatoug, N.; Bembi, B.; Bosch, A.; Brouwers, M.; Dekker, H.; Dobbelaere, D.; Engelen, M.; Groenendijk, M.C.; Lachmann, R.; Langendonk, J.G.; Langeveld, M.; Linthorst, G.; Morava, E.; Tien Poll-The, B.; Rahman, S.; Rubio-Gozalbo, M.E.; Spiekerkoetter, U.; Treacy, E.; Wanders, R.; Zschocke, J.; Hagendijk, R.

    2016-01-01

    A call from the EU for the set-up of European Reference Networks (ERNs) is expected to be launched in the first quarter of 2016. ERNs are intended to improve the care for patients with low prevalent or rare diseases throughout the EU by, among other things, facilitating the pooling and exchange of

  20. Position statement on the role of healthcare professionals, patient organizations and industry in European Reference Networks

    NARCIS (Netherlands)

    C.E.M. Hollak (Carla); M. Biegstraaten (Marieke); M.R. Baumgartner (Matthias R.); N. Belmatoug (Nadia); B. Bembi (Bruno); A.M. Bosch (Annet); M.C.G.J. Brouwers (M. C G J); H. Dekker (Hanka); D. Dobbelaere (Dries); M. Engelen (Marc); M.C. Groenendijk (Marike C.); R.H. Lachmann (Robin); J.G. Langendonk (Janneke); M. Langeveld (Mirjam); G. Linthorst (Gabor); E. Morava (Eva); B.T. Poll-The; S. Rahman (Shamima); M.E. Rubio-Gozalbo (Estela); U. Spiekerkoeter (Ute); E. Treacy (Eileen); R.J.A. Wanders (Ronald); J. Zschocke (Johannes); R. Hagendijk (Rob)

    2016-01-01

    textabstractA call from the EU for the set-up of European Reference Networks (ERNs) is expected to be launched in the first quarter of 2016. ERNs are intended to improve the care for patients with low prevalent or rare diseases throughout the EU by, among other things, facilitating the pooling and

  1. Network Alterations Supporting Word Retrieval in Patients with Medial Temporal Lobe Epilepsy

    Science.gov (United States)

    Protzner, Andrea B.; McAndrews, Mary Pat

    2011-01-01

    Although the hippocampus is not considered a key structure in semantic memory, patients with medial-temporal lobe epilepsy (mTLE) have deficits in semantic access on some word retrieval tasks. We hypothesized that these deficits reflect the negative impact of focal epilepsy on remote cerebral structures. Thus, we expected that the networks that…

  2. Prediction of Clinical Outcome Using Gene Expression Profiling and Artificial Neural Networks for Patients with Neuroblastoma

    Science.gov (United States)

    Wei, Jun S.; Greer, Braden T.; Westermann, Frank; Steinberg, Seth M.; Son, Chang-Gue; Chen, Qing-Rong; Whiteford, Craig C.; Bilke, Sven; Krasnoselsky, Alexei L.; Cenacchi, Nicola; Catchpoole, Daniel; Berthold, Frank; Schwab, Manfred; Khan, Javed

    2005-01-01

    Currently, patients with neuroblastoma are classified into risk groups (e.g., according to the Children’s Oncology Group risk-stratification) to guide physicians in the choice of the most appropriate therapy. Despite this careful stratification, the survival rate for patients with high-risk neuroblastoma remains artificial neural networks to develop an accurate predictor of survival for each individual patient with neuroblastoma. Using principal component analysis we found that neuroblastoma tumors exhibited inherent prognostic specific gene expression profiles. Subsequent artificial neural network-based prognosis prediction using expression levels of all 37,920 good-quality clones achieved 88% accuracy. Moreover, using an artificial neural network-based gene minimization strategy in a separate analysis we identified 19 genes, including 2 prognostic markers reported previously, MYCN and CD44, which correctly predicted outcome for 98% of these patients. In addition, these 19 predictor genes were able to additionally partition Children’s Oncology Group-stratified high-risk patients into two subgroups according to their survival status (P = 0.0005). Our findings provide evidence of a gene expression signature that can predict prognosis independent of currently known risk factors and could assist physicians in the individual management of patients with high-risk neuroblastoma. PMID:15466177

  3. Altered modular organization of intrinsic brain functional networks in patients with Parkinson's disease.

    Science.gov (United States)

    Ma, Qing; Huang, Biao; Wang, Jinhui; Seger, Carol; Yang, Wanqun; Li, Changhong; Wang, Junjing; Feng, Jieying; Weng, Ling; Jiang, Wenjie; Huang, Ruiwang

    2017-04-01

    Although previous studies reported altered topology of brain functional networks in patients with Parkinson's disease (PD), the modular organization of brain functional networks in PD patients remains largely unknown. Using the resting-state functional MRI (R-fMRI) and graph theory, we examined the modular organization of brain functional networks in 32 unmedicated patients with early-to-mid motor stage PD and 31 healthy controls. Compared to the controls, the PD patients tended to show decreased integrity and segregation, both within and between modules. This was inferred by significantly increased intra-modular characteristic path length (L p) within four modules: mPFC, SN, SMN, and FPN, decreased inter-modular functional connectivity (FC) between mPFC and SN, SMN, and VN, and decreased intra-modular clustering in the PD patients. Intra-modular characteristic path length within the mPFC showed significantly positive correlation with general cognitive ability in the PD group. Receiver operating characteristic (ROC) analysis revealed that FC between mPFC and SN had the highest significant accuracy in differentiating the patients from the controls. Our findings may provide new insight in understanding the pathological changes that underlie impairment in cognition and movement in Parkinson's disease.

  4. A queueing network model to analyze the impact of parallelization of care on patient cycle time.

    Science.gov (United States)

    Jiang, Lixiang; Giachetti, Ronald E

    2008-09-01

    The total time a patient spends in an outpatient facility, called the patient cycle time, is a major contributor to overall patient satisfaction. A frequently recommended strategy to reduce the total time is to perform some activities in parallel thereby shortening patient cycle time. To analyze patient cycle time this paper extends and improves upon existing multi-class open queueing network model (MOQN) so that the patient flow in an urgent care center can be modeled. Results of the model are analyzed using data from an urgent care center contemplating greater parallelization of patient care activities. The results indicate that parallelization can reduce the cycle time for those patient classes which require more than one diagnostic and/ or treatment intervention. However, for many patient classes there would be little if any improvement, indicating the importance of tools to analyze business process reengineering rules. The paper makes contributions by implementing an approximation for fork/join queues in the network and by improving the approximation for multiple server queues in both low traffic and high traffic conditions. We demonstrate the accuracy of the MOQN results through comparisons to simulation results.

  5. Building a Governance Strategy for CER: The Patient Outcomes Research to Advance Learning (PORTAL) Network Experience.

    Science.gov (United States)

    Paolino, Andrea R; McGlynn, Elizabeth A; Lieu, Tracy; Nelson, Andrew F; Prausnitz, Stephanie; Horberg, Michael A; Arterburn, David E; Gould, Michael K; Laws, Reesa L; Steiner, John F

    2016-01-01

    The Patient Outcomes Research to Advance Learning (PORTAL) Network was established with funding from the Patient-Centered Outcomes Research Institute (PCORI) in 2014. The PORTAL team adapted governance structures and processes from past research network collaborations. We will review and outline the structures and processes of the PORTAL governance approach and describe how proactively focusing on priority areas helped us to facilitate an ambitious research agenda. For years a variety of funders have supported large-scale infrastructure grants to promote the use of clinical datasets to answer important comparative effectiveness research (CER) questions. These awards have provided the impetus for health care systems to join forces in creating clinical data research networks. Often, these scientific networks do not develop governance processes proactively or systematically, and address issues only as problems arise. Even if network leaders and collaborators foresee the need to develop governance approaches, they may underestimate the time and effort required to develop sound processes. The resulting delays can impede research progress. Because the PORTAL sites had built trust and a foundation of collaboration by participating with one another in past research networks, essential elements of effective governance such as guiding principles, decision making processes, project governance, data governance, and stakeholders in governance were familiar to PORTAL investigators. This trust and familiarity enabled the network to rapidly prioritize areas that required sound governance approaches: responding to new research opportunities, creating a culture of trust and collaboration, conducting individual studies, within the broader network, assigning responsibility and credit to scientific investigators, sharing data while protecting privacy/security, and allocating resources. The PORTAL Governance Document, complete with a Toolkit of Appendices is included for reference and

  6. Abnormal functional brain network in epilepsy patients with focal cortical dysplasia.

    Science.gov (United States)

    Jeong, Woorim; Jin, Seung-Hyun; Kim, Museong; Kim, June Sic; Chung, Chun Kee

    2014-11-01

    Focal cortical dysplasia (FCD) is the second most common pathological entity in surgically treated neocortical focal epilepsy. Despite the recent increase of interest in network approaches derived from graph theory on epilepsy, resting state network analysis of the FCD brain has not been adequately investigated. In this study, we investigated the difference in the resting state functional network between epilepsy patients with FCD and healthy controls using whole-brain magnetoencephalography (MEG) recordings. Global mutual information (MIglob) and global efficiency (Eglob) were calculated for theta (4-7 Hz), alpha (8-12 Hz), beta (13-30 Hz), and gamma (31-45 Hz) bands in 35 epilepsy patients with FCD and 23 healthy controls. Resting state FCD brains had stronger functional connectivity (MIglob) in the beta and gamma bands and higher functional efficiency (Eglob) in the beta and gamma bands than those of the controls (ptype I and II brains in the beta band were higher than those of healthy control brains (ptype II brains were higher than those of control and FCD type I brains (ptype of FCD. The resting state network analysis could be useful in a clinical setting because we observed network differences even when there was no prominent interictal spike activity. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Distinctive Resting State Network Disruptions Among Alzheimer's Disease, Subcortical Vascular Dementia, and Mixed Dementia Patients.

    Science.gov (United States)

    Kim, Hee Jin; Cha, Jungho; Lee, Jong-Min; Shin, Ji Soo; Jung, Na-Yeon; Kim, Yeo Jin; Choe, Yearn Seong; Lee, Kyung Han; Kim, Sung Tae; Kim, Jae Seung; Lee, Jae Hong; Na, Duk L; Seo, Sang Won

    2016-01-01

    Recent advances in resting-state functional MRI have revealed altered functional networks in Alzheimer's disease (AD), especially those of the default mode network (DMN) and central executive network (CEN). However, few studies have evaluated whether small vessel disease (SVD) or combined amyloid and SVD burdens affect the DMN or CEN. The aim of this study was to evaluate whether SVD or combined amyloid and SVD burdens affect the DMN or CEN. In this cross-sectional study, we investigated the resting-state functional connectivity within DMN and CEN in 37 Pittsburgh compound-B (PiB)(+) AD, 37 PiB(-) subcortical vascular dementia (SVaD), 13 mixed dementia patients, and 65 normal controls. When the resting-state DMN of PiB(+) AD and PiB(-) SVaD patients were compared, the PiB(+) AD patients displayed lower functional connectivity in the inferior parietal lobule while the PiB(-) SVaD patients displayed lower functional connectivity in the medial frontal and superior frontal gyri. Compared to the PiB(-) SVaD or PiB(+) AD, the mixed dementia patients displayed lower functional connectivity within the DMN in the posterior cingulate gyrus. When the resting-state CEN connectivity of PiB(+) AD and PiB(-) SVaD patients were compared, the PiB(-) SVaD patients displayed lower functional connectivity in the anterior insular region. Compared to the PiB(-) SVaD or PiB(+) AD, the mixed dementia patients displayed lower functional connectivity within the CEN in the inferior frontal gyrus. Our findings suggest that in PiB(+) AD and PiB(-) SVaD, there is divergent disruptions in resting-state DMN and CEN. Furthermore, patients with combined amyloid and SVD burdens exhibited more disrupted resting-state DMN and CEN than patients with only amyloid or SVD burden.

  8. Topological correlations of structural and functional networks in patients with traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Karen eCaeyenberghs

    2013-11-01

    Full Text Available Despite an increasing amount of specific correlation studies between structural and functional connectivity, there is still a need for combined studies, especially in pathological conditions. Impairments of brain white matter and diffuse axonal injuries are commonly suspected to be responsible for the disconnection hypothesis in traumatic brain injury (TBI patients. Moreover, our previous research on TBI patients shows a strong relationship between abnormalities in topological organization of brain networks and behavioral deficits. In this study, we combined task-related functional connectivity (using event-related fMRI with structural connectivity (derived from fiber tractography using diffusion MRI data estimates in the same participants (17 adults with TBI and 16 controls, allowing for direct comparison between graph metrics of the different imaging modalities. Connectivity matrices were computed covering the switching motor network, which includes the basal ganglia, anterior cingulate cortex/supplementary motor area, and anterior insula/inferior frontal gyrus. The edges constituting this network consisted of the partial correlations between the fMRI time series from each node of the switching motor network. The interregional anatomical connections between the switching-related areas were determined using the fiber tractography results. We found that graph metrics and hubs obtained showed no agreement in both groups. The topological properties of brain functional networks could not be solely accounted for the properties of the underlying structural networks. However, combining complementary information from both different imaging modalities could improve accuracy in prediction of switching performance. Direct comparison between functional task-related and anatomical structural connectivity, presented here for the first time in TBI patients, links two powerful approaches to map the patterns of brain connectivity that may underlie behavioral

  9. Distinguishing patients with Parkinson's disease subtypes from normal controls based on functional network regional efficiencies.

    Directory of Open Access Journals (Sweden)

    Delong Zhang

    Full Text Available Many studies have demonstrated that the pathophysiology and clinical symptoms of Parkinson's disease (PD are inhomogeneous. However, the symptom-specific intrinsic neural activities underlying the PD subtypes are still not well understood. Here, 15 tremor-dominant PD patients, 10 non-tremor-dominant PD patients, and 20 matched normal controls (NCs were recruited and underwent resting-state functional magnetic resonance imaging (fMRI. Functional brain networks were constructed based on randomly generated anatomical templates with and without the cerebellum. The regional network efficiencies (i.e., the local and global efficiencies were further measured and used to distinguish subgroups of PD patients (i.e., with tremor-dominant PD and non-tremor-dominant PD from the NCs using linear discriminant analysis. The results demonstrate that the subtype-specific functional networks were small-world-organized and that the network regional efficiency could discriminate among the individual PD subgroups and the NCs. Brain regions involved in distinguishing between the study groups included the basal ganglia (i.e., the caudate and putamen, limbic regions (i.e., the hippocampus and thalamus, the cerebellum, and other cerebral regions (e.g., the insula, cingulum, and calcarine sulcus. In particular, the performances of the regional local efficiency in the functional network were better than those of the global efficiency, and the performances of global efficiency were dependent on the inclusion of the cerebellum in the analysis. These findings provide new evidence for the neurological basis of differences between PD subtypes and suggest that the cerebellum may play different roles in the pathologies of different PD subtypes. The present study demonstrated the power of the combination of graph-based network analysis and discrimination analysis in elucidating the neural basis of different PD subtypes.

  10. Using Conjugate Gradient Network to Classify Stress Level of Patients.

    Directory of Open Access Journals (Sweden)

    Er. S. Pawar

    2013-02-01

    Full Text Available Diagnosis of stress is important because it can cause many diseases e.g., heart disease, headache, migraine, sleep problems, irritability etc. Diagnosis of stress in patients often involves acquisition of biological signals for example heart rate, electrocardiogram (ECG, electromyography signals (EMG etc. Stress diagnosis using biomedical signals is difficult and since the biomedical signals are too complex to generate any rule an experienced person or expert is needed to determine stress levels. Also, it is not feasible to use all the features that are available or possible to extract from the signal. So, relevant features should be chosen from the extracted features that are capable to diagnose stress. Electronics devices are increasingly being seen in the field of medicine for diagnosis, therapy, checking of stress levels etc. The research and development work of medical electronics engineers leads to the manufacturing of sophisticated diagnostic medical equipment needed to ensure good health care. Biomedical engineering combines the design and problem solving skills of engineering with medical and biological sciences to improve health care diagnosis and treatment.

  11. Dysregulated daily rhythmicity of neuronal resting-state networks in MCI patients.

    Science.gov (United States)

    Blautzik, Janusch; Vetter, Céline; Schneider, Annalisa; Gutyrchik, Evgeny; Reinisch, Veronika; Keeser, Daniel; Paolini, Marco; Pöppel, Ernst; Bao, Yan; Reiser, Maximilian; Roenneberg, Till; Meindl, Thomas

    2014-11-01

    In young healthy participants, the degree of daily rhythmicity largely varies across different neuronal resting-state networks (RSNs), while it is to date unknown whether this temporal pattern of activity is conserved in healthy and pathological aging. Twelve healthy elderly (mean age=65.1±5.7 years) and 12 patients with amnestic mild cognitive impairment (aMCI; mean age=69.6±6.2 years) underwent four resting-state functional magnetic resonance imaging scans at fixed 2.5 h intervals throughout a day. Time courses of a RSN were extracted by a connectivity strength and a spatial extent approach performed individually for each participant. Highly rhythmic RSNs included a sensorimotor, a cerebellar and a visual network in healthy elderly; the least rhythmic RSNs in this group included a network associated with executive control and an orbitofrontal network. The degree of daily rhythmicity in aMCI patients was reduced and dysregulated. For healthy elderly, the findings are in accordance with results reported for young healthy participants suggesting a comparable distribution of daily rhythmicity across RSNs during healthy aging. In contrast, the reduction and dysregulation of daily rhythmicity observed in aMCI patients is presumably indicative of underlying neurodegenerative processes in this group.

  12. The partnership of patient advocacy groups and clinical investigators in the rare diseases clinical research network.

    Science.gov (United States)

    Merkel, Peter A; Manion, Michele; Gopal-Srivastava, Rashmi; Groft, Stephen; Jinnah, H A; Robertson, David; Krischer, Jeffrey P

    2016-05-18

    Among the unique features of the Rare Diseases Clinical Research Network (RDCRN) Program is the requirement for each Consortium to include patient advocacy groups (PAGs) as research partners. This development has transformed the work of the RDCRN and is a model for collaborative research. This article outlines the roles patients and PAGs play in the RDCRN and reports on the PAGs' impact on the Network's success. Principal Investigators from the 17 RDCRN Consortia and 28 representatives from 76 PAGs affiliated with these Consortia were contacted by email to provide feedback via an online RDCRN survey. Impact was measured in the key areas of 1) Research logistics; 2) Outreach and communication; and 3) Funding and in-kind support. Rating choices were: 1-very negative, 2-somewhat negative, 3-no impact, 4-somewhat positive, and 5-very positive. Twenty-seven of the PAGs (96 %) disseminate information about the RDCRN within the patient community. The Consortium Principal Investigators also reported high levels of PAG involvement. Sixteen (94 %) Consortium Principal Investigators and 25 PAGs (89 %) reported PAGs participation in protocol review, study design, Consortium conference calls, attending Consortium meetings, or helping with patient recruitment. PAGs are actively involved in shaping Consortia's research agendas, help ensure the feasibility and success of research protocols by assisting with study design and patient recruitment, and support training programs. This extensive PAG-Investigator partnership in the RDCRN has had a strongly positive impact on the success of the Network.

  13. Increased default-mode network centrality in cognitively impaired multiple sclerosis patients.

    Science.gov (United States)

    Eijlers, Anand J C; Meijer, Kim A; Wassenaar, Thomas M; Steenwijk, Martijn D; Uitdehaag, Bernard M J; Barkhof, Frederik; Wink, Alle M; Geurts, Jeroen J G; Schoonheim, Menno M

    2017-03-07

    To investigate how changes in functional network hierarchy determine cognitive impairment in multiple sclerosis (MS). A cohort consisting of 332 patients with MS (age 48.1 ± 11.0 years, symptom duration 14.6 ± 8.4 years) and 96 healthy controls (HCs; age 45.9 ± 10.4 years) underwent structural MRI, fMRI, and extensive neuropsychological testing. Patients were divided into 3 groups: cognitively impaired (CI; n = 87), mildly cognitively impaired (MCI; n = 65), and cognitively preserved (CP; n = 180). The functional importance of brain regions was quantified with degree centrality, the average strength of the functional connections of a brain region with the rest of the brain, and eigenvector centrality, which adds to this concept by adding additional weight to connections with brain hubs because these are known to be especially important. Centrality values were calculated for each gray matter voxel based on resting-state fMRI data, registered to standard space. Group differences were assessed with a cluster-wise permutation-based method corrected for age, sex, and education. CI patients demonstrated widespread centrality increases compared to both HCs and CP patients, mainly in regions making up the default-mode network. Centrality decreases were similar in all patient groups compared to HCs, mainly in occipital and sensorimotor areas. Results were robust across centrality measures. Patients with MS with cognitive impairment show hallmark alterations in functional network hierarchy with increased relative importance (centrality) of the default-mode network. © 2017 American Academy of Neurology.

  14. Inefficient preparatory fMRI-BOLD network activations predict working memory dysfunctions in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Anja eBaenninger

    2016-03-01

    Full Text Available Patients with schizophrenia show abnormal dynamics and structure of temporally coherent networks (TCNs assessed using fMRI, which undergo adaptive shifts in preparation for a cognitively demanding task. During working memory (WM tasks, patients with schizophrenia show persistent deficits in TCNs as well as EEG indices of WM. Studying their temporal relationship during WM tasks might provide novel insights into WM performance deficits seen in schizophrenia.Simultaneous EEG-fMRI data were acquired during the performance of a verbal Sternberg WM task with two load levels (load 2 & load 5 in 17 patients with schizophrenia and 17 matched healthy controls. Using covariance mapping, we investigated the relationship of the activity in the TCNs before the memoranda were encoded and EEG spectral power during the retention interval. We assessed four TCNs – default mode network (DMN, dorsal attention network (dAN, left and right working memory networks (WMNs – and three EEG bands – theta, alpha, and beta.In healthy controls, there was a load dependent inverse relation between DMN and frontal-midline theta power and an anti-correlation between DMN and dAN. Both effects were not significantly detectable in patients. In addition, healthy controls showed a left-lateralized load-dependent recruitment of the WMNs. Activation of the WMNs was bilateral in patients, suggesting more resources were recruited for successful performance on the WM task.Our findings support the notion of schizophrenia patients showing deviations in their neurophysiological responses before the retention of relevant information in a verbal WM task. Thus, treatment strategies as neurofeedback targeting pre-states could be beneficial as task performance relies on the preparatory state of the brain.

  15. Surgical Site Infection Reduction by the Solutions for Patient Safety Hospital Engagement Network.

    Science.gov (United States)

    Schaffzin, Joshua K; Harte, Lory; Marquette, Scott; Zieker, Karen; Wooton, Sharyl; Walsh, Kathleen; Newland, Jason G

    2015-11-01

    Surgical site infections (SSIs) negatively affect patients and the health care system. National standards for SSI prevention do not exist in pediatric settings. We sought to reduce SSI-related harm by implementing a prevention bundle through the Solutions for Patient Safety (SPS) national hospital engagement network. Our study period was January 2011 to December 2013. We formed a national workgroup of content and quality improvement experts. We focused on 3 procedure types at high risk for SSIs: cardiothoracic, neurosurgical shunt, and spinal fusion surgeries. We used the Model for Improvement methodology and the Centers for Disease Control and Prevention SSI definition. After literature review and consultation with experts, we distributed a recommended bundle among network partners. Institutions were permitted to adopt all or part of the bundle and reported local bundle adherence and SSI rates monthly. Our learning network used webinars, discussion boards, targeted leader messaging, and in-person learning sessions. Recommended bundle elements encompassed proper preoperative bathing, intraoperative skin antisepsis, and antibiotic delivery. Within 6 months, the network achieved 96.7% reliability among institutions reporting adherence data. A 21% reduction in SSI rate was reported across network hospitals, from a mean baseline rate of 2.5 SSIs per 100 procedures to a mean rate of 1.8 SSIs per 100 procedures. The reduced rate was sustained for 15 months. Adoption of a SSI prevention bundle with concomitant reliability measurement reduced the network SSI rate. Linking reliability measurement to standardization at an institutional level may lead to safer care. Copyright © 2015 by the American Academy of Pediatrics.

  16. Prediction of Clinical Deterioration in Hospitalized Adult Patients with Hematologic Malignancies Using a Neural Network Model.

    Science.gov (United States)

    Hu, Scott B; Wong, Deborah J L; Correa, Aditi; Li, Ning; Deng, Jane C

    2016-01-01

    Clinical deterioration (ICU transfer and cardiac arrest) occurs during approximately 5-10% of hospital admissions. Existing prediction models have a high false positive rate, leading to multiple false alarms and alarm fatigue. We used routine vital signs and laboratory values obtained from the electronic medical record (EMR) along with a machine learning algorithm called a neural network to develop a prediction model that would increase the predictive accuracy and decrease false alarm rates. Retrospective cohort study. The hematologic malignancy unit in an academic medical center in the United States. Adult patients admitted to the hematologic malignancy unit from 2009 to 2010. None. Vital signs and laboratory values were obtained from the electronic medical record system and then used as predictors (features). A neural network was used to build a model to predict clinical deterioration events (ICU transfer and cardiac arrest). The performance of the neural network model was compared to the VitalPac Early Warning Score (ViEWS). Five hundred sixty five consecutive total admissions were available with 43 admissions resulting in clinical deterioration. Using simulation, the neural network outperformed the ViEWS model with a positive predictive value of 82% compared to 24%, respectively. We developed and tested a neural network-based prediction model for clinical deterioration in patients hospitalized in the hematologic malignancy unit. Our neural network model outperformed an existing model, substantially increasing the positive predictive value, allowing the clinician to be confident in the alarm raised. This system can be readily implemented in a real-time fashion in existing EMR systems.

  17. The world of e-patients: A content analysis of online social networks focusing on diseases.

    Science.gov (United States)

    Orizio, Grazia; Schulz, Peter; Gasparotti, Cinzia; Caimi, Luigi; Gelatti, Umberto

    2010-12-01

    as the participatory Web developed to create virtual worlds and communities, health institutions and activists discovered Web 2.0 tools, in particular the creation of health-related online social networks. To analyze the existing online social networks dedicated to health issues, we performed an active search on the Internet for such Web sites and analyzed their features according to the content analysis method. the study was performed in September and October 2009. We analyzed a sample of health social networks for patients, selected using four common search engines. A codebook was elaborated to investigate four areas: general information; technical characteristics and utilities; characteristics of the Web site and contents, both general and related to the online community. the search led to a sample of 41 social networks. Twenty-three Web sites (56.1%) were dedicated to several diseases, the others to one only. Although the majority of the sample (87.8%) provided a way to contact the Web site, only five (12.2%) showed the name of the author or operating organization. Eight Web sites (19.5%) indicated one or more sponsors, and nine (22.0%) named one or more partners. It was often hard to tell whether an institution mentioned was a sponsor or a partner. Five Web sites (12.2%) enabled users to buy health-related products online. Twelve Web sites (29.3%) offered users the chance to search for doctors, and 12 (29.3%) gave therapeutic information. Two Web sites (4.9%) published aggregate statistical data about the patients registered with the social network. the data reveal the high heterogeneity of health-related social networks and raise interesting considerations on such controversial topics as the quality of online health information, research perspectives, interactivity, and empowerment. In particular, our findings are relevant to criticism regarding the openness and transparency of these Web sites, the use of personal data, and privacy issues.

  18. Stroke Social Network Scale: development and psychometric evaluation of a new patient-reported measure.

    Science.gov (United States)

    Northcott, Sarah; Hilari, Katerina

    2013-09-01

    To describe the development and psychometric evaluation of a new patient-reported measure that assesses a person's social network in the first six months post stroke. Although it is known that the social networks of those with stroke and aphasia are vulnerable to change, there is currently no social network scale that has been validated for this population. Repeated measures psychometric study, evaluating internal consistency, construct validity, and responsiveness to change of the Stroke Social Network Scale. Participants were interviewed two weeks, three months and six months following a first stroke. Stroke Social Network Scale; Medical Outcomes Studies (MOS) Social Support Survey; National Institute of Health Stroke Scale; Stroke and Aphasia Quality of Life Scale-39g; Frenchay Aphasia Screening Test. 87 participants were recruited, of whom 71 were followed up at six months. Factor analysis was used with the Stroke Social Network Scale to derive five subdomains: satisfaction; children; relatives; friends; and groups, which explained 63% of variance. There was good evidence for the scale's internal consistency (α = 0.85); acceptability; and convergent (r = 0.34; r = 0.53) and discriminant validity (r = -0.10; r = -0.19). It differentiated between those with high versus low perceived social support (p = 0.01). Moderate changes from two weeks to six months supported responsiveness (d = 0.32; standardised response mean (SRM) = 0.46), with the friends factor, as expected, showing more change than the children's factor (friends factor: d = 0.46; SRM = 0.50; children's factor: d = 0.06; SRM = 0.19). The Stroke Social Network Scale is a new measure that demonstrates good internal consistency, validity and responsiveness to change.

  19. [Quality circle in a trauma network of the German Association for Trauma Surgery. Upgrading patient care].

    Science.gov (United States)

    Ernstberger, A; Koller, M; Nerlich, M

    2011-02-01

    In industry, especially in the automobile industry, improvements in efficiency could be demonstrated by quality management and quality circles. There is no doubt that in medicine, major trauma is also a very complex challenge.The German Association for Trauma Surgery published the White Paper on the Management of the Seriously Injured in 2006. The White Paper specifies the demand for quality of care, sets the level of structural requirements for trauma care and postulates the cooperation of regional hospitals within a network of dedicated trauma centres. The Trauma Network Eastern Bavaria (TNO) was the first certified trauma network in Germany. One of the reasons for this success is the fact that cooperation between trauma surgeons has already had a long tradition in this geographic area. The key factor is communication which is supported by all technical and organisational means. The formal installation of quality circles on each level of trauma care, e.g. within and across institutions, was accepted by all partners within the network. The goal is the improvement of patient care in trauma above and beyond the guidelines of the White Paper. This paper shows the instruments used to enhance the quality of trauma care within a network.

  20. Depressive symptoms, social network, and bereavement service utilization and preferences among spouses of former hospice patients.

    Science.gov (United States)

    Bergman, Elizabeth J; Haley, William E

    2009-02-01

    Bereavement services are an important part of comprehensive end-of-life care with potential to ameliorate physical, psychological, and spiritual distress. We studied bereaved spouses of hospice patients to examine bereavement service utilization, barriers, and preferences regarding content, structure, and delivery of potential bereavement services. We also examined the impact of depressive symptoms and social network. Retrospective cohort study of bereaved spousal caregivers of patients of three hospices in Tampa Bay, Florida. Descriptive and univariate analyses assessed demographics, depressive symptoms, social network, service utilization, barriers, and preferences. Nearly half utilized at least one type of specialized professional bereavement intervention to aid in coping with their loss. The most frequently used services were provided by clergy members and physicians. Primarily attitudinal in nature, barriers included the finding that more than one third felt available services did not fit their needs or interests. Individual and spiritually-based services were highly endorsed, as were services designed to provide tools to reframe the loss and cope with accompanying changes and emotions. Lower social network was associated with higher content preferences for services consistent primarily with restoration-oriented coping. Clinicians and service providers may facilitate coping by routinely screening for depressive symptoms and social network and tailoring interventions to those identified as experiencing elevated distress or lacking social resources. Attitudinal barriers and preferences suggest that even in the service-rich environment of hospice some modification of bereavement services might reach more bereaved spouses. Future studies might address whether preferences lead individuals to services of the greatest benefit.

  1. EEG functional network topology is associated with disability in patients with amyotrophic lateral sclerosis

    Science.gov (United States)

    Fraschini, Matteo; Demuru, Matteo; Hillebrand, Arjan; Cuccu, Lorenza; Porcu, Silvia; di Stefano, Francesca; Puligheddu, Monica; Floris, Gianluca; Borghero, Giuseppe; Marrosu, Francesco

    2016-12-01

    Amyotrophic Lateral Sclerosis (ALS) is one of the most severe neurodegenerative diseases, which is known to affect upper and lower motor neurons. In contrast to the classical tenet that ALS represents the outcome of extensive and progressive impairment of a fixed set of motor connections, recent neuroimaging findings suggest that the disease spreads along vast non-motor connections. Here, we hypothesised that functional network topology is perturbed in ALS, and that this reorganization is associated with disability. We tested this hypothesis in 21 patients affected by ALS at several stages of impairment using resting-state electroencephalography (EEG) and compared the results to 16 age-matched healthy controls. We estimated functional connectivity using the Phase Lag Index (PLI), and characterized the network topology using the minimum spanning tree (MST). We found a significant difference between groups in terms of MST dissimilarity and MST leaf fraction in the beta band. Moreover, some MST parameters (leaf, hierarchy and kappa) significantly correlated with disability. These findings suggest that the topology of resting-state functional networks in ALS is affected by the disease in relation to disability. EEG network analysis may be of help in monitoring and evaluating the clinical status of ALS patients.

  2. High-Dose Aspirin Is Required to Influence Plasma Fibrin Network Structure in Patients With Type 1 Diabetes

    OpenAIRE

    Tehrani, Sara; Antovic, Aleksandra; Mobarrez, Fariborz; Mageed, Koteiba; Lins, Per-Eric; Adamson, Ulf; Wall?n, H?kan N.; J?rneskog, Gun

    2012-01-01

    OBJECTIVE Patients with type 1 diabetes form a less permeable fibrin network, which could contribute to their increased risk of cardiovascular disease (CVD). Low-dose aspirin treatment is the standard in the management of CVD; however, the effect seems reduced in patients with diabetes. We investigated the effects of low- and high-dose aspirin treatment on fibrin network formation in patients with type 1 diabetes (primary aim) and the possible interaction between the treatment effects of aspi...

  3. Exploring the impact of different multi-level measures of physician communities in patient-centric care networks on healthcare outcomes: A multi-level regression approach

    National Research Council Canada - National Science Library

    Uddin, Shahadat

    2016-01-01

    .... In order to assess the impact different multi-level attributes of patient-centric care networks on healthcare outcomes, this study first captured patient-centric care networks for 85 hospitals using...

  4. Altered effective connectivity of resting state networks by acupuncture stimulation in stroke patients with left hemiplegia: A multivariate granger analysis.

    Science.gov (United States)

    Fu, Cai-Hong; Li, Kuang-Shi; Ning, Yan-Zhe; Tan, Zhong-Jian; Zhang, Yong; Liu, Hong-Wei; Han, Xiao; Zou, Yi-Huai

    2017-11-01

    The aim of this study was to explore the response feature of resting-state networks (RSNs) of stroke patients with left hemiplegia by acupuncture stimulation.Nineteen stroke patients with left hemiplegia and 17 controls were recruited in this study. Resting-state functional magnetic resonance imaging data before and after acupuncture were acquired using magnetic scanning. The independent component analysis (ICA) was employed to extract RSNs related to motion, sensation, cognition, and execution, including sensorimotor network (SMN), left and right frontoparietal network (LFPN and RFPN), anterior and posterior default mode network (aDMN, pDMN), visual network (VN), and salience network (SN). Granger causality method was used to explore how acupuncture stimulation affects the causality between intrinsic RSNs in stroke patients. Compared with healthy subjects, stroke patients presented the more complex effective connectivity. Before acupuncture stimulation, LFPN inputted most information from other networks while DMN outputted most information to other networks; however, the above results were reversal by acupuncture. In addition, we found aDMN reside in between SMN and LFPN after acupuncture.The finding suggested that acupuncture probably integrated the effective connectivity internetwork by modulating multiple networks and transferring information between LFPN and SMN by DMN as the relay station. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  5. Decreased default-mode network homogeneity in unaffected siblings of schizophrenia patients at rest.

    Science.gov (United States)

    Guo, Wenbin; Liu, Feng; Yao, Dapeng; Jiang, Jiajing; Su, Qinji; Zhang, Zhikun; Zhang, Jian; Yu, Liuyu; Zhai, Jinguo; Xiao, Changqing

    2014-12-30

    The dysconnectivity hypothesis proposes that abnormal resting state connectivity within the default-mode network (DMN) plays a key role in schizophrenia. Little is known, however, about alterations of the network homogeneity (NH) of the DMN in unaffected siblings of patients with schizophrenia. Unaffected siblings have unique advantages as subjects of neuroimaging studies independent of the clinical and treatment issues that complicate studies of the patients themselves. In the present study, we investigated NH of the DMN in unaffected siblings of schizophrenia. Participants comprised 46 unaffected siblings of schizophrenia patients and 50 age-, sex-, and education-matched healthy controls who underwent resting state functional magnetic resonance imaging (fMRI). Automated NH and group independent component analysis (ICA) approaches were used to analyze the data. Compared with healthy controls, the unaffected siblings of schizophrenia patients showed decreased DMN homogeneity in the left precuneus. No significantly increased DMN homogeneity was found in the sibling group relative to the control group. Our results suggest that there is decreased NH of the DMN in unaffected siblings of schizophrenia patients and indicate that the alternative perspective of examining the DMN NH in patients׳ siblings may improve understanding of the nature of schizophrenia. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Functional connectivity analysis of resting-state fMRI networks in nicotine dependent patients

    Science.gov (United States)

    Smith, Aria; Ehtemami, Anahid; Fratte, Daniel; Meyer-Baese, Anke; Zavala-Romero, Olmo; Goudriaan, Anna E.; Schmaal, Lianne; Schulte, Mieke H. J.

    2016-03-01

    Brain imaging studies identified brain networks that play a key role in nicotine dependence-related behavior. Functional connectivity of the brain is dynamic; it changes over time due to different causes such as learning, or quitting a habit. Functional connectivity analysis is useful in discovering and comparing patterns between functional magnetic resonance imaging (fMRI) scans of patients' brains. In the resting state, the patient is asked to remain calm and not do any task to minimize the contribution of external stimuli. The study of resting-state fMRI networks have shown functionally connected brain regions that have a high level of activity during this state. In this project, we are interested in the relationship between these functionally connected brain regions to identify nicotine dependent patients, who underwent a smoking cessation treatment. Our approach is on the comparison of the set of connections between the fMRI scans before and after treatment. We applied support vector machines, a machine learning technique, to classify patients based on receiving the treatment or the placebo. Using the functional connectivity (CONN) toolbox, we were able to form a correlation matrix based on the functional connectivity between different regions of the brain. The experimental results show that there is inadequate predictive information to classify nicotine dependent patients using the SVM classifier. We propose other classification methods be explored to better classify the nicotine dependent patients.

  7. When information is insufficient: inspiring patients for medication adherence and the role of social support networking.

    Science.gov (United States)

    Hennessey, Maureen; Heryer, John W

    2011-01-01

    A report presented by the RAND Corporation for the Agency for Healthcare Research and Quality recommends that patient self-management programs should include supportive coaching, and the World Health Organization has suggested that the enhancement of patient motivation and behavioral skills is crucial to increasing patient care adherence. The US healthcare reform legislation also provides incentives for evidence-based activities (eg, coaching) that promote healthy behaviors. To review the current research on evidence-based coaching methods and their impact on medication adherence, as well as offer practical applications for such coaching interventions. The authors review the role of medication adherence in reducing the burden of chronic diseases, using the definitions of coaching and Network Coaching as a starting point for interventions that can enhance providers' skills in motivating patients to improve their treatment adherence. Practical examples are included throughout the article to illustrate the benefits of these coaching methods for patients and providers. The mnemonic COPE is used to assist providers in the recall of 4 significant coaching and Network Coaching concepts-connectedness and collaboration, open-ended questions, positive attitude, and encourage support. Following COPE can reinforce physicians and pharmacists in their attempt to improve patient medication adherence. The article presents healthcare providers, including physicians and pharmacists, with a rationale for developing evidence-based coaching skills and offers suggestions for the application of key coaching concepts.

  8. Neural Network for Determining Risk Rate of Post-Heart Stroke Patients

    Directory of Open Access Journals (Sweden)

    Oldřich Trenz

    2014-01-01

    Full Text Available The ischemic heart disease presents an important health problem that affects a great part of the population and is the cause of one third of all deaths in the Czech Republic. The availability of data describing the patients’ prognosis enables their further analysis, with the aim of lowering the patients’ risk, by proposing optimum treatment. The main reason for creating the neural network model is not only to automate the process of establishing the risk rate of patients suffering from ischemic heart disease, but also to adapt it for practical use in clinical conditions. Our aim is to identify especially the specific group of risk-rate patients whose well-timed preventive care can improve the quality and prolong the length of their lives.The aim of the paper is to propose a patient-parameter structure, using which we could create a suitable model based on a self-taught neural network. The emphasis is placed on identifying key descriptive parameters (in the form of a reduction of the available descriptive parameters that are crucial for identifying the required patients, and simultaneously to achieve a portability of the model among individual clinical workplaces (availability of parameters.

  9. Social networking and Internet use among pelvic floor patients: a multicenter survey.

    Science.gov (United States)

    Mazloomdoost, Donna; Kanter, Gregory; Chan, Robert C; Deveaneau, Nicolette; Wyman, Allison M; Von Bargen, Emily C; Chaudhry, Zaid; Elshatanoufy, Solafa; Miranne, Jeannine M; Chu, Christine M; Pauls, Rachel N; Arya, Lily A; Antosh, Danielle D

    2016-11-01

    Internet resources are becoming increasingly important for patients seeking medical knowledge. It is imperative to understand patient use and preferences for using the Internet and social networking websites to optimize patient education. The purpose of this study was to evaluate social networking and Internet use among women with pelvic floor complaints to seek information for their conditions as well as describe the likelihood, preferences, and predictors of website usage. This was a cross-sectional, multicenter study of women presenting to clinical practices of 10 female pelvic medicine and reconstructive surgery fellowship programs across the United States, affiliated with the Fellows' Pelvic Research Network. New female patients presenting with pelvic floor complaints, including urinary incontinence, pelvic organ prolapse, and fecal incontinence were eligible. Participants completed a 24 item questionnaire designed by the authors to assess demographic information, general Internet use, preferences regarding social networking websites, referral patterns, and resources utilized to learn about their pelvic floor complaints. Internet use was quantified as high (≥4 times/wk), moderate (2-3 times/wk), or minimal (≤1 time/wk). Means were used for normally distributed data and medians for data not meeting this assumption. Fisher's exact and χ2 tests were used to evaluate the associations between variables and Internet use. A total of 282 surveys were analyzed. The majority of participants, 83.3%, were white. The mean age was 55.8 years old. Referrals to urogynecology practices were most frequently from obstetrician/gynecologists (39.9%) and primary care providers (27.8%). Subjects were well distributed geographically, with the largest representation from the South (38.0%). Almost one third (29.9%) were most bothered by prolapse complaints, 22.0% by urgency urinary incontinence, 20.9% by stress urinary incontinence, 14.9% by urgency/frequency symptoms, and 4

  10. On the Feasibility of Wearable Exotendon Networks for Whole-Hand Movement Patterns in Stroke Patients

    OpenAIRE

    Park, Sangwoo; Bishop, Lauri; Post, Tara; Xiao, Yuchen; Stein, Joel; Ciocarlie, Matei

    2017-01-01

    Fully wearable hand rehabilitation and assistive devices could extend training and improve quality of life for patients affected by hand impairments. However, such devices must deliver meaningful manipulation capabilities in a small and lightweight package. In this context, this paper investigates the capability of single-actuator devices to assist whole-hand movement patterns through a network of exotendons. Our prototypes combine a single linear actuator (mounted on a forearm splint) with a...

  11. Difficult encounters with psychiatric patients: a South Texas Psychiatry practice-based research network (PBRN) study.

    Science.gov (United States)

    Sellers, Randall V; Salazar, Ricardo; Martinez, Cervando; Gelfond, Stephen D; Deuter, Melissa; Hayes, Holly G; Ketchum, Norma; Pollock, Brad H

    2012-01-01

    To examine the prevalence of difficult psychiatrist-patient interactions of 20 psychiatrists in the South Texas Psychiatric practice-based research network, determine what characteristics were associated with "difficult" patients, and compare findings with previous studies in primary care. During a 2-month observational study, psychiatrists collected patient information on setting, demographics, diagnoses, and medications and rated the patients using the Difficult Doctor-Patient Relationship Questionnaire, which had previously been used and validated in the primary care setting. A total of 905 valid data cards were collected. Difficult patients were identified in 15% of the sample. Diagnoses of schizophrenia, alcohol/substance abuse, and personality disorder were associated with difficulty. Psychiatrists least burdened by difficult patients were older and in a solo practice and worked 51 to 55 hours per week. This cross-sectional study demonstrates that psychiatrists encounter difficult patients at a rate (15%) similar to that of primary care physicians. Mentoring programs and structured treatment interventions for the most difficult patient groups may assist all physicians who treat psychiatric patients, whether in specialty, family medicine, or other primary care settings.

  12. Artificial neural networks to predict presence of significant pathology in patients presenting to routine colorectal clinics.

    Science.gov (United States)

    Maslekar, S; Gardiner, A B; Monson, J R T; Duthie, G S

    2010-12-01

    Artificial neural networks (ANNs) are computer programs used to identify complex relations within data. Routine predictions of presence of colorectal pathology based on population statistics have little meaning for individual patient. This results in large number of unnecessary lower gastrointestinal endoscopies (LGEs - colonoscopies and flexible sigmoidoscopies). We aimed to develop a neural network algorithm that can accurately predict presence of significant pathology in patients attending routine outpatient clinics for gastrointestinal symptoms. Ethics approval was obtained and the study was monitored according to International Committee on Harmonisation - Good Clinical Practice (ICH-GCP) standards. Three-hundred patients undergoing LGE prospectively completed a specifically developed questionnaire, which included 40 variables based on clinical symptoms, signs, past- and family history. Complete data sets of 100 patients were used to train the ANN; the remaining data was used for internal validation. The primary output used was positive finding on LGE, including polyps, cancer, diverticular disease or colitis. For external validation, the ANN was applied to data from 50 patients in primary care and also compared with the predictions of four clinicians. Clear correlation between actual data value and ANN predictions were found (r = 0.931; P = 0.0001). The predictive accuracy of ANN was 95% in training group and 90% (95% CI 84-96) in the internal validation set and this was significantly higher than the clinical accuracy (75%). ANN also showed high accuracy in the external validation group (89%). Artificial neural networks offer the possibility of personal prediction of outcome for individual patients presenting in clinics with colorectal symptoms, making it possible to make more appropriate requests for lower gastrointestinal endoscopy. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.

  13. Abnormal Default-Mode Network Activation in Cirrhotic Patients: A Functional Magnetic Resonance Imaging Study

    Energy Technology Data Exchange (ETDEWEB)

    Long Jiang Zhang; Guifen Yang; Jianzhong Yin; Yawu Liu; Ji Qi [Dept. of Radiology, Tianjin First Central Hospital, Tianjin Medical Univ., Tianjin (China)

    2007-09-15

    Background: Recently, increasing numbers of studies have demonstrated that, in humans, a default-mode functional network exists in the resting state. Abnormal default-mode network in various diseases has been reported; however, no report concerning hepatic cirrhosis has been published to date. Purpose: To prospectively explore whether the resting-state network in patients with hepatic cirrhosis is abnormal or not, using functional magnetic resonance imaging (fMRI). Material and Methods: 14 patients with hepatic cirrhosis (12 male, two female; 45{+-}9 years) and 14 age- and gender-matched healthy volunteers (12 male, two female; 42{+-}10 years) participated in a blocked-design fMRI study. A modified Stroop task with Chinese characters was used as the target stimulus. Statistical Parametric Mapping 99 software was employed to process the functional data. Individual maps and group data were generated for patients with hepatic cirrhosis and for healthy controls, respectively. Intergroup analysis between patients and healthy controls was also generated using the two-sample t-test model. Cluster analyses were done based on the group data, and an identical P value 0.01 with continuously connected voxels of no less than 10 was defined as significant deactivation. After fMRI scanning was complete, behavioral Stroop interference tests were performed on all subjects; reaction time and error number were recorded. Results: Functionally, deactivation of the posterior cingulate cortex (PCC) and precuneus was absent when subjects performed the incongruous word-reading task; deactivation of the PCC, precuneus, and ventral medial prefrontal cortex was increased when they performed the incongruous color-naming task. Conclusion: The functional as well as behavioral data suggest that cirrhotic patients may have an abnormal deactivation mode. The absence of deactivation in the PCC and precuneus may be a sensitive rather than specific marker in patients with hepatic cirrhosis.

  14. Motor network recovery in patients with chronic spinal cord compression: a longitudinal study following decompression surgery.

    Science.gov (United States)

    Ryan, Kayla; Goncalves, Sandy; Bartha, Robert; Duggal, Neil

    2018-01-19

    OBJECTIVE The authors used functional MRI to assess cortical reorganization of the motor network after chronic spinal cord compression and to characterize the plasticity that occurs following surgical intervention. METHODS A 3-T MRI scanner was used to acquire functional images of the brain in 22 patients with reversible cervical spinal cord compression and 10 control subjects. Controls performed a finger-tapping task on 3 different occasions (baseline, 6-week follow-up, and 6-month follow-up), whereas patients performed the identical task before surgery and again 6 weeks and 6 months after spinal decompression surgery. RESULTS After surgical intervention, an increased percentage blood oxygen level-dependent signal and volume of activation was observed within the contralateral and ipsilateral motor network. The volume of activation of the contralateral primary motor cortex was associated with functional measures both at baseline (r = 0.55, p motor area 6 months after surgery was associated with increased function 6 months after surgery (r = 0.48, p motor network plays complementary roles in maintaining neurological function in patients with spinal cord compression and may be critical in the recovery phase following surgery.

  15. Social support network to family caregiver of a patient with Spinal Muscular Atrophy I and II.

    Directory of Open Access Journals (Sweden)

    Rafael Barreto de Mesquita

    2010-06-01

    Full Text Available Objective: To assess the formal and informal support given to the family caregiver of a patient with Spinal Muscular Atrophy I and II. Method: This was a study with a qualitative approach developed in 2008 in the homes of informants and in the premises of the Hospital Infantil Albert Sabin in Fortaleza, Ceara, conducted with 13 mothers, primary caregivers for their ill children. For data collection we used both the interview and the instrument generator of the names and qualifier of the relations, adapted for this study. Quantitative data were processed using the programs UCINET NetDraw 6.123 and 2.38, while the qualitative data were organized based on the technique of the Collective Subject Discourse. The analyses were conducted by means of network maps and collective discourses raised by central ideas. Results: The formal social network of family caregivers was composed of 72 actors, among professionals in the areas of health, education and others, linked to 12 institutions. The informal network was comprised of 83 actors. It was found that the management of care, even when the caregiver has support from other people is a cause of stress and overload. Conclusion: It is evident the importance of applying Social Network Analysis as a tool for understanding structural features and the dynamics of social relations of family caregiver. Of a patient with spinal muscular atrophy. The analysis suggests the need for intervention in thestudy group as a way to contribute to the recognition and use of existing services, increasing the significance of the help provided by network interactions.

  16. Network modules uncover mechanisms of skeletal muscle dysfunction in COPD patients

    Directory of Open Access Journals (Sweden)

    Ákos Tényi

    2018-02-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD patients often show skeletal muscle dysfunction that has a prominent negative impact on prognosis. The study aims to further explore underlying mechanisms of skeletal muscle dysfunction as a characteristic systemic effect of COPD, potentially modifiable with preventive interventions (i.e. muscle training. The research analyzes network module associated pathways and evaluates the findings using independent measurements. Methods We characterized the transcriptionally active network modules of interacting proteins in the vastus lateralis of COPD patients (n = 15, FEV1 46 ± 12% pred, age 68 ± 7 years and healthy sedentary controls (n = 12, age 65 ± 9  years, at rest and after an 8-week endurance training program. Network modules were functionally evaluated using experimental data derived from the same study groups. Results At baseline, we identified four COPD specific network modules indicating abnormalities in creatinine metabolism, calcium homeostasis, oxidative stress and inflammatory responses, showing statistically significant associations with exercise capacity (VO2 peak, Watts peak, BODE index and blood lactate levels (P < 0.05 each, but not with lung function (FEV1. Training-induced network modules displayed marked differences between COPD and controls. Healthy subjects specific training adaptations were significantly associated with cell bioenergetics (P < 0.05 which, in turn, showed strong relationships with training-induced plasma metabolomic changes; whereas, effects of training in COPD were constrained to muscle remodeling. Conclusion In summary, altered muscle bioenergetics appears as the most striking finding, potentially driving other abnormal skeletal muscle responses. Trial registration The study was based on a retrospectively registered trial (May 2017, ClinicalTrials.gov identifier: NCT03169270

  17. MRI to MGMT: predicting methylation status in glioblastoma patients using convolutional recurrent neural networks.

    Science.gov (United States)

    Han, Lichy; Kamdar, Maulik R

    2018-01-01

    Glioblastoma Multiforme (GBM), a malignant brain tumor, is among the most lethal of all cancers. Temozolomide is the primary chemotherapy treatment for patients diagnosed with GBM. The methylation status of the promoter or the enhancer regions of the O6-methylguanine methyltransferase (MGMT) gene may impact the efficacy and sensitivity of temozolomide, and hence may affect overall patient survival. Microscopic genetic changes may manifest as macroscopic morphological changes in the brain tumors that can be detected using magnetic resonance imaging (MRI), which can serve as noninvasive biomarkers for determining methylation of MGMT regulatory regions. In this research, we use a compendium of brain MRI scans of GBM patients collected from The Cancer Imaging Archive (TCIA) combined with methylation data from The Cancer Genome Atlas (TCGA) to predict the methylation state of the MGMT regulatory regions in these patients. Our approach relies on a bi-directional convolutional recurrent neural network architecture (CRNN) that leverages the spatial aspects of these 3-dimensional MRI scans. Our CRNN obtains an accuracy of 67% on the validation data and 62% on the test data, with precision and recall both at 67%, suggesting the existence of MRI features that may complement existing markers for GBM patient stratification and prognosis. We have additionally presented our model via a novel neural network visualization platform, which we have developed to improve interpretability of deep learning MRI-based classification models.

  18. Activity and High-Order Effective Connectivity Alterations in Sanfilippo C Patient-Specific Neuronal Networks

    Directory of Open Access Journals (Sweden)

    Isaac Canals

    2015-10-01

    Full Text Available Induced pluripotent stem cell (iPSC technology has been successfully used to recapitulate phenotypic traits of several human diseases in vitro. Patient-specific iPSC-based disease models are also expected to reveal early functional phenotypes, although this remains to be proved. Here, we generated iPSC lines from two patients with Sanfilippo type C syndrome, a lysosomal storage disorder with inheritable progressive neurodegeneration. Mature neurons obtained from patient-specific iPSC lines recapitulated the main known phenotypes of the disease, not present in genetically corrected patient-specific iPSC-derived cultures. Moreover, neuronal networks organized in vitro from mature patient-derived neurons showed early defects in neuronal activity, network-wide degradation, and altered effective connectivity. Our findings establish the importance of iPSC-based technology to identify early functional phenotypes, which can in turn shed light on the pathological mechanisms occurring in Sanfilippo syndrome. This technology also has the potential to provide valuable readouts to screen compounds, which can prevent the onset of neurodegeneration.

  19. Self-Powered Wireless Sensor Networks for Remote Patient Monitoring in Hospitals

    Directory of Open Access Journals (Sweden)

    Dinesh Bhatia

    2006-09-01

    Full Text Available Patient vital sign monitoring within hospitals requires the use of non-invasivesensors that are hardwired to bedside monitors. This set-up is cumbersome, forcing thepatient to be confined to his hospital bed thereby not allowing him to move around freelywithin the hospital premises. This paper addresses the use of wireless sensor networks formonitoring patient vital sign data in a hospital setting. Crossbow MICAz motes have beenused to design a robust mesh network that routes patient data to a remote base station withinthe hospital premises. A hospital care giver can have access to this data at any point in timeand doesn’t have to be physically present in the patient’s room to review the readings. Thenetwork infrastructure nodes are self-powered and draw energy from overhead 34Wfluorescent lights via solar panels. The sensor nodes can be interfaced to a variety of vitalsign sensors such as electrocardiograms (ECGs, pulse-oximeters and blood pressure (BPsensors. In order to verify a completely functioning system, a commercial BP/heart-ratemonitor (BPM was interfaced to a wireless sensor node. The sensor node controls the BPMto initiate a reading, then collects the data and forwards it to the base station. An attractivegraphical user interface (GUI was designed to store and display patient data on the basestation PC. The set-up was found to be extremely robust with low power consumption.

  20. Intraoperative mechanical ventilation strategies for obese patients: a systematic review and network meta-analysis.

    Science.gov (United States)

    Wang, C; Zhao, N; Wang, W; Guo, Libo; Guo, Lei; Chi, C; Wang, X; Pi, X; Cui, Y; Li, E

    2015-06-01

    Several intraoperative ventilation strategies are available for obese patients. However, the same ventilation interventions have exhibited different effects on PaO2 /FIO2 concerning obese patients in different trials, and the issue remains controversial. Therefore, we conducted a network meta-analysis to identify the optimal mechanical ventilation strategy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Embase, MEDLINE, CINAHL and Web of Science for studies published up to June 2014, and the PaO2 /FIO2 in obese patients given different mechanical ventilation strategies was assessed. We assessed the studies for eligibility and extracted data and then pooled the data and used a Bayesian fixed-effect model to combine direct comparisons with indirect evidence. Eligible studies evaluated different ventilation strategies for obese patients and reported the intraoperative PaO2 /FIO2 ratio, atelectasis and pulmonary compliance. Thirteen randomized controlled trials were included for network meta-analysis, including 476 patients who received 1 of 12 ventilation strategies. Volume-controlled ventilation with higher PEEP plus single recruitment manoeuvres (VCV + higher PEEP + single RM) was associated with the highest PaO2 /FiO2 ratio, improving intraoperative pulmonary compliance and reducing the incidence of intraoperative atelectasis. © 2015 World Obesity.

  1. Professionalism and social networking: can patients, physicians, nurses, and supervisors all be "friends?".

    Science.gov (United States)

    Peluchette, Joy; Karl, Katherine; Coustasse, Alberto; Emmett, Dennis

    2012-01-01

    The purpose of this study was to examine the use of social networking (Facebook) among nurse anesthetists. We examined whether they would have concerns about their supervisor, patients, or physicians seeing their Facebook profile. We also examined their attitudes related to maintaining professional boundaries with regard to the initiation or receipt of Facebook "friend" requests from their supervisor, patients, or physicians they work with. Our respondents consisted of 103 nurses currently enrolled in a graduate-level nurse anesthetist program. All respondents had a minimum of 2 years of work experience in critical care nursing. Most respondents were found to be neutral about physicians and supervisors viewing their Facebook profiles but expressed concerns about patients seeing such information. A vast majority indicated they would accept a friend request from their supervisor and a physician but not a patient. Surprisingly, about 40% had initiated a friend request to their supervisor or physician they work with. Implications for health care managers are discussed.

  2. Children's Specialized Hospital and GetWellNetwork Collaborate to Improve Patient Education and Outcomes Using an Innovative Approach.

    Science.gov (United States)

    Kompany, Laura; Luis, Kiersten; Manganaro, Julie; Motacki, Kathleen; Mustacchio, Elaine; Provenzano, Donna

    2016-01-01

    Patient education in a pediatric setting is unique. There are different patient ages, degrees of learning, and diagnoses to take into account when educating children and their families. A new and innovative trend in practice called Interactive Patient Care (IPC) integrates technology into care processes to advance pediatric nursing education and patient and family satisfaction. Children's Specialized Hospital is the first pediatric rehabilitation hospital to develop and implement this type of program using an IPC platform from the GetWellNetwork. With the implementation of the GetWellNetwork, Children's Specialized Hospital has achieved positive results in patient satisfaction, health care utilization, quality, and safety measures.

  3. Network meta-analysis of (individual patient) time to event data alongside (aggregate) count data.

    Science.gov (United States)

    Saramago, Pedro; Chuang, Ling-Hsiang; Soares, Marta O

    2014-09-10

    Network meta-analysis methods extend the standard pair-wise framework to allow simultaneous comparison of multiple interventions in a single statistical model. Despite published work on network meta-analysis mainly focussing on the synthesis of aggregate data, methods have been developed that allow the use of individual patient-level data specifically when outcomes are dichotomous or continuous. This paper focuses on the synthesis of individual patient-level and summary time to event data, motivated by a real data example looking at the effectiveness of high compression treatments on the healing of venous leg ulcers. This paper introduces a novel network meta-analysis modelling approach that allows individual patient-level (time to event with censoring) and summary-level data (event count for a given follow-up time) to be synthesised jointly by assuming an underlying, common, distribution of time to healing. Alternative model assumptions were tested within the motivating example. Model fit and adequacy measures were used to compare and select models. Due to the availability of individual patient-level data in our example we were able to use a Weibull distribution to describe time to healing; otherwise, we would have been limited to specifying a uniparametric distribution. Absolute effectiveness estimates were more sensitive than relative effectiveness estimates to a range of alternative specifications for the model. The synthesis of time to event data considering individual patient-level data provides modelling flexibility, and can be particularly important when absolute effectiveness estimates, and not just relative effect estimates, are of interest.

  4. Changes in Female Support Network Systems and Adaptation after Breast Cancer Diagnosis: Differences between Older and Younger Patients

    Science.gov (United States)

    Ashida, Sato; Palmquist, Aunchalee E. L.; Basen-Engquist, Karen; Singletary, S. Eva; Koehly, Laura M.

    2009-01-01

    Purpose: This study evaluates the changes in social networks of older and younger breast cancer patients over a 6-month period following their first diagnosis and how such modifications are associated with changes in the patients' mood state. Design and Methods: Newly diagnosed breast cancer patients were interviewed shortly after their diagnosis…

  5. Integrated palliative care networks from the perspectives of patients: A cross-sectional explorative study in five European countries.

    Science.gov (United States)

    den Herder-van der Eerden, Marlieke; Ebenau, Anne; Payne, Sheila; Preston, Nancy; Radbruch, Lukas; Linge-Dahl, Lisa; Csikos, Agnes; Busa, Csilla; Van Beek, Karen; Groot, Marieke; Vissers, Kris; Hasselaar, Jeroen

    2018-02-01

    Although examining perspectives of patients on integrated palliative care organisation is essential, available literature is largely based on administrative data or healthcare professionals' perspectives. (1) Providing insight into the composition and quality of care networks of patients receiving palliative care and (2) describing perceived integration between healthcare professionals within these networks and its association with overall satisfaction. Cross-sectional explorative design. We recruited 157 patients (62% cancer, 25% chronic obstructive pulmonary disease, 13% chronic heart failure, mean age 68 years, 55% female) from 23 integrated palliative care initiatives in Belgium, Germany, the United Kingdom, Hungary and the Netherlands. About 33% reported contact with a palliative care specialist and 48% with a palliative care nurse. Relationships with palliative care specialists were rated significantly higher than other physicians ( p palliative care specialists and patients with chronic obstructive pulmonary disease (odds ratio = 0.23, confidence interval (0.08; 0.71)) had significantly lower odds of reporting contact with palliative care nurses. Perceptions of main responsible healthcare professionals or caregivers in patient's care networks varied across countries. Perceived integration was significantly associated with overall satisfaction. Palliative care professionals are not always present or recognised as such in patients' care networks. Expert palliative care involvement needs to be explicated especially for non-cancer patients. One healthcare professional should support patients in understanding and navigating their palliative care network. Patients seem satisfied with care provision as long as continuity of care is provided.

  6. Gastric bypass patients' goal-strategy-monitoring networks for long-term dietary management.

    Science.gov (United States)

    Lynch, Amanda; Bisogni, Carole A

    2014-10-01

    Following gastric bypass surgery, patients must make dramatic dietary changes, but little is known about patients' perspectives on long-term dietary management after this surgery. This grounded theory, qualitative study sought to advance conceptual understanding of food choice by examining how gastric bypass patients constructed personal food systems to guide food and eating behaviors 12 months post-surgery. Two in-depth interviews were conducted with each of 16 adults, purposively sampled from bariatric support groups. Using constant comparative analysis of verbatim interview transcripts, researchers identified participants' goal-strategy-monitoring networks representing how participants used specific food and eating behaviors towards their main goals of: Weight Management, Overall Health, Avoiding Negative Reactions to Eating, and Integrating Dietary Changes with Daily Life. Linked to each main goal was a hierarchy of intermediary goals, strategies, and tactics. Participants used monitoring behaviors to assess strategy effectiveness towards goal achievement. Individuals' Weight Management networks were compared to uncover similarities and differences among strategy use and monitoring methods among those who maintained weight loss and those who regained weight. The complex, multilevel goal-strategy-monitoring networks identified illustrate the "work" involved in constructing new personal food systems after surgery, as well as advance understanding of strategies as a component of people's personal food systems. These findings provide researchers and practitioners with insight into the long-term dietary issues that gastric bypass patients face and a potential method for representing how people relate deliberate dietary behaviors to their goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Working memory impairment in fibromyalgia patients associated with altered frontoparietal memory network.

    Directory of Open Access Journals (Sweden)

    Jeehye Seo

    Full Text Available BACKGROUND: Fibromyalgia (FM is a disorder characterized by chronic widespread pain and frequently associated with other symptoms. Patients with FM commonly report cognitive complaints, including memory problem. The objective of this study was to investigate the differences in neural correlates of working memory between FM patients and healthy subjects, using functional magnetic resonance imaging (MRI. METHODOLOGY/PRINCIPAL FINDINGS: Nineteen FM patients and 22 healthy subjects performed an n-back memory task during MRI scan. Functional MRI data were analyzed using within- and between-group analysis. Both activated and deactivated brain regions during n-back task were evaluated. In addition, to investigate the possible effect of depression and anxiety, group analysis was also performed with depression and anxiety level in terms of Beck depression inventory (BDI and Beck anxiety inventory (BAI as a covariate. Between-group analyses, after controlling for depression and anxiety level, revealed that within the working memory network, inferior parietal cortex was strongly associated with the mild (r = 0.309, P = 0.049 and moderate (r = 0.331, P = 0.034 pain ratings. In addition, between-group comparison revealed that within the working memory network, the left DLPFC, right VLPFC, and right inferior parietal cortex were associated with the rating of depression and anxiety? CONCLUSIONS/SIGNIFICANCE: Our results suggest that the working memory deficit found in FM patients may be attributable to differences in neural activation of the frontoparietal memory network and may result from both pain itself and depression and anxiety associated with pain.

  8. A Personal Health Network for Chemotherapy Care Coordination: Evaluation of Usability Among Patients.

    Science.gov (United States)

    Kim, Katherine K; Bell, Janice F; Bold, Richard; Davis, Andra; Ngo, Victoria; Reed, Sarah C; Joseph, Jill G

    2016-01-01

    Cancer is a top concern globally. Cancer care suffers from lack of coordination, silos of information, and high cost. Interest is emerging in person-centered technology to assist with coordination to address these challenges. This study evaluates the usability of the "personal health network" (PHN), a novel solution leveraging social networking and mobile technologies, among individuals undergoing chemotherapy and receiving care coordination. Early results from interviews of 12 participants in a randomized pragmatic trial suggest that they feel more connected to the healthcare team using the PHN, find value in access to the patient education library, and are better equipped to organize the many activities that occur during chemotherapy. Improvements are needed in navigation, connectivity, and integration with electronic health records. Findings contribute to improvements in the PHN and informs a roadmap for potentially greater impact in technology-enabled cancer care coordination.

  9. A comparison of vertebral venous networks in adolescent idiopathic scoliosis patients and healthy controls.

    Science.gov (United States)

    Grant, Caroline A; Newell, Nicolas; Izatt, Maree T; Keenan, Bethany E; Askin, Geoffrey N; Labrom, Robert D; Pearcy, Mark J

    2017-03-01

    Cadaveric studies have previously documented a typical pattern of venous drainage within vertebral bodies (VBs), comprised primarily of the basivertebral vein. These studies, however, are limited by the number of samples available. MRI is able to provide 3D images of soft tissue structures in the spine, including the basivertebral vein without the use of contrast in both healthy controls and subjects with abnormal anatomy such as adolescent idiopathic scoliosis (AIS). This study aimed to quantify the venous networks within VBs of 15 healthy adolescent controls and 15 AIS patients. Five transverse slices through the VBs were examined simultaneously and the observable vascular network traced. The length of the network on the left and right sides of the VB was calculated, and the spatial patterning assessed level-by-level within each subject. Significant differences were seen in the left/right distribution of vessels in both the control and AIS subjects, with both groups having greater length on the right side of all of their VBs. No difference was seen between AIS and control subjects in any region. Large individual variations in patterns were seen in both groups; however, the control group showed more consistent spatial patterning of the vascular networks across levels in comparison to the AIS group. The length of the basivertebral vein was seen to have a significant bias to the right hand side of the VB in both healthy and AIS adolescents. The spatial pattern of this vein showed large variations in branching both within and across individuals. No significant differences were seen between AIS and control subjects, suggesting both that this network is preserved in deformed AIS vertebrae, and that the vertebral venous system does not play a role in the etiology of AIS.

  10. Using a Bayesian belief network model to categorize length of stay for radical prostatectomy patients.

    Science.gov (United States)

    Michalowski, Wojtek; Wilk, Szymon; Thijssen, Anthony; Li, Mingmei

    2006-11-01

    A clinical pathway implements best medical practices and represents sequencing and timing of interventions by clinicians for a particular clinical presentation. We used a Bayesian belief network (BBN) to model a clinical pathway for radical prostatectomy and to categorize patient's length of stay (LOS) as being met or delayed given the patient's outcomes and activities. A BBN model constructed from historical data collected as part of a retrospective chart study represents probabilistic dependencies between specific events from the pathway and identifies events directly affecting LOS. Preliminary evaluation of a BBN model on an independent test sample of patients' data shows that model reliably categorizes LOS for the second and third day after the surgery (with overall accuracy of 82 and 84%, respectively).

  11. Outcome assessment of patients with metastatic renal cell carcinoma under systemic therapy using artificial neural networks.

    Science.gov (United States)

    Buchner, Alexander; Kendlbacher, Martin; Nuhn, Philipp; Tüllmann, Cordula; Haseke, Nicolas; Stief, Christian G; Staehler, Michael

    2012-03-01

    The outcome of patients with advanced renal cell carcinoma (RCC) under systemic therapy shows remarkable variability, and there is a need to identify prognostic parameters that allow individual prognostic stratification and selection of optimal therapy. Artificial neural networks (ANN) are software systems that can be trained to recognize complex data patterns. In this study, we used ANNs to identify poor prognosis of patients with RCC based on common clinical parameters available at the beginning of systemic therapy. Data from patients with RCC who started systemic therapy were collected prospectively in a single center database; 175 data sets with follow-up data (median, 36 months) were available for analysis. Age, sex, body mass index, performance status, histopathologic parameters, time interval between primary tumor and detection of metastases, type of systemic therapy, number of metastases, and metastatic sites were used as input data for the ANN. The target variable was overall survival after 36 months. Logistic regression models were constructed by using the same variables. Death after 36 months occurred in 26% of the patients in the tyrosine kinase inhibitors group and in 37% of the patients in the immunotherapy group (P = .22). ANN achieved 95% overall accuracy and significantly outperformed logistic regression models (78% accuracy). Pathologic T classification, invasion of vessels, and tumor grade had the highest impact on the network's decision. ANN is a promising approach for individual risk stratification of patients with advanced RCC under systemic therapy, based on clinical parameters, and can help to optimize the therapeutic strategy. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Talking about your health to strangers: understanding the use of online social networks by patients

    Science.gov (United States)

    Colineau, Nathalie; Paris, Cécile

    2010-04-01

    The internet has become a participatory place where everyone can contribute and interact with others. In health in particular, social media have changed traditional patient-physician relationships. Patients are organising themselves in groups, sharing observations and helping each other, although there is still little evidence of the effectiveness of these online communities on people's health. To understand why and how people use health-related sites, we studied these sites and identified three dimensions characterising most of them: informational/supportive; general/focused; and new relationships/existing ones. We conducted an online survey about the use of health-related social networking (SN) sites and learnt that, consistent with previous research, most patients were seeking information about their medical condition online, while, at the same time, still interacting with health professionals to talk about sensitive information and complex issues. We also found that, while people's natural social network played an important role for emotional support, sometimes, people chose to not involve their family, but instead interact with peers online because of their perceived support and ability to understand someone's experience, and also to maintain a comfortable emotional distance. Finally, our results show that people using general SN sites do not necessarily use health-related sites and vice versa.

  13. The effect of souvenaid on functional brain network organisation in patients with mild Alzheimer's disease: a randomised controlled study.

    Science.gov (United States)

    de Waal, Hanneke; Stam, Cornelis J; Lansbergen, Marieke M; Wieggers, Rico L; Kamphuis, Patrick J G H; Scheltens, Philip; Maestú, Fernando; van Straaten, Elisabeth C W

    2014-01-01

    Synaptic loss is a major hallmark of Alzheimer's disease (AD). Disturbed organisation of large-scale functional brain networks in AD might reflect synaptic loss and disrupted neuronal communication. The medical food Souvenaid, containing the specific nutrient combination Fortasyn Connect, is designed to enhance synapse formation and function and has been shown to improve memory performance in patients with mild AD in two randomised controlled trials. To explore the effect of Souvenaid compared to control product on brain activity-based networks, as a derivative of underlying synaptic function, in patients with mild AD. A 24-week randomised, controlled, double-blind, parallel-group, multi-country study. 179 drug-naïve mild AD patients who participated in the Souvenir II study. Patients were randomised 1∶1 to receive Souvenaid or an iso-caloric control product once daily for 24 weeks. In a secondary analysis of the Souvenir II study, electroencephalography (EEG) brain networks were constructed and graph theory was used to quantify complex brain structure. Local brain network connectivity (normalised clustering coefficient gamma) and global network integration (normalised characteristic path length lambda) were compared between study groups, and related to memory performance. THE NETWORK MEASURES IN THE BETA BAND WERE SIGNIFICANTLY DIFFERENT BETWEEN GROUPS: they decreased in the control group, but remained relatively unchanged in the active group. No consistent relationship was found between these network measures and memory performance. The current results suggest that Souvenaid preserves the organisation of brain networks in patients with mild AD within 24 weeks, hypothetically counteracting the progressive network disruption over time in AD. The results strengthen the hypothesis that Souvenaid affects synaptic integrity and function. Secondly, we conclude that advanced EEG analysis, using the mathematical framework of graph theory, is useful and feasible for

  14. Preliminary evidence of reduced brain network activation in patients with post-traumatic migraine following concussion.

    Science.gov (United States)

    Kontos, Anthony P; Reches, Amit; Elbin, R J; Dickman, Dalia; Laufer, Ilan; Geva, Amir B; Shacham, Galit; DeWolf, Ryan; Collins, Michael W

    2016-06-01

    Post-traumatic migraine (PTM) (i.e., headache, nausea, light and/or noise sensitivity) is an emerging risk factor for prolonged recovery following concussion. Concussions and migraine share similar pathophysiology characterized by specific ionic imbalances in the brain. Given these similarities, patients with PTM following concussion may exhibit distinct electrophysiological patterns, although researchers have yet to examine the electrophysiological brain activation in patients with PTM following concussion. A novel approach that may help differentiate brain activation in patients with and without PTM is brain network activation (BNA) analysis. BNA involves an algorithmic analysis applied to multichannel EEG-ERP data that provides a network map of cortical activity and quantitative data during specific tasks. A prospective, repeated measures design was used to evaluate BNA (during Go/NoGo task), EEG-ERP, cognitive performance, and concussion related symptoms at 1, 2, 3, and 4 weeks post-injury intervals among athletes with a medically diagnosed concussion with PTM (n = 15) and without (NO-PTM) (n = 22); and age, sex, and concussion history matched controls without concussion (CONTROL) (n = 20). Participants with PTM had significantly reduced BNA compared to NO-PTM and CONTROLS for Go and NoGo components at 3 weeks and for NoGo component at 4 weeks post-injury. The PTM group also demonstrated a more prominent deviation of network activity compared to the other two groups over a longer period of time. The composite BNA algorithm may be a more sensitive measure of electrophysiological change in the brain that can augment established cognitive assessment tools for detecting impairment in individuals with PTM.

  15. Neural substrates of motor and cognitive dysfunctions in SCA2 patients: A network based statistics analysis

    Directory of Open Access Journals (Sweden)

    G. Olivito

    2017-01-01

    In the present study, the network-based statistics (NBS approach was used to assess differences in functional connectivity between specific cerebellar and cerebral “nodes” in SCA2 patients. Altered inter-nodal connectivity was found between more posterior regions in the cerebellum and regions in the cerebral cortex clearly related to cognition and emotion. Furthermore, more anterior cerebellar lobules showed altered inter-nodal connectivity with motor and somatosensory cerebral regions. The present data suggest that in SCA2 a cerebellar dysfunction affects long-distance cerebral regions and that the clinical symptoms may be specifically related with connectivity changes between motor and non-motor cerebello-cortical nodes.

  16. Weighted gene co-expression network analysis of the peripheral blood from Amyotrophic Lateral Sclerosis patients

    Directory of Open Access Journals (Sweden)

    DeYoung Joseph

    2009-08-01

    Full Text Available Abstract Background Amyotrophic Lateral Sclerosis (ALS is a lethal disorder characterized by progressive degeneration of motor neurons in the brain and spinal cord. Diagnosis is mainly based on clinical symptoms, and there is currently no therapy to stop the disease or slow its progression. Since access to spinal cord tissue is not possible at disease onset, we investigated changes in gene expression profiles in whole blood of ALS patients. Results Our transcriptional study showed dramatic changes in blood of ALS patients; 2,300 probes (9.4% showed significant differential expression in a discovery dataset consisting of 30 ALS patients and 30 healthy controls. Weighted gene co-expression network analysis (WGCNA was used to find disease-related networks (modules and disease related hub genes. Two large co-expression modules were found to be associated with ALS. Our findings were replicated in a second (30 patients and 30 controls and third dataset (63 patients and 63 controls, thereby demonstrating a highly significant and consistent association of two large co-expression modules with ALS disease status. Ingenuity Pathway Analysis of the ALS related module genes implicates enrichment of functional categories related to genetic disorders, neurodegeneration of the nervous system and inflammatory disease. The ALS related modules contain a number of candidate genes possibly involved in pathogenesis of ALS. Conclusion This first large-scale blood gene expression study in ALS observed distinct patterns between cases and controls which may provide opportunities for biomarker development as well as new insights into the molecular mechanisms of the disease.

  17. Altered Default Network Resting State Functional Connectivity in Patients with a First Episode of Psychosis

    Science.gov (United States)

    Alonso-Solís, Anna; Corripio, Iluminada; de Castro-Manglano, Pilar; Duran-Sindreu, Santiago; Garcia-Garcia, Manuel; Proal, Erika; Nuñez-Marín, Fidel; Soutullo, Cesar; Alvarez, Enric; Gómez-Ansón, Beatriz; Kelly, Clare; Castellanos, F. Xavier

    2012-01-01

    Background Default network (DN) abnormalities have been identified in patients with chronic schizophrenia using “resting state” functional magnetic resonance imaging (R-fMRI). Here, we examined the integrity of the DN in patients experiencing their first episode of psychosis (FEP) compared with sex- and age-matched healthy controls. Methods We collected R-fMRI data from 19 FEP patients (mean age 24.9±4.8 yrs, 14 males) and 19 healthy controls (26.1±4.8 yrs, 14 males) at 3 Tesla. Following standard preprocessing, we examined the functional connectivity (FC) of two DN subsystems and the two DN hubs (P<0.0045, corrected). Results Patients with FEP exhibited abnormal FC that appeared largely restricted to the dorsomedial prefrontal cortex (dMPFC) DN subsystem. Relative to controls, FEP patients exhibited weaker positive FC between dMPFC and posterior cingulate cortex (PCC) and precuneus, extending laterally through the parietal lobe to the posterior angular gyrus. Patients with FEP exhibited weaker negative FC between the lateral temporal cortex and the intracalcarine cortex, bilaterally. The PCC and temporo-parietal junction also exhibited weaker negative FC with the right fusiform gyrus extending to the lingual gyrus and lateral occipital cortex, in FEP patients, compared to controls. By contrast, patients with FEP showed stronger negative FC between the temporal pole and medial motor cortex, anterior precuneus and posterior mid-cingulate cortex. Conclusions Abnormalities in the dMPFC DN subsystem in patients with a FEP suggest that FC patterns are altered even in the early stages of psychosis. PMID:22633527

  18. The impact of major trauma network triage systems on patients with major burns.

    Science.gov (United States)

    Nizamoglu, Metin; O'Connor, Edmund Fitzgerald; Bache, Sarah; Theodorakopoulou, Evgenia; Sen, Sankhya; Sherren, Peter; Barnes, David; Dziewulski, Peter

    2016-12-01

    Trauma is a leading cause of death and disability worldwide. Patients presenting with severe trauma and burns benefit from specifically trained multidisciplinary teams. Regional trauma systems have shown improved outcomes for trauma patients. The aim of this study is to determine whether the development of major trauma systems have improved the management of patients with major burns. A retrospective study was performed over a four-year period reviewing all major burns in adults and children received at a regional burns centre in the UK before and after the implementation of the regional trauma systems and major trauma centres (MTC). Comparisons were drawn between three areas: (1) Patients presenting before the introduction of MTC and after the introduction of MTC. (2) Patients referred from MTC and non-MTC within the region, following the introduction of MTC. (3) Patients referred using the urban trauma protocol and the rural trauma protocol. Following the introduction of regional trauma systems and major trauma centres (MTC), isolated burn patients seen at our regional burns centre did not show any significant improvement in transfer times, admission resuscitation parameters, organ dysfunction or survival when referred from a MTC compared to a non-MTC emergency department. There was also no significant difference in survival when comparing referrals from all hospitals pre and post establishment of the major trauma network. No significant outcome benefit was demonstrated for burns patients referred via MTCs compared to non-MTCs. We suggest further research is needed to ascertain whether burns patients benefit from prolonged transfer times to a MTC compared to those seen at their local hospitals prior to transfer to a regional burns unit for further specialist care. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  19. Teleradiology network to improve patient care in a peacekeeping military operation

    Science.gov (United States)

    Cleary, Kevin R.; Levine, Betty A.; Norton, Gary S.; Mun, Seong K.; Cramer, Timothy J.; de Treville, Robert E.

    1997-05-01

    The Imaging Science and Information Systems (ISIS) Center of the Department of Radiology at Georgetown University Medical Center recently collaborated with the US Army in developing an off-the-shelf teleradiology network for Operation Joint Endeavor, the peace-keeping mission in Bosnia-Herzegovina. The network is part of Operation Primetime III, a project to deploy advanced communications and medical equipment to provide state-of-the-art medical care to the 20,000 US troops stationed there. The network encompasses three major sites: the 212th Mobile Army Surgical Hospital (MASH) near Tuzla, Bosnia-Herzegovina; the 67th Combat Support Hospital (CSH) in Taszar, Hungary; and the Landstuhl Regional Medical Center (LRMC) in Landstuhl, Germany. Planning for the project began in January 1996, and all three sites were operational by April 1996. Since the system was deployed, computed radiography (CR) has been sued almost exclusively at the MASH and CSH for all general x-ray exams. From mid- May to September 1996, over 2700 CR images were acquired at the MASH and over 1600 at the CSH. Since there was not a radiologist a the MASH, the images were transferred to the CSH for primary diagnosis and archiving. In the same time period, over 550 patient folders were sent from the MASH to the CSH.

  20. Changes of Cerebral Perfusion and Functional Brain Network Organization in Patients with Mild Cognitive Impairment.

    Science.gov (United States)

    Lou, Wutao; Shi, Lin; Wong, Adrian; Chu, Winnie C W; Mok, Vincent C T; Wang, Defeng

    2016-08-10

    Disruptions of the functional brain network and cerebral blood flow (CBF) have been revealed in patients with mild cognitive impairment (MCI). However, the neurophysiological mechanism of hypoperfusion as well as the reorganization of the intrinsic whole brain network due to the neuropathology of MCI are still unclear. In this study, we aimed to investigate the changes of CBF and the whole brain network organization in MCI by using a multimodal MRI approach. Resting state ASL MRI and BOLD MRI were used to evaluate disruptions of CBF and underlying functional connectivity in 27 patients with MCI and 35 cognitive normal controls (NC). The eigenvector centrality mapping (ECM) was used to assess the whole brain network reorganization in MCI, and a seed-based ECM approach was proposed to reveal the contributions of the whole brain network on the ECM alterations. Significantly decreased perfusion in the posterior parietal cortex as well as its connectivity within the default mode network and occipital cortex were found in the MCI group compared to the NC group. The ECM analysis revealed decreased EC in the middle cingulate cortex, parahippocampal gyrus, medial frontal gyrus, and increased EC in the right calcarine sulcus, superior temporal gyrus, and supplementary motor area in the MCI group. The results of this study indicate that there are deficits in cerebral blood flow and functional connectivity in the default mode network, and that sensory-processing networks might play a compensatory role to make up for the decreased connections in MCI.

  1. Dynamics of intracranial electroencephalographic recordings from epilepsy patients using univariate and bivariate recurrence networks.

    Science.gov (United States)

    Subramaniyam, Narayan Puthanmadam; Hyttinen, Jari

    2015-02-01

    Recently Andrezejak et al. combined the randomness and nonlinear independence test with iterative amplitude adjusted Fourier transform (iAAFT) surrogates to distinguish between the dynamics of seizure-free intracranial electroencephalographic (EEG) signals recorded from epileptogenic (focal) and nonepileptogenic (nonfocal) brain areas of epileptic patients. However, stationarity is a part of the null hypothesis for iAAFT surrogates and thus nonstationarity can violate the null hypothesis. In this work we first propose the application of the randomness and nonlinear independence test based on recurrence network measures to distinguish between the dynamics of focal and nonfocal EEG signals. Furthermore, we combine these tests with both iAAFT and truncated Fourier transform (TFT) surrogate methods, which also preserves the nonstationarity of the original data in the surrogates along with its linear structure. Our results indicate that focal EEG signals exhibit an increased degree of structural complexity and interdependency compared to nonfocal EEG signals. In general, we find higher rejections for randomness and nonlinear independence tests for focal EEG signals compared to nonfocal EEG signals. In particular, the univariate recurrence network measures, the average clustering coefficient C and assortativity R, and the bivariate recurrence network measure, the average cross-clustering coefficient C(cross), can successfully distinguish between the focal and nonfocal EEG signals, even when the analysis is restricted to nonstationary signals, irrespective of the type of surrogates used. On the other hand, we find that the univariate recurrence network measures, the average path length L, and the average betweenness centrality BC fail to distinguish between the focal and nonfocal EEG signals when iAAFT surrogates are used. However, these two measures can distinguish between focal and nonfocal EEG signals when TFT surrogates are used for nonstationary signals. We also

  2. Dynamics of intracranial electroencephalographic recordings from epilepsy patients using univariate and bivariate recurrence networks

    Science.gov (United States)

    Subramaniyam, Narayan Puthanmadam; Hyttinen, Jari

    2015-02-01

    Recently Andrezejak et al. combined the randomness and nonlinear independence test with iterative amplitude adjusted Fourier transform (iAAFT) surrogates to distinguish between the dynamics of seizure-free intracranial electroencephalographic (EEG) signals recorded from epileptogenic (focal) and nonepileptogenic (nonfocal) brain areas of epileptic patients. However, stationarity is a part of the null hypothesis for iAAFT surrogates and thus nonstationarity can violate the null hypothesis. In this work we first propose the application of the randomness and nonlinear independence test based on recurrence network measures to distinguish between the dynamics of focal and nonfocal EEG signals. Furthermore, we combine these tests with both iAAFT and truncated Fourier transform (TFT) surrogate methods, which also preserves the nonstationarity of the original data in the surrogates along with its linear structure. Our results indicate that focal EEG signals exhibit an increased degree of structural complexity and interdependency compared to nonfocal EEG signals. In general, we find higher rejections for randomness and nonlinear independence tests for focal EEG signals compared to nonfocal EEG signals. In particular, the univariate recurrence network measures, the average clustering coefficient C and assortativity R , and the bivariate recurrence network measure, the average cross-clustering coefficient Ccross, can successfully distinguish between the focal and nonfocal EEG signals, even when the analysis is restricted to nonstationary signals, irrespective of the type of surrogates used. On the other hand, we find that the univariate recurrence network measures, the average path length L , and the average betweenness centrality BC fail to distinguish between the focal and nonfocal EEG signals when iAAFT surrogates are used. However, these two measures can distinguish between focal and nonfocal EEG signals when TFT surrogates are used for nonstationary signals. We also

  3. Modeling contact networks of patients and MRSA spread in Swedish hospitals

    CERN Document Server

    Rocha, Luis E C; Esch, Markus; Lenaerts, Tom; Stenhem, Mikael; Liljeros, Fredrik; Thorson, Anna

    2016-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a difficult-to-treat infection that only in the European Union affects about 150,000 patients and causes extra costs of 380 million Euros annually to the health-care systems. Increasing efforts have been taken to mitigate the epidemics and to avoid potential outbreaks in low endemic settings. Understanding the population dynamics of MRSA through modeling is essential to identify the causal mechanisms driving the epidemics and to generalize conclusions to different contexts. We develop an innovative high-resolution spatiotemporal contact network model of interactions between patients to reproduce the hospital population in the context of the Stockholm County in Sweden and simulate the spread of MRSA within this population. Our model captures the spatial and temporal heterogeneity caused by human behavior and by the dynamics of mobility within wards and hospitals. We estimate that in this population the epidemic threshold is at about 0.008. We also identify ...

  4. Altered resting-state network connectivity in stroke patients with and without apraxia of speech

    Directory of Open Access Journals (Sweden)

    Anneliese B. New

    2015-01-01

    Full Text Available Motor speech disorders, including apraxia of speech (AOS, account for over 50% of the communication disorders following stroke. Given its prevalence and impact, and the need to understand its neural mechanisms, we used resting state functional MRI to examine functional connectivity within a network of regions previously hypothesized as being associated with AOS (bilateral anterior insula (aINS, inferior frontal gyrus (IFG, and ventral premotor cortex (PM in a group of 32 left hemisphere stroke patients and 18 healthy, age-matched controls. Two expert clinicians rated severity of AOS, dysarthria and nonverbal oral apraxia of the patients. Fifteen individuals were categorized as AOS and 17 were AOS-absent. Comparison of connectivity in patients with and without AOS demonstrated that AOS patients had reduced connectivity between bilateral PM, and this reduction correlated with the severity of AOS impairment. In addition, AOS patients had negative connectivity between the left PM and right aINS and this effect decreased with increasing severity of non-verbal oral apraxia. These results highlight left PM involvement in AOS, begin to differentiate its neural mechanisms from those of other motor impairments following stroke, and help inform us of the neural mechanisms driving differences in speech motor planning and programming impairment following stroke.

  5. Altered resting-state network connectivity in stroke patients with and without apraxia of speech.

    Science.gov (United States)

    New, Anneliese B; Robin, Donald A; Parkinson, Amy L; Duffy, Joseph R; McNeil, Malcom R; Piguet, Olivier; Hornberger, Michael; Price, Cathy J; Eickhoff, Simon B; Ballard, Kirrie J

    2015-01-01

    Motor speech disorders, including apraxia of speech (AOS), account for over 50% of the communication disorders following stroke. Given its prevalence and impact, and the need to understand its neural mechanisms, we used resting state functional MRI to examine functional connectivity within a network of regions previously hypothesized as being associated with AOS (bilateral anterior insula (aINS), inferior frontal gyrus (IFG), and ventral premotor cortex (PM)) in a group of 32 left hemisphere stroke patients and 18 healthy, age-matched controls. Two expert clinicians rated severity of AOS, dysarthria and nonverbal oral apraxia of the patients. Fifteen individuals were categorized as AOS and 17 were AOS-absent. Comparison of connectivity in patients with and without AOS demonstrated that AOS patients had reduced connectivity between bilateral PM, and this reduction correlated with the severity of AOS impairment. In addition, AOS patients had negative connectivity between the left PM and right aINS and this effect decreased with increasing severity of non-verbal oral apraxia. These results highlight left PM involvement in AOS, begin to differentiate its neural mechanisms from those of other motor impairments following stroke, and help inform us of the neural mechanisms driving differences in speech motor planning and programming impairment following stroke.

  6. Prevalence of fecal incontinence in a cohort of systemic sclerosis patients within a regional referral network.

    Science.gov (United States)

    Garros, A; Marjoux, S; Khouatra, C; Coppere, B; Grange, C; Hot, A; Roman, S; Damon, H; Mion, F

    2017-11-01

    The prevalence of gastrointestinal involvement in systemic sclerosis is higher than 75%. The estimated prevalence of fecal incontinence varies from 22% to 77%, but suffers from recruitment bias and patient reluctance. Our goal was to evaluate the prevalence of fecal incontinence in systemic sclerosis, and to identify associated risk factors. Patients were recruited in the referral systemic sclerosis network of the Lyon University Hospitals, using self-administered questionnaires including constipation, fecal incontinence and Bristol Stool scales, quality of life, anxiety and depression. The cohort was compared with the historical ORALIA cohort that established the prevalence of fecal incontinence in the general population of the Rhône-Alpes region (France). Seventy-seven patients were included (mean age: 60 years, range: 32-84), and 86% were female. These were compared to 153 ORALIA individuals matched for age and sex. Fecal incontinence was present in 38% of patients and 6% of the general population. A longer duration of systemic sclerosis was the only characteristic associated with fecal incontinence. Abnormal stool consistency was more frequent in patients with fecal incontinence. Fecal incontinence and abnormal stool consistency are common in systemic sclerosis and should be systematically addressed.

  7. Graph theoretical analysis reveals the reorganization of the brain network pattern in primary open angle glaucoma patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jieqiong [Chinese Academy of Sciences, State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Beijing (China); Li, Ting; Xian, Junfang [Capital Medical University, Department of Radiology, Beijing Tongren Hospital, Beijing (China); Wang, Ningli [Capital Medical University, Department of Ophthalmology, Beijing Tongren Hospital, Beijing (China); He, Huiguang [Chinese Academy of Sciences, State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Beijing (China); Chinese Academy of Sciences, Research Center for Brain-Inspired Intelligence, Institute of Automation, Beijing (China)

    2016-11-15

    Most previous glaucoma studies with resting-state fMRI have focused on the neuronal activity in the individual structure of the brain, yet ignored the functional communication of anatomically separated structures. The purpose of this study is to investigate the efficiency of the functional communication change or not in glaucoma patients. We applied the resting-state fMRI data to construct the connectivity network of 25 normal controls and 25 age-gender-matched primary open angle glaucoma patients. Graph theoretical analysis was performed to assess brain network pattern differences between the two groups. No significant differences of the global network measures were found between the two groups. However, the local measures were radically reorganized in glaucoma patients. Comparing with the hub regions in normal controls' network, we found that six hub regions disappeared and nine hub regions appeared in the network of patients. In addition, the betweenness centralities of two altered hub regions, right fusiform gyrus and right lingual gyrus, were significantly correlated with the visual field mean deviation. Although the efficiency of functional communication is preserved in the brain network of the glaucoma at the global level, the efficiency of functional communication is altered in some specialized regions of the glaucoma. (orig.)

  8. Online social network use by health care providers in a high traffic patient care environment.

    Science.gov (United States)

    Black, Erik; Light, Jennifer; Paradise Black, Nicole; Thompson, Lindsay

    2013-05-17

    The majority of workers, regardless of age or occupational status, report engaging in personal Internet use in the workplace. There is little understanding of the impact that personal Internet use may have on patient care in acute clinical settings. The objective of this study was to investigate the volume of one form of personal Internet use-online social networking (Facebook)-generated by workstations in the emergency department (ED) in contrast to measures of clinical volume and severity. The research team analyzed anonymous network utilization records for 68 workstations located in the emergency medicine department within one academic medical center for 15 consecutive days (12/29/2009 to 1/12/2010). This data was compared to ED work index (EDWIN) data derived by the hospital information systems. Health care workers spent an accumulated 4349 minutes (72.5 hours) browsing Facebook, staff cumulatively visited Facebook 9369 times and spent, on average, 12.0 minutes per hour browsing Facebook. There was a statistically significant difference in the time spent on Facebook according to time of day (19.8 minutes per hour versus 4.3 minutes per hour, P<.001). There was a significant, positive correlation between EDWIN scores and time spent on Facebook (r=.266, P<.001). Facebook use constituted a substantive percentage of staff time during the 15-day observation period. Facebook use increased with increased patient volume and severity within the ED.

  9. Aberrant emotion networks in early major depressive disorder patients: an eigenvector centrality mapping study.

    Science.gov (United States)

    Song, Z; Zhang, M; Huang, P

    2016-05-24

    Major depressive disorder (MDD) is a serious mental disorder that negatively affects the quality of life of many individuals, and is a heavy economic burden to society. In recent years it was thought that depression is a 'disconnection syndrome'. Disorganized brain activity and un-modulated emotion responses were considered the key neuropathologies underlying depression. In the present study, we investigated the alteration of whole brain network connectivity in 28 first-episode, drug-naive patients, using resting-state functional magnetic resonance imaging and a new analytical method called voxel-based eigenvector centrality mapping. We found that compared with normal controls, MDD patients had lower functional connectivity in the bilateral middle frontal gyrus, insula, hippocampus, amygdala and cerebellum, and higher functional connectivity in the medial prefrontal cortex. The functional connectivity strength at the right hippocampus (r=-0.413, P=0.032) and the right insula (r=-0.372, P=0.041) negatively correlated with the severity of the disease. We further examined coordination among these regions, and found that frontal-subcortical connection was reduced and insula-medial prefrontal cortex (mPFC) connection was increased. These results are consistent with previous hypotheses on the neural mechanism of MDD, and provide further evidence that emotion networks are already interrupted in early stages of depression.

  10. High-dose aspirin is required to influence plasma fibrin network structure in patients with type 1 diabetes.

    Science.gov (United States)

    Tehrani, Sara; Antovic, Aleksandra; Mobarrez, Fariborz; Mageed, Koteiba; Lins, Per-Eric; Adamson, Ulf; Wallén, Håkan N; Jörneskog, Gun

    2012-02-01

    Patients with type 1 diabetes form a less permeable fibrin network, which could contribute to their increased risk of cardiovascular disease (CVD). Low-dose aspirin treatment is the standard in the management of CVD; however, the effect seems reduced in patients with diabetes. We investigated the effects of low- and high-dose aspirin treatment on fibrin network formation in patients with type 1 diabetes (primary aim) and the possible interaction between the treatment effects of aspirin on fibrin network permeability and glycemic control in these patients (secondary aim). Forty-eight patients (24 subjects with good [HbA(1c) 8.4%] glycemic control) were randomly assigned to treatment with 75 or 320 mg/day aspirin during 4 weeks in a crossover fashion. A 4-week washout period separated the treatment periods. The plasma fibrin network was assessed by determination of the permeability coefficient (K(s)). Treatment with 75 mg aspirin did not influence fibrin network permeability (K(s)). However, K(s) increased significantly during treatment with 320 mg aspirin (P = 0.004), and a significant treatment effect was seen compared with treatment with 75 mg aspirin (P = 0.009). The increase in K(s) during high-dose aspirin treatment was significant in patients with poor glycemic control (P = 0.02), whereas K(s) only tended to increase in patients with good glycemic control (P = 0.06). A high dose of aspirin is required to influence fibrin network permeability in patients with type 1 diabetes. The observed lack of effect with low-dose aspirin may contribute to aspirin treatment failure in diabetes.

  11. Supporting patients self-managing respiratory health: a qualitative study on the impact of the Breathe Easy voluntary group network.

    Science.gov (United States)

    Hashem, Ferhana; Merritt, Rowena

    2018-01-01

    Self-management strategies are designed to improve lung and respiratory health through structured self-management plans with regular practitioner reviews. Strategies have not, however, focused upon how patient support groups and advocacy networks can help with the management of these conditions; therefore, it is unknown what impact they may have on patient self-management. A qualitative study was designed to help understand what impact the British Lung Foundation's Breathe Easy (BE) groups have on patients managing their lung and respiratory conditions. A semistructured telephone interview schedule was developed to study the network. Topics covered included: perceptions about the BE groups; current referrals systems and integration pathways; benefits of attending the BE groups; and integration of the BE groups into the respiratory pathway. Key themes explored included: shared patient experience and peer support; patient self-management and self-education; attendance of healthcare professionals; and the impact of integrating BE groups into the respiratory pathway. BE networks were shown to support self-care initiatives for people attending the groups, and members expressed a social and educational benefit. BE networks were working with the local National Health Service to become an integral part of the respiratory pathway, yet there was evidence of resistance from the health service in incorporating the networks.

  12. Resting-state functional magnetic resonance imaging shows altered brain network topology in Type 2 diabetic patients without cognitive impairment.

    Science.gov (United States)

    Chen, Guan-Qun; Zhang, Xin; Xing, Yue; Wen, Dong; Cui, Guang-Bin; Han, Ying

    2017-11-28

    We analyzed topology of brain functional networks in type 2 diabetes mellitus (T2DM) patients without mild cognitive impairment. We recruited T2DM patients without mild cognitive impairment (4 males and 8 females) and healthy control subjects (8 males and 16 females) to undergo cognitive testing and resting-state functional magnetic resonance imaging. Graph theoretical analysis of functional brain networks revealed abnormal small-world architecture in T2DM patients as compared to control subjects. The functional brain networks of T2DM patients showed increased path length, decreased global efficiency and disrupted long-distance connections. Moreover, reduced nodal characteristics were distributed in the frontal, parietal and temporal lobes, while increased nodal characteristics were distributed in the frontal, occipital lobes, and basal ganglia in the T2DM patients. The disrupted topological properties correlated with cognitive performance of T2DM patients. These findings demonstrate altered topological organization of functional brain networks in T2DM patients without mild cognitive impairment.

  13. Social support network and quality of life in multiple sclerosis patients.

    Science.gov (United States)

    Costa, David Castro; Sá, Maria José; Calheiros, José Manuel

    2017-05-01

    To analyse the relationship between the social support network (SSN) and health related quality of life (HRQOL) in multiple sclerosis (MS) patients. The sample comprised 150 consecutive MS patients attending our MS clinic. To assess the socio-demographic data, a specifically designed questionnaire was applied. The HRQOL dimensions were measured with the Short-Form Health Survey Questionnaire-SF36 and the SSN with the Medical Outcomes Study Social Support Survey. Spearman's correlation was used to compare the magnitude of the relationship between the SSN and HRQOL. The mean patient age was 41.7 years (± 10.4; range: 18-70 yr); the mean Expanded Disability Status Score was 2.5 (±2.4; range: 0-9). There was a statistically significant correlation between the structure of the SSN and the HRQOL. The composition of the SSN, social group membership and participation in voluntary work have an important role in the HRQOL of patients with MS.

  14. Rhythm-specific modulation of the sensorimotor network in drug-naive patients with Parkinson's disease by levodopa.

    Science.gov (United States)

    Esposito, Fabrizio; Tessitore, Alessandro; Giordano, Alfonso; De Micco, Rosita; Paccone, Antonella; Conforti, Renta; Pignataro, Giuseppe; Annunziato, Lucio; Tedeschi, Gioacchino

    2013-03-01

    Brain activity during rest is characterized by slow (0.01-0.1 Hz) fluctuations of blood oxygenation level-dependent functional magnetic resonance imaging signals. These fluctuations are organized as functional connectivity networks called resting-state networks, anatomically corresponding to specific neuronal circuits. As Parkinson's disease is mainly characterized by a dysfunction of the sensorimotor pathways, which can be influenced by levodopa administration, the present study investigated the functional connectivity changes within the sensorimotor resting-state network in drug-naïve patients with Parkinson's disease after acute levodopa administration. Using a double-blind placebo-controlled design, resting-state functional magnetic resonance imaging was carried out in 20 drug-naïve patients with Parkinson's disease, immediately before and 60 min after, oral administration of either levodopa or placebo. Control resting-state functional magnetic resonance imaging data were recorded in 18 age- and sex-matched healthy volunteers. Independent component analysis was performed to extract resting-state network maps and associated time-course spectral features. At the anatomical level, levodopa enhanced the sensorimotor network functional connectivity in the supplementary motor area, a region where drug-naïve patients with Parkinson's disease exhibited reduced signal fluctuations compared with untreated patients. At the spectral frequency level, levodopa stimulated these fluctuations in a selective frequency band of the sensorimotor network. The reported effects induced by levodopa on sensorimotor network topological and spectral features confirm that the sensorimotor system is a target of acute levodopa administration in drug-naïve patients with Parkinson's disease. Moreover, while the regional changes in supplementary motor area reflect the functional improvement in motor function, the rhythm-specific modulation induced by the dopamine precursor discloses a novel

  15. Social Networking Services-Based Communicative Care for Patients with Diabetes Mellitus in Korea.

    Science.gov (United States)

    Kim, Hun-Sung; Jeong, Yoo Jin; Baik, Sun Jung; Yang, So Jung; Kim, Tong Min; Kim, Hyunah; Lee, Hyunyong; Lee, Seung-Hwan; Cho, Jae Hyoung; Choi, In-Young; Yoon, Kun-Ho

    2016-09-28

    Social networking services (SNS)-based online communities are good examples of improving quality of care by incorporating information technology into medicine. Therefore, we created an SNS-based community care webpage for communication among patients with diabetes mellitus (DM). We aimed to identify what diabetic patients wanted to know and were interested in by analyzing their posts and classified content in which users were interested. As opposed to the existing physician-focused health information websites, we built a patient-focused experience exchange website, "I love insulin (http://www.iloveinsulin.co.kr)." The DM communication webpage was divided into "My Web-Chart," "My community-free board," and "Life & Health." The contents analysis targeted users' postings, and replies were classified by theme from May 2012 to June 2013. The data included number of questions asked, answers, and question-to-answer (QA) ratio in each category. A total of 264 patients registered on the "I Love Insulin" website. The most frequent topic of posts classified as questions were about diabetes itself (23%), diet (22%), and glucose levels (19%). Conversely, most answers and information provided by users were about daily life with no relationship to diabetes mellitus (54%). While there were many questions about diet, there were very few answers (2%). Whereas there was much provision of knowledge about general DM, sharing diet information was rare. The ratios of answers to questions on diet (ratio=0.059, 1/17), glucose level (ratio=0.067, 1/15), insulin regulation (ratio=0.222, 2/9) and webpage (ratio=0.167, 1/6) were significantly low compared to DM itself (all p knowledge about diet and insulin regulation; continuously providing diet and insulin regulation information are desirable. It is hoped that the patients would be motivated to participate actively by "knowledge sharing." Through this process, patients learn about their diseases not from the physicians but from among

  16. Clinic Network Collaboration and Patient Tracing to Maximize Retention in HIV Care.

    Directory of Open Access Journals (Sweden)

    James H McMahon

    Full Text Available Understanding retention and loss to follow up in HIV care, in particular the number of people with unknown outcomes, is critical to maximise the benefits of antiretroviral therapy. Individual-level data are not available for these outcomes in Australia, which has an HIV epidemic predominantly focused amongst men who have sex with men.A network of the 6 main HIV clinical care sites was established in the state of Victoria, Australia. Individuals who had accessed care at these sites between February 2011 and June 2013 as assessed by HIV viral load testing but not accessed care between June 2013 and February 2014 were considered individuals with potentially unknown outcomes. For this group an intervention combining cross-referencing of clinical data between sites and phone tracing individuals with unknown outcomes was performed. 4966 people were in care in the network and before the intervention estimates of retention ranged from 85.9%-95.8% and the proportion with unknown outcomes ranged from 1.3-5.5%. After the intervention retention increased to 91.4-98.8% and unknown outcomes decreased to 0.1-2.4% (p<.01 for all sites for both outcomes. Most common reasons for disengagement from care were being too busy to attend or feeling well. For those with unknown outcomes prior to the intervention documented active psychiatric illness at last visit was associated with not re-entering care (p = 0.04.The network demonstrated low numbers of people with unknown outcomes and high levels of retention in care. Increased levels of retention in care and reductions in unknown outcomes identified after the intervention largely reflected confirmation of clinic transfers while a smaller number were successfully re-engaged in care. Factors associated with disengagement from care were identified. Systems to monitor patient retention, care transfer and minimize disengagement will maximise individual and population-level outcomes for populations with HIV.

  17. Working memory performance of early MS patients correlates inversely with modularity increases in resting state functional connectivity networks.

    Science.gov (United States)

    Gamboa, O L; Tagliazucchi, E; von Wegner, F; Jurcoane, A; Wahl, M; Laufs, H; Ziemann, U

    2014-07-01

    Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating and neurodegenerative disorder of the central nervous system characterized by multifocal white matter brain lesions leading to alterations in connectivity at the subcortical and cortical level. Graph theory, in combination with neuroimaging techniques, has been recently developed into a powerful tool to assess the large-scale structure of brain functional connectivity. Considering the structural damage present in the brain of MS patients, we hypothesized that the topological properties of resting-state functional networks of early MS patients would be re-arranged in order to limit the impact of disease expression. A standardized dual task (Paced Auditory Serial Addition Task simultaneously performed with a paper and pencil task) was administered to study the interactions between behavioral performance and functional network re-organization. We studied a group of 16 early MS patients (35.3±8.3 years, 11 females) and 20 healthy controls (29.9±7.0 years, 10 females) and found that brain resting-state networks of the MS patients displayed increased network modularity, i.e. diminished functional integration between separate functional modules. Modularity correlated negatively with dual task performance in the MS patients. Our results shed light on how localized anatomical connectivity damage can globally impact brain functional connectivity and how these alterations can impair behavioral performance. Finally, given the early stage of the MS patients included in this study, network modularity could be considered a promising biomarker for detection of earliest-stage brain network reorganization, and possibly of disease progression. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Functional Activity and Connectivity Differences of Five Resting-State Networks in Patients with Alzheimer's Disease or Mild Cognitive Impairment.

    Science.gov (United States)

    Chen, Yu; Yan, Hao; Han, Zaizhu; Bi, Yanchao; Chen, Hongyan; Liu, Jia; Wu, Meiru; Wang, Yongjun; Zhang, Yumei

    2016-01-01

    We aimed to investigate the activity within and the connectivity between resting state networks (RSNs) in healthy subjects and patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI). Magnetic resonance imaging (MRI) and resting-state MRI were performed on patients diagnosed with AD (n=18) or MCI (n=16) and on healthy subjects (n=18) with matching demographic characteristics (age, sex, and education level). Independent component analysis and Granger causality analysis (GCA) were used during image postprocessing. We calculated 'In + Out degree' for each RSN. Then, we investigated the relationships between "In + Out degree" of each brain network and the cognitive behavioural data. RSNs were obtained using the optimal matching method. The core areas of the five RSNs were similar between the AD, MCI, and healthy control groups, but the activity within these five RSNs was significantly lower in the AD and MCI groups than in the healthy control group (P<0.01, false discovery rate corrected). The GCA results showed that the connectivity between the five RSNs, particularly the connectivity from the default mode network (DMN) to the other RSNs, was slightly lower in MCI patients and was significantly lower in AD patients than in healthy subjects. In contrast, increased connectivity was evident between the memory network and the executive control network in the AD and MCI patients. The "In + Out degree" of the DMN negatively correlated with the Montreal Cognitive Assessment score in AD patients (R=-0.43, P<0.05). In conclusion, the activity within RSNs and the connectivity between RSNs differed between AD patients, MCI patients, and normal individuals; these results provide an imaging reference for the diagnosis of AD and the measurement of disease progression and reveal insight into the pathogenesis of AD.

  19. Lithium-responsive genes and gene networks in bipolar disorder patient-derived lymphoblastoid cell lines.

    Science.gov (United States)

    Breen, M S; White, C H; Shekhtman, T; Lin, K; Looney, D; Woelk, C H; Kelsoe, J R

    2016-10-01

    Lithium (Li) is the mainstay mood stabilizer for the treatment of bipolar disorder (BD), although its mode of action is not yet fully understood nor is it effective in every patient. We sought to elucidate the mechanism of action of Li and to identify surrogate outcome markers that can be used to better understand its therapeutic effects in BD patients classified as good (responders) and poor responders (nonresponders) to Li treatment. To accomplish these goals, RNA-sequencing gene expression profiles of lymphoblastoid cell lines (LCLs) were compared between BD Li responders and nonresponders with healthy controls before and after treatment. Several Li-responsive gene coexpression networks were discovered indicating widespread effects of Li on diverse cellular signaling systems including apoptosis and defense response pathways, protein processing and response to endoplasmic reticulum stress. Individual gene markers were also identified, differing in response to Li between BD responders and nonresponders, involved in processes of cell cycle and nucleotide excision repair that may explain part of the heterogeneity in clinical response to treatment. Results further indicated a Li gene expression signature similar to that observed with clonidine treatment, an α2-adrenoceptor agonist. These findings provide a detailed mechanism of Li in LCLs and highlight putative surrogate outcome markers that may permit for advanced treatment decisions to be made and for facilitating recovery in BD patients.

  20. Health Social Networks as Online Life Support Groups for Patients With Cardiovascular Diseases

    Energy Technology Data Exchange (ETDEWEB)

    Medina, Edhelmira Lima, E-mail: edhyly@ic.uff.br; Loques, Orlando Filho [Instituto de Computação - Universidade Federal Fluminense, Niterói, RJ (Brazil); Mesquita, Cláudio Tinoco [Hospital Universitário Antônio Pedro - Universidade Federal Fluminense, Niterói, RJ (Brazil)

    2013-08-15

    The number of patients who use the internet in search for information that might improve their health conditions has increased. Among them, those looking for virtual environments to share experiences, doubts, opinions, and emotions, and to foster relationships aimed at giving and getting support stand out. Therefore, there is an increasing need to assess how those environments can affect the patients' health. This study was aimed at identifying scientific studies on the proliferation and impact of virtual communities, known as health social networks or online support groups, directed to cardiovascular diseases, which might be useful to patients with certain conditions, providing them with information and emotional support. A systematic review of the literature was conducted with articles published from 2007 to 2012, related to cardiovascular diseases and collected from the following databases: PubMed; Association for Computing Machinery(ACM); and Institute of Electrical and Electronics Engineers (IEEE). Four articles meeting the inclusion criteria were selected. The results were interesting and relevant from the health viewpoint, identifying therapeutic benefits, such as provision of emotional support, greater compliance to treatment, and information sharing on diseases and on life experiences.

  1. CAPriCORN: Chicago Area Patient-Centered Outcomes Research Network

    Science.gov (United States)

    Kho, Abel N; Hynes, Denise M; Goel, Satyender; Solomonides, Anthony E; Price, Ron; Hota, Bala; Sims, Shannon A; Bahroos, Neil; Angulo, Francisco; Trick, William E; Tarlov, Elizabeth; Rachman, Fred D; Hamilton, Andrew; Kaleba, Erin O; Badlani, Sameer; Volchenboum, Samuel L; Silverstein, Jonathan C; Tobin, Jonathan N; Schwartz, Michael A; Levine, David; Wong, John B; Kennedy, Richard H; Krishnan, Jerry A; Meltzer, David O; Collins, John M; Mazany, Terry

    2014-01-01

    The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of data integration, marketplace competition, and care fragmentation to develop, test, and implement strategies to improve care for diverse populations and reduce health disparities. PMID:24821736

  2. Length of Hospital Stay Prediction at the Admission Stage for Cardiology Patients Using Artificial Neural Network

    Directory of Open Access Journals (Sweden)

    Pei-Fang (Jennifer Tsai

    2016-01-01

    Full Text Available For hospitals’ admission management, the ability to predict length of stay (LOS as early as in the preadmission stage might be helpful to monitor the quality of inpatient care. This study is to develop artificial neural network (ANN models to predict LOS for inpatients with one of the three primary diagnoses: coronary atherosclerosis (CAS, heart failure (HF, and acute myocardial infarction (AMI in a cardiovascular unit in a Christian hospital in Taipei, Taiwan. A total of 2,377 cardiology patients discharged between October 1, 2010, and December 31, 2011, were analyzed. Using ANN or linear regression model was able to predict correctly for 88.07% to 89.95% CAS patients at the predischarge stage and for 88.31% to 91.53% at the preadmission stage. For AMI or HF patients, the accuracy ranged from 64.12% to 66.78% at the predischarge stage and 63.69% to 67.47% at the preadmission stage when a tolerance of 2 days was allowed.

  3. A Low-Cost Body Inertial-Sensing Network for Practical Gait Discrimination of Hemiplegia Patients

    Science.gov (United States)

    Guo, Yanwei; Wu, Dan; Liu, Guanzheng; Zhao, Guoru; Huang, Bangyu

    2012-01-01

    Abstract Gait analysis is widely used in detecting human walking disorders. Current gait analysis methods like video- or optical-based systems are expensive and cause invasion of human privacy. This article presents a self-developed low-cost body inertial-sensing network, which contains a base station, three wearable inertial measurement nodes, and the affiliated wireless communication protocol, for practical gait discrimination between hemiplegia patients and asymptomatic subjects. Every sensing node contains one three-axis accelerometer, one three-axis magnetometer, and one three-axis gyroscope. Seven hemiplegia patients (all were abnormal on the right side) and 7 asymptomatic subjects were examined. The three measurement nodes were attached on the thigh, the shank, and the dorsum of the foot, respectively (all on the right side of the body). A new method, which does not need to obtain accurate positions of the sensors, was used to calculate angles of knee flexion/extension and foot in the gait cycle. The angle amplitudes of initial contact, toe off, and knee flexion/extension were extracted. The results showed that there were significant differences between the two groups in the three angle amplitudes examined (−0.52±0.98° versus 6.94±2.63°, 28.33±11.66° versus 47.34±7.90°, and 26.85±8.6° versus 50.91±6.60°, respectively). It was concluded that the body inertial-sensing network platform provided a practical approach for wearable biomotion acquisition and was effective for discriminating gait symptoms between hemiplegia and asymptomatic subjects. PMID:22449064

  4. Resting-state functional connectivity alterations in the default network of schizophrenia patients with persistent auditory verbal hallucinations.

    Science.gov (United States)

    Alonso-Solís, Anna; Vives-Gilabert, Yolanda; Grasa, Eva; Portella, Maria J; Rabella, Mireia; Sauras, Rosa Blanca; Roldán, Alexandra; Núñez-Marín, Fidel; Gómez-Ansón, Beatriz; Pérez, Víctor; Alvarez, Enric; Corripio, Iluminada

    2015-02-01

    To understand the neural mechanism that underlies treatment resistant auditory verbal hallucinations (AVH), is still an important issue in psychiatric research. Alterations in functional connectivity during rest have been frequently reported in patients with schizophrenia. Though the default mode network (DN) appears to be abnormal in schizophrenia patients, little is known about its role in resistant AVH. We collected resting-state functional magnetic resonance imaging (R-fMRI) data with a 3T scanner from 19 schizophrenia patients with chronic AVH resistant to pharmacological treatment, 14 schizophrenia patients without AVH and 20 healthy controls. Using seed-based correlation analysis, we created spherical seed regions of interest (ROI) to examine functional connectivity of the two DN hub regions (posterior cingulate cortex and anteromedial prefrontal cortex) and the two DN subsystems: dorsomedial prefrontal cortex subsystem and medial temporal lobe subsystem (p<0.0045 corrected). Patients with hallucinations exhibited higher FC between dMPFC ROI and bilateral central opercular cortex, bilateral insular cortex and bilateral precentral gyrus compared to non hallucinating patients and healthy controls. Additionally, patients with hallucinations also exhibited lower FC between vMPFC ROI and bilateral paracingulate and dorsal anterior cingulate cortex. As the anterior cingulate cortex and the insula are two hubs of the salience network, our results suggest cross-network abnormalities between DN and salience system in patients with persistent hallucinations. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Supporting wellbeing in motor neurone disease for patients, carers, social networks, and health professionals: A scoping review and synthesis.

    Science.gov (United States)

    Harris, Melanie; Thomas, Geoff; Thomas, Mary; Cafarella, Paul; Stocks, Allegra; Greig, Julia; McEvoy, R Doug

    2017-08-22

    Disease management in motor neurone disease (MND) is focused on preserving quality of life. However, the emphasis has so far been on physical symptoms and functioning and not psychosocial wellbeing. MND affects the wellbeing of carers, of family and social network members, and of healthcare providers, as well as of the patients. We therefore aimed to assess and synthesize the knowledge about maximizing MND-related psychosocial wellbeing across all these groups. We used a systematic search and selection process to assess the scope of the literature along with a narrative synthesis of recent high-quality reviews. The original studies were mainly observational studies of patients and, to a lesser extent, of carers. There were few interventional studies, mainly of patients. There were very few studies of any type on wellbeing in their wider social network or in healthcare professionals. All the review literature looked at MND patient or carer wellbeing, with some covering both. No reviews were found of wellbeing in other family members, patients' social networks, or their healthcare professionals. The reviews demonstrated wellbeing problems for patients linked to psychosocial issues. Carer wellbeing is also compromised. Psychotherapies, social supports, improved decision supports, and changes to healthcare delivery are among the suggested strategies for improved patient and carer wellbeing, but no proven interventions were identified for either. Early access to palliative care, also not well-tested but recommended, is poorly implemented. Work on interventions to deal with well-established wellbeing problems for patients and carers is now a research priority. Explicit use of current methods for patient and public involvement and for design and testing of interventions provide a toolkit for this research. Observational research is needed in other groups. There is a potential in considering needs across patients' social networks rather than looking individually at

  6. An integrated geometric modelling framework for patient-specific computational haemodynamic study on wide-ranged vascular network.

    Science.gov (United States)

    Torii, Ryo; Oshima, Marie

    2012-01-01

    Patient-specific haemodynamic computations have been used as an effective tool in researches on cardiovascular disease associated with haemodynamics such as atherosclerosis and aneurysm. Recent development of computer resource has enabled 3D haemodynamic computations in wide-spread arterial network but there are still difficulties in modelling vascular geometry because of noise and limited resolution in medical images. In this paper, an integrated framework to model an arterial network tree for patient-specific computational haemodynamic study is developed. With this framework, 3D vascular geometry reconstruction of an arterial network and quantification of its geometric feature are aimed. The combination of 3D haemodynamic computation and vascular morphology quantification helps better understand the relationship between vascular morphology and haemodynamic force behind 'geometric risk factor' for cardiovascular diseases. The proposed method is applied to an intracranial arterial network to demonstrate its accuracy and effectiveness. The results are compared with the marching-cubes (MC) method. The comparison shows that the present modelling method can reconstruct a wide-ranged vascular network anatomically more accurate than the MC method, particularly in peripheral circulation where the image resolution is low in comparison to the vessel diameter, because of the recognition of an arterial network connectivity based on its centreline.

  7. Asymmetric pedunculopontine network connectivity in parkinsonian patients with freezing of gait

    Science.gov (United States)

    Fling, Brett W.; Cohen, Rajal G.; Mancini, Martina; Nutt, John G.; Fair, Damian A.

    2013-01-01

    Freezing of gait is one of the most debilitating symptoms in Parkinson’s disease as it causes falls and reduces mobility and quality of life. The pedunculopontine nucleus is one of the major nuclei of the mesencephalic locomotor region and has neurons related to anticipatory postural adjustments preceding step initiation as well as to the step itself, thus it may be critical for coupling posture and gait to avoid freezing. Because freezing of gait and postural impairments have been related to frontal lesions and frontal dysfunction such as executive function, we hypothesized that freezing is associated with disrupted connectivity between midbrain locomotor regions and medial frontal cortex. We used diffusion tensor imaging to quantify structural connectivity of the pedunculopontine nucleus in patients with Parkinson’s disease with freezing of gait, without freezing, and healthy age-matched controls. We also included behavioural tasks to gauge severity of freezing of gait, quantify gait metrics, and assess executive cognitive functions to determine whether between-group differences in executive dysfunction were related to pedunculopontine nucleus structural network connectivity. Using seed regions from the pedunculopontine nucleus, we were able to delineate white matter connections between the spinal cord, cerebellum, pedunculopontine nucleus, subcortical and frontal/prefrontal cortical regions. The current study is the first to demonstrate differences in structural connectivity of the identified locomotor pathway in patients with freezing of gait. We report reduced connectivity of the pedunculopontine nucleus with the cerebellum, thalamus and multiple regions of the frontal cortex. Moreover, these structural differences were observed solely in the right hemisphere of patients with freezing of gait. Finally, we show that the more left hemisphere-lateralized the pedunculopontine nucleus tract volume, the poorer the performance on cognitive tasks requiring the

  8. Disrupted small world networks in patients without overt hepatic encephalopathy: A resting state fMRI study

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Long Jiang, E-mail: kevinzhlj@163.com [Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002 (China); Zheng, Gang [Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002 (China); College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu 210016 (China); Zhang, Liping [College of Natural Science, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu 210016 (China); Zhong, Jianhui [Department of Biomedical Engineering, Zhejiang University, Hangzhou, Zhejiang 310027 (China); Li, Qiang [College of Natural Science, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu 210016 (China); Zhao, Tie Zhu [Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002 (China); College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu 210016 (China); Lu, Guang Ming, E-mail: cjr.luguangming@vip.163.com [Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002 (China)

    2014-10-15

    Purpose: To explore changes in functional connectivity and topological organization of brain functional networks in cirrhotic patients with minimal hepatic encephalopathy (MHE) and non hepatic encephalopathy (nonHE) and their relationship with clinical markers. Materials and methods: Resting-state functional MR imaging was acquired in 22 MHE, 29 nonHE patients and 33 healthy controls. Functional connectivity networks were obtained by computing temporal correlations between any pairs of 90 cortical and subcortical regions. Graph analysis measures were quantitatively assessed for each subject. One-way analysis of covariance was applied to identify statistical differences of functional connectivity and network parameters among three groups. Correlations between clinical markers, such as Child–Pugh scores, venous blood ammonia level, and number connection test type A (NCT-A)/digit symbol test (DST) scores, and connectivity/graph metrics were calculated. Results: Thirty functional connectivities represented by edges were found to be abnormal (P < 0.05, FDR corrected) in cirrhotic patients, in which 16 edges (53.3%) were related with sub-cortical regions. MHE patients showed abnormal small-world attributes in the functional connectivity networks. Cirrhotic patients had significantly reduced nodal degree in 8 cortical regions and increased nodal centrality in 3 cortical regions. Twenty edges were correlated with either NCT-A or DST scores, in which 13 edges were related with sub-cortical regions. No correlation was found between Child–Pugh scores and graph theoretical measures in cirrhotic patients. Conclusion: Disturbances of brain functional connectivity and small world property loss are associated with neurocognitive impairment of cirrhotic patients. Reorganization of brain network occurred during disease progression from nonHE to MHE.

  9. Optimal oral antithrombotic regimes for patients with acute coronary syndrome: a network meta-analysis.

    Directory of Open Access Journals (Sweden)

    Yicong Ye

    Full Text Available We performed a network meta-analysis to investigate the optimal antithrombotic regime by indirectly comparing new antithrombotic regimes (new P2Y12 inhibitors plus aspirin or novel oral anticoagulants on top of traditional dual antiplatelet therapy [DAPT] in patients with acute coronary syndrome (ACS.A systematic search of MEDLINE, EMBASE, and the Cochrane databases was performed to identify all phase 3 randomized controlled trials (RCTs involving novel oral anticoagulants or oral P2Y12 inhibitors in patients with ACS. Major adverse cardiac events (MACE were regarded as the efficacy endpoint, and thrombolysis in myocardial infarction (TIMI major bleeding events were used as the safety endpoint. The net clinical benefit was calculated as the sum of MACE and TIMI major bleeding events.Five phase 3 RCTs with 64,476 ACS patients were included. Although there were no significant differences among new antithrombotic regimes, rivaroxaban 5 mg twice daily plus traditional DAPT might be the most effective in reducing the incidence of MACE, accompanying the highest risk of TIMI major bleeding. Ticagrelor plus aspirin presented slight advantage on the net clinical benefit over other new antithrombotic regimes, with the highest probability of being the best regimes for net clinical benefit (35.0%, followed by prasugrel plus aspirin (28.0%, and rivaroxaban 2.5 mg twice daily plus traditional DAPT (19.5%.Novel antithrombotic regime with ticagrelor plus aspirin brings a larger clinical benefit in comparison with other regimes, suggesting that it may be the optimal antithrombotic regime for patients with ACS.

  10. Optimal oral antithrombotic regimes for patients with acute coronary syndrome: a network meta-analysis.

    Science.gov (United States)

    Ye, Yicong; Xie, Hongzhi; Zeng, Yong; Zhao, Xiliang; Tian, Zhuang; Zhang, Shuyang

    2014-01-01

    We performed a network meta-analysis to investigate the optimal antithrombotic regime by indirectly comparing new antithrombotic regimes (new P2Y12 inhibitors plus aspirin or novel oral anticoagulants on top of traditional dual antiplatelet therapy [DAPT]) in patients with acute coronary syndrome (ACS). A systematic search of MEDLINE, EMBASE, and the Cochrane databases was performed to identify all phase 3 randomized controlled trials (RCTs) involving novel oral anticoagulants or oral P2Y12 inhibitors in patients with ACS. Major adverse cardiac events (MACE) were regarded as the efficacy endpoint, and thrombolysis in myocardial infarction (TIMI) major bleeding events were used as the safety endpoint. The net clinical benefit was calculated as the sum of MACE and TIMI major bleeding events. Five phase 3 RCTs with 64,476 ACS patients were included. Although there were no significant differences among new antithrombotic regimes, rivaroxaban 5 mg twice daily plus traditional DAPT might be the most effective in reducing the incidence of MACE, accompanying the highest risk of TIMI major bleeding. Ticagrelor plus aspirin presented slight advantage on the net clinical benefit over other new antithrombotic regimes, with the highest probability of being the best regimes for net clinical benefit (35.0%), followed by prasugrel plus aspirin (28.0%), and rivaroxaban 2.5 mg twice daily plus traditional DAPT (19.5%). Novel antithrombotic regime with ticagrelor plus aspirin brings a larger clinical benefit in comparison with other regimes, suggesting that it may be the optimal antithrombotic regime for patients with ACS.

  11. Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer.

    Directory of Open Access Journals (Sweden)

    Tjibbe Donker

    Full Text Available Hospital-acquired infections (HAI are often seen as preventable incidents that result from unsafe practices or poor hospital hygiene. This however ignores the fact that transmissibility is not only a property of the causative organisms but also of the hosts who can translocate bacteria when moving between hospitals. In an epidemiological sense, hospitals become connected through the patients they share. We here postulate that the degree of hospital connectedness crucially influences the rates of infections caused by hospital-acquired bacteria. To test this hypothesis, we mapped the movement of patients based on the UK-NHS Hospital Episode Statistics and observed that the proportion of patients admitted to a hospital after a recent episode in another hospital correlates with the hospital-specific incidence rate of MRSA bacteraemia as recorded by mandatory reporting. We observed a positive correlation between hospital connectedness and MRSA bacteraemia incidence rate that is significant for all financial years since 2001 except for 2008-09. All years combined, this correlation is positive and significantly different from zero (partial correlation coefficient r = 0.33 (0.28 to 0.38. When comparing the referral pattern for English hospitals with referral patterns observed in the Netherlands, we predict that English hospitals more likely see a swifter and more sustained spread of HAIs. Our results indicate that hospitals cannot be viewed as individual units but rather should be viewed as connected elements of larger modular networks. Our findings stress the importance of cooperative effects that will have a bearing on the planning of health care systems, patient management and hospital infection control.

  12. Within-patient correspondence of amyloid-β and intrinsic network connectivity in Alzheimer’s disease

    Science.gov (United States)

    Pasquini, Lorenzo; Göttler, Jens; Grimmer, Timo; Koch, Kathrin; Ortner, Marion; Neitzel, Julia; Mühlau, Mark; Förster, Stefan; Kurz, Alexander; Förstl, Hans; Zimmer, Claus; Wohlschläger, Afra M.; Riedl, Valentin; Drzezga, Alexander; Sorg, Christian

    2014-01-01

    There is striking overlap between the spatial distribution of amyloid-β pathology in patients with Alzheimer’s disease and the spatial distribution of high intrinsic functional connectivity in healthy persons. This overlap suggests a mechanistic link between amyloid-β and intrinsic connectivity, and indeed there is evidence in patients for the detrimental effects of amyloid-β plaque accumulation on intrinsic connectivity in areas of high connectivity in heteromodal hubs, and particularly in the default mode network. However, the observed spatial extent of amyloid-β exceeds these tightly circumscribed areas, suggesting that previous studies may have underestimated the negative impact of amyloid-β on intrinsic connectivity. We hypothesized that the known positive baseline correlation between patterns of amyloid-β and intrinsic connectivity may mask the larger extent of the negative effects of amyloid-β on connectivity. Crucially, a test of this hypothesis requires the within-patient comparison of intrinsic connectivity and amyloid-β distributions. Here we compared spatial patterns of amyloid-β-plaques (measured by Pittsburgh compound B positron emission tomography) and intrinsic functional connectivity (measured by resting-state functional magnetic resonance imaging) in patients with prodromal Alzheimer’s disease via spatial correlations in intrinsic networks covering fronto-parietal heteromodal cortices. At the global network level, we found that amyloid-β and intrinsic connectivity patterns were positively correlated in the default mode and several fronto-parietal attention networks, confirming that amyloid-β aggregates in areas of high intrinsic connectivity on a within-network basis. Further, we saw an internetwork gradient of the magnitude of correlation that depended on network plaque-load. After accounting for this globally positive correlation, local amyloid-β-plaque concentration in regions of high connectivity co-varied negatively with

  13. Altered brain anatomical networks and disturbed connection density in brain tumor patients revealed by diffusion tensor tractography.

    Science.gov (United States)

    Yu, Zhou; Tao, Ling; Qian, Zhiyu; Wu, Jiangfen; Liu, Hongyi; Yu, Yun; Song, Jiantai; Wang, Shaobo; Sun, Jinyang

    2016-11-01

    Brain tumor patients are usually accompanied by impairments in cognitive functions, and these dysfunctions arise from the altered diffusion tensor of water molecules and disrupted neuronal conduction in white matter. Diffusion tensor imaging (DTI) is a powerful noninvasive imaging technique that can reflect diffusion anisotropy of water and brain white matter neural connectivity in vivo. This study was aimed to analyze the topological properties and connection densities of the brain anatomical networks in brain tumor patients based on DTI and provide new insights into the investigation of the structural plasticity and compensatory mechanism of tumor patient's brain. In this study, the brain anatomical networks of tumor patients and healthy controls were constructed using the tracking of white matter fiber bundles based on DTI and the topological properties of these networks were described quantitatively. The statistical comparisons were performed between two groups with six DTI parameters: degree, regional efficiency, local efficiency, clustering coefficient, vulnerability, and betweenness centrality. In order to localize changes in structural connectivity to specific brain regions, a network-based statistic approach was utilized. By comparing the edge connection density of brain network between two groups, the edges with greater difference in connection density were associated with three functional systems. Compared with controls, tumor patients show a significant increase in small-world feature of cerebral structural network. Two-sample two-tailed t test indicates that the regional properties are altered in 17 regions ([Formula: see text]). Study reveals that the positive and negative changes in vulnerability take place in the 14 brain areas. In addition, tumor patients lose 3 hub regions and add 2 new hubs when compared to normal controls. Eleven edges show much significantly greater connection density in the patients than in the controls. Most of the edges with

  14. Secure Authentication for Remote Patient Monitoring with Wireless Medical Sensor Networks.

    Science.gov (United States)

    Hayajneh, Thaier; Mohd, Bassam J; Imran, Muhammad; Almashaqbeh, Ghada; Vasilakos, Athanasios V

    2016-03-24

    There is broad consensus that remote health monitoring will benefit all stakeholders in the healthcare system and that it has the potential to save billions of dollars. Among the major concerns that are preventing the patients from widely adopting this technology are data privacy and security. Wireless Medical Sensor Networks (MSNs) are the building blocks for remote health monitoring systems. This paper helps to identify the most challenging security issues in the existing authentication protocols for remote patient monitoring and presents a lightweight public-key-based authentication protocol for MSNs. In MSNs, the nodes are classified into sensors that report measurements about the human body and actuators that receive commands from the medical staff and perform actions. Authenticating these commands is a critical security issue, as any alteration may lead to serious consequences. The proposed protocol is based on the Rabin authentication algorithm, which is modified in this paper to improve its signature signing process, making it suitable for delay-sensitive MSN applications. To prove the efficiency of the Rabin algorithm, we implemented the algorithm with different hardware settings using Tmote Sky motes and also programmed the algorithm on an FPGA to evaluate its design and performance. Furthermore, the proposed protocol is implemented and tested using the MIRACL (Multiprecision Integer and Rational Arithmetic C/C++) library. The results show that secure, direct, instant and authenticated commands can be delivered from the medical staff to the MSN nodes.

  15. Mortality Predicted Accuracy for Hepatocellular Carcinoma Patients with Hepatic Resection Using Artificial Neural Network

    Directory of Open Access Journals (Sweden)

    Herng-Chia Chiu

    2013-01-01

    Full Text Available The aim of this present study is firstly to compare significant predictors of mortality for hepatocellular carcinoma (HCC patients undergoing resection between artificial neural network (ANN and logistic regression (LR models and secondly to evaluate the predictive accuracy of ANN and LR in different survival year estimation models. We constructed a prognostic model for 434 patients with 21 potential input variables by Cox regression model. Model performance was measured by numbers of significant predictors and predictive accuracy. The results indicated that ANN had double to triple numbers of significant predictors at 1-, 3-, and 5-year survival models as compared with LR models. Scores of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC of 1-, 3-, and 5-year survival estimation models using ANN were superior to those of LR in all the training sets and most of the validation sets. The study demonstrated that ANN not only had a great number of predictors of mortality variables but also provided accurate prediction, as compared with conventional methods. It is suggested that physicians consider using data mining methods as supplemental tools for clinical decision-making and prognostic evaluation.

  16. Patient Specific Seizure Prediction System Using Hilbert Spectrum and Bayesian Networks Classifiers

    Directory of Open Access Journals (Sweden)

    Nilufer Ozdemir

    2014-01-01

    Full Text Available The aim of this paper is to develop an automated system for epileptic seizure prediction from intracranial EEG signals based on Hilbert-Huang transform (HHT and Bayesian classifiers. Proposed system includes decomposition of the signals into intrinsic mode functions for obtaining features and use of Bayesian networks with correlation based feature selection for binary classification of preictal and interictal recordings. The system was trained and tested on Freiburg EEG database. 58 hours of preictal data, 40-minute data blocks prior to each of 87 seizures collected from 21 patients, and 503.1 hours of interictal data were examined resulting in 96.55% sensitivity with 0.21 false alarms per hour, 13.896% average proportion of time spent in warning, and 33.21 minutes of average detection latency using 30-second EEG segments with 50% overlap and a simple postprocessing technique resulting in a decision (a seizure is expected/not expected every 5 minutes. High sensitivity and low false positive rate with reasonable detection latency show that HHT based features are acceptable for patient specific seizure prediction from intracranial EEG data. Time spent for testing an EEG segment was 4.1451 seconds on average, which makes the system viable for use in real-time seizure control systems.

  17. Distinctive Structural and Effective Connectivity Changes of Semantic Cognition Network across Left and Right Mesial Temporal Lobe Epilepsy Patients

    Science.gov (United States)

    Fan, Xiaotong; Shang, Kun; Wang, Xiaocui; Wang, Peipei; Shan, Yongzhi; Lu, Jie

    2016-01-01

    Occurrence of language impairment in mesial temporal lobe epilepsy (mTLE) patients is common and left mTLE patients always exhibit a primary problem with access to names. To explore different neuropsychological profiles between left and right mTLE patients, the study investigated both structural and effective functional connectivity changes within the semantic cognition network between these two groups and those from normal controls. We found that gray matter atrophy of left mTLE patients was more severe than that of right mTLE patients in the whole brain and especially within the semantic cognition network in their contralateral hemisphere. It suggested that seizure attacks were rather targeted than random for patients with hippocampal sclerosis (HS) in the dominant hemisphere. Functional connectivity analysis during resting state fMRI revealed that subregions of the anterior temporal lobe (ATL) in the left HS patients were no longer effectively connected. Further, we found that, unlike in right HS patients, increased causal linking between ipsilateral regions in the left HS epilepsy patients cannot make up for their decreased contralateral interaction. It suggested that weakened contralateral connection and disrupted effective interaction between subregions of the unitary, transmodal hub of the ATL may be the primary cause of anomia in the left HS patients. PMID:28018680

  18. Predicting patient survival after liver transplantation using evolutionary multi-objective artificial neural networks.

    Science.gov (United States)

    Cruz-Ramírez, Manuel; Hervás-Martínez, César; Fernández, Juan Carlos; Briceño, Javier; de la Mata, Manuel

    2013-05-01

    The optimal allocation of organs in liver transplantation is a problem that can be resolved using machine-learning techniques. Classical methods of allocation included the assignment of an organ to the first patient on the waiting list without taking into account the characteristics of the donor and/or recipient. In this study, characteristics of the donor, recipient and transplant organ were used to determine graft survival. We utilised a dataset of liver transplants collected by eleven Spanish hospitals that provides data on the survival of patients three months after their operations. To address the problem of organ allocation, the memetic Pareto evolutionary non-dominated sorting genetic algorithm 2 (MPENSGA2 algorithm), a multi-objective evolutionary algorithm, was used to train radial basis function neural networks, where accuracy was the measure used to evaluate model performance, along with the minimum sensitivity measurement. The neural network models obtained from the Pareto fronts were used to develop a rule-based system. This system will help medical experts allocate organs. The models obtained with the MPENSGA2 algorithm generally yielded competitive results for all performance metrics considered in this work, namely the correct classification rate (C), minimum sensitivity (MS), area under the receiver operating characteristic curve (AUC), root mean squared error (RMSE) and Cohen's kappa (Kappa). In general, the multi-objective evolutionary algorithm demonstrated a better performance than the mono-objective algorithm, especially with regard to the MS extreme of the Pareto front, which yielded the best values of MS (48.98) and AUC (0.5659). The rule-based system efficiently complements the current allocation system (model for end-stage liver disease, MELD) based on the principles of efficiency and equity. This complementary effect occurred in 55% of the cases used in the simulation. The proposed rule-based system minimises the prediction probability

  19. Ensuring Patient Safety by using Colored Petri Net Simulation in the Design of Heterogeneous, Multi-Vendor, Integrated, Life-Critical Wireless (802.x) Patient Care Device Networks.

    Science.gov (United States)

    Sloane, Elliot; Gehlot, Vijay

    2005-01-01

    Hospitals and manufacturers are designing and deploying the IEEE 802.x wireless technologies in medical devices to promote patient mobility and flexible facility use. There is little information, however, on the reliability or ultimate safety of connecting multiple wireless life-critical medical devices from multiple vendors using commercial 802.11a, 802.11b, 802.11g or pre-802.11n devices. It is believed that 802.11-type devices can introduce unintended life-threatening risks unless delivery of critical patient alarms to central monitoring systems and/or clinical personnel is assured by proper use of 802.11e Quality of Service (QoS) methods. Petri net tools can be used to simulate all possible states and transitions between devices and/or systems in a wireless device network, and can identify failure modes in advance. Colored Petri Net (CPN) tools are ideal, in fact, as they allow tracking and controlling each message in a network based on pre-selected criteria. This paper describes a research project using CPN to simulate and validate alarm integrity in a small multi-modality wireless patient monitoring system. A 20-monitor wireless patient monitoring network is created in two versions: one with non-prioritized 802.x CSM protocols and the second with simulated Quality of Service (QoS) capabilities similar to 802.11e (i.e., the second network allows message priority management.) In the standard 802.x network, dangerous heart arrhythmia and pulse oximetry alarms could not be reliably and rapidly communicated, but the second network's QoS priority management reduced that risk significantly.

  20. Artificial neural networks accurately predict mortality in patients with nonvariceal upper GI bleeding.

    Science.gov (United States)

    Rotondano, Gianluca; Cipolletta, Livio; Grossi, Enzo; Koch, Maurizio; Intraligi, Marco; Buscema, Massimo; Marmo, Riccardo

    2011-02-01

    Risk stratification systems that accurately identify patients with a high risk for bleeding through the use of clinical predictors of mortality before endoscopic examination are needed. Computerized (artificial) neural networks (ANNs) are adaptive tools that may improve prognostication. To assess the capability of an ANN to predict mortality in patients with nonvariceal upper GI bleeding and compare the predictive performance of the ANN with that of the Rockall score. Prospective, multicenter study. Academic and community hospitals. This study involved 2380 patients with nonvariceal upper GI bleeding. Upper GI endoscopy. The primary outcome variable was 30-day mortality, defined as any death occurring within 30 days of the index bleeding episode. Other outcome variables were recurrent bleeding and need for surgery. We performed analysis of certified outcomes of 2380 patients with nonvariceal upper GI bleeding. The Rockall score was compared with a supervised ANN (TWIST system, Semeion), adopting the same result validation protocol with random allocation of the sample in training and testing subsets and subsequent crossover. Overall, death occurred in 112 cases (4.70%). Of 68 pre-endoscopic input variables, 17 were selected and used by the ANN versus 16 included in the Rockall score. The sensitivity of the ANN-based model was 83.8% (76.7-90.8) versus 71.4% (62.8-80.0) for the Rockall score. Specificity was 97.5 (96.8-98.2) and 52.0 (49.8 4.2), respectively. Accuracy was 96.8% (96.0-97.5) versus 52.9% (50.8-55.0) (Pperformance of the ANN-based model for prediction of mortality was significantly superior to that of the complete Rockall score (area under the curve 0.95 [0.92-0.98] vs 0.67 [0.65-0.69]; P<.001). External validation on a subsequent independent population is needed, patients with variceal bleeding and obscure GI hemorrhage are excluded. In patients with nonvariceal upper GI bleeding, ANNs are significantly superior to the Rockall score in predicting the

  1. Patient satisfaction point-of-care technology makes media waves. Public relations campaign heightens presence for GetWell:)Network.

    Science.gov (United States)

    2007-01-01

    GetWell:)Network, a Bethesda, MD-based interactive patient care provider, had the right tool. What it didn't have was the means to get the word out about that tool. So in September 2006, the provider tapped Waltham, MA-based healthcare public relations agency Schwartz Communications to design and execute a national media relations campaign about the PatientLife:)System, GetWell's interactive educational bedside tool.

  2. Disease-free survival assessment by artificial neural networks for hepatocellular carcinoma patients after radiofrequency ablation

    Directory of Open Access Journals (Sweden)

    Chiueng-Fang Wu

    2017-10-01

    Conclusion: This study revealed that the proposed artificial neural network models constructed with 15 clinical HCC relevant features could achieve an acceptable prediction performance for DFS. Such models can support clinical physicians to deal with clinical decision-making processes on the prognosis of HCC patients receiving RFA treatments.

  3. Participation of the Netherlands in the European Union Network for Patient Safety and Quality of Care (PaSQ).

    NARCIS (Netherlands)

    Steeg, L. van de; Schoten, S. van; Loos, E. de; Wagner, C.

    2015-01-01

    De deelname aan het European Union Network for Patient Safety and Quality of Care (PaSQ) betekende een nieuwe impuls voor de implementatie van good practices in deelnemende Nederlandse ziekenhuizen. Met steun van het Nederlandse PaSQ team – bestaande uit het NIVEL en CBO – hebben zeven Nederlandse

  4. Changes in Brain Structural Networks and Cognitive Functions in Testicular Cancer Patients Receiving Cisplatin-Based Chemotherapy

    NARCIS (Netherlands)

    Amidi, Ali; Hosseini, S. M.Hadi; Leemans, Alexander; Kesler, Shelli R.; Agerbæk, Mads; Wu, Lisa M.; Zachariae, Robert

    2017-01-01

    Background: Cisplatin-based chemotherapy may have neurotoxic effects within the central nervous system. The aims of this study were 1) to longitudinally investigate the impact of cisplatin-based chemotherapy on whole-brain networks in testicular cancer patients undergoing treatment and 2) to explore

  5. Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes.

    Science.gov (United States)

    Bernhard, Gerda; Ose, Dominik; Baudendistel, Ines; Seidling, Hanna M; Stützle, Marion; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

    2017-04-01

    Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients' self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients' needs and priorities and guide patient-centered interventions to support patients' self-management activities. Community and social support networks operating in patients' lives need to be engaged in the self-management support.

  6. Capsule endoscopy in a network cooperation: assessment of the experience in 822 patients.

    Science.gov (United States)

    Farnbacher, Michael Julius; Keles, Murat; Meier, Michael; Hagel, Alexander; Schneider, Thomas

    2013-09-01

    Capsule endoscopy (CE) is firmly established as a standard procedure in the diagnostic algorithm of occult or obscure gastrointestinal bleeding and Crohn's disease. Despite its excellent diagnostic yield, missing expertise, reading time and financial expenditure limit an area-wide availability. A multicentric cooperation might compensate these disadvantages. CE device was bought by a central hospital (CH). Requested equipment is transported to the network partner (NP) and the procedure performed at the spot in personal responsibility. Video reading is exclusively done in the CH. Within 10 years, 822 CE (438 m., 384 f.; 63 ± 17 (13-92) years) were performed by 18 cooperating gastroenterological departments. 587/822 (71%) CE were done at NP, 235/822 (29%) in the CH. Between 2002 (n = 39) and 2011 (n = 123) the annual number of CE increased threefold. 95% of the capital investment in each cooperating hospital could be avoided by sharing one workstation within the network. Leading indication for CE was suspected mid-GI-bleeding (80%). Mean latencies between requested date and actual examination were 0 and between equipment's return and report 2 days. 45/191(24%) flexible enteroscopies performed in the CH followed CE findings from NP. Our 10 years experience show that mobile use of CE is feasible providing quality parameters similar to a single center solution, increases the number of CE investigations, therefore, improves reading expertise and enables both an area-wide and economic offer for this technique. Additionally, patients with the need for invasive enteroscopy are identified and attracted to that NP who provides an invasive SB endocopy device.

  7. Altered Recruitment of the Attention Network Is Associated with Disability and Cognitive Impairment in Pediatric Patients with Acquired Brain Injury.

    Science.gov (United States)

    Strazzer, Sandra; Rocca, Maria A; Molteni, Erika; De Meo, Ermelinda; Recla, Monica; Valsasina, Paola; Arrigoni, Filippo; Galbiati, Susanna; Bardoni, Alessandra; Filippi, Massimo

    2015-01-01

    We assessed abnormalities of brain functional magnetic resonance imaging (fMRI) activity during a sustained attention task (Conners' Continuous Performance Test (CCPT)) in 20 right-handed pediatric acquired brain injury (ABI) patients versus 7 right-handed age-matched healthy controls, and we estimated the correlation of such abnormalities with clinical and cognitive deficits. Patients underwent the Wechsler Intelligence Scale for Children (WISC), Wisconsin Card Sorting Test, and Functional Independence Measure (FIM) evaluations. During fMRI, patients and controls activated regions of the attention network. Compared to controls, ABI patients experienced a decreased average fMRI recruitment of the left cerebellum and a decreased deactivation of the left anterior cingulate cortex. With increasing task demand, compared to controls, ABI patients had an impaired ability to increase the recruitment of several posterior regions of the attention network. They also experienced a greater activation of frontal regions, which was correlated with worse performance on FIM, WISC, and fMRI CCPT. Such abnormal brain recruitment was significantly influenced by the type of lesion (focal versus diffuse axonal injury) and time elapsed from the event. Pediatric ABI patients experienced an inability to optimize attention network recruitment, especially when task difficulty was increased, which likely contributes to their clinical and cognitive deficits.

  8. Altered Recruitment of the Attention Network Is Associated with Disability and Cognitive Impairment in Pediatric Patients with Acquired Brain Injury

    Directory of Open Access Journals (Sweden)

    Sandra Strazzer

    2015-01-01

    Full Text Available We assessed abnormalities of brain functional magnetic resonance imaging (fMRI activity during a sustained attention task (Conners’ Continuous Performance Test (CCPT in 20 right-handed pediatric acquired brain injury (ABI patients versus 7 right-handed age-matched healthy controls, and we estimated the correlation of such abnormalities with clinical and cognitive deficits. Patients underwent the Wechsler Intelligence Scale for Children (WISC, Wisconsin Card Sorting Test, and Functional Independence Measure (FIM evaluations. During fMRI, patients and controls activated regions of the attention network. Compared to controls, ABI patients experienced a decreased average fMRI recruitment of the left cerebellum and a decreased deactivation of the left anterior cingulate cortex. With increasing task demand, compared to controls, ABI patients had an impaired ability to increase the recruitment of several posterior regions of the attention network. They also experienced a greater activation of frontal regions, which was correlated with worse performance on FIM, WISC, and fMRI CCPT. Such abnormal brain recruitment was significantly influenced by the type of lesion (focal versus diffuse axonal injury and time elapsed from the event. Pediatric ABI patients experienced an inability to optimize attention network recruitment, especially when task difficulty was increased, which likely contributes to their clinical and cognitive deficits.

  9. Multiple Linear Regression and Artificial Neural Network to Predict Blood Glucose in Overweight Patients.

    Science.gov (United States)

    Wang, J; Wang, F; Liu, Y; Xu, J; Lin, H; Jia, B; Zuo, W; Jiang, Y; Hu, L; Lin, F

    2016-01-01

    Overweight individuals are at higher risk for developing type II diabetes than the general population. We conducted this study to analyze the correlation between blood glucose and biochemical parameters, and developed a blood glucose prediction model tailored to overweight patients. A total of 346 overweight Chinese people patients ages 18-81 years were involved in this study. Their levels of fasting glucose (fs-GLU), blood lipids, and hepatic and renal functions were measured and analyzed by multiple linear regression (MLR). Based the MLR results, we developed a back propagation artificial neural network (BP-ANN) model by selecting tansig as the transfer function of the hidden layers nodes, and purelin for the output layer nodes, with training goal of 0.5×10(-5). There was significant correlation between fs-GLU with age, BMI, and blood biochemical indexes (P<0.05). The results of MLR analysis indicated that age, fasting alanine transaminase (fs-ALT), blood urea nitrogen (fs-BUN), total protein (fs-TP), uric acid (fs-BUN), and BMI are 6 independent variables related to fs-GLU. Based on these parameters, the BP-ANN model was performed well and reached high prediction accuracy when training 1 000 epoch (R=0.9987). The level of fs-GLU was predictable using the proposed BP-ANN model based on 6 related parameters (age, fs-ALT, fs-BUN, fs-TP, fs-UA and BMI) in overweight patients. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Modulatory effects of acupuncture on brain networks in mild cognitive impairment patients

    Directory of Open Access Journals (Sweden)

    Ting-ting Tan

    2017-01-01

    Full Text Available Functional magnetic resonance imaging has been widely used to investigate the effects of acupuncture on neural activity. However, most functional magnetic resonance imaging studies have focused on acute changes in brain activation induced by acupuncture. Thus, the time course of the therapeutic effects of acupuncture remains unclear. In this study, 32 patients with amnestic mild cognitive impairment were randomly divided into two groups, where they received either Tiaoshen Yizhi acupuncture or sham acupoint acupuncture. The needles were either twirled at Tiaoshen Yizhi acupoints, including Sishencong (EX-HN1, Yintang (EX-HN3, Neiguan (PC6, Taixi (KI3, Fenglong (ST40, and Taichong (LR3, or at related sham acupoints at a depth of approximately 15 mm, an angle of ± 60°, and a rate of approximately 120 times per minute. Acupuncture was conducted for 4 consecutive weeks, five times per week, on weekdays. Resting-state functional magnetic resonance imaging indicated that connections between cognition-related regions such as the insula, dorsolateral prefrontal cortex, hippocampus, thalamus, inferior parietal lobule, and anterior cingulate cortex increased after acupuncture at Tiaoshen Yizhi acupoints. The insula, dorsolateral prefrontal cortex, and hippocampus acted as central brain hubs. Patients in the Tiaoshen Yizhi group exhibited improved cognitive performance after acupuncture. In the sham acupoint acupuncture group, connections between brain regions were dispersed, and we found no differences in cognitive function following the treatment. These results indicate that acupuncture at Tiaoshen Yizhi acupoints can regulate brain networks by increasing connectivity between cognition-related regions, thereby improving cognitive function in patients with mild cognitive impairment.

  11. Modular organization of functional network connectivity in healthy controls and patients with schizophrenia during the resting state

    Directory of Open Access Journals (Sweden)

    Qingbao eYu

    2012-01-01

    Full Text Available Neuroimaging studies have shown that functional brain networks composed from select regions of interest (ROIs have a modular community structure. However, the organization of functional network connectivity (FNC, comprising a purely data-driven network built from spatially independent brain components, is not yet clear. The aim of this study is to explore the modular organization of FNC in both healthy controls (HCs and patients with schizophrenia (SZs. Resting state functional magnetic resonance imaging (R-fMRI data of HCs and SZs were decomposed into independent components (ICs by group independent component analysis (ICA. Then weighted brain networks (in which nodes are brain components were built based on correlations among of ICA time courses. Clustering coefficients and connectivity strength of the networks were computed. A dynamic branch cutting algorithm was used to identify modules of the FNC in HCs and SZs. Results show stronger connectivity strength and higher clustering coefficient in HCs with more and smaller modules in SZs. In addition, HCs and SZs had some different hubs. Our findings demonstrate altered modular architecture of the FNC in schizophrenia and provide insights into abnormal topological organization of intrinsic brain networks in this mental illness.

  12. Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Tawfik A

    2016-08-01

    Full Text Available Amy Tawfik,1,2 Joanna M Bielecki,2 Murray Krahn,1,2 Paul Dorian,3,4 Jeffrey S Hoch,1,3,5 Heather Boon,1 Don Husereau,6 Petros Pechlivanoglou2 1Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, 2Toronto Health Economics and Technology Assessment (THETA Collaborative, University of Toronto, 3Centre for Excellence in Economic Analysis Research (CLEAR, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 4Department of Medicine and Cardiology, University of Toronto, 5Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, 6Institute of Health Economics, Edmonton, AB, Canada Background: In the last 4 years, four novel oral anticoagulants have been developed as alternatives to warfarin and antiplatelet agents for stroke prevention in atrial fibrillation (AF patients. The objective of this review was to estimate the comparative effectiveness of all antithrombotic treatments for AF patients.Materials and methods: Data sources were Medline Ovid (1946 to October 2015, Embase Ovid (1980 to October 2015, and the Cochrane Central Register of Controlled Trials (­CENTRAL, Issue 9, 2015. Randomized controlled trials of AF patients were selected if they compared at least two of the following: placebo, aspirin, aspirin and clopidogrel combination therapy, adjusted-dose warfarin (target international normalized ratio 2.0–3.0, dabigatran, rivaroxaban, apixaban, and edoxaban. Bayesian network meta-analyses were conducted for outcomes of interest (all stroke, ischemic stroke, myocardial infarction, overall mortality, major bleeding, and intracranial hemorrhage.Results: Based on 16 randomized controlled trials of 96,826 patients, all oral anticoagulants were more effective than antiplatelet agents at reducing the risk of ischemic stroke and all strokes. Compared to warfarin, dabigatran 150 mg (rate ratio 0.65, 95% credible interval 0.52–0.82 and apixaban (rate ratio 0.82, 95% credible interval 0.69–0.97 reduced the risk of

  13. Phelan-McDermid syndrome data network: Integrating patient reported outcomes with clinical notes and curated genetic reports.

    Science.gov (United States)

    Kothari, Cartik; Wack, Maxime; Hassen-Khodja, Claire; Finan, Sean; Savova, Guergana; O'Boyle, Megan; Bliss, Geraldine; Cornell, Andria; Horn, Elizabeth J; Davis, Rebecca; Jacobs, Jacquelyn; Kohane, Isaac; Avillach, Paul

    2017-09-01

    The heterogeneity of patient phenotype data are an impediment to the research into the origins and progression of neuropsychiatric disorders. This difficulty is compounded in the case of rare disorders such as Phelan-McDermid Syndrome (PMS) by the paucity of patient clinical data. PMS is a rare syndromic genetic cause of autism and intellectual deficiency. In this paper, we describe the Phelan-McDermid Syndrome Data Network (PMS_DN), a platform that facilitates research into phenotype-genotype correlation and progression of PMS by: a) integrating knowledge of patient phenotypes extracted from Patient Reported Outcomes (PRO) data and clinical notes-two heterogeneous, underutilized sources of knowledge about patient phenotypes-with curated genetic information from the same patient cohort and b) making this integrated knowledge, along with a suite of statistical tools, available free of charge to authorized investigators on a Web portal https://pmsdn.hms.harvard.edu. PMS_DN is a Patient Centric Outcomes Research Initiative (PCORI) where patients and their families are involved in all aspects of the management of patient data in driving research into PMS. To foster collaborative research, PMS_DN also makes patient aggregates from this knowledge available to authorized investigators using distributed research networks such as the PCORnet PopMedNet. PMS_DN is hosted on a scalable cloud based environment and complies with all patient data privacy regulations. As of October 31, 2016, PMS_DN integrates high-quality knowledge extracted from the clinical notes of 112 patients and curated genetic reports of 176 patients with preprocessed PRO data from 415 patients. © 2017 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.

  14. Determinants of hospital choice of rural hospital patients: the impact of networks, service scopes, and market competition.

    Science.gov (United States)

    Roh, Chul-Young; Lee, Keon-Hyung; Fottler, Myron D

    2008-08-01

    Among 10,384 rural Colorado female patients who received MDC 14 (obstetric services) from 2000 to 2003, 6,615 (63.7%) were admitted to their local rural hospitals; 1,654 (15.9%) were admitted to other rural hospitals; and 2,115 (20.4%) traveled to urban hospitals for inpatient services. This study is to examine how network participation, service scopes, and market competition influences rural women's choice of hospital for their obstetric care. A conditional logistic regression analysis was used. The network participation (p market competition had a positive and significant relationship with patients' choice to receive obstetric care. That is, rural patients prefer to receive care from a hospital that participates in a network, that provides more number of services, and that has a greater market share (i.e., a lower level of market competition) in their locality. Rural hospitals could actively increase their competitiveness and market share by increasing the number of health care services provided and seeking to network with other hospitals.

  15. [Improving Health Care for Patients with Somatoform and Functional Disorders: A Collaborative Stepped Care Network (Sofu-Net)].

    Science.gov (United States)

    Shedden-Mora, Meike; Lau, Katharina; Kuby, Amina; Groß, Beatrice; Gladigau, Maria; Fabisch, Alexandra; Löwe, Bernd

    2015-07-01

    The management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy and overuse of health care. To address these difficulties, this study aimed to establish a collaborative stepped health care network (Sofu-Net). Sofu-Net was established among 41 primary care physicians, 35 psychotherapists and 8 mental health clinics. Baseline assessment in primary care showed elevated psychopathology and deficits in health care among patients with somatoform symptoms. Network partners provided positive evaluations of Sofu-Net. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Comparing six antihypertensive medication classes for preventing new-onset diabetes mellitus among hypertensive patients: a network meta-analysis.

    Science.gov (United States)

    Yang, Yang; Xu, Huilan

    2017-09-01

    Hypertensive patients usually have a higher risk of new-onset diabetes mellitus (NOD) which may trigger cardiovascular diseases. In this study, the effectiveness of six antihypertensive agents with respect to NOD prevention in hypertensive patients was assessed. A network meta-analysis was conducted to compare the efficacy of specific drug classes. PubMed and Embase databases were searched for relevant articles. Results of the pairwised meta-analysis were illustrated by odd ratios (OR) and a corresponding 95% confidence interval (CI). The probabilities and outcome of each treatment were ranked and summarized using the surface under the cumulative ranking curve (SUCRA).Twenty-three trials were identified, including 224,832 patients with an average follow-up period of 3.9 ± 1.0 years. The network meta-analysis showed that patients treated by angiotensin II receptor blockers (ARBs) were associated with a lower risk of NOD compared to placebo (PCB), calcium channel blockers (CCBs) and β-blockers, while diuretic appeared to be ineffective for NOD prevention. Network meta-analysis results of specific drugs showed that enalapril exhibited distinct advantages and hydrochlorothiazide also exhibited a reliable performance. Our results suggested that both ARBs and angiotensin converse enzyme inhibitors (ACEIs), especially candesartan and enalapril, were preferable for NOD prevention in hypertensive patients. Hydrochlorothiazide also exhibited a reliable performance in comparison with other agents. © 2017 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

  17. Immunizing Patients With Adverse Events After Immunization and Potential Contraindications to Immunization: A Report From the Special Immunization Clinics Network.

    Science.gov (United States)

    Top, Karina A; Billard, Marie-Noelle; Gariepy, Marie-Claude; Rouleau, Isabelle; Pernica, Jeffrey M; Pham-Huy, Anne; Quach, Caroline; Tran, Dat; Vaudry, Wendy; Dobson, Simon; Boucher, François D; Carignan, Alex; Jadavji, Taj; McConnell, Athena; McNeil, Shelly A; Halperin, Scott A; De Serres, Gaston

    2016-12-01

    For patients who have experienced adverse events following immunization (AEFI) or who have specific medical conditions, there is limited evidence regarding the best approach to immunization. The Special Immunization Clinics (SICs) Network was established to standardize patient management and assess outcomes after reimmunization. The study objective was to describe the first 2 years of the network's implementation. Twelve SICs were established across Canada by infectious diseases specialists and allergists. Inclusion criteria were as follows: local reaction ≥ 10 cm, allergic symptoms immunization recommendations were made by expert physicians and patients were followed up to capture AEFI. After individual consent, data were transferred to a central database for analysis. From June 2013 to May 2015, 151 patients were enrolled. Most were referred for prior AEFI (132/151, 87%): 42 (32%) for allergic-like reactions, 31 (23%) for injection-site reactions, 20 (15%) for neurologic symptoms and 39 (30%) for other systemic symptoms. Nineteen patients (13%) were seen for underlying conditions that complicated immunization. Reimmunization was recommended for 109 patients, 60 of whom (55%) were immunized and followed up. Eleven patients (18%) experienced recurrence of their AEFI; none were serious (eg, resulting in hospitalization, permanent disability or death). The most frequent reasons for referral to a SIC were allergic-like events and injection site reactions. Reimmunization was safe in most patients. Larger studies are needed to determine outcomes for specific types of AEFI.

  18. Social Network Analysis of peer-specific safety support and ergonomic behaviors: An application to safe patient handling.

    Science.gov (United States)

    Hurtado, David A; Dumet, Lisset M; Greenspan, Samuel A; Rodriguez, Yaritza I

    2018-04-01

    This study applied Social Network Analysis (SNA) to test whether advice-seeking interactions among peers about safe patient handling correlate with a higher frequency of equipment use. Patient-care workers (n=38) at a community hospital in Oregon nominated peers they would consult for advice regarding safe patient handling. Results show a positive correlation between identifying more peers for safe patient handling advice and using equipment more frequently. Moreover, nurses with more reciprocal advice seeking nominations used safe patient handling equipment more frequently. However, employees who would be more consulted about safe patient handling by their peers did not use equipment more frequently than nurses with fewer nominations. Despite the small sample size, the magnitude of the adjusted regressions coefficients ranged between 3 to 4 standard deviations. These results suggest that having more or reciprocal sources of peer-based support may trigger ergonomic related behaviors such as frequent utilization of equipment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook.

    Science.gov (United States)

    Greene, Jeremy A; Choudhry, Niteesh K; Kilabuk, Elaine; Shrank, William H

    2011-03-01

    Several disease-specific information exchanges now exist on Facebook and other online social networking sites. These new sources of knowledge, support, and engagement have become important for patients living with chronic disease, yet the quality and content of the information provided in these digital arenas are poorly understood. To qualitatively evaluate the content of communication in Facebook communities dedicated to diabetes. We identified the 15 largest Facebook groups focused on diabetes management. For each group, we downloaded the 15 most recent "wall posts" and the 15 most recent discussion topics from the 10 largest groups. Four hundred eighty unique users were identified in a series of 690 comments from wall posts and discussion topics. Posts were abstracted and aggregated into a database. Two investigators evaluated the posts, developed a thematic coding scheme, and applied codes to the data. Patients with diabetes, family members, and their friends use Facebook to share personal clinical information, to request disease-specific guidance and feedback, and to receive emotional support. Approximately two-thirds of posts included unsolicited sharing of diabetes management strategies, over 13% of posts provided specific feedback to information requested by other users, and almost 29% of posts featured an effort by the poster to provide emotional support to others as members of a community. Approximately 27% of posts featured some type of promotional activity, generally presented as testimonials advertising non-FDA approved, "natural" products. Clinically inaccurate recommendations were infrequent, but were usually associated with promotion of a specific product or service. Thirteen percent of posts contained requests for personal information from Facebook participants. Facebook provides a forum for reporting personal experiences, asking questions, and receiving direct feedback for people living with diabetes. However, promotional activity and personal

  20. Classification of schizophrenia patients based on resting-state functional network connectivity

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Arbabshirani

    2013-07-01

    Full Text Available There is a growing interest in automatic classification of mental disorders based on neuroimaging data. Small training data sets (subjects and very large amount of high dimensional data make it a challenging task to design robust and accurate classifiers for heterogeneous disorders such as schizophrenia. Most previous studies considered structural MRI, diffusion tensor imaging and task-based fMRI for this purpose. However, resting-state data has been rarely used in discrimination of schizophrenia patients from healthy controls. Resting data are of great interest, since they are relatively easy to collect, and not confounded by behavioral performance on a task. Several linear and non-linear classification methods were trained using a training dataset and evaluate with a separate testing dataset. Results show that classification with high accuracy is achievable using simple non-linear discriminative methods such as k-nearest neighbors which is very promising. We compare and report detailed results of each classifier as well as statistical analysis and evaluation of each single feature. To our knowledge our effects represent the first use of resting-state functional network connectivity features to classify schizophrenia.

  1. CANCER-PATIENTS AND THEIR NETWORK - THE MEANING OF THE SOCIAL NETWORK AND SOCIAL INTERACTIONS FOR QUALITY-OF-LIFE

    NARCIS (Netherlands)

    DERUITER, JH; DEHAES, JCJM

    A lot of research is carried out on the subject of social relations and quality of life. One should find at least some indication for an association between the social environment and quality of life of cancer patients; will interventions be appropriate and well-considered? But until now, less has

  2. USE OF NEURAL NETWORK SIMULATION TO MONITOR PATIENTS UNDERGOING RADICAL PROSTATECTOMY

    National Research Council Canada - National Science Library

    I. V. Lukyanov; N. A. Demchenko

    2014-01-01

    .... Based on neural network simulation, the Department of Urology, Russian Medical Academy of Postgraduate Education, has developed an accounting prognostic system to monitor the postoperative course...

  3. Metabolic and protein interaction sub-networks controlling the proliferation rate of cancer cells and their impact on patient survival.

    Science.gov (United States)

    Feizi, Amir; Bordel, Sergio

    2013-10-24

    Cancer cells can have a broad scope of proliferation rates. Here we aim to identify the molecular mechanisms that allow some cancer cell lines to grow up to 4 times faster than other cell lines. The correlation of gene expression profiles with the growth rate in 60 different cell lines has been analyzed using several genome-scale biological networks and new algorithms. New possible regulatory feedback loops have been suggested and the known roles of several cell cycle related transcription factors have been confirmed. Over 100 growth-correlated metabolic sub-networks have been identified, suggesting a key role of simultaneous lipid synthesis and degradation in the energy supply of the cancer cells growth. Many metabolic sub-networks involved in cell line proliferation appeared also to correlate negatively with the survival expectancy of colon cancer patients.

  4. The role of health literacy and social networks in arthritis patients' health information-seeking behavior: a qualitative study.

    Science.gov (United States)

    Ellis, Janette; Mullan, Judy; Worsley, Anthony; Pai, Nagesh

    2012-01-01

    Background. Patients engage in health information-seeking behaviour to maintain their wellbeing and to manage chronic diseases such as arthritis. Health literacy allows patients to understand available treatments and to critically appraise information they obtain from a wide range of sources. Aims. To explore how arthritis patients' health literacy affects engagement in arthritis-focused health information-seeking behaviour and the selection of sources of health information available through their informal social network. Methods. An exploratory, qualitative study consisting of one-on-one semi-structured interviews. Twenty participants with arthritis were recruited from community organizations. The interviews were designed to elicit participants' understanding about their arthritis and arthritis medication and to determine how the participants' health literacy informed selection of where they found information about their arthritis and pain medication. Results. Participants with low health literacy were less likely to be engaged with health information-seeking behaviour. Participants with intermediate health literacy were more likely to source arthritis-focused health information from newspapers, television, and within their informal social network. Those with high health literacy sourced information from the internet and specialist health sources and were providers of information within their informal social network. Conclusion. Health professionals need to be aware that levels of engagement in health information-seeking behaviour and sources of arthritis-focused health information may be related to their patients' health literacy.

  5. Characteristics of patients seeking health information online via social health networks versus general Internet sites: a comparative study.

    Science.gov (United States)

    Magnezi, Racheli; Grosberg, Dafna; Novikov, Ilya; Ziv, Arnona; Shani, Mordechai; Freedman, Laurence S

    2015-03-01

    Camoni.co.il, a Hebrew-language social health network offers advice, consultation, and connection to others with chronic illness. This study compared characteristics and objectives of Camoni.co.il users and individuals seeking medical information through general Internet sites. Similar questionnaires were sent to 1009 Internet and 900 Camoni users. Cluster analysis defined four modes of online social health network use: "acquiring information and support", "communicating", "networking" and "browsing". Six hundred and five Internet and 125 Camoni users responded. Diabetes, hypertension, obesity and lung diseases were found more often among general Internet users than Camoni users. Among Camoni users, "acquiring information and support" was the main motivation for individuals over age 55 years, women, those with lower income, chronic pain, obesity and depression. "Communicating" was the main incentive of men, those 20-34 years old, those with less education, or an eating disorder. "Networking" was the most significant motivation for those with multiple sclerosis or depression. Browsing was most frequent among individuals with multiple sclerosis. Identifying needs of social health network surfers will allow planning unique contents and enhancing social health sites. Physicians might advise patients to use them to obtain support and information regarding their conditions, possibly leading to improved compliance and self-management.

  6. Components of patient satisfaction with a dental restorative visit: results from the Dental Practice-Based Research Network.

    Science.gov (United States)

    Riley, Joseph L; Gordan, Valeria V; Rindal, D Brad; Fellows, Jeffrey L; Qvist, Vibeke; Patel, Sagar; Foy, Pat; Williams, O Dale; Gilbert, Gregg H

    2012-09-01

    The authors conducted a study to identify components of patient satisfaction with restorative dental care and to test the hypothesis that certain dentist, patient and procedure factors are associated with patient satisfaction. Practitioner-investigators (P-Is) from 197 practices in The Dental Practice-Based Research Network (DPBRN) recruited consecutively seen patients who had defective permanent-tooth restorations that were replaced or repaired. At the end of the treatment visit, P-Is asked each participant to complete a satisfaction survey and mail it directly to a DPBRN regional coordinator. Analysis of the results of 5,879 satisfaction surveys revealed three satisfaction components: interpersonal relationship-comfort factors, material choice-value factors and sensory-evaluative factors. Satisfaction was highest among patients who received care in a private practice model, whose restorations were repaired rather than replaced and whose restored teeth were not molars. These data suggest that a patient's judgments of a dentist's skills and quality of care are based on personal interactions with the dentist, the level of comfort the patient perceives while receiving care and any experience of posttreatment sensitivity in the treated tooth. These conclusions have direct implications for management of patient care before, during and after the procedure. By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the service provided, thereby enabling themselves to focus on what each patient values most.

  7. Concordance between patient satisfaction and the dentist’s view: findings from the National Dental Practice-Based Research Network

    Science.gov (United States)

    Riley, Joseph L.; Hudak-Boss, Susan; Fellows, Jeffery L.; Rindal, Brad; Gilbert, Gregg H.

    2014-01-01

    Objectives This study examined the dentist’s view of the patient’s experience and concordance with the patient’s rating of satisfaction. Methods Practitioners from 197 practices in the National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the treatment visit, the treating dentist and 5,879 patients completed and returned a survey that asked about the patient’s satisfaction. Results Dentists viewed their patients as satisfied with their treatment experience (89% n=4,719) and that they had been perceived as friendly (97%, n=5,136). Dentists had less strong feelings about whether patients had a preference for the restorative material (43%, n=2,271) or an interest in information about the procedure (33%, n=1,757). Overall, patients were satisfied, and most of the time dentists correctly predicted this. Among patients who were less than satisfied, there was a substantial subset of cases where dentists were not aware. Conclusion For improved patient-centered care, patient desires, expectations and perception of the dental care experience need to be assessed by the dentist and then managed or corrected as needed. Practice implications By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the service provided, thereby enabling themselves to focus on what each patient values most. PMID:24686969

  8. Changes in MEG resting-state networks are related to cognitive decline in type 1 diabetes mellitus patients.

    Science.gov (United States)

    Demuru, Matteo; van Duinkerken, Eelco; Fraschini, Matteo; Marrosu, Francesco; Snoek, Frank J; Barkhof, Frederik; Klein, Martin; Diamant, Michaela; Hillebrand, Arjan

    2014-01-01

    Integrity of resting-state functional brain networks (RSNs) is important for proper cognitive functioning. In type 1 diabetes mellitus (T1DM) cognitive decrements are commonly observed, possibly due to alterations in RSNs, which may vary according to microvascular complication status. Thus, we tested the hypothesis that functional connectivity in RSNs differs according to clinical status and correlates with cognition in T1DM patients, using an unbiased approach with high spatio-temporal resolution functional network. Resting-state magnetoencephalographic (MEG) data for T1DM patients with (n = 42) and without (n = 41) microvascular complications and 33 healthy participants were recorded. MEG time-series at source level were reconstructed using a recently developed atlas-based beamformer. Functional connectivity within classical frequency bands, estimated by the phase lag index (PLI), was calculated within eight commonly found RSNs. Neuropsychological tests were used to assess cognitive performance, and the relation with RSNs was evaluated. Significant differences in terms of RSN functional connectivity between the three groups were observed in the lower alpha band, in the default-mode (DMN), executive control (ECN) and sensorimotor (SMN) RSNs. T1DM patients with microvascular complications showed the weakest functional connectivity in these networks relative to the other groups. For DMN, functional connectivity was higher in patients without microangiopathy relative to controls (all p cognitive performance for both patient groups was worse compared with healthy controls. Lower DMN alpha band functional connectivity correlated with poorer general cognitive ability in patients with microvascular complications. Altered RSN functional connectivity was found in T1DM patients depending on clinical status. Lower DMN functional connectivity was related to poorer cognitive functioning. These results indicate that functional connectivity may play a key role in T1DM

  9. Complex Network Analysis of Resting State EEG in Amnestic Mild Cognitive Impairment Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Ke eZeng

    2015-10-01

    Full Text Available Purpose: Diabetes is a great risk factor for dementia and mild cognitive impairment. This study inves-tigates whether complex network-derived features in resting state EEG (rsEEG could be applied as a biomarker to distinguish amnestic mild cognitive impairment (aMCI from normal cognitive function in subjects with type 2 diabetes. Method: In this study, EEG was recorded in 28 patients with type 2 diabetes (16 aMCI patients and 12 controls during a no-task eyes-closed resting state. Pair-wise synchronization of rsEEG signals were assessed in six frequency bands (delta, theta, lower alpha, upper alpha, beta, and gamma using phase lag index (PLI and grouped into long distance (intra- and inter-hemispheric and short distance inter-actions. PLI-weighted connectivity networks were also constructed, and characterized by mean clus-tering coefficient and path length. The correlation of these features and Montreal Cognitive Assess-ment (MoCA scores was assessed.Results: Main findings of this study were as follows: (1 In comparison with controls, patients with aMCI had a significant decrease of global mean PLI in lower alpha, upper alpha, and beta bands. Lower functional connection at short and long intra-hemispheric distance mainly appeared on the left hemisphere. (2 In the lower alpha band, clustering coefficient was significantly lower in aMCI group, and the path length significantly increased. (3 Cognitive status measured by MoCA had a significant positive correlation with cluster coefficient and negative correlation with path length in lower alpha band. Conclusions: The brain network of aMCI patients displayed a disconnection syndrome and a loss of small-world architecture. The correlation between cognitive states and network characteristics sug-gested that the more in deterioration of the diabetes patients’ cognitive state, the less optimal the net-work organization become. Hence, the complex network-derived biomarkers based on EEG could be employed

  10. Can a Bayesian Belief Network Be Used to Estimate 1-year Survival in Patients With Bone Sarcomas?

    Science.gov (United States)

    Nandra, Rajpal; Parry, Michael; Forsberg, Jonathan; Grimer, Robert

    2017-06-01

    Extremity sarcoma has a preponderance to present late with advanced stage at diagnosis. It is important to know why these patients die early from sarcoma and to predict those at high risk. Currently we have mid- to long-term outcome data on which to counsel patients and support treatment decisions, but in contrast to other cancer groups, very little on short-term mortality. Bayesian belief network modeling has been used to develop decision-support tools in various oncologic diagnoses, but to our knowledge, this approach has not been applied to patients with extremity sarcoma. We sought to (1) determine whether a Bayesian belief network could be used to estimate the likelihood of 1-year mortality using receiver operator characteristic analysis; (2) describe the hierarchal relationships between prognostic and outcome variables; and (3) determine whether the model was suitable for clinical use using decision curve analysis. We considered all patients treated for primary bone sarcoma between 1970 and 2012, and excluded secondary metastasis, presentation with local recurrence, and benign tumors. The institution's database yielded 3499 patients, of which six (0.2%) were excluded. Data extracted for analysis focused on patient demographics (age, sex), tumor characteristics at diagnosis (size, metastasis, pathologic fracture), survival, and cause of death. A Bayesian belief network generated conditional probabilities of variables and survival outcome at 1 year. A lift analysis determined the hierarchal relationship of variables. Internal validation of 699 test patients (20% dataset) determined model accuracy. Decision curve analysis was performed comparing net benefit (capped at 85.5%) for all threshold probabilities (survival output from model). We successfully generated a Bayesian belief network with five first-degree associates and describe their conditional relationship with survival after the diagnosis of primary bone sarcoma. On internal validation, the resultant

  11. Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM)

    OpenAIRE

    Ciach, Katarzyna; Niedoszytko, Marek; Abacjew-Chmylko, Anna; Pabin, Izabela; Adamski, Przemyslaw; Leszczynska, Katarzyna; Preis, Krzysztof; Olszewska, Hanna; Wydra, Dariusz G.; Hansdorfer-Korzon, Rita

    2016-01-01

    Objective To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. Design Case control national study. Setting Polish Center of the European Competence Network on Mastocytosis (ECNM). Population or Sample 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999?2014, before becoming pregnant. Methods Prospective analysis outcomes of pregnancies and deliveries. Main Outcome Measures Survey developed in...

  12. Changes in task-based effective connectivity in language networks following rehabilitation in post-stroke patients with aphasia

    OpenAIRE

    Swathi eKiran; Meier, Erin L.; Kushal Janardan Kapse; Peter eGlynn

    2015-01-01

    In this study, we examined regions in the left and right hemisphere language network that were altered in terms of the underlying neural activation and effective connectivity subsequent to language rehabilitation. Eight persons with chronic post-stroke aphasia and eight normal controls participated in the current study. Patients received a 10 week semantic feature-based rehabilitation program to improve their skills. Therapy was provided on atypical examples of one trained category while two ...

  13. Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis

    Science.gov (United States)

    Gerger, Heike; Nüesch, Eveline; Trelle, Sven; Znoj, Hansjörg; Jüni, Peter; Cuijpers, Pim

    2013-01-01

    Background Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression. Methods and Findings We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d = −0.62 to d = −0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d = 0.01 to d = −0.30). Interpersonal therapy was significantly more effective than supportive therapy (d = −0.30, 95% credibility interval [CrI] [−0.54 to −0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δd = 0.29 [−0.01 to 0.58]; p = 0.063) and large size (Δd = 0.33 [0.08 to 0.61]; p = 0.012) and those that had adequate outcome assessment (Δd = 0.38 [−0.06 to 0.87]; p = 0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions. Conclusions Overall our

  14. Investigating Brain Network Characteristics Interrupted by Covert White Matter Injury in Patients with Moyamoya Disease: Insights from Graph Theoretical Analysis.

    Science.gov (United States)

    Kazumata, Ken; Tha, Khin Khin; Narita, Hisashi; Shichinohe, Hideo; Ito, Masaki; Uchino, Haruto; Abumiya, Takeo

    2016-05-01

    Chronic ischemia in adult moyamoya disease (MMD) reduces the integrity of normal-appearing white matter (WM). We investigated whether covert WM impairment alters large-scale brain networks and specific neural circuits associated with neurocognitive dysfunction in MMD. Forty-six participants (control, n = 23; MMD, n = 23) were examined using diffusion tensor imaging and streamline tractography. Structural connectivity among 90 cortical and subcortical brain regions was evaluated using the mean fractional anisotropy along the fiber tracts. Graph theoretical analysis was used to measure network parameters and inter-regional connectivity. Global network parameters were reduced in patients with MMD, including cluster coefficient (controls vs. MMD: 3.62 ± 0.24 vs. 3.26 ± 0.36; P < 0.0001), characteristic path length (controls vs. MMD: 1.20 ± 0.02 vs. 1.17 ± 0.01; P < 0.001), and small-world property (controls vs. MMD: 3.07 ± 0.18 vs. 2.83 ± 0.27; P < 0.001). Reduced pairwise connectivity was found in prefrontal neural circuits within the middle/inferior frontal gyrus; supplementary motor area; and insular, inferior temporal, and dorsal cingulate cortices. Covert WM microstructural changes in patients with MMD alter large-scale brain networks, as well as lateral prefrontal neural circuits. Evaluation of structural connectivity may be useful to assess the severity of chronic ischemic injury from a network perspective. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Cognitive control networks in OCD: A resting-state connectivity study in unmedicated patients with obsessive-compulsive disorder and their unaffected relatives.

    Science.gov (United States)

    de Vries, Froukje E; de Wit, Stella J; van den Heuvel, Odile A; Veltman, Dick J; Cath, Danielle C; van Balkom, Anton J L M; van der Werf, Ysbrand D

    2017-09-18

    Executive network deficits are putative neurocognitive endophenotypes for obsessive-compulsive disorder (OCD). Yet, unlike alterations in fronto-striatal and limbic connectivity, connectivity in the fronto-parietal (FPN) and cingulo-opercular (CON) networks involved in cognitive control has received little attention. The coherence of FPN, CON and fronto-limbic networks was investigated in 39 unmedicated OCD patients, 16 of their unaffected siblings and 36 healthy controls using resting-state functional-connectivity MRI and a seed-based analysis approach. FPN and CON connectivity was similar for patients and controls. Siblings showed higher connectivity than patients within the CON, and between the CON and FPN compared to patients and controls (trend level). In OCD patients, but not in siblings, fronto-limbic hyperconnectivity was present compared to controls. In contrast to our expectations, no group differences in resting-state connectivity of the cognitive control networks were observed between OCD patients and controls. The increased within- and between-network connectivity in siblings, but not in patients, could indicate a mechanism of increased cognitive control that may act as a protective mechanism. None of the observed network alterations can be considered an endophenotype for OCD since differences were present in either patients or siblings, but not in both groups.

  16. Disparity between dorsal and ventral networks in patients with obsessive-compulsive disorder: Evidence revealed by graph theoretical analysis based on cortical thickness from MRI

    Directory of Open Access Journals (Sweden)

    Seung-Goo eKim

    2013-07-01

    Full Text Available As one of the most widely accepted neuroanatomical models on OCD, it has been hypothesized that imbalance between an excitatory direct (ventral pathway and an inhibitory indirect (dorsal pathway in cortico-striato-thalamic circuit underlies the emergence of OCD. Here we examine the structural network in drug-free patients with OCD in terms of graph theoretical measures for the first time. We used a measure called efficiency which quantifies how a node transfers information efficiently. To construct brain networks, cortical thickness was automatically estimated using T1-weighted magnetic resonance imaging. We found that the network of the OCD patients was as efficient as that of healthy controls so that the both networks were in the small-world regime. More importantly, however, disparity between the dorsal and the ventral networks in the OCD patients was found, suggesting a positive evidence to the imbalance theory on the underlying pathophysiology of OCD.

  17. An internet-based communication network for information transfer during patient transitions from skilled nursing facility to the emergency department.

    Science.gov (United States)

    Hustey, Fredric M; Palmer, Robert M

    2010-06-01

    To determine whether the implementation of an Internet-based communication system improves the amount of essential information conveyed between a skilled nursing facility (SNF) and the emergency department (ED) during patient care transitions. Interventional; before and after. ED of an urban teaching hospital with approximately 55,000 visits per year and a 55-bed subacute free-standing rehabilitation facility (the SNF). All patients transferred from the SNF to the ED over 16 months. An Internet-based communication network with SNF-ED transfer form for communication during patient care transitions. Nine elements of patient information assessed before and after intervention through chart review. changes in efficiency of information transfer and staff satisfaction. Two hundred thirty-four of 237 preintervention and all 276 postintervention care transitions were reviewed. The Internet communication network was used in 78 (26%) of all care transitions, peaking at 40% by the end of the study. There was more critical patient information (1.85 vs 4.29 of 9 elements; Pcommunication was higher among ED physicians after the intervention. The use of an Internet-based system increased the amount of information communicated during SNF-ED care transitions and significantly reduced the number of pages in which this information was contained.

  18. Smart Multi-Level Tool for Remote Patient Monitoring Based on a Wireless Sensor Network and Mobile Augmented Reality

    Science.gov (United States)

    González, Fernando Cornelio Jimènez; Villegas, Osslan Osiris Vergara; Ramírez, Dulce Esperanza Torres; Sánchez, Vianey Guadalupe Cruz; Domínguez, Humberto Ochoa

    2014-01-01

    Technological innovations in the field of disease prevention and maintenance of patient health have enabled the evolution of fields such as monitoring systems. One of the main advances is the development of real-time monitors that use intelligent and wireless communication technology. In this paper, a system is presented for the remote monitoring of the body temperature and heart rate of a patient by means of a wireless sensor network (WSN) and mobile augmented reality (MAR). The combination of a WSN and MAR provides a novel alternative to remotely measure body temperature and heart rate in real time during patient care. The system is composed of (1) hardware such as Arduino microcontrollers (in the patient nodes), personal computers (for the nurse server), smartphones (for the mobile nurse monitor and the virtual patient file) and sensors (to measure body temperature and heart rate), (2) a network layer using WiFly technology, and (3) software such as LabView, Android SDK, and DroidAR. The results obtained from tests show that the system can perform effectively within a range of 20 m and requires ten minutes to stabilize the temperature sensor to detect hyperthermia, hypothermia or normal body temperature conditions. Additionally, the heart rate sensor can detect conditions of tachycardia and bradycardia. PMID:25230306

  19. Smart Multi-Level Tool for Remote Patient Monitoring Based on a Wireless Sensor Network and Mobile Augmented Reality

    Directory of Open Access Journals (Sweden)

    Fernando Cornelio Jiménez González

    2014-09-01

    Full Text Available Technological innovations in the field of disease prevention and maintenance of patient health have enabled the evolution of fields such as monitoring systems. One of the main advances is the development of real-time monitors that use intelligent and wireless communication technology. In this paper, a system is presented for the remote monitoring of the body temperature and heart rate of a patient by means of a wireless sensor network (WSN and mobile augmented reality (MAR. The combination of a WSN and MAR provides a novel alternative to remotely measure body temperature and heart rate in real time during patient care. The system is composed of (1 hardware such as Arduino microcontrollers (in the patient nodes, personal computers (for the nurse server, smartphones (for the mobile nurse monitor and the virtual patient file and sensors (to measure body temperature and heart rate, (2 a network layer using WiFly technology, and (3 software such as LabView, Android SDK, and DroidAR. The results obtained from tests show that the system can perform effectively within a range of 20 m and requires ten minutes to stabilize the temperature sensor to detect hyperthermia, hypothermia or normal body temperature conditions. Additionally, the heart rate sensor can detect conditions of tachycardia and bradycardia.

  20. Development of a program for tele-rehabilitation of COPD patients across sectors: co-innovation in a network

    Directory of Open Access Journals (Sweden)

    Birthe Dinesen

    2011-03-01

    Full Text Available Introduction: The aim of the Telekat project is to prevent re-admissions of patients with chronic obstructive pulmonary disease (COPD by developing a preventive programof tele-rehabilitation across sectors for COPD patients. The development of the program is based on a co-innovation process between COPD patients, relatives, healthcare professionals and representatives from private firms and universities. This paper discusses theobstacles that arise in the co-innovation process of developing an integrated technique for tele-rehabilitation of COPD patients.Theory: Network and innovation theory.Methods: The casestudy was applied. A triangulation of data collection techniques was used: documents, observations (123 hours, qualitative interviews (n=32 and action research.Findings: Obstacles were identified in the network context; these obstacles included the mindset of the healthcare professionals, inter-professionals relations, views of technology as a tool and competing visions for the goals of tele-rehabilitation.Conclusion: We have identified obstacles that emerge in the co-innovation process when developing a programme for tele-rehabilitation of COPD patients in an inter-organizational context. Action research has been carried out and can have helped to facilitate the co-innovation process.

  1. Smart multi-level tool for remote patient monitoring based on a wireless sensor network and mobile augmented reality.

    Science.gov (United States)

    González, Fernando Cornelio Jiménez; Villegas, Osslan Osiris Vergara; Ramírez, Dulce Esperanza Torres; Sánchez, Vianey Guadalupe Cruz; Domínguez, Humberto Ochoa

    2014-09-16

    Technological innovations in the field of disease prevention and maintenance of patient health have enabled the evolution of fields such as monitoring systems. One of the main advances is the development of real-time monitors that use intelligent and wireless communication technology. In this paper, a system is presented for the remote monitoring of the body temperature and heart rate of a patient by means of a wireless sensor network (WSN) and mobile augmented reality (MAR). The combination of a WSN and MAR provides a novel alternative to remotely measure body temperature and heart rate in real time during patient care. The system is composed of (1) hardware such as Arduino microcontrollers (in the patient nodes), personal computers (for the nurse server), smartphones (for the mobile nurse monitor and the virtual patient file) and sensors (to measure body temperature and heart rate), (2) a network layer using WiFly technology, and (3) software such as LabView, Android SDK, and DroidAR. The results obtained from tests show that the system can perform effectively within a range of 20 m and requires ten minutes to stabilize the temperature sensor to detect hyperthermia, hypothermia or normal body temperature conditions. Additionally, the heart rate sensor can detect conditions of tachycardia and bradycardia.

  2. The African Lupus Genetics Network (ALUGEN) registry: standardized, prospective follow-up studies in African patients with systemic lupus erythematosus.

    Science.gov (United States)

    Hodkinson, B; Mapiye, D; Jayne, D; Kalla, A; Tiffin, N; Okpechi, I

    2016-03-01

    The prevalence and severity of systemic lupus erythematosus (SLE) differs between ethnic groups and geographical regions. Although initially reported as rare, there is growing evidence that SLE is prevalent and runs a severe course in Africa. There is a paucity of prospective studies on African SLE patients. The African Lupus Genetics Network (ALUGEN) is a multicentred framework seeking to prospectively assess outcomes in SLE patients in Africa. Outcomes measured will be death, hospital admission, disease activity flares, and SLE-related damage. We will explore predictors for these outcomes including clinical, serological, socio-demographic, therapeutic and genetic factors. Further, we will investigate comorbidities and health-related quality of life amongst these patients. Data of patients recently (≤ 5 yrs) diagnosed with SLE will be collected at baseline and annual follow-up visits, and captured electronically. The ALUGEN project will facilitate standardized data capture for SLE cases in Africa, allowing participating centres to develop their own SLE registries, and enabling collaboration to enrich our understanding of inter-ethnic and regional variations in disease expression. Comprehensive, high-quality multi-ethnic data on African SLE patients will expand knowledge of the disease and inform clinical practice, in addition to augmenting research capacity and networking links and providing a platform for future biomarker and interventional studies. © The Author(s) 2015.

  3. Altered functional network architecture in orbitofronto-striato-thalamic circuit of unmedicated patients with obsessive-compulsive disorder.

    Science.gov (United States)

    Jung, Wi Hoon; Yücel, Murat; Yun, Je-Yeon; Yoon, Youngwoo B; Cho, Kang Ik K; Parkes, Linden; Kim, Sung Nyun; Kwon, Jun Soo

    2017-01-01

    Dysfunction of corticostriatal loops has been proposed to underlie certain cognitive and behavioral problems associated with various neuropsychiatric disorders, such as obsessive-compulsive disorder (OCD) characterized by repetitive, unwanted thoughts, and behaviors. Although functional abnormalities in the loops involving the orbitofronto-striato-thalamic (OFST) circuitry in patients with OCD have been reported, our understanding of a link between disruptions in the architecture of the intrinsic functional network of the OFST circuit and their symptoms remain incomplete. Using resting-state functional MRI in conjunction with unsupervised clustering and multilevel functional connectivity (FC) techniques, FC of the OFST network and its topological organization in 61 OCD patients versus 61 matched controls were characterized. Patients exhibited disruptions in small-world properties of the OFST circuit, which indicates an imbalance between functional integration and segregation. Patients also showed decreased FC between the central orbitofrontal cortex and dorsomedial striatum but increased FC between the medial thalamus and striatal areas. Using one of the largest samples of unmedicated OCD patients to date, our findings provide evidence supporting the OFST dysconnection hypothesis in OCD as a basic pathophysiological mechanism underlying the disorder, showing the disruption of FC between specific cortical, striatal, and thalamic clusters and aberrant topological patterns of the OFST circuit. Hum Brain Mapp 38:109-119, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Modafinil modulates resting-state functional network connectivity and cognitive control in alcohol-dependent patients

    NARCIS (Netherlands)

    Schmaal, Lianne; Goudriaan, Anna E.; Joos, Leen; Krüse, Anne Maren; Dom, Geert; van den Brink, Wim; Veltman, Dick J.

    2013-01-01

    Chronic alcohol abuse is associated with deficits in cognitive control functions. Cognitive control is likely to be mediated through the interaction between intrinsic large-scale brain networks involved in externally oriented executive functioning and internally focused thought processing. Improving

  5. Modafinil Modulates Resting-State Functional Network Connectivity and Cognitive Control in Alcohol-Dependent Patients

    NARCIS (Netherlands)

    Schmaal, L.; Goudriaan, A.E.; Joos, L.; Kruse, A.M.; Dom, G.; van den Brink, W.; Veltman, D.J.

    2013-01-01

    Background: Chronic alcohol abuse is associated with deficits in cognitive control functions. Cognitive control is likely to be mediated through the interaction between intrinsic large-scale brain networks involved in externally oriented executive functioning and internally focused thought

  6. Resting-state networks distinguish locked-in from vegetative state patients

    Directory of Open Access Journals (Sweden)

    Daniel Roquet

    2016-01-01

    Conclusions: This study reinforces previous reports on the preservation of the default mode network in locked-in syndrome in contrast to vegetative state but extends them by suggesting that other networks might be relevant to the diagnosis of locked-in syndrome. The aforementioned analysis of fMRI brain activity at rest might be a step in the development of a diagnostic biomarker to distinguish locked-in syndrome from vegetative state.

  7. Altered affective, executive and sensorimotor resting state networks in patients with pediatric mania.

    Science.gov (United States)

    Wu, Minjie; Lu, Lisa H; Passarotti, Alessandra M; Wegbreit, Ezra; Fitzgerald, Jacklynn; Pavuluri, Mani N

    2013-07-01

    The aim of the present study was to map the pathophysiology of resting state functional connectivity accompanying structural and functional abnormalities in children with bipolar disorder. Children with bipolar disorder and demographically matched healthy controls underwent resting-state functional magnetic resonance imaging. A model-free independent component analysis was performed to identify intrinsically interconnected networks. We included 34 children with bipolar disorder and 40 controls in our analysis. Three distinct resting state networks corresponding to affective, executive and sensorimotor functions emerged as being significantly different between the pediatric bipolar disorder (PBD) and control groups. All 3 networks showed hyperconnectivity in the PBD relative to the control group. Specifically, the connectivity of the dorsal anterior cingulate cortex (ACC) differentiated the PBD from the control group in both the affective and the executive networks. Exploratory analysis suggests that greater connectivity of the right amygdala within the affective network is associated with better executive function in children with bipolar disorder, but not in controls. Unique clinical characteristics of the study sample allowed us to evaluate the pathophysiology of resting state connectivity at an early state of PBD, which led to the lack of generalizability in terms of comorbid disorders existing in a typical PBD population. Abnormally engaged resting state affective, executive and sensorimotor networks observed in children with bipolar disorder may reflect a biological context in which abnormal task-based brain activity can occur. Dual engagement of the dorsal ACC in affective and executive networks supports the neuroanatomical interface of these networks, and the amygdala's engagement in moderating executive function illustrates the intricate interplay of these neural operations at rest.

  8. J2ME and smart phones as platform for a Bluetooth body area network for patient-telemonitoring.

    Science.gov (United States)

    Morón, M J; Luque, J R; Botella, A A; Cuberos, E J; Casilari, E; Díaz-Estrella, A

    2007-01-01

    A prototype of a system based on a Bluetooth Body Area Network (BAN) for continuous and wireless telemonitoring of patients' biosignals is presented. Smart phones and Java (J2ME) have been selected as platform to build a central node in patients' BAN. A midlet running in the smart phone compiles information about patient's location and health status. The midlet encrypts and retransmits it to the server through 802.11 or GPRS/UMTS. Besides when an alerting condition is detected, the midlet generates a MMS and a SMS to be sent to patients' relatives and to physician, respectively. Additionally, the system provides to physicians the possibility of configuring BAN's parameters remotely, from a PC or even a smart phone.

  9. Using individualized brain network for analyzing structural covariance of the cerebral cortex in Alzheimer’s patients

    Directory of Open Access Journals (Sweden)

    Hee-Jong Kim

    2016-09-01

    Full Text Available Cortical thinning patterns in Alzheimer’s disease (AD have been widely reported through conventional regional analysis. In addition, the coordinated variance of cortical thickness in different brain regions has been investigated both at the individual and group network levels. In this study, we aim to investigate network architectural characteristics of a structural covariance network (SCN in AD, and further to show that the structural covariance connectivity becomes disorganized across the brain regions in AD, while the normal control (NC subjects maintain more clustered and consistent coordination in cortical atrophy variations. We generated SCNs directly from T1-weighted MR images of individual patients using surface-based cortical thickness data, with structural connectivity defined as similarity in cortical thickness within different brain regions. Individual SCNs were constructed using morphometric data from the Samsung Medical Center (SMC dataset. The structural covariance connectivity showed higher clustering than randomly generated networks, as well as similar minimum path lengths, indicating that the SCNs are small world. There were significant difference between NC and AD group in characteristic path lengths (z=-2.97, p<0.01 and small-worldness values (z=4.05, p<0.01. Clustering coefficients in AD was smaller than that of NC but there was no significant difference (z=1.81, not significant. We further observed that the AD patients had significantly disrupted structural connectivity. We also show that the coordinated variance of cortical thickness is distributed more randomly from one region to other regions in AD patients when compared to NC subjects. Our proposed SCN may provide surface-based measures for understanding interaction between two brain regions with co-atrophy of the cerebral cortex due to normal aging or AD. We applied our method to the AD Neuroimaging Initiative (ADNI data to show consistency in results with the SMC

  10. Central Somatosensory Networks Respond to a De Novo Innervated Penis: A Proof of Concept in Three Spina Bifida Patients.

    Science.gov (United States)

    Kortekaas, Rudie; Nanetti, Luca; Overgoor, Max L E; de Jong, Bauke M; Georgiadis, Janniko R

    2015-09-01

    Spina bifida (SB) causes low spinal lesions, and patients often have absent genital sensation and a highly impaired sex life. TOMAX (TO MAX-imize sensation, sexuality and quality of life) is a surgical procedure whereby the penis is newly innervated using a sensory nerve originally targeting the inguinal area. Most TOMAX-treated SB patients initially experience penile stimulation as inguinal sensation, but eventually, the perception shifts to penis sensation with erotic feelings. The brain mechanisms mediating this perceptual shift, which are completely unknown, could hold relevance for understanding the brain's role in sexual development. The aim of this study was to study how a newly perceived penis would be mapped onto the brain after a lifelong disconnection. Three TOMAX-treated SB patients participated in a functional magnetic resonance imagery experiment while glans penis, inguinal area, and index finger were stimulated with a paint brush. Brush stimulation-induced activation of the primary somatosensory cortex (SI) and functional connectivity between SI and remote cerebral regions. Stimulation of the re-innervated side of the glans penis and the intact contralateral inguinal area activated a very similar location on SI. Yet, connectivity analysis identified distinct SI functional networks. In all three subjects, the middle cingulate cortex (MCC) and the parietal operculum-insular cortex (OIC) were functionally connected to SI activity during glans penis stimulation, but not to SI activity induced by inguinal stimulation. Investigating central somatosensory network activity to a de novo innervated penis in SB patients is feasible and informative. The consistent involvement of MCC and OIC above and beyond the brain network expected on the basis of inguinal stimulation suggests that these areas mediate the novel penis sensation in these patients. The potential role of MCC and OIC in this process is discussed, along with recommendations for further research.

  11. Abnormal functional connectivity of brain network hubs associated with symptom severity in treatment-naive patients with obsessive-compulsive disorder: A resting-state functional MRI study.

    Science.gov (United States)

    Tian, Lin; Meng, Chun; Jiang, Ying; Tang, Qunfeng; Wang, Shuai; Xie, Xiyao; Fu, Xiangshuai; Jin, Chunhui; Zhang, Fuquan; Wang, Jidong

    2016-04-03

    Abnormal brain networks have been observed in patients with obsessive-compulsive disorder (OCD). However, detailed network hub and connectivity changes remained unclear in treatment-naive patients with OCD. Here, we sought to determine whether patients show hub-related connectivity changes in their whole-brain functional networks. We used resting-state functional magnetic resonance imaging data and voxel-based graph-theoretic analysis to investigate functional connectivity strength and hubs of whole-brain networks in 29 treatment-naive patients with OCD and 29 age- and gender-matched healthy controls. Correlation analysis was applied for potential associations with OCD symptom severity. OCD selectively targeted brain regions of higher functional connectivity strength than the average including brain network hubs, mainly distributed in the cortico-striato-thalamo-cortical (CSTC) circuits and additionally parietal, occipital, temporal and cerebellar regions. Moreover, affected functional connectivity strength in the cerebellum, the medial orbitofrontal cortex and superior occipital cortex was significantly associated with global OCD symptom severity. Our results provide the evidence about OCD-related brain network hub changes, not only in the CSTC circuits but more distributed in whole brain networks. Data suggest that whole brain network hub analysis is useful for understanding the pathophysiology of OCD. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Prediction of individual patient outcome in cancer: comparison of artificial neural networks and Kaplan--Meier methods.

    Science.gov (United States)

    Bostwick, D G; Burke, H B

    2001-04-15

    There is a great need for accurate treatment and outcome prediction in cancer. Two methods for prediction, artificial neural networks and Kaplan--Meier plots, have not, to the authors' knowledge, been compared previously. This review compares the advantages and disadvantages of the use of artificial neural networks and Kaplan--Meier curves for treatment and outcome prediction in cancer. Artificial neural networks are useful for prediction of outcome for individual patients with cancer because they are as accurate as the best traditional statistical methods, are able to capture complex phenomena without a priori knowledge, and can be reduced to a simpler model if the phenomena are not complex. Kaplan--Meier plots are of limited accuracy for prediction because they require partitioning of variables, require cutting continuous variables into discrete pieces, and can only handle one or two variables effectively. Artificial neural networks are an efficient statistical method for outcome prediction in cancer that utilizes all available powerful prognostic factors and maximizes predictive accuracy. Use of Kaplan--Meier plots for predictions is discouraged because of serious technical limitations and low accuracy. Copyright 2001 American Cancer Society.

  13. The role of expectations in patient assessments of hospital care: an example from a university hospital network, Turkey.

    Science.gov (United States)

    Bakar, Coskun; Akgün, H Seval; Al Assaf, A F

    2008-01-01

    The aim of this paper is to document a study, in which the SERVQUAL scale was used to evaluate hospital services, conducting a preliminary assessment of patient attitudes regarding the important aspects of service dimensions. The SERVQUAL scale was implemented into routine use at the Baskent University Hospitals Network in Baskent, Turkey. The study consisted of 550 randomly chosen patients who presented to any member hospital in that network during January and February 2006 and received treatment as inpatients or outpatients at those healthcare facilities. The SERVQUAL scale was utilised to evaluate hospital services. A questionnaire was completed by a total of 472 (86.0 per cent) patients. The perceived scores of the patients were higher than expected for an ordinary hospital but lower than expected for a high-quality hospital. The highest difference between the perceived service score and the expected service score was found at the Alanya Application and Research Center in Alanya, Turkey. The paper demonstrates the use of the SERVQUAL scale in measuring the functional quality of the hospitals assessed.

  14. Altered power spectral density in the resting-state sensorimotor network in patients with myotonic dystrophy type 1.

    Science.gov (United States)

    Park, Jin-Sung; Seo, Jeehye; Cha, Hyunsil; Song, Hui-Jin; Lee, Sang-Hoon; Jang, Kyung Eun; Lee, Hui Joong; Park, Juyoung; Lee, Ho-Won; Chang, Yongmin

    2018-01-17

    Myotonic dystrophy type 1 (DM1) is a multisystemic disease that involves the brain with several neurological symptoms. Although there were few imaging studies on DM1, no studies have investigated functional alterations in the sensorimotor network at rest in patients with DM1. In the current study, a power spectral density (PSD) analysis of resting-state fMRI data was performed to assess possible alteration in spontaneous neural activity of the sensorimotor network in patients with DM1. Compared to healthy controls, patients with DM1 showed higher PSD responses in the orbitofrontal cortex, parahippocampus and basal ganglia (corrected P < 0.05). Patients with DM1 showed higher PSD responses in white matter structures associated with motor function (corrected P < 0.05). Furthermore, correlation analysis indicated that the brain regions showing PSD differences were correlated with measures of motor performance (P < 0.05). In gray matter, our findings suggest that motor disability in DM1 is not an isolated deterioration of the motor power but a multimodal dysfunction that also involves the visual system. In addition, the widespread PSD alteration in white matter structures suggest that motor deficits in DM1 involve motor movement structures as well as structures important for its coordination and regulation.

  15. Systematic review with network meta-analysis: comparative efficacy of different enteral immunonutrition formulas in patients underwent gastrectomy.

    Science.gov (United States)

    Song, Guo-Min; Liu, Xiao-Ling; Bian, Wei; Wu, Jing; Deng, Yong-Hong; Zhang, Hui; Tian, Xu

    2017-04-04

    Optimal enteral immunonutrition (EIN) regime for gastric cancer (GC) patients underwent gastrectomy remains uncertainty. To assess comparative efficacy of different EIN formulas in GC patients underwent gastrectomy, we performed network meta-analysis. We included 11 RCTs enrolling 840 patients. Pairwise meta-analysis indicated that EIN (RR 0.56, 95% CI 0.36-0.86; MD -0.42, 95% CI -0.74-0.10), Arg+RNA+ω-3-FAs (RR 0.37, 95% CI 0.22-0.63; MD -0.42, 95% CI -0.75-0.07), Arg+Gln+ω-3-FAs (RR 0.22, 95% CI 0.05-0.94; MD -0.69, 95% CI -1.22-1.07) reduced ICs and LOS. Network meta-analysis confirmed the potential of Arg+RNA+ω-3-FAs for ICs (OR 0.27, 95% Crl 0.12-0.49) and Arg+Gln+ω-3-FAs for CIs (OR 0.22, 95% Crl 0.02-0.84) and LOS (SMD -0.63, 95% Crl -1.07-0.13), and indicated that Arg+RNA+ω-3-FAs was superior to Arg+RNA and Arg+Gln for ICs as well. We performed direct and network meta-analyses for randomized controlled trials comparing EIN formulas with each other or standard enteral nutrition (SEN) in reducing infectious complications (ICs), noninfectious complications (NICs) and length of hospital stay (LOS), through January 2016. The surface under the cumulative ranking curve (SCURA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to rank regimes and rate qualities of evidences respectively. As for GC patients underwent gastrectomy, Arg+RNA+ω-3-FAs and Arg+Gln+ω-3-FAs are the optimal regimes of reducing ICs and LOS.

  16. Sentinel Network

    Science.gov (United States)

    The Sentinel Network is an integrated, electronic, national medical product safety initiative that compiles information about the safe and effective use of medical products accessible to patients and healthcare practitioners.

  17. Online activity and participation in treatment affects the perceived efficacy of social health networks among patients with chronic illness.

    Science.gov (United States)

    Magnezi, Racheli; Bergman, Yoav S; Grosberg, Dafna

    2014-01-10

    The use of online health-related social networks for support, peer-to-peer connections, and obtaining health information has increased dramatically. Participation in an online health-related social network can enhance patients' self-efficacy and empowerment, as they are given knowledge and tools to manage their chronic health condition more effectively. Thus, we can deduce that patient activation, the extent to which individuals are able to manage their own health care, also increases. However, little is known about the effects of participation in online health-related social networks and patient activation on the perceived usefulness of a website across disease groups. The intent of the study was to evaluate the effects and benefits of participation in an online health-related social network and to determine which variables predict perceived site usefulness, while examining patient activation. Data were collected from "Camoni", the first health-related social network in the Hebrew language. It offers medical advice, including blogs, forums, support groups, internal mail, chats, and an opportunity to consult with experts. This study focused on the site's five largest and most active communities: diabetes, heart disease, kidney disease, spinal injury, and depression/anxiety. Recruitment was conducted during a three-month period in which a link to the study questionnaire was displayed on the Camoni home page. Three questionnaires were used: a 13-item measure of perceived usefulness (Cronbach alpha=.93) to estimate the extent to which an individual found the website helpful and informative, a 9-item measure of active involvement in the website (Cronbach alpha=.84), and The Patient Activation Measure (PAM-13, Cronbach alpha=.86), which assesses a patient's level of active participation in his or her health care. There were 296 participants. Men 30-39 years of age scored higher in active involvement than those 40-49 years (P=.03), 50-64 years (P=.004), or 65+ years (P

  18. Changes of the directional brain networks related with brain plasticity in patients with long-term unilateral sensorineural hearing loss.

    Science.gov (United States)

    Zhang, G-Y; Yang, M; Liu, B; Huang, Z-C; Li, J; Chen, J-Y; Chen, H; Zhang, P-P; Liu, L-J; Wang, J; Teng, G-J

    2016-01-28

    Previous studies often report that early auditory deprivation or congenital deafness contributes to cross-modal reorganization in the auditory-deprived cortex, and this cross-modal reorganization limits clinical benefit from cochlear prosthetics. However, there are inconsistencies among study results on cortical reorganization in those subjects with long-term unilateral sensorineural hearing loss (USNHL). It is also unclear whether there exists a similar cross-modal plasticity of the auditory cortex for acquired monaural deafness and early or congenital deafness. To address this issue, we constructed the directional brain functional networks based on entropy connectivity of resting-state functional MRI and researched changes of the networks. Thirty-four long-term USNHL individuals and seventeen normally hearing individuals participated in the test, and all USNHL patients had acquired deafness. We found that certain brain regions of the sensorimotor and visual networks presented enhanced synchronous output entropy connectivity with the left primary auditory cortex in the left long-term USNHL individuals as compared with normally hearing individuals. Especially, the left USNHL showed more significant changes of entropy connectivity than the right USNHL. No significant plastic changes were observed in the right USNHL. Our results indicate that the left primary auditory cortex (non-auditory-deprived cortex) in patients with left USNHL has been reorganized by visual and sensorimotor modalities through cross-modal plasticity. Furthermore, the cross-modal reorganization also alters the directional brain functional networks. The auditory deprivation from the left or right side generates different influences on the human brain. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

  19. SU-E-T-206: Improving Radiotherapy Toxicity Based On Artificial Neural Network (ANN) for Head and Neck Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Daniel D; Wernicke, A Gabriella; Nori, Dattatreyudu; Chao, KSC; Parashar, Bhupesh; Chang, Jenghwa [Weill Cornell Medical College, NY, NY (United States)

    2014-06-01

    Purpose/Objective(s): The aim of this study is to build the estimator of toxicity using artificial neural network (ANN) for head and neck cancer patients Materials/Methods: An ANN can combine variables into a predictive model during training and considered all possible correlations of variables. We constructed an ANN based on the data from 73 patients with advanced H and N cancer treated with external beam radiotherapy and/or chemotherapy at our institution. For the toxicity estimator we defined input data including age, sex, site, stage, pathology, status of chemo, technique of external beam radiation therapy (EBRT), length of treatment, dose of EBRT, status of post operation, length of follow-up, the status of local recurrences and distant metastasis. These data were digitized based on the significance and fed to the ANN as input nodes. We used 20 hidden nodes (for the 13 input nodes) to take care of the correlations of input nodes. For training ANN, we divided data into three subsets such as training set, validation set and test set. Finally, we built the estimator for the toxicity from ANN output. Results: We used 13 input variables including the status of local recurrences and distant metastasis and 20 hidden nodes for correlations. 59 patients for training set, 7 patients for validation set and 7 patients for test set and fed the inputs to Matlab neural network fitting tool. We trained the data within 15% of errors of outcome. In the end we have the toxicity estimation with 74% of accuracy. Conclusion: We proved in principle that ANN can be a very useful tool for predicting the RT outcomes for high risk H and N patients. Currently we are improving the results using cross validation.

  20. Network 13 partnership to improve the influenza, pneumococcal pneumonia, and hepatitis B vaccination rates among dialysis patients.

    Science.gov (United States)

    Duval, Linda; George, Cheryl; Hedrick, Nellie; Woodruff, Sandra; Kleinpeter, Myra A

    2011-01-01

    Vaccinations are available for primary prevention of many infections in adults. Morbidity and mortality from invasive diseases such as influenza and Streptococcus pneumoniae (pneumococcus) remain high and may be largely preventable by vaccination of high-risk adults, including dialysis patients. The current 23-valent vaccine-efficacious, with a low adverse event profile-is widely available. Revaccination is also recommended in patients with immunocompromising conditions, including chronic kidney disease. Despite having many opportunities to be vaccinated, adult hemodialysis and peritoneal dialysis patients are often missed During the recent H1N1 influenza outbreak, we conducted a performance improvement project to increase the vaccination rates for pneumococcal pneumonia, hepatitis B, and influenza, with a special focus on prevention. The project included an education phase, baseline assessment of vaccination rates, intervention, and a follow-up assessment of vaccination rates. The geographic jurisdiction of ESRD Network 13 encompasses the states of Arkansas, Louisiana, and Oklahoma. At the beginning of the network-wide project, the documented state-specific rates for influenza immunization were below the average influenza immunization rates for adults reported by Centers for Disease Control and Prevention and far below its target for adults. Our improvement project incorporated educational interventions to improve patient acceptance of vaccinations, educational interventions to improve staff participation in quality improvement activities, and improved techniques of quality improvement data collection and analysis by participants. During this project, the immunization rates for hepatitis B and pneumococcal pneumonia were also reviewed. At project's conclusion, improvement was demonstrated in all three focus areas, with statistically significant improvements noted in both influenza and pneumococcus vaccination rates. The use of educational interventions to improve

  1. Provider-based research networks and diffusion of surgical technologies among patients with early-stage kidney cancer.

    Science.gov (United States)

    Tan, Hung-Jui; Meyer, Anne-Marie; Kuo, Tzy-Mey; Smith, Angela B; Wheeler, Stephanie B; Carpenter, William R; Nielsen, Matthew E

    2015-03-15

    Provider-based research networks such as the National Cancer Institute's Community Clinical Oncology Program (CCOP) have been shown to facilitate the translation of evidence-based cancer care into clinical practice. This study compared the utilization of laparoscopy and partial nephrectomy among patients with early-stage kidney cancer according to their exposure to CCOP-affiliated providers. With linked Surveillance, Epidemiology, and End Results-Medicare data, patients with T1aN0M0 kidney cancer who had been treated with nephrectomy from 2000 to 2007 were identified. For each patient, the receipt of care from a CCOP physician or hospital and treatment with laparoscopy or partial nephrectomy were determined. Adjusted for patient characteristics (eg, age, sex, and marital status) and other organizational features (eg, community hospital and National Cancer Institute-designated cancer center), multivariate logistic regression was used to estimate the association between each surgical innovation and CCOP affiliation. During the study interval, 1578 patients (26.8%) were treated by a provider with a CCOP affiliation. Trends in the utilization of laparoscopy and partial nephrectomy remained similar between affiliated and nonaffiliated providers (P ≥ .05). With adjustments for patient characteristics, organizational features, and clustering, no association was noted between CCOP affiliation and the use of laparoscopy (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.81-1.53) or partial nephrectomy (OR, 1.04; 95% CI, 0.82-1.32) despite the more frequent receipt of these treatments in academic settings (P kidney cancer, indicating perhaps a more limited scope to provider-based research networks as they pertain to translational efforts in cancer care. © 2014 American Cancer Society.

  2. Abnormal topological organization in white matter structural networks revealed by diffusion tensor tractography in unmedicated patients with obsessive-compulsive disorder.

    Science.gov (United States)

    Zhong, Zhaoxi; Zhao, Tengda; Luo, Jia; Guo, Zhihua; Guo, Meng; Li, Ping; Sun, Jing; He, Yong; Li, Zhanjiang

    2014-06-03

    Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder defined by recurrent thoughts, intrusive and distressing impulses, or images and ritualistic behaviors. Although focal diverse regional abnormalities white matter integrity in specific brain regions have been widely studied in populations with OCD, alterations in the structural connectivities among them remain poorly understood. The aim was to investigate the abnormalities in the topological efficiency of the white matter networks and the correlation between the network metrics and Yale-Brown Obsessive-Compulsive Scale scores in unmedicated OCD patients, using diffusion tensor tractography and graph theoretical approaches. This study used diffusion tensor imaging and deterministic tractography to map the white matter structural networks in 26 OCD patients and 39 age- and gender-matched healthy controls; and then applied graph theoretical methods to investigate abnormalities in the global and regional properties of the white matter network in these patients. The patients and control participants both showed small-world organization of the white matter networks. However, the OCD patients exhibited significant abnormal global topology, including decreases in global efficiency (t = -2.32, p = 0.02) and increases in shortest path length, Lp (t = 2.30, p = 0.02), the normalized weighted shortest path length, λ (t = 2.08, p=0.04), and the normalized clustering coefficient, γ (t = 2.26, p = 0.03), of their white matter structural networks compared with healthy controls. Further, the OCD patients showed a reduction in nodal efficiency predominately in the frontal regions, the parietal regions and caudate nucleus. The normalized weighted shortest path length of the network metrics was significantly negatively correlated with obsessive subscale of the Yale-Brown Obsessive-Compulsive Scale (r = -0.57, p = 0.0058). These findings demonstrate the abnormal topological efficiency in the white matter networks

  3. Irritable Bowel Syndrome in female patients is associated with alterations in structural brain networks

    Science.gov (United States)

    Labus, Jennifer; Dinov, Ivo D.; Jiang, Zhiguo; Ashe-McNalley, Cody; Zamanyan, Alen; Shi, Yonggang; Hong, Jui-Yang; Gupta, Arpana; Tillisch, Kirsten; Ebrat, Bahar; Hobel, Sam; Gutman, Boris A.; Joshi, Shantanu; Thompson, Paul M.; Toga, Arthur W.; Mayer, Emeran A.

    2014-01-01

    Alterations in gray matter (GM) density/ volume and cortical thickness (CT) have been demonstrated in small and heterogeneous samples of subjects with different chronic pain syndromes, including irritable bowel syndrome (IBS). Aggregating across 7 structural neuroimaging studies conducted at UCLA between August 2006 and April 2011, we examined group differences in regional GM volume in 201 predominantly premenopausal female subjects (82 IBS, mean age: 32 ± 10 SD, 119 Healthy Controls [HCs], 30± 10 SD). Applying graph theoretical methods and controlling for total brain volume, global and regional properties of large-scale structural brain networks were compared between IBS and HC groups. Relative to HCs, the IBS group had lower volumes in bilateral superior frontal gyrus, bilateral insula, bilateral amygdala, bilateral hippocampus, bilateral middle orbital frontal gyrus, left cingulate, left gyrus rectus, brainstem, and left putamen. Higher volume was found for the left postcentral gyrus. Group differences were no longer significant for most regions when controlling for Early Trauma Inventory global score with the exception of the right amygdala and the left post central gyrus. No group differences were found for measures of global and local network organization. Compared to HCs, the right cingulate gyrus and right thalamus were identified as significantly more critical for information flow. Regions involved in endogenous pain modulation and central sensory amplification were identified as network hubs in IBS. Overall, evidence for central alterations in IBS was found in the form of regional GM volume differences and altered global and regional properties of brain volumetric networks. PMID:24076048

  4. Reduced Connectivity in the Self-Processing Network of Schizophrenia Patients with Poor Insight

    NARCIS (Netherlands)

    Liemburg, Edith J.; van der Meer, Lisette; Swart, Marte; Curcic-Blake, Branislava; Bruggeman, Richard; Knegtering, Henderikus; Aleman, Andre

    2012-01-01

    Lack of insight (unawareness of illness) is a common and clinically relevant feature of schizophrenia. Reduced levels of self-referential processing have been proposed as a mechanism underlying poor insight. The default mode network (DMN) has been implicated as a key node in the circuit for

  5. Communication technology access, use, and preferences among primary care patients: from the Residency Research Network of Texas (RRNeT).

    Science.gov (United States)

    Hill, Jason H; Burge, Sandra; Haring, Anna; Young, Richard A

    2012-01-01

    The digital revolution is changing the manner in which patients communicate with their health care providers, yet many patients still lack access to communication technology. We conducted this study to evaluate access to, use of, and preferences for using communication technology among a predominantly low-income patient population. We determined whether access, use, and preferences were associated with type of health insurance, sex, age, and ethnicity. In 2011, medical student researchers administered questionnaires to patients of randomly selected physicians within 9 primary care clinics in the Residency Research Network of Texas. Surveys addressed access to and use of cell phones and home computers and preferences for communicating with health care providers. In this sample of 533 patients (77% response rate), 448 (84%) owned a cell phone and 325 (62%) owned computers. Only 48% reported conducting Internet searches, sending and receiving E-mails, and looking up health information on the Internet. Older individuals, those in government sponsored insurance programs, and individuals from racial/ethnic minority groups had the lowest levels of technology adoption. In addition, more than 60% of patients preferred not to send and receive health information over the Internet, by instant messaging, or by text messaging. Many patients in this sample did not seek health information electronically nor did they want to communicate electronically with their physicians. This finding raises concerns about the vision of the patient-centered medical home to enhance the doctor-patient relationship through communication technology. Our patients represent some of the more vulnerable populations in the United States and, as such, deserve attention from health care policymakers who are promoting widespread use of communication technology.

  6. Geriatric outcomes for trauma patients in the state of Florida after the advent of a large trauma network.

    Science.gov (United States)

    Ang, Darwin; Norwood, Scott; Barquist, Erik; McKenney, Mark; Kurek, Stanley; Kimbrell, Brian; Garcia, Alejandro; Walsh, Charles B; Liu, Huazhi; Ziglar, Michele; Hurst, James

    2014-07-01

    Florida State has one of the largest geriatric populations in the United States. However, recent data show that up to the year 2010, geriatric trauma patients were least served by designated trauma centers (TCs). One existing TC and five provisional Level 2 TCs were combined to create a large-scale trauma network (TN). The new TCs were placed in those areas with the lowest ratios of TC to residents based on census data. The aim of this study was to measure the TN impact on the population of geriatric trauma patients. Data from the Florida State Agency for Health Care Administration were used to determine mortality, length of stay, and complication rates for geriatric trauma patients (≥ 65 years). The potential effect of the TN was measured by comparing outcomes before and after the initiation of the TN. A total of 165,640 geriatric patients were evaluated. Multivariate regression methods were used to match and adjust for age, injury status (penetrating vs. nonpenetrating), sex, race, comorbidity, and injury severity (DRG International Classification of Diseases-9th Rev. Injury Severity Score). Since the advent of the TN, an additional 1,711 geriatric patients were treated compared with the previous period. The TN was responsible 86% of these new patients. There was a temporal association with a decrease in both mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.85-0.96) and length of stay (p geriatric patients since the advent of the TN. The improved access was associated with a significant decrease in mortality in the regions serviced by the TN. Geriatric patients make up a significant proportion of trauma patients within the TN. The temporal improvement in outcomes may be associated with the increased proportion of patients being treated in state-designated TCs as a result of the addition of the TN. Epidemiologic study, level III.

  7. Gene expression profiles and protein–protein interaction network analysis in AIDS patients with HIV-associated encephalitis and dementia

    Directory of Open Access Journals (Sweden)

    Shityakov S

    2015-11-01

    Full Text Available Sergey Shityakov,1 Thomas Dandekar,2 Carola Förster1 1Department of Anesthesia and Critical Care, 2Department of Bioinformatics, University of Würzburg, Würzburg, Germany Abstract: Central nervous system dysfunction is an important cause of morbidity and mortality in patients with human immunodeficiency virus type 1 (HIV-1 infection and acquired immunodeficiency virus syndrome (AIDS. Patients with AIDS are usually affected by HIV-associated encephalitis (HIVE with viral replication limited to cells of monocyte origin. To examine the molecular mechanisms underlying HIVE-induced dementia, the GSE4755 Affymetrix data were obtained from the Gene Expression Omnibus database and the differentially expressed genes (DEGs between the samples from AIDS patients with and without apparent features of HIVE-induced dementia were identified. In addition, protein–protein interaction networks were constructed by mapping DEGs into protein–protein interaction data to identify the pathways that these DEGs are involved in. The results revealed that the expression of 1,528 DEGs is mainly involved in the immune response, regulation of cell proliferation, cellular response to inflammation, signal transduction, and viral replication cycle. Heat-shock protein alpha, class A member 1 (HSP90AA1, and fibronectin 1 were detected as hub nodes with degree values >130. In conclusion, the results indicate that HSP90A and fibronectin 1 play important roles in HIVE pathogenesis.Keywords: microarray, human immunodeficiency virus, differentially expressed genes, protein–protein interaction network, gene ontology, encephalitis, dementia

  8. The Effect of Souvenaid on Functional Brain Network Organisation in Patients with Mild Alzheimer’s Disease: A Randomised Controlled Study

    Science.gov (United States)

    de Waal, Hanneke; Stam, Cornelis J.; Lansbergen, Marieke M.; Wieggers, Rico L.; Kamphuis, Patrick J. G. H.; Scheltens, Philip; Maestú, Fernando; van Straaten, Elisabeth C. W.

    2014-01-01

    Background Synaptic loss is a major hallmark of Alzheimer’s disease (AD). Disturbed organisation of large-scale functional brain networks in AD might reflect synaptic loss and disrupted neuronal communication. The medical food Souvenaid, containing the specific nutrient combination Fortasyn Connect, is designed to enhance synapse formation and function and has been shown to improve memory performance in patients with mild AD in two randomised controlled trials. Objective To explore the effect of Souvenaid compared to control product on brain activity-based networks, as a derivative of underlying synaptic function, in patients with mild AD. Design A 24-week randomised, controlled, double-blind, parallel-group, multi-country study. Participants 179 drug-naïve mild AD patients who participated in the Souvenir II study. Intervention Patients were randomised 1∶1 to receive Souvenaid or an iso-caloric control product once daily for 24 weeks. Outcome In a secondary analysis of the Souvenir II study, electroencephalography (EEG) brain networks were constructed and graph theory was used to quantify complex brain structure. Local brain network connectivity (normalised clustering coefficient gamma) and global network integration (normalised characteristic path length lambda) were compared between study groups, and related to memory performance. Results The network measures in the beta band were significantly different between groups: they decreased in the control group, but remained relatively unchanged in the active group. No consistent relationship was found between these network measures and memory performance. Conclusions The current results suggest that Souvenaid preserves the organisation of brain networks in patients with mild AD within 24 weeks, hypothetically counteracting the progressive network disruption over time in AD. The results strengthen the hypothesis that Souvenaid affects synaptic integrity and function. Secondly, we conclude that advanced EEG

  9. EEG-based motor network biomarkers for identifying target patients with stroke for upper limb rehabilitation and its construct validity.

    Directory of Open Access Journals (Sweden)

    Chun-Chuan Chen

    Full Text Available Rehabilitation is the main therapeutic approach for reducing poststroke functional deficits in the affected upper limb; however, significant between-patient variability in rehabilitation efficacy indicates the need to target patients who are likely to have clinically significant improvement after treatment. Many studies have determined robust predictors of recovery and treatment gains and yielded many great results using linear approachs. Evidence has emerged that the nonlinearity is a crucial aspect to study the inter-areal communication in human brains and abnormality of oscillatory activities in the motor system is linked to the pathological states. In this study, we hypothesized that combinations of linear and nonlinear (cross-frequency network connectivity parameters are favourable biomarkers for stratifying patients for upper limb rehabilitation with increased accuracy. We identified the biomarkers by using 37 prerehabilitation electroencephalogram (EEG datasets during a movement task through effective connectivity and logistic regression analyses. The predictive power of these biomarkers was then tested by using 16 independent datasets (i.e. construct validation. In addition, 14 right handed healthy subjects were also enrolled for comparisons. The result shows that the beta plus gamma or theta network features provided the best classification accuracy of 92%. The predictive value and the sensitivity of these biomarkers were 81.3% and 90.9%, respectively. Subcortical lesion, the time poststroke and initial Wolf Motor Function Test (WMFT score were identified as the most significant clinical variables affecting the classification accuracy of this predictive model. Moreover, 12 of 14 normal controls were classified as having favourable recovery. In conclusion, EEG-based linear and nonlinear motor network biomarkers are robust and can help clinical decision making.

  10. Functional and white matter abnormalities in the language network in patients with schizophrenia: a combined study with diffusion tensor imaging and functional magnetic resonance imaging.

    Science.gov (United States)

    Leroux, Elise; Delcroix, Nicolas; Alary, Mathieu; Razafimandimby, Annick; Brazo, Perrine; Delamillieure, Pascal; Dollfus, Sonia

    2013-10-01

    Schizophrenia is a mental disorder characterized by functional abnormalities in the language network. Anatomical white matter (WM) abnormalities (volume and integrity) have also been reported for this pathology. Nevertheless, few studies have investigated anatomo-functional relationships in schizophrenia, and none has focused on the language comprehension network in relation to various diffusion parameters. We hypothesized that the WM abnormalities that are reflected by several diffusion parameters underlie functional deficits in the language network. Eighteen DSM-IV patients with schizophrenia and 18 healthy controls without any significant differences in sex, age, or level of education were included. First, functional brain activation within the language network was estimated. Then, using diffusion tensor imaging, fractional anisotropy (FA), radial diffusivity (RD), and mean diffusivity (MD) values were extracted within WM regions adjacent to this network and their anatomo-functional relationships were investigated. Compared with healthy participants, both functional and diffusion deficits were observed in patients with schizophrenia. Primarily, an altered diffusion-functional relationship was observed in patients in the left middle temporal region: functional activations were positively correlated with FA, but were negatively correlated with RD. Our findings indicate a close relationship between diffusion and functional deficits in patients with schizophrenia, suggesting that WM integrity disturbance might be one cause of functional alterations in the language network in patients with schizophrenia. Thus, the present multimodal study improves our understanding of the pathophysiology of schizophrenia. © 2013 Elsevier B.V. All rights reserved.

  11. Interictal high frequency oscillations correlating with seizure outcome in patients with widespread epileptic networks in tuberous sclerosis complex.

    Science.gov (United States)

    Okanishi, Tohru; Akiyama, Tomoyuki; Tanaka, Shin-Ichi; Mayo, Ellen; Mitsutake, Ayu; Boelman, Cyrus; Go, Cristina; Snead, O Carter; Drake, James; Rutka, James; Ochi, Ayako; Otsubo, Hiroshi

    2014-10-01

    Multiple tubers in patients with tuberous sclerosis complex (TSC) often are responsible for drug-resistant epilepsy. The complexity of the epileptic network formed by multiple tubers complicates localization of the epileptogenic zone that is needed to design a surgical treatment strategy. High frequency oscillations (HFOs) on intracranial video-electroencephalography (IVEEG) may be a valuable surrogate marker for the localization of the epileptogenic zone. The purpose of this study was to test the hypothesis that high occurrence rate (OR) of interictal HFOs can guide the localization of the epileptogenic zone. We analyzed the OR of interictal HFOs at 80-200 Hz (ripples) and >200 Hz (fast ripples, FRs). We divided OR of interictal HFOs between high and low rates by thresholding. We analyzed the correlation between seizure outcomes using Engel classification and the resection ratio of the seizure onset zone (SOZ), and high-OR HFOs using ordinal logistic regression analysis. We collected 10 patients. The seizure outcomes resulted in Engel classification I in three patients, II in four, III in one, and IV in two. High-OR ripples (5-57 [mean 29] channels, 1-4 [2.8] lobes) and high-OR FRs (9-66 [mean 27] channels, 1-4 [2.6] lobes) were widely distributed. The resection ratio of SOZ did not show statistically significant correlation with the seizure outcome. The resection ratio of high-OR ripples showed statistically significant correlation with the seizure outcome (p = 0.038). The resection ratio of high-OR FRs showed statistically significant correlation with the seizure outcome (p = 0.048). The multiple extensive zones with high-OR HFOs suggest a complex and widespread epileptic network in patients with TSC. In a subset of TSC patients with drug-resistant epilepsy, resection of cortex with both interictal high-OR FRs and ripples on IVEEG correlated with a good seizure outcome. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  12. Prediction of outcome in patients with urothelial carcinoma of the bladder following radical cystectomy using artificial neural networks.

    Science.gov (United States)

    Buchner, A; May, M; Burger, M; Bolenz, C; Herrmann, E; Fritsche, H-M; Ellinger, J; Höfner, T; Nuhn, P; Gratzke, C; Brookman-May, S; Melchior, S; Peter, J; Moritz, R; Tilki, D; Gilfrich, C; Roigas, J; Zacharias, M; Hohenfellner, M; Haferkamp, A; Trojan, L; Wieland, W F; Müller, S C; Stief, C G; Bastian, P J

    2013-04-01

    The outcome of patients with urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) shows remarkable variability. We evaluated the ability of artificial neural networks (ANN) to perform risk stratification in UCB patients based on common parameters available at the time of RC. Data from 2111 UCB patients that underwent RC in eight centers were analysed; the median follow-up was 30 months (IQR: 12-60). Age, gender, tumour stage and grade (TURB/RC), carcinoma in situ (TURB/RC), lymph node status, and lymphovascular invasion were used as input data for the ANN. Endpoints were tumour recurrence, cancer-specific mortality (CSM) and all-cause death (ACD). Additionally, the predictive accuracies (PA) of the ANNs were compared with the PA of Cox proportional hazards regression models. The recurrence-, CSM-, and ACD- rates after 5 years were 36%, 33%, and 46%, respectively. The best ANN had 74%, 76% and 69% accuracy for tumour recurrence, CSM and ACD, respectively. Lymph node status was one of the most important factors for the network's decision. The PA of the ANNs for recurrence, CSM and ACD were improved by 1.6% (p = 0.247), 4.7% (p < 0.001) and 3.5% (p = 0.007), respectively, in comparison to the Cox models. ANN predicted tumour recurrence, CSM, and ACD in UCB patients after RC with reasonable accuracy. In this study, ANN significantly outperformed the Cox models regarding prediction of CSM and ACD using the same patients and variables. ANNs are a promising approach for individual risk stratification and may optimize individual treatment planning. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Using Patient Pathway Analysis to Design Patient-centered Referral Networks for Diagnosis and Treatment of Tuberculosis: The Case of the Philippines.

    Science.gov (United States)

    Garfin, Celine; Mantala, Mariquita; Yadav, Rajendra; Hanson, Christy L; Osberg, Mike; Hymoff, Aaron; Makayova, Julia

    2017-11-06

    Tuberculosis (TB) is the 8th leading cause of death in the Philippines. A recent prevalence survey found that there were nearly 70% more cases of tuberculosis than previously estimated. Given these new data, the National TB Program (NTP), operating through a decentralized health system, identified about 58% of the estimated new drug-sensitive (DS) TB patients in 2016. However, the NTP only identified and commenced treatment for around 17% of estimated new drug-resistant patients. In order to reach the remaining 42% of drug-sensitive patients and 83% of drug-resistant patients, it is necessary to develop a better understanding of where patients seek care. National and regional patient pathway analyses (PPAs) were undertaken using existing national survey and NTP data. The PPA assessed the alignment between patient care seeking and the availability of TB diagnostic and treatment services. Systemic referral networks from the community-level Barangay Health Stations (BHSs) to diagnostic facilities have enabled more efficient detection of drug-sensitive tuberculosis in the public sector. Approximately 36% of patients initiated care in the private sector, where there is limited coverage of appropriate diagnostic technologies. Important differences in the alignment between care seeking patterns and diagnostic and treatment availability were found between regions. The PPA identified opportunities for strengthening access to care for all forms of tuberculosis and for accelerating the time to diagnosis by aligning services to where patients initiate care. Geographic variations in care seeking may guide prioritization of some regions for intensified engagement with the private sector.

  14. Brain network properties in depressed patients receiving seizure therapy: A graph theoretical analysis of peri-treatment resting EEG.

    Science.gov (United States)

    Deng, Zhi-De; McClinctock, Shawn M; Lisanby, Sarah H

    2015-08-01

    Electroconvulsive therapy (ECT), the most efficacious antidepressant therapy for treatment-resistant depression, has been reported to alter functional brain network architecture by down-regulating connectivity in frontotemporal circuitry. Magnetic seizure therapy (MST), which induces therapeutic seizures with high dose repetitive transcranial magnetic stimulation, has been introduced to improve the seizure therapy risk/benefit ratio. Unfortunately, there is limited understanding of seizure therapy's underlying mechanisms of action. In this study, we apply graph theory-based connectivity analysis to peri-treatment, resting-state, topographical electroencephalography (EEG) in patients with depression receiving seizure therapy. Functional connectivity was assessed using the de-biased weighted phase lag index, a measure of EEG phase synchronization. Brain network structure was quantified using graph theory metrics, including betweenness centrality, clustering coefficient, network density, and characteristic path length. We found a significant reduction in the phase synchronization and aberration of the small-world architecture in the beta frequency band, which could be related to acute clinical and cognitive effects of seizure therapy.

  15. Altered brain rhythms and functional network disruptions involved in patients with generalized fixation-off epilepsy

    OpenAIRE

    Solana Sánchez, Ana Beatriz; Hernández Tamames, J.A.; E MOLINA; Martínez, K.; Pineda Pardo, José Ángel; Bruña Fernandez, Ricardo; Toledano, Rafael; San Antonio-Arce, Victoria; Garcia Morales, Irene; Gil Nagel, Antonio; Alfayate, E.; Álvarez Linera, Juan; Pozo Guerrero, Francisco del

    2012-01-01

    Fixation-off sensitivity (FOS) denotes the forms of epilepsy elicited by elimination of fixation. FOS-IGE patients are rare cases [1]. In a previous work [2] we showed that two FOS-IGE patients had different altered EEG rhythms when closing eyes; only beta band was altered in patient 1 while theta, alpha and beta were altered in patient 2. In the present work, we explain the relationship between the altered brain rhythms in these patients and the disruption in functional brain net...

  16. A general dental practice research network: impact of oral health in general dental practice patients.

    Science.gov (United States)

    Kay, E J; Ward, N; Locker, D

    2003-06-14

    To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health. Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery. General dental Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health. Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts. Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists personality and professional beliefs on patients well-being needs to be undertaken.

  17. Time-related patient data retrieval for the case studies from the pharmacogenomics research network

    OpenAIRE

    Zhu, Qian; Tao, Cui; Ding, Ying; Chute, Christopher G.

    2012-01-01

    There are lots of question-based data elements from the pharmacogenomics research network (PGRN) studies. Many data elements contain temporal information. To semantically represent these elements so that they can be machine processiable is a challenging problem for the following reasons: (1) the designers of these studies usually do not have the knowledge of any computer modeling and query languages, so that the original data elements usually are represented in spreadsheets in human languages...

  18. A Compressed Sensing-Based Wearable Sensor Network for Quantitative Assessment of Stroke Patients.

    Science.gov (United States)

    Yu, Lei; Xiong, Daxi; Guo, Liquan; Wang, Jiping

    2016-02-05

    Clinical rehabilitation assessment is an important part of the therapy process because it is the premise for prescribing suitable rehabilitation interventions. However, the commonly used assessment scales have the following two drawbacks: (1) they are susceptible to subjective factors; (2) they only have several rating levels and are influenced by a ceiling effect, making it impossible to exactly detect any further improvement in the movement. Meanwhile, energy constraints are a primary design consideration in wearable sensor network systems since they are often battery-operated. Traditionally, for wearable sensor network systems that follow the Shannon/Nyquist sampling theorem, there are many data that need to be sampled and transmitted. This paper proposes a novel wearable sensor network system to monitor and quantitatively assess the upper limb motion function, based on compressed sensing technology. With the sparse representation model, less data is transmitted to the computer than with traditional systems. The experimental results show that the accelerometer signals of Bobath handshake and shoulder touch exercises can be compressed, and the length of the compressed signal is less than 1/3 of the raw signal length. More importantly, the reconstruction errors have no influence on the predictive accuracy of the Brunnstrom stage classification model. It also indicated that the proposed system can not only reduce the amount of data during the sampling and transmission processes, but also, the reconstructed accelerometer signals can be used for quantitative assessment without any loss of useful information.

  19. A Compressed Sensing-Based Wearable Sensor Network for Quantitative Assessment of Stroke Patients

    Science.gov (United States)

    Yu, Lei; Xiong, Daxi; Guo, Liquan; Wang, Jiping

    2016-01-01

    Clinical rehabilitation assessment is an important part of the therapy process because it is the premise for prescribing suitable rehabilitation interventions. However, the commonly used assessment scales have the following two drawbacks: (1) they are susceptible to subjective factors; (2) they only have several rating levels and are influenced by a ceiling effect, making it impossible to exactly detect any further improvement in the movement. Meanwhile, energy constraints are a primary design consideration in wearable sensor network systems since they are often battery-operated. Traditionally, for wearable sensor network systems that follow the Shannon/Nyquist sampling theorem, there are many data that need to be sampled and transmitted. This paper proposes a novel wearable sensor network system to monitor and quantitatively assess the upper limb motion function, based on compressed sensing technology. With the sparse representation model, less data is transmitted to the computer than with traditional systems. The experimental results show that the accelerometer signals of Bobath handshake and shoulder touch exercises can be compressed, and the length of the compressed signal is less than 1/3 of the raw signal length. More importantly, the reconstruction errors have no influence on the predictive accuracy of the Brunnstrom stage classification model. It also indicated that the proposed system can not only reduce the amount of data during the sampling and transmission processes, but also, the reconstructed accelerometer signals can be used for quantitative assessment without any loss of useful information. PMID:26861337

  20. A Compressed Sensing-Based Wearable Sensor Network for Quantitative Assessment of Stroke Patients

    Directory of Open Access Journals (Sweden)

    Lei Yu

    2016-02-01

    Full Text Available Clinical rehabilitation assessment is an important part of the therapy process because it is the premise for prescribing suitable rehabilitation interventions. However, the commonly used assessment scales have the following two drawbacks: (1 they are susceptible to subjective factors; (2 they only have several rating levels and are influenced by a ceiling effect, making it impossible to exactly detect any further improvement in the movement. Meanwhile, energy constraints are a primary design consideration in wearable sensor network systems since they are often battery-operated. Traditionally, for wearable sensor network systems that follow the Shannon/Nyquist sampling theorem, there are many data that need to be sampled and transmitted. This paper proposes a novel wearable sensor network system to monitor and quantitatively assess the upper limb motion function, based on compressed sensing technology. With the sparse representation model, less data is transmitted to the computer than with traditional systems. The experimental results show that the accelerometer signals of Bobath handshake and shoulder touch exercises can be compressed, and the length of the compressed signal is less than 1/3 of the raw signal length. More importantly, the reconstruction errors have no influence on the predictive accuracy of the Brunnstrom stage classification model. It also indicated that the proposed system can not only reduce the amount of data during the sampling and transmission processes, but also, the reconstructed accelerometer signals can be used for quantitative assessment without any loss of useful information.

  1. Methods for network meta-analysis of continuous outcomes using individual patient data: a case study in acupuncture for chronic pain.

    Science.gov (United States)

    Saramago, Pedro; Woods, Beth; Weatherly, Helen; Manca, Andrea; Sculpher, Mark; Khan, Kamran; Vickers, Andrew J; MacPherson, Hugh

    2016-10-06

    Network meta-analysis methods, which are an extension of the standard pair-wise synthesis framework, allow for the simultaneous comparison of multiple interventions and consideration of the entire body of evidence in a single statistical model. There are well-established advantages to using individual patient data to perform network meta-analysis and methods for network meta-analysis of individual patient data have already been developed for dichotomous and time-to-event data. This paper describes appropriate methods for the network meta-analysis of individual patient data on continuous outcomes. This paper introduces and describes network meta-analysis of individual patient data models for continuous outcomes using the analysis of covariance framework. Comparisons are made between this approach and change score and final score only approaches, which are frequently used and have been proposed in the methodological literature. A motivating example on the effectiveness of acupuncture for chronic pain is used to demonstrate the methods. Individual patient data on 28 randomised controlled trials were synthesised. Consistency of endpoints across the evidence base was obtained through standardisation and mapping exercises. Individual patient data availability avoided the use of non-baseline-adjusted models, allowing instead for analysis of covariance models to be applied and thus improving the precision of treatment effect estimates while adjusting for baseline imbalance. The network meta-analysis of individual patient data using the analysis of covariance approach is advocated to be the most appropriate modelling approach for network meta-analysis of continuous outcomes, particularly in the presence of baseline imbalance. Further methods developments are required to address the challenge of analysing aggregate level data in the presence of baseline imbalance.

  2. Altered task-specific deactivation in the default mode network depends on valence in patients with major depressive disorder.

    Science.gov (United States)

    Zhang, Bin; Li, Shijia; Zhuo, Chuanjun; Li, Meng; Safron, Adam; Genz, Axel; Qin, Wen; Yu, Chunshui; Walter, Martin

    2017-01-01

    Major depressive disorder (MDD) is a highly prevalent psychiatric condition in which patients often have difficulties regulating their emotions. Prior studies have shown that attention bias towards negative emotion is linked to activation in regions of the default mode network (DMN) in MDD individuals. Furthermore, MDD patients showed increased resting-state functional connectivity (FC) between the medial prefrontal cortex and other DMN structures. Twenty-one MDD patients that currently experiencing depressive episodes and twenty-five healthy control participants performed the current emotional expectancy paradigm in a gradient-echo SENSE-SPIRAL fMRI. Whole brain and psycho-physiological interaction (PPI) analysis were applied to explore the task-related brain activity and FCs. Relative to healthy participants, we found MDD patients had greater activity in dorsal medial prefrontal cortex as a function of positive vs. neutral expectancy conditions. PPI results revealed a significant group difference of MDD patients having relatively decreased task-dependent decoupling from dorsal medial prefrontal cortex (DMPFC) towards posterior cingulate cortex (PCC) and parieto-occipital cortex during positive vs. neutral expectancy conditions, and patients exhibited a positive correlation between PPI (DMPFC and PCC) and anhedonia as measured via SHAPS during the same conditions. Modest sample size and lack of concurrent depressive episodes limit the generalizability of our findings. In MDD patients, insufficient DMN decoupling might occur in response to positive expectancy conditions. Our findings are consistent with the hypothesis that high intrinsic DMN connectivity in MDD patients interfere with the down-regulation of intrinsic focus in order to incorporate information derived from external positive events. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study.

    Science.gov (United States)

    Choi, Stephanie K Y; Boyle, Eleanor; Cairney, John; Gardner, Sandra; Collins, Evan J; Bacon, Jean; Rourke, Sean B

    2016-01-01

    Major depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada. We conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with administrative health databases in the province of Ontario, Canada. Current depression was assessed using the Center for Epidemiologic Depression Scale or the Kessler Psychological Distress Scale. Multivariable regressions were used to characterize prevalence outcomes. Of 990 HIV-positive patients with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low income or educational attainment, or as non-native English speakers or immigrants to Canada were less likely to obtain care. Of 493 patients using mental health services, 250 (51%) received mental health care for depression in accordance with existing Canadian guidelines. Our results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive patient needs and reduce depression's impact on their lives.

  4. Applying an artificial neural network model for developing a severity score for patients with hereditary amyloid polyneuropathy.

    Science.gov (United States)

    Novis, Shenia; Machado, Felipe; Costa, Victor B; Foguel, Debora; Cruz, Marcia W; de Seixas, José Manoel

    2017-09-01

    Hereditary (familial) amyloid polyneuropathy (FAP) is a systemic disease that includes a sensorimotor polyneuropathy related to transthyretin (TTR) mutations. So far, a scale designed to classify the severity of this disease has not yet been validated. This work proposes the implementation of an artificial neural network (ANN) in order to develop a severity scale for monitoring the disease progression in FAP patients. In order to achieve this goal, relevant symptoms and laboratory findings were collected from 98 Brazilian patients included in THAOS - the Transthyretin Amyloidosis Outcomes Survey. Ninety-three percent of them bore Val30Met, the most prevalent variant of TTR worldwide; 63 were symptomatic and 35 were asymptomatic. These data were numerically codified for the purpose of constructing a Self-Organizing Map (SOM), which maps data onto a grid of artificial neurons. Mapped data could be clustered by similarity into five groups, based on increasing FAP severity (from Groups 1 to 5). Most symptoms were virtually absent from patients who mapped to Group 1, which also includes the asymptomatic patients. Group 2 encompasses the patients bearing symptoms considered to be initial markers of FAP, such as first signs of walking disabilities and lack of sensitivity to temperature and pain. Interestingly, the patients with cardiac symptoms, which also carry cardiac-associated mutations of the TTR gene (such as Val112Ile and Ala19Asp), were concentrated in Group 3. Symptoms such as urinary and fecal incontinence and diarrhea characterized particularly Groups 4 and 5. Renal impairment was found almost exclusively in Group 5. Model validation was accomplished by considering the symptoms from a sample with 48 additional Brazilian patients. The severity scores proposed here not only identify the current stage of a patient's disease but also offer to the physician an easy-to-read, 2D map that makes it possible to track disease progression.

  5. Comparative Efficacy and Safety of Antihypertensive Agents for Adult Diabetic Patients with Microalbuminuric Kidney Disease: A Network Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Rongzhong Huang

    Full Text Available Antihypertensive treatment mitigates the progression of chronic kidney disease. Here, we comparatively assessed the effects of antihypertensive agents in normotensive and hypertensive diabetic patients with microalbuminuric kidney disease.MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs comparing oral antihypertensive agents in adult diabetic patients with microalbuminuria. The primary efficacy outcome was reduction in albuminuria, and the primary safety outcomes were dry cough, presyncope, and edema. Random-effects pairwise and Bayesian network meta-analyses were performed to produce outcome estimates for all RCTs, only hypertensive RCTs, or only normotensive RCTs. Surface under the cumulative ranking (SUCRA probability rankings were calculated for all outcomes. Sensitivity analyses on type 2 diabetes status, age, or follow-up duration were also performed.A total of 38 RCTs were included in the meta-analyses. The angiotensin-converting enzyme inhibitor-calcium channel blocker (ACEI-CCB combination therapy of captopril+diltiazem was most efficacious in reducing albuminuria irrespective of blood pressure status. However, the ACEI-angiotensin receptor blocker (ACEI-ARB combination therapy of trandolapril+candesartan was the most efficacious in reducing albuminuria for normotensive patients, while the ACEI-CCB combination therapy of fosinopril+amlodipine was the most efficacious in reducing albuminuria for hypertensive patients. The foregoing combination therapies displayed inferior safety profiles relative to ACEI monotherapy with respect to dry cough, presyncope, and edema. With respect to type 2 diabetic patients with microalbuminuria, the Chinese herbal medicine Tangshen formula followed by the ACEI ramipril were the most efficacious in reducing albuminuria.Trandolapril+candesartan appears to be the most efficacious intervention for reducing albuminuria

  6. Fatigue in Patients with Chronic Hepatitis B Living in North America: Results from the Hepatitis B Research Network (HBRN).

    Science.gov (United States)

    Evon, Donna M; Wahed, Abdus S; Johnson, Geoffrey; Khalili, Mandana; Lisker-Melman, Mauricio; Fontana, Robert J; Sarkar, Souvik; Reeve, Bryce B; Hoofnagle, Jay H

    2016-04-01

    Fatigue is a common symptom of liver disease but not well characterized in patients with chronic hepatitis B virus (HBV). We assessed the rate of fatigue using a validated instrument in patients with HBV and identified demographic, virologic, and clinical features associated with fatigue in a cross-sectional cohort study from the Hepatitis B Research Network. Participants were English- and Spanish-speaking adults with chronic HBV who were not pregnant nor on treatment. Fatigue was measured using the PROMIS® Fatigue 7-item Short Form. The sample included 948 adults: median age 42; 51 % female; 71 % Asian; 74 % college educated; 77 % employed; 41 % inactive HBV carriers; 36 % with active chronic disease; and 2 % with advanced fibrosis, defined as AST-platelet ratio index (APRI) > 1.50. Patients with chronic HBV had a mean fatigue T-score of 46.8 ± SD = 7.9, compared to a mean fatigue T-score of 50.0 ± 10 in the US general population (p fatigue was associated with demographic and clinical features such as female sex, lower income, more comorbidities, higher APRI score, and poorer mental health (p fatigue in this large cohort of North American chronic HBV patients may be equal to or lower than that reported in the US general population. Patients with advanced fibrosis, more comorbidities, and poorer mental health report worse fatigue.

  7. microRNA Expression in Sentinel Nodes from Progressing Melanoma Patients Identifies Networks Associated with Dysfunctional Immune Response

    Directory of Open Access Journals (Sweden)

    Viviana Vallacchi

    2016-12-01

    Full Text Available Sentinel node biopsy (SNB is a main staging biomarker in melanoma and is the first lymph node to drain the tumor, thus representing the immunological site where anti-tumor immune dysfunction is established and where potential prognostic immune markers can be identified. Here we analyzed microRNA (miR profiles in archival tumor-positive SNBs derived from melanoma patients with different outcomes and performed an integrated analysis of transcriptional data to identify deregulated immune signaling networks. Twenty-six miRs were differentially expressed in melanoma-positive SNB samples between patients with disease progression and non-progressing patients, the majority being previously reported in the regulation of immune responses. A significant variation in miR expression levels was confirmed in an independent set of SNB samples. Integrated information from genome-wide transcriptional profiles and in vitro assessment in immune cells led to the identification of miRs associated with the regulation of the TNF receptor superfamily member 8 (TNFRSF8 gene encoding the CD30 receptor, a marker increased in lymphocytes of melanoma patients with progressive disease. These findings indicate that miRs are involved in the regulation of pathways leading to immune dysfunction in the sentinel node and may provide valuable markers for developing prognostic molecular signatures for the identification of stage III melanoma patients at risk of recurrence.

  8. Disease-free survival after hepatic resection in hepatocellular carcinoma patients: a prediction approach using artificial neural network.

    Directory of Open Access Journals (Sweden)

    Wen-Hsien Ho

    Full Text Available BACKGROUND: A database for hepatocellular carcinoma (HCC patients who had received hepatic resection was used to develop prediction models for 1-, 3- and 5-year disease-free survival based on a set of clinical parameters for this patient group. METHODS: The three prediction models included an artificial neural network (ANN model, a logistic regression (LR model, and a decision tree (DT model. Data for 427, 354 and 297 HCC patients with histories of 1-, 3- and 5-year disease-free survival after hepatic resection, respectively, were extracted from the HCC patient database. From each of the three groups, 80% of the cases (342, 283 and 238 cases of 1-, 3- and 5-year disease-free survival, respectively were selected to provide training data for the prediction models. The remaining 20% of cases in each group (85, 71 and 59 cases in the three respective groups were assigned to validation groups for performance comparisons of the three models. Area under receiver operating characteristics curve (AUROC was used as the performance index for evaluating the three models. CONCLUSIONS: The ANN model outperformed the LR and DT models in terms of prediction accuracy. This study demonstrated the feasibility of using ANNs in medical decision support systems for predicting disease-free survival based on clinical databases in HCC patients who have received hepatic resection.

  9. Use of an Artificial Neural Network to Construct a Model of Predicting Deep Fungal Infection in Lung Cancer Patients.

    Science.gov (United States)

    Chen, Jian; Chen, Jie; Ding, Hong-Yan; Pan, Qin-Shi; Hong, Wan-Dong; Xu, Gang; Yu, Fang-You; Wang, Yu-Min

    2015-01-01

    The statistical methods to analyze and predict the related dangerous factors of deep fungal infection in lung cancer patients were several, such as logic regression analysis, meta-analysis, multivariate Cox proportional hazards model analysis, retrospective analysis, and so on, but the results are inconsistent. A total of 696 patients with lung cancer were enrolled. The factors were compared employing Student's t-test or the Mann-Whitney test or the Chi-square test and variables that were significantly related to the presence of deep fungal infection selected as candidates for input into the final artificial neural network analysis (ANN) model. The receiver operating characteristic (ROC) and area under curve (AUC) were used to evaluate the performance of the artificial neural network (ANN) model and logistic regression (LR) model. The prevalence of deep fungal infection from lung cancer in this entire study population was 32.04%(223/696), deep fungal infections occur in sputum specimens 44.05% (200/454). The ratio of candida albicans was 86.99% (194/223) in the total fungi. It was demonstrated that older (≥65 years), use of antibiotics, low serum albumin concentrations (≤37.18 g /L), radiotherapy, surgery, low hemoglobin hyperlipidemia (≤93.67 g /L), long time of hospitalization (≥14 days) were apt to deep fungal infection and the ANN model consisted of the seven factors. The AUC of ANN model (0.829±0.019) was higher than that of LR model (0.756±0.021). The artificial neural network model with variables consisting of age, use of antibiotics, serum albumin concentrations, received radiotherapy, received surgery, hemoglobin, time of hospitalization should be useful for predicting the deep fungal infection in lung cancer.

  10. Use of an artificial neural network to predict risk factors of nosocomial infection in lung cancer patients.

    Science.gov (United States)

    Chen, Jie; Pan, Qin-Shi; Hong, Wan-Dong; Pan, Jingye; Zhang, Wen-Hui; Xu, Gang; Wang, Yu-Min

    2014-01-01

    Statistical methods to analyze and predict the related risk factors of nosocomial infection in lung cancer patients are various, but the results are inconsistent. A total of 609 patients with lung cancer were enrolled to allow factor comparison using Student's t-test or the Mann-Whitney test or the Chi-square test. Variables that were significantly related to the presence of nosocomial infection were selected as candidates for input into the final ANN model. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the performance of the artificial neural network (ANN) model and logistic regression (LR) model. The prevalence of nosocomial infection from lung cancer in this entire study population was 20.1% (165/609), nosocomial infections occurring in sputum specimens (85.5%), followed by blood (6.73%), urine (6.0%) and pleural effusions (1.82%). It was shown that long term hospitalization (≥ 22 days, P= 0.000), poor clinical stage (IIIb and IV stage, P=0.002), older age (≥ 61 year old, P=0.023), and use the hormones were linked to nosocomial infection and the ANN model consisted of these four factors .The artificial neural network model with variables consisting of age, clinical stage, time of hospitalization, and use of hormones should be useful for predicting nosocomial infection in lung cancer cases.

  11. Negative mood influences default mode network functional connectivity in patients with chronic low back pain: implications for functional neuroimaging biomarkers.

    Science.gov (United States)

    Letzen, Janelle E; Robinson, Michael E

    2017-01-01

    The default mode network (DMN) has been proposed as a biomarker for several chronic pain conditions. Default mode network functional connectivity (FC) is typically examined during resting-state functional neuroimaging, in which participants are instructed to let thoughts wander. However, factors at the time of data collection (eg, negative mood) that might systematically impact pain perception and its brain activity, influencing the application of the DMN as a pain biomarker, are rarely reported. This study measured whether positive and negative moods altered DMN FC patterns in patients with chronic low back pain (CLBP), specifically focusing on negative mood because of its clinical relevance. Thirty-three participants (CLBP = 17) underwent resting-state functional magnetic resonance imaging scanning before and after sad and happy mood inductions, and rated levels of mood and pain intensity at the time of scanning. Two-way repeated-measures analysis of variances were conducted on resting-state functional connectivity data. Significant group (CLBP > healthy controls) × condition (sadness > baseline) interaction effects were identified in clusters spanning parietal operculum/postcentral gyrus, insular cortices, anterior cingulate cortex, frontal pole, and a portion of the cerebellum (PFDR baseline (PFDR negative mood in individuals with and without CLBP. It is possible that DMN FC seen in patients with chronic pain is related to an affective dimension of pain, which is important to consider in future neuroimaging biomarker development and implementation.

  12. Examination of the association of sex and race/ethnicity with appearance concerns: A Scleroderma Patient-centered Intervention Network (SPIN) cohort study

    NARCIS (Netherlands)

    Jewett, L.R.; Kwakkenbos, C.M.C.; Carrier, M.E.; Malcarne, V.L.; Bartlett, S.J.; Furst, D.E.; Gottesman, K.; Mayes, M.D.; Assassi, S.; Harcourt, D.; Williamson, H.; Johnson, S.R.; Körner, A.; Steen, V.; Fox, R.S.; Gholizadeh, S.; Mills, S.D.; Molnar, J.C.; Rice, D.B.; Thombs, B.D.

    2016-01-01

    OBJECTIVES: Appearance concerns are common in systemic sclerosis (SSc) and have been linked to younger age and more severe disease. No study has examined their association with sex or race/ethnicity. METHODS: SSc patients were sampled from the Scleroderma Patient-centered Intervention Network

  13. The impact of a social network based intervention on self-management behaviours among patients with type 2 diabetes living in socioeconomically deprived neighbourhoods: a mixed methods approach

    NARCIS (Netherlands)

    Vissenberg, Charlotte; Nierkens, Vera; van Valkengoed, Irene; Nijpels, Giel; Uitewaal, Paul; Middelkoop, Barend; Stronks, Karien

    2017-01-01

    Aims: This paper aims to explore the effect of the social network based intervention Powerful Together with Diabetes on diabetes self-management among socioeconomically deprived patients. This 10-month group intervention targeting patients and significant others aimed to improve self-management by

  14. Altered eigenvector centrality is related to local resting-state network functional connectivity in patients with longstanding type 1 diabetes mellitus.

    Science.gov (United States)

    van Duinkerken, Eelco; Schoonheim, Menno M; IJzerman, Richard G; Moll, Annette C; Landeira-Fernandez, Jesus; Klein, Martin; Diamant, Michaela; Snoek, Frank J; Barkhof, Frederik; Wink, Alle-Meije

    2017-04-21

    Longstanding type 1 diabetes (T1DM) is associated with microangiopathy and poorer cognition. In the brain, T1DM is related to increased functional resting-state network (RSN) connectivity in patients without, which was decreased in patients with clinically evident microangiopathy. Subcortical structure seems affected in both patient groups. How these localized alterations affect the hierarchy of the functional network in T1DM is unknown. Eigenvector centrality mapping (ECM) and degree centrality are graph theoretical methods that allow determining the relative importance (ECM) and connectedness (degree centrality) of regions within the whole-brain network hierarchy. Therefore, ECM and degree centrality of resting-state functional MRI-scans were compared between 51 patients with, 53 patients without proliferative retinopathy, and 49 controls, and associated with RSN connectivity, subcortical gray matter volume, and cognition. In all patients versus controls, ECM and degree centrality were lower in the bilateral thalamus and the dorsal striatum, with lowest values in patients without proliferative retinopathy (PFWE  centrality were related to altered visual, sensorimotor, and auditory and language RSN connectivity (PFWE   0.05). The findings suggested reorganization of the hierarchy of the cortical connectivity network in patients without proliferative retinopathy, which is lost with disease progression. Centrality seems sensitive to capture early T1DM-related functional connectivity alterations, but not disease progression. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  15. Social media: opportunities for quality improvement and lessons for providers-a networked model for patient-centered care through digital engagement.

    Science.gov (United States)

    Bornkessel, Alexandra; Furberg, Robert; Lefebvre, R Craig

    2014-07-01

    Social media brings a new dimension to health care for patients, providers, and their support networks. Increasing evidence demonstrates that patients who are more actively involved in their healthcare experience have better health outcomes and incur lower costs. In the field of cardiology, social media are proposed as innovative tools for the education and update of clinicians, physicians, nurses, and medical students. This article reviews the use of social media by healthcare providers and patients and proposes a model of "networked care" that integrates the use of digital social networks and platforms by both patients and providers and offers recommendations for providers to optimize their use and understanding of social media for quality improvement.

  16. The alliance between genetic biobanks and patient organisations: the experience of the telethon network of genetic biobanks

    Directory of Open Access Journals (Sweden)

    Chiara Baldo

    2016-10-01

    Full Text Available Abstract Background Rare diseases (RDs are often neglected because they affect a small percentage of the population (6–8 %, which makes research and development of new therapies challenging processes. Easy access to high-quality samples and associated clinical data is therefore a key prerequisite for biomedical research. In this context, Genetic Biobanks are critical to developing basic, translational and clinical research on RDs. The Telethon Network of Genetic Biobanks (TNGB is aware of the importance of biobanking as a service for patients and has started a dialogue with RD-Patient Organisations via promotion of dedicated meetings and round-tables, as well as by including their representatives on the TNGB Advisory Board. This has enabled the active involvement of POs in drafting biobank policies and procedures, including those concerning ethical issues. Here, we report on our experience with RD-Patient Organisations who have requested the services of existing biobanks belonging to TNGB and describe how these relationships were established, formalised and maintained. Results The process of patient engagement has proven to be successful both for lay members, who increased their understanding of the complex processes of biobanking, and for professionals, who gained awareness of the needs and expectations of the people involved. This collaboration has resulted in a real interest on the part of Patient Organisations in the biobanking service, which has led to 13 written agreements designed to formalise this process. These agreements enabled the centralisation of rare genetic disease biospecimens and their related data, thus making them available to the scientific community. Conclusions The TNGB experience has proven to be an example of good practice with regard to patient engagement in biobanking and may serve as a model of collaboration between disease-oriented Biobanks and Patient Organisations. Such collaboration serves to enhance awareness

  17. A Simple Network to Remove Interference in Surface EMG Signal from Single Gene Affected Phenylketonuria Patients for Proper Diagnosis

    Science.gov (United States)

    Mohanty, Madhusmita; Basu, Mousumi; Pattanayak, Deba Narayan; Mohapatra, Sumant Kumar

    2018-01-01

    Recently Autosomal Recessive Single Gene (ARSG) diseases are highly effective to the children within the age of 5-10 years. One of the most ARSG disease is a Phenylketonuria (PKU). This single gene disease is associated with mutations in the gene that encodes the enzyme phenylalanine hydroxylase (PAH, Gene 612349). Through this mutation process, PAH of the gene affected patient can not properly manufacture PAH as a result the patients suffer from decreased muscle tone which shows abnormality in EMG signal. Here the extraction of the quality of the PKU affected EMG (PKU-EMG) signal is a keen interest, so it is highly necessary to remove the added ECG signal as well as the biological and instrumental noises. In the Present paper we proposed a method for detection and classification of the PKU affected EMG signal. Here Discrete Wavelet Transformation is implemented for extraction of the features of the PKU affected EMG signal. Adaptive Neuro-Fuzzy Inference System (ANFIS) network is used for the classification of the signal. Modified Particle Swarm Optimization (MPSO) and Modified Genetic Algorithm (MGA) are used to train the ANFIS network. Simulation result shows that the proposed method gives better performance as compared to existing approaches. Also it gives better accuracy of 98.02% for the detection of PKU-EMG signal. The advantages of the proposed model is to use MGA and MPSO to train the parameters of ANFIS network for classification of ECG and EMG signal of PKU affected patients. The proposed method obtained the high SNR (18.13 ± 0.36 dB), SNR (0.52 ± 1.62 dB), RE (0.02 ± 0.32), MSE (0.64 ± 2.01), CC (0.99 ± 0.02), RMSE (0.75 ± 0.35) and MFRE (0.01 ± 0.02), RMSE (0.75 ± 0.35) and MFRE (0.01 ± 0.02). From authors knowledge, this is the first time a composite method is used for diagnosis of PKU affected patients. The accuracy (98.02%), sensitivity (100%) and specificity (98.59%) helps for proper clinical treatment. It can help for readers

  18. Impacts of social networking sites on patient care in the emergency department.

    Science.gov (United States)

    Bennett, Anne; Pourmand, Ali; Shokoohi, Hamid; Shesser, Robert; Sanchez, Jesus; Joyce, Joseph

    2014-01-01

    The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a "hot topic" in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her to the emergency department. The girl's statements and photographs, as reported by her parents, were used by an emergency physician to make a diagnosis of suicidal risk and to disposition of the patient to an inpatient psychiatric ward. We discuss the potential diagnostic utility of information posted on Facebook and briefly discuss the ethical questions surrounding this situation.

  19. The National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study Cohort: Rationale, Methods, and Baseline Characteristics.

    Science.gov (United States)

    Toh, Sengwee; Rasmussen-Torvik, Laura J; Harmata, Emily E; Pardee, Roy; Saizan, Rosalinde; Malanga, Elisha; Sturtevant, Jessica L; Horgan, Casie E; Anau, Jane; Janning, Cheri D; Wellman, Robert D; Coley, R Yates; Cook, Andrea J; Courcoulas, Anita P; Coleman, Karen J; Williams, Neely A; McTigue, Kathleen M; Arterburn, David; McClay, James

    2017-12-05

    Although bariatric procedures are commonly performed in clinical practice, long-term data on the comparative effectiveness and safety of different procedures on sustained weight loss, comorbidities, and adverse effects are limited, especially in important patient subgroups (eg, individuals with diabetes, older patients, adolescents, and minority patients). The objective of this study was to create a population-based cohort of patients who underwent 3 commonly performed bariatric procedures-adjustable gastric band (AGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG)-to examine the long-term comparative effectiveness and safety of these procedures in both adults and adolescents. We identified adults (20 to 79 years old) and adolescents (12 to 19 years old) who underwent a primary (first observed) AGB, RYGB, or SG procedure between January 1, 2005 and September 30, 2015 from 42 health systems participating in the Clinical Data Research Networks within the National Patient-Centered Clinical Research Network (PCORnet). We extracted information on patient demographics, encounters with healthcare providers, diagnoses recorded and procedures performed during these encounters, vital signs, and laboratory test results from patients' electronic health records (EHRs). The outcomes of interest included weight change, incidence of major surgery-related adverse events, and diabetes remission and relapse, collected for up to 10 years after the initial bariatric procedure. A total of 65,093 adults and 777 adolescents met the eligibility criteria of the study. The adult subcohort had a mean age of 45 years and was predominantly female (79.30%, 51,619/65,093). Among adult patients with non-missing race or ethnicity information, 72.08% (41,248/57,227) were White, 21.13% (12,094/57,227) were Black, and 20.58% (13,094/63,637) were Hispanic. The average highest body mass index (BMI) recorded in the year prior to surgery was 49 kg/m2. RYGB was the most common bariatric

  20. SentiHealth-Cancer: A sentiment analysis tool to help detecting mood of patients in online social networks.

    Science.gov (United States)

    Rodrigues, Ramon Gouveia; das Dores, Rafael Marques; Camilo-Junior, Celso G; Rosa, Thierson Couto

    2016-01-01

    Cancer is a critical disease that affects millions of people and families around the world. In 2012 about 14.1 million new cases of cancer occurred globally. Because of many reasons like the severity of some cases, the side effects of some treatments and death of other patients, cancer patients tend to be affected by serious emotional disorders, like depression, for instance. Thus, monitoring the mood of the patients is an important part of their treatment. Many cancer patients are users of online social networks and many of them take part in cancer virtual communities where they exchange messages commenting about their treatment or giving support to other patients in the community. Most of these communities are of public access and thus are useful sources of information about the mood of patients. Based on that, Sentiment Analysis methods can be useful to automatically detect positive or negative mood of cancer patients by analyzing their messages in these online communities. The objective of this work is to present a Sentiment Analysis tool, named SentiHealth-Cancer (SHC-pt), that improves the detection of emotional state of patients in Brazilian online cancer communities, by inspecting their posts written in Portuguese language. The SHC-pt is a sentiment analysis tool which is tailored specifically to detect positive, negative or neutral messages of patients in online communities of cancer patients. We conducted a comparative study of the proposed method with a set of general-purpose sentiment analysis tools adapted to this context. Different collections of posts were obtained from two cancer communities in Facebook. Additionally, the posts were analyzed by sentiment analysis tools that support the Portuguese language (Semantria and SentiStrength) and by the tool SHC-pt, developed based on the method proposed in this paper called SentiHealth. Moreover, as a second alternative to analyze the texts in Portuguese, the collected texts were automatically translated

  1. Characteristics of cancer patients presenting to an integrative medicine practice-based research network.

    Science.gov (United States)

    Edman, Joel S; Roberts, Rhonda S; Dusek, Jeffery A; Dolor, Rowena; Wolever, Ruth Q; Abrams, Donald I

    2014-09-01

    To assess psychosocial characteristics, symptoms and reasons for seeking integrative medicine (IM) care in cancer patients presenting to IM clinical practices. A survey of 3940 patients was conducted at 8 IM sites. Patient reported outcome measures were collected and clinicians provided health status data. This analysis compares 353 participants self-identified as cancer patients with the larger noncancer cohort. Mean age of the cancer cohort was 55.0 years. Participants were predominantly white (85.9%), female (76.4%), and well educated (80.5% completed college). For 15.2% of cancer patients, depression scores were consistent with depressive symptoms, and average scores for perceived stress were higher than normal, but neither were significantly different from noncancer patients. The most prevalent comorbid symptoms were chronic pain (39.8%), fatigue (33.5%), and insomnia (23.3%). In the cancer cohort, perceived stress was significantly associated with depression, fatigue, insomnia, pain, and QOL. Cancer patients who chose an IM clinical practice "seeking healthcare settings that address spirituality as an aspect of care" had significantly higher levels of perceived stress, depression, and pain than those not selecting this reason. Demographic characteristics, depression scores, perceived stress scores, and reasons for seeking integrative cancer care were not significantly different between cancer patients and noncancer patients. Perceived stress may be an important indicator of QOL. The association of perceived stress, depression and pain with seeking spirituality suggests that providing IM interventions, such as effective stress management techniques and pastoral or spiritual counseling, may be helpful to patients living with cancer. © The Author(s) 2014.

  2. Identifying clinical and support-service resources and network practices for cancer patients and survivors in southern Puerto Rico

    Science.gov (United States)

    Castro, Eida M.; Jiménez, Julio C.; Quinn, Gwendolyn; García, Myra; Colón, Yesenia; Ramos, Axel; Brandon, Thomas; Simmons, Vani; Gwede, Clement; Vadaparampil, Susan; Nazario, Cruz María

    2015-01-01

    Objective The objectives of this study were to identify cancer-related health care services and to explore the presence of inter-organizational interactions among clinical and support oncology services in southern Puerto Rico. Methods From January through July of 2010, a survey was completed by 54 health care organizations offering clinical, supportive, or both services to cancer patients/survivors (CPS) in southern PR. Survey data were compiled and descriptive analyses performed using the software Statistical Package for a Social Science (SPSS), version 18.0. Results The distribution of the primary services provided by the participating organizations was the following: 26 had clinical services, 16 had support services, and 12 offered a combination of clinical and support services. Only 24% of the surveyed organizations offered their services exclusively to patients diagnosed with cancer. In terms of referral practices, 61% of the responses were for medical specialists, 43% were for mental health services, and 37% were referrals for primary care services. The most common reason for interacting (n = 27) was to provide a given patient both an referral and information. Conclusion Findings suggest gaps in both the availability of oncology services and the delivery of integrated health care. Lack of communication among clinical and support organizations (for cancer patients, specifically) could negatively impact the quality of the services that they offer. Further network analysis studies are needed to confirm these gaps. Until systemic, structural changes occur, more efforts are needed to facilitate communication and collaboration among these kinds of organization. PMID:25249352

  3. Assessment of the impact of adjunctive proactive telephone counseling to promote smoking cessation among lung cancer patients' social networks.

    Science.gov (United States)

    Bastian, Lori A; Fish, Laura J; Peterson, Bercedis L; Biddle, Andrea K; Garst, Jennifer; Lyna, Pauline; Molner, Stephanie; Bepler, Gerold; Kelley, Mike; Keefe, Francis J; McBride, Colleen M

    2013-01-01

    When a patient is diagnosed with lung cancer, members of his/her social network may be more likely to engage in smoking cessation efforts. Proactive telephone counseling combined with a tailored self-directed intervention may be more effective at promoting smoking cessation than a tailored self-directed intervention alone. Randomized controlled trial. Four clinical sites. Current smokers who are family members and close friends of patients with lung cancer. Six counselor-initiated counseling calls using motivational interviewing techniques and focusing on teaching adaptive coping skills based on the transactional model of stress and coping along with tailored self-directed materials (including nicotine patches, if not contraindicated) (n  =  245) vs. tailored self-directed materials (including nicotine patches, if not contraindicated) (n  =  251). Participants were surveyed at baseline and at 2 weeks, 6 months, and 12 months postintervention. The outcome was 7-day point prevalent abstinence. The objective of this study was to test for arm differences in smoking cessation rates at 2 weeks and 6 months postintervention (primary) and at 12 months postintervention (secondary). We found no overall effect of the proactive intervention on cessation rates. Among younger participants (age 50), there were no group differences. Proactive telephone counseling focusing on adaptive coping skills was difficult to implement among smokers in lung cancer patients' social network. Although this study did not demonstrate any added benefit to cessation rates, this null finding may be a result of an intervention that was weaker than intended, owing to difficulties in completing the counseling phone calls. We discuss lessons learned and areas for future research in this special population.

  4. Defective support network: a major obstacle to coping for patients with heart failure: a qualitative study

    Directory of Open Access Journals (Sweden)

    Parvin Mangolian Shahrbabaki

    2016-04-01

    Full Text Available Background: Heart failure as a chronic disease poses many challenges for a patient in his or her everyday life. Support in various aspects of life positively affects coping strategies and influences the well-being and health outcomes of heart failure patients. Inadequate support may lead to a worsening of symptoms, increased hospital readmissions, psychological disorders, and a reduced quality of life. Objective: This study explored obstacles to coping related to support for heart failure patients as viewed by the patients themselves and their family members and caregivers. Design: This qualitative study was conducted using content analysis. The 20 Iranian participants included 11 patients with heart failure, three cardiologists, three nurses, and three family members of heart failure patients selected through purposive sampling. Data were collected through semi-structured interviews and analyzed using the Lundman and Graneheim qualitative content analysis method. Results: During data analysis, ‘defective support network’ developed as the main theme along with four other categories of ‘inadequate family performance’, ‘inadequate support by the healthcare team’, ‘distorted societal social support’, and ‘inadequate welfare support’. Conclusion: The findings of the current study can assist health authorities and planners in identifying the needs of patients with heart failure so as to focus and plan on facilitating their coping as much as possible by obviating the existing obstacles.

  5. Steering patients to safer hospitals? The effect of a tiered hospital network on hospital admissions.

    Science.gov (United States)

    Scanlon, Dennis P; Lindrooth, Richard C; Christianson, Jon B

    2008-10-01

    To determine if a tiered hospital benefit and safety incentive shifted the distribution of admissions toward safer hospitals. A large manufacturing company instituted the hospital safety incentive (HSI) for union employees. The HSI gave union patients a financial incentive to choose hospitals that met the Leapfrog Group's three patient safety "leaps." The analysis merges data from four sources: claims and enrollment data from the company, the American Hospital Association, the AHRQ HCUP-SID, and a state Office of the Insurance Commissioner. Changes in hospital admissions' patterns for union and nonunion employees using a difference-in-difference design. We estimate the probability of choosing a specific hospital from a set of available alternatives using conditional logistic regression. Patients affiliated with the engineers' union and admitted for a medical diagnosis were 2.92 times more likely to select a hospital designated as safer in the postperiod than in the preperiod, while salaried nonunion (SNU) patients (not subject to the financial incentive) were 0.64 times as likely to choose a compliant hospital in the post- versus preperiod. The difference-in-difference estimate, which is based on the predictions of the conditional logit model, is 0.20. However, the machinists' union was also exposed to the incentive and they were no more likely to choose a safer hospital than the SNU patients. The incentive did not have an effect on patients admitted for a surgical diagnosis, regardless of union status. All patients were averse to travel time, but those union patients selecting an incentive hospital were less averse to travel time. Patient price incentives and quality/safety information may influence hospital selection decisions, particularly for medical admissions, though the optimal incentive level for financial return to the plan sponsor is not clear.

  6. Investigating the BOLD spectral power of the intrinsic connectivity networks in fibromyalgia patients: A resting-state fMRI study.

    Science.gov (United States)

    Jarrahi, Behnaz; Martucci, Katherine T; Nilakantan, Aneesha S; Mackey, Sean

    2017-07-01

    Recent advances in multivariate statistical analysis of blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) have provided novel insights into the network organization of the human brain. Here, we applied group independent component analysis, a well-established approach for detecting brain intrinsic connectivity networks, to examine the spontaneous BOLD fluctuations in patients with fibromyalgia and healthy controls before and after exposure to a stressor. The BOLD spectral power characteristics of component time courses were calculated using the fast Fourier transform (FFT) algorithm, and group comparison was performed at six frequency bins between 0 and 0.24 Hz at 0.04 Hz intervals. Relative to controls, patients with fibromyalgia displayed significant BOLD spectral power differences in the default-mode, salience, and subcortical networks at the baseline level (PBon ferroni-corrected MANCOVA) further revealed significant effects of the cold water temperature, and pain rating on the spectral power of the sensorimotor, salience, and prefrontal networks, while the diagnosis of fibromyalgia influenced the BOLD spectral power of the salience and subcortical networks (PFDR-corrected <; 0.05). Since the BOLD spectral power reflects the degree of fluctuations within a network, future studies of the correlation between BOLD spectral power and pain processing can cast additional light on the nature of the central nervous system dysfunction in patients with chronic pain syndromes.

  7. The pooling of manpower and resources through the establishment of European reference networks and rare disease patient registries is a necessary area of collaboration for rare renal disorders.

    Science.gov (United States)

    Parker, Samantha

    2014-09-01

    This review aims to provide guidance on emerging concepts and policy related to European reference networks (ERNs) for rare diseases (RDs) and the development and management of RD patient registries. A major problem facing many RDs including rare renal disorders is that patients do not have a specialist centre that they can attend where clinicians, working as a multidisciplinary team, are experts in the particular disease. Furthermore, for most RDs, no single centre, and in many cases no single country, has sufficient numbers of patients and resources to fully understand the natural history or to conduct clinical and translational research. Therefore, the pooling of manpower and resources through the establishment of ERN and RD patient registries is a common and necessary area of collaboration. The concept of European networks for RDs dates back to the early 2000s and the Commission launch of a call for European pilot reference networks for RDs. These networks of expert centres have been brought together through the desire for further knowledge and innovation in RD areas. Networks demand a holistic approach and long-term vision with close collaboration between clinicians, diagnostic laboratories, scientists, patients and their families. The development of legal measures for ERNs is in progress at the Commission and these networks will be a shared responsibility of the Commission and member states. In the context of ERNs, an essential activity is the patient registries. Patient registries are organized databases where patient information, including demographic, medical and family history, are collected, stored and available for retrieval via standardized and secure methods. Patient registries are increasingly recognized as crucial tools for RD research for which international collaboration is absolutely essential to understand the pathogenesis of rare genotypes, achieve a unified collection of phenotypic data, foster natural history studies providing the foundation

  8. Literacy analysis of National Comprehensive Cancer Network patient guidelines for the most common malignancies in the United States.

    Science.gov (United States)

    Tran, Bao Ngoc N; Ruan, Qing Z; Epstein, Sherise; Ricci, Joseph A; Rudd, Rima E; Lee, Bernard T

    2017-11-27

    Cancer information is of critical interest to the public. The National Comprehensive Cancer Network (NCCN) offers a series of comprehensive patient guidelines on the management of the most common cancer diagnoses. This study was aimed at assessing the health literacy demands of NCCN patient guidelines for the most common malignancies in the United States. The American Cancer Society's most common malignancies by annual incidence in the United States and their corresponding NCCN patient guidelines were identified. Four validated tools were used to evaluate literacy levels: 1) the Simple Measure of Gobbledygook, 2) the Peter Mosenthal and Irwin Kirsch readability formula (PMOSE/IKIRSCH), 3) the Patient Education Materials Assessment Tool (PEMAT), and 4) the Clear Communication Index from the Centers for Disease Control and Prevention (CDC). The average reading grade level was 10.3, which was higher than the recommended 6th-grade level. The average PMOSE/IKIRSCH score was 11; this corresponded to moderate complexity and required some college-level education for interpretation. Only 1 tool, the PEMAT, yielded scores above the benchmarks for high-quality materials. The PEMAT's understandability, actionability, and overall scores were 94%, 83%, and 91%, respectively. The average CDC index was 85%, which was below the recommended 90% for an appropriate health literacy demand. Overall, the assessment indicates high demand scores for the readability and complexity of the NCCN patient guidelines and thus that the materials are not quite suitable for the general US adult population. Further input from patient focus groups to address appropriateness and usefulness is critical. Cancer 2017. © 2017 American Cancer Society. © 2017 American Cancer Society.

  9. Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM.

    Directory of Open Access Journals (Sweden)

    Katarzyna Ciach

    Full Text Available To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients.Case control national study.Polish Center of the European Competence Network on Mastocytosis (ECNM.23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant.Prospective analysis outcomes of pregnancies and deliveries.Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast, Hospital Virgen del Valle, Toledo, Red Espańola de Mastocitosis (REMA, Spain.All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies. Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%. None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during

  10. Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM)

    Science.gov (United States)

    Pabin, Izabela; Adamski, Przemyslaw; Leszczynska, Katarzyna; Preis, Krzysztof; Olszewska, Hanna; Wydra, Dariusz G.; Hansdorfer-Korzon, Rita

    2016-01-01

    Objective To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. Design Case control national study. Setting Polish Center of the European Competence Network on Mastocytosis (ECNM). Population or Sample 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999–2014, before becoming pregnant. Methods Prospective analysis outcomes of pregnancies and deliveries. Main Outcome Measures Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espańola de Mastocitosis (REMA), Spain. Results All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients

  11. Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM).

    Science.gov (United States)

    Ciach, Katarzyna; Niedoszytko, Marek; Abacjew-Chmylko, Anna; Pabin, Izabela; Adamski, Przemyslaw; Leszczynska, Katarzyna; Preis, Krzysztof; Olszewska, Hanna; Wydra, Dariusz G; Hansdorfer-Korzon, Rita

    2016-01-01

    To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. Case control national study. Polish Center of the European Competence Network on Mastocytosis (ECNM). 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant. Prospective analysis outcomes of pregnancies and deliveries. Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espańola de Mastocitosis (REMA), Spain. All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy

  12. Mining online social network data for biomedical research: a comparison of clinicians' and patients' perceptions about amyotrophic lateral sclerosis treatments.

    Science.gov (United States)

    Nakamura, Carlos; Bromberg, Mark; Bhargava, Shivani; Wicks, Paul; Zeng-Treitler, Qing

    2012-06-21

    While only one drug is known to slow the progress of amyotrophic lateral sclerosis (ALS), numerous drugs can be used to treat its symptoms. However, very few randomized controlled trials have assessed the efficacy, safety, and side effects of these drugs. Due to this lack of randomized controlled trials, consensus among clinicians on how to treat the wide range of ALS symptoms and the efficacy of these treatments is low. Given the lack of clinical trials data, the wide range of reported symptoms, and the low consensus among clinicians on how to treat those symptoms, data on the prevalence and efficacy of treatments from a patient's perspective could help advance the understanding of the symptomatic treatment of ALS. To compare clinicians' and patients' perspectives on the symptomatic treatment of ALS by comparing data from a traditional survey study of clinicians with data from a patient social network. We used a survey of clinicians' perceptions by Forshew and Bromberg as our primary data source and adjusted the data from PatientsLikeMe to allow for comparisons. We first extracted the 14 symptoms and associated top four treatments listed by Forshew and Bromberg. We then searched the PatientsLikeMe database for the same symptom-treatment pairs. The PatientsLikeMe data are structured and thus no preprocessing of the data was required. After we eliminated pairs with a small sample, 15 symptom-treatment pairs remained. All treatments identified as useful were prescription drugs. We found similarities and discrepancies between clinicians' and patients' perceptions of treatment prevalence and efficacy. In 7 of the 15 pairs, the differences between the two groups were above 10%. In 3 pairs the differences were above 20%. Lorazepam to treat anxiety and quinine to treat muscle cramps were among the symptom-treatment pairs with high concordance between clinicians' and patients' perceptions. Conversely, amitriptyline to treat labile emotional effect and oxybutynin to treat

  13. Orthodontic marketing through social media networks: the patient and practitioner's perspective.

    Science.gov (United States)

    Nelson, Kristin L; Shroff, Bhavna; Best, Al M; Lindauer, Steven J

    2015-11-01

    To (1) assess orthodontic patient and practitioner use of and preferences for social media and (2) investigate the potential benefit of social media in marketing and communication strategies in orthodontic practices. A survey was developed and randomly distributed to orthodontists via the American Association of Orthodontists and to patients/parents via private practices throughout the United States. Participants were asked to answer questions related to their use of social media and their perceptions of the use of social media in the orthodontic practice. Of the participants, 76% of orthodontists and 89% of patients/parents use social media. Furthermore, Facebook was the social media platform that was most preferred. Social media use was more common in female and younger adult participants. Orthodontists posted information more often in the morning (40%) and afternoon (56%), and patients/parents used social media mainly in the evening (76%). The most commonly used marketing strategies in the orthodontic practices were social media (76%) and a practice website (59%). Social media and practice websites were positively related with new patient starts (P  =  .0376, P  =  .0035, respectively). Most orthodontists and patients/parents used social media. Social media may be an effective marketing and communication tool in an orthodontic practice.

  14. Functional networks of motor inhibition in conversion disorder patients and feigning subjects

    Directory of Open Access Journals (Sweden)

    Thomas Hassa

    2016-01-01

    Full Text Available The neural correlates of motor inhibition leading to paresis in conversion disorder are not well known. The key question is whether they are different of those of normal subjects feigning the symptoms. Thirteen conversion disorder patients with hemiparesis and twelve healthy controls were investigated using functional magnetic resonance tomography under conditions of passive motor stimulation of the paretic/feigned paretic and the non-paretic hand. Healthy controls were also investigated in a non-feigning condition. During passive movement of the affected right hand conversion disorder patients exhibited activations in the bilateral triangular part of the inferior frontal gyri (IFG, with a left side dominance compared to controls in non-feigning condition. Feigning controls revealed for the same condition a weak unilateral activation in the right triangular part of IFG and an activity decrease in frontal midline areas, which couldn't be observed in patients. The results suggest that motor inhibition in conversion disorder patients is mediated by the IFG that was also involved in inhibition processes in normal subjects. The activity pattern in feigning controls resembled that of conversion disorder patients but with a clear difference in the medial prefrontal cortex. Healthy controls showed decreased activity in this region during feigning compared to non-feigning conditions suggesting a reduced sense of self-agency during feigning. Remarkably, no activity differences could be observed in medial prefrontal cortex for patients vs healthy controls in feigning or non-feigning conditions suggesting self-agency related activity in patients to be in between those of non-feigning and feigning healthy subjects.

  15. Effectiveness of multi-drug regimen chemotherapy treatment in osteosarcoma patients: a network meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Wang, Xiaojie; Zheng, Hong; Shou, Tao; Tang, Chunming; Miao, Kun; Wang, Ping

    2017-03-29

    Osteosarcoma is the most common malignant bone tumour. Due to the high metastasis rate and drug resistance of this disease, multi-drug regimens are necessary to control tumour cells at various stages of the cell cycle, eliminate local or distant micrometastases, and reduce the emergence of drug-resistant cells. Many adjuvant chemotherapy protocols have shown different efficacies and controversial results. Therefore, we classified the types of drugs used for adjuvant chemotherapy and evaluated the differences between single- and multi-drug chemotherapy regimens using network meta-analysis. We searched electronic databases, including PubMed (MEDLINE), EmBase, and the Cochrane Library, through November 2016 using the keywords "osteosarcoma", "osteogenic sarcoma", "chemotherapy", and "random*" without language restrictions. The major outcome in the present analysis was progression-free survival (PFS), and the secondary outcome was overall survival (OS). We used a random effect network meta-analysis for mixed multiple treatment comparisons. We included 23 articles assessing a total of 5742 patients in the present systematic review. The analysis of PFS indicated that the T12 protocol (including adriamycin, bleomycin, cyclophosphamide, dactinomycin, methotrexate, cisplatin) plays a more critical role in osteosarcoma treatment (surface under the cumulative ranking (SUCRA) probability 76.9%), with a better effect on prolonging the PFS of patients when combined with ifosfamide (94.1%) or vincristine (81.9%). For the analysis of OS, we separated the regimens to two groups, reflecting the disconnection. The T12 protocol plus vincristine (94.7%) or the removal of cisplatinum (89.4%) is most likely the best regimen. We concluded that multi-drug regimens have a better effect on prolonging the PFS and OS of osteosarcoma patients, and the T12 protocol has a better effect on prolonging the PFS of osteosarcoma patients, particularly in combination with ifosfamide or vincristine

  16. Shared networks of interpreter services, at relatively low cost, can help providers serve patients with limited english skills.

    Science.gov (United States)

    Jacobs, Elizabeth A; Leos, Ginelle Sanchez; Rathouz, Paul J; Fu, Paul

    2011-10-01

    Language barriers in health care-a large and growing problem in the United States-contribute to disparities in health care quality and outcomes in populations with limited English proficiency. Providing access to adequate interpreter services has been shown to reduce health disparities in these populations. However, many health care organizations do not provide such services because of the perceived high cost. In this observational study we calculated the costs incurred by a group of California public hospitals that formed a network to make trained interpreters available via videoconference and telephone. We found that encounters in this network where interpreters helped patients and providers communicate lasted an average of 10.6 minutes and cost an average of $24.86 per encounter. Such costs should be weighed against the likely alternatives, such as the opportunity costs of having other hospital staff act as ad hoc interpreters; medical errors that could result from inadequate interpretation; and the fact that not providing such services may leave providers out of compliance with federal law. We also discuss ways in which providers could be compensated for providing interpreter services.

  17. Effects of different anticoagulant drugs on the prevention of complications in patients after arthroplasty: A network meta-analysis.

    Science.gov (United States)

    Gao, Ji-Hai; Chu, Xiu-Cheng; Wang, Lin-Liang; Ning, Bo; Zhao, Chuan-Xin

    2017-10-01

    After arthroplasty treatment, some complications commonly occur, such as early revision, infection/dislocation, and venous thromboembolism (VTE). This study aims to use a network meta-analysis to compare effects of 9 anticoagulant drugs (edoxaban, dabigatan, apixaban, rivaroxaban, warfarin, heparin, bemiparin, ximelagatran, and enoxaparin) in preventing postoperative complications in arthroplasty patients. After retrieving PubMed, Embase, and Cochrane Library database from the inception to November 2016, randomized controlled trials were enrolled. The integration of direct and indirect evidences was performed to calculate odd ratios and the surface under the cumulative ranking curves. Nineteen eligible randomized controlled trials were included. The network meta-analysis results showed that compared with warfarin, edoxaban, apixaban, and rivaroxaban had a lower incidence rate in asymptomatic deep venous thrombosis, which indicated that edoxaban, apixaban, and rivaroxaban had better effects on prevention. Similarly, in comparison to enoxaparin, edoxaban and rivaroxaban had better effect; rivaroxaban was better than ximelagatran in preventive effects. Compared with apixaban, edoxaban, dabigatan, rivaroxaban, and enoxaparin had a higher incidence rate in clinically relevant non-major bleeding, which showed that preventive effects were relatively poor. In addition, the results of the surface under the cumulative ranking curves showed that rivaroxaban and bemiparin worked best on symptomatic deep venous thrombosis and pulmonary embolism. In terms of bleeding, apixaban and warfarin had better preventive effects. Our findings suggested that rivaroxaban may work better in terms of symptomatic deep venous thrombosis and pulmonary embolism, whereas apixaban had better preventive effects in bleeding.

  18. Applying Social Network Analysis to Identify the Social Support Needs of Adolescent and Young Adult Cancer Patients and Survivors.

    Science.gov (United States)

    Koltai, Kolina; Walsh, Casey; Jones, Barbara; Berkelaar, Brenda L

    2017-11-06

    This article examines how theoretical and clinical applications of social network analysis (SNA) can inform opportunities for innovation and advancement of social support programming for adolescent and young adult (AYA) cancer patients and survivors. SNA can help address potential barriers and challenges to initiating and sustaining AYA peer support by helping to identify the diverse psychosocial needs among individuals in the AYA age range; find strategic ways to support and connect AYAs at different phases of the cancer trajectory with resources and services; and increase awareness of psychosocial resources and referrals from healthcare providers. Network perspectives on homophily, proximity, and evolution provide a foundational basis to explore the utility of SNA in AYA clinical care and research initiatives. The uniqueness of the AYA oncology community can also provide insight into extending and developing current SNA theories. Using SNA in AYA psychosocial cancer research has the potential to create new ideas and pathways for supporting AYAs across the continuum of care, while also extending theories of SNA. SNA may also prove to be a useful tool for examining social support resources for AYAs with various chronic health conditions and other like groups.

  19. Characteristics and functional demands of patients at a local rehabilitation network: analysis from first contact.

    Science.gov (United States)

    Souza, Mariana Angélica Peixoto de; Dias, Jane Fonseca; Ferreira, Fabiane Ribeiro; Mancini, Marisa Cotta; Kirkwood, Renata Noce; Sampaio, Rosana Ferreira

    2016-10-01

    The cross sectional study aims to create the patients' profile and understand their demands for seeking public rehabilitation services from Belo Horizonte. Data were analyzed from 516 patients who gained entry into the health care system by means of the Protocol for Identification of Problems for Rehabilitation (PLPR). It allows for gathering information related to one's health and the social context, including a brief functional description (BFD) with 25 items. Most patients were females, mean age of 57 years, and 54% declared to be responsible for the family income. Severe or complete difficulty in at least one item from the BFD was reported by 87%. Pain and Mobility domains showed greater disability. The patient's demand for services referred them mostly to physical therapy (89%), and psychology (14%); 77% were referred to basic care (BC) and 21% to specialized care (SC). Those that started rehabilitation in SC were younger, had increased number of high ratings in item's qualifiers and higher total score in the BFD, indicating increased functional limitation and restriction. It is intended that the information provided by the PLPR may contribute to the organization of patients' flow and the planning of actions.

  20. Comparing the Effects of Education Using Telephone Follow-Up and Smartphone-Based Social Networking Follow-Up on Self-Management Behaviors among Patients with Hypertension.

    Science.gov (United States)

    Najafi Ghezeljeh, Tahereh; Sharifian, Sanaz; Nasr Isfahani, Mehdi; Haghani, Hamid

    2018-02-16

    The use of social networks in healthcare is a new area of research. Little is known about the benefits of this method in the management of the physical conditions of patients. The aim of this study was to compare the effects of self-management education using telephone follow-up and mobile phone-based social networking on self-management behaviors among patients with hypertension. This randomized clinical trial was conducted with 100 patients who were selected using a convenience sampling method. They were randomly allocated to four groups as (i) control, (ii) self-management training without follow-up, (iii) telephone follow-up and (iv) smartphone-based social networking follow up. The hypertension self-management behavior questionnaire was used for data collection before and six weeks after the study. The patients had statistically significant differences in terms of self-management (p<0.001). Those patients who underwent self-management education training (with and without follow-up) had statistically significant differences from those in the control group in terms of self-management behaviors (p<0.001). There was no statistical significant difference between the telephone follow-up and the smartphone follow-up groups. Self-management education using telephone follow-up and/or smartphone-based social networking follow up influenced self-management behaviors among patients with hypertension. Impact statement: Since the time of receiving information by patients is short when they are discharged from the hospital, telephone follow-up or smartphone-based social networking follow up can improve patients' self-management behaviors.

  1. The application of artificial neural networks and decision tree model in predicting post-operative complication for gastric cancer patients.

    Science.gov (United States)

    Chien, Ching-Wen; Lee, Yi-Chih; Ma, Tsochiang; Lee, Tian-Shyug; Lin, Yang-Chu; Wang, Weu; Lee, Wei-Jei

    2008-01-01

    Gastric cancer remains a leading cause of death worldwide. Post-operative complication is one important factor which causes mortality of gastric cancer patients after gastrectomy. Better prediction of post-operative complication before gastrectomy can significantly reduce post-operative mortality and morbidity. Therefore, 3 data mining techniques were applied in this study on improving prediction of post-operative complication. A retrospective study was performed on 521 patients from 3 over 2,000 acute-bed medical centers in Taiwan during February 2002 to October 2004. Pre- and post-operative clinical data were collected and analyzed by applying 3 data mining techniques, included Artificial Neural Networks (ANN), Decision Tree (DT) and Logistic Regression (LR). Results of this study indicated that ANN was a better technique than DT and LR in predicting post-operative complication. Nutritious status, pathological characteristics and operational characteristics were important predictors of post-operative complication. Further study on predicting postoperative complication in gastric cancer patients is still important. However, how to combine different data mining techniques to improve accuracies of prediction will be another important issue for clinicians and researchers.

  2. Default Mode Network Alterations during Implicit Emotional Faces Processing in First-episode, Treatment-naive Major Depression Patients

    Directory of Open Access Journals (Sweden)

    Huqing eShi

    2015-08-01

    Full Text Available Previous studies have focused on resting-state default mode network (DMN alterations in the development and maintenance of depression; however, only a few studies have addressed DMN changes during task-related processing and their results are inconsistent. Therefore, we explored DMN patterns in young adult patients with first-episode, treatment-naïve major depressive disorder (MDD performing an implicit emotional processing task. Patients with MDD (N = 29 and healthy controls (N = 33 were subjected to functional magnetic resonance imaging (fMRI at rest and while performing a gender judgment task. Group independent component analysis (ICA was used to identify DMN component under task state for both groups. The DMN of participants with MDD had decreased functional connectivity in bilateral prefrontal areas compared to controls. Right prefrontal gyrus connectivity for MDD patients correlated negatively with scores on maladaptive scales of the Cognitive Emotion Regulation Questionnaire (CERQ. Our findings suggest that depressed people have altered DMN patterns during implicit emotional processing, which might be related to impaired internal monitoring and emotional regulation ability.

  3. Effects and safety of oral tolvaptan in patients with congestive heart failure: A systematic review and network meta-analysis.

    Science.gov (United States)

    Wu, Mei-Yi; Chen, Tzu-Ting; Chen, Ying-Chun; Tarng, Der-Cherng; Wu, Yun-Chun; Lin, Hsien-Ho; Tu, Yu-Kang

    2017-01-01

    Several studies reported treatment benefits of tolvaptan in patients with congestive heart failure (CHF). However, the optimal dosage remains unclear. We aimed to compare different dosage of tolvaptan to determine the optimal dosage in terms of the efficacy and safety. We searched MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and ClinicalTrials.gov through Aug 31, 2016. Randomized controlled trials (RCTs) comparing tolvaptan of different dosages or to placebo in patients with CHF were included. We used network meta-analysis to look for the optimal dosage in terms of effectiveness and safety. Urine output, body weight change and change in serum sodium were the main outcomes of efficacy. Adverse effects were the secondary outcomes. Quality was assessed by Cochrane risk-of-bias tool. Twelve RCTs reporting 14 articles with 5793 patients (mean age, 65.7 ± 11.9 years; 73.7% man) were included. Compared with placebo, the tolvaptan 30 mg had similar effects to tolvaptan 45-90 mg in terms of urine output (mean difference [MD] 2.03 liter; 95% confidence interval [CI] 1.3 to 2.71), body weight change (MD -1.12 kg; 95% CI -1.37 to -0.88) and change in serum sodium (MD 3.06 meq/L; 95% CI 2.43 to 3.68). Compared with placebo, tolvaptan of different dosage showed a non-significant higher risk of adverse effects. These findings suggest that tolvaptan 30 mg and 45 mg may be the optimum dosage for CHF patients, because of its ability to provide favourable clinical results without greater adverse effects. However, tolvaptan is not beneficial for reducing all-cause mortality in CHF patients.

  4. Effects and safety of oral tolvaptan in patients with congestive heart failure: A systematic review and network meta-analysis.

    Directory of Open Access Journals (Sweden)

    Mei-Yi Wu

    Full Text Available Several studies reported treatment benefits of tolvaptan in patients with congestive heart failure (CHF. However, the optimal dosage remains unclear. We aimed to compare different dosage of tolvaptan to determine the optimal dosage in terms of the efficacy and safety.We searched MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and ClinicalTrials.gov through Aug 31, 2016. Randomized controlled trials (RCTs comparing tolvaptan of different dosages or to placebo in patients with CHF were included. We used network meta-analysis to look for the optimal dosage in terms of effectiveness and safety. Urine output, body weight change and change in serum sodium were the main outcomes of efficacy. Adverse effects were the secondary outcomes. Quality was assessed by Cochrane risk-of-bias tool.Twelve RCTs reporting 14 articles with 5793 patients (mean age, 65.7 ± 11.9 years; 73.7% man were included. Compared with placebo, the tolvaptan 30 mg had similar effects to tolvaptan 45-90 mg in terms of urine output (mean difference [MD] 2.03 liter; 95% confidence interval [CI] 1.3 to 2.71, body weight change (MD -1.12 kg; 95% CI -1.37 to -0.88 and change in serum sodium (MD 3.06 meq/L; 95% CI 2.43 to 3.68. Compared with placebo, tolvaptan of different dosage showed a non-significant higher risk of adverse effects.These findings suggest that tolvaptan 30 mg and 45 mg may be the optimum dosage for CHF patients, because of its ability to provide favourable clinical results without greater adverse effects. However, tolvaptan is not beneficial for reducing all-cause mortality in CHF patients.

  5. Interhemispheric motor networks are abnormal in patients with Gilles de la Tourette syndrome.

    Science.gov (United States)

    Bäumer, Tobias; Thomalla, Götz; Kroeger, Johan; Jonas, Melanie; Gerloff, Christian; Hummel, Friedhelm Christoph; Müller-Vahl, Kirsten; Schnitzler, Alfons; Siebner, Hartwig Roman; Orth, Michael; Münchau, Alexander

    2010-12-15

    Brain imaging has shown altered corpus callosum (CC) morphology in patients with Gilles de la Tourette syndrome (GTS). Yet it is unclear whether these morphological changes are associated with altered interhemispheric interactions. Here, we combined transcranial magnetic stimulation (TMS) with diffusion tensor magnetic resonance imaging (DTI) to explore functional and structural interhemispheric connections between the left and right motor hand areas. We studied 14 unmedicated GTS patients without psychiatric comorbidity (2 women, mean age 35.5 years) and 15 healthy volunteers (3 women, mean age 35 years). Left-to-right and right-to-left interhemispheric inhibitions (IHIs) were measured in hand muscles with TMS. In 13 GTS patients and all healthy controls, we measured fractional anisotropy (FA) with DTI to examine the relation between functional measures of interhemispheric connectivity as derived by TMS and structural properties of the CC region that carries fibers interconnecting both motor cortices. In GTS patients, left-to-right IHI was weaker than right-to-left IHI. Left-to-right IHI in GTS patients was also reduced compared with healthy controls. Voxel-based morphometric analysis revealed that FA in the motor region of the CC did not differ between groups. However, there was a significant interaction between groups and the relation between regional FA and left-to-right IHI in the motor region of the CC. A negative linear relation between FA and left-to-right IHI was present in control subjects but not in patients. Our combined TMS-DTI approach demonstrates abnormal functional interhemispheric connectivity in GTS accompanied by an altered structure-function relationship in the motor CC. © 2010 Movement Disorder Society.

  6. Comparative efficacy of antihypertensive agents in salt-sensitive hypertensive patients: a network meta-analysis.

    Science.gov (United States)

    Qi, Han; Liu, Zheng; Cao, Han; Sun, Wei-Ping; Peng, Wen-Juan; Liu, Bin; Dong, Sheng-Jie; Xiang, Yu-Tao; Zhang, Ling

    2018-02-09

    Salt-sensitive hypertension (SSH) is an intermediate inherited phenotype of essential hypertension as well as being an independent risk factor for cardiovascular disease. However, effective medications for the treatment of SSH have not been clarified. This study was to compare the efficacious of different classes of antihypertensive agents combined with salt intake on the reduction of blood pressure in patients with salt-sensitive hypertension (SSH). We used sources as PubMed, EMBASE, Cochrane Library, CENTRAL, ClinicalTrials.gov, ICTRP, CNKI and WANFANG database from inception to November 2016. Studies that compared the efficacy of two or more antihypertensive agents or placebos in adult salt-sensitive hypertensive patients were included. The outcomes included variations in mean arterial blood pressure, systolic and diastolic blood pressure. Twenty-five studies were involved in this meta-analysis. A CCB with hydrochlorothiazide and moderate salt intake was significantly the most efficacious in comparison with placebo [standardized mean differences (SMD), 95% credibility intervals (CI): 26.66, 12.60-40.16], ARBs [SMD, 95% CI: 22.94, 5.26-40.51] and the other interventions for patients with SSH and no concomitant diseases. For SSH patients who were obese, the effect size of CCB with metformin and moderate salt intake was [SMD, 95% CI: 17.90, 6.26 -29.33]. For SSH patients with no concomitant diseases, CCB combined with hydrochlorothiazide and moderate salt intake were optimal in reducing blood pressure, while CCB combined with metformin and moderate salt intake were the most efficacious at reducing blood pressure in SSH patients with coexisting obesity.

  7. Detection of Abnormal Resting-state Networks in Individual Patients Suffering from Focal Epilepsy: An Initial Step toward Individual Connectivity Assessment

    Directory of Open Access Journals (Sweden)

    Christian eDansereau

    2014-12-01

    Full Text Available The spatial coherence of spontaneous slow fluctuations in the blood-oxygen-level dependent (BOLD signal at rest is routinely used to characterize the underlying resting-state networks (RSNs. Studies have demonstrated that these patterns are organized in space and highly reproducible from subject to subject. Moreover, RSNs reorganizations have been suggested in pathological conditions. Comparisons of RSNs organization have been performed between groups of subjects but have rarely been applied at the individual level, a step required for clinical application. Defining the notion of modularity as the organization of brain activity in stable networks, we propose DANI - Detection of Abnormal Networks in Individuals - to identify modularity changes at the individual level. The stability of each RSN was estimated using a spatial clustering method: BASC Bootstrap Analysis of Stable Clusters (Bellec et al Neuroimage,51(3,2010. Our contributions consisted in (i providing functional maps of the most stable cores of each networks and (ii in detecting abnormal individual changes in networks organization when compared to a population of healthy controls. DANI was first evaluated using realistic simulated data, showing that focussing on a conservative core size (50% most stable regions improved the sensitivity to detect modularity changes. DANI was then applied to resting state fMRI data of six patients with focal epilepsy who underwent multimodal assessment using simultaneous EEG/fMRI acquisition followed by surgery. Only patient with a seizure free outcome were selected and the resected area was identified using a post-operative MRI. DANI automatically detected abnormal changes in 5 out of 6 patients, with excellent sensitivity, showing for each of them at least one abnormal lateralized network closely related to the epileptic focus. For each patient, we also detected some distant networks as abnormal, suggesting some remote reorganization in the epileptic

  8. Empiric treatment against invasive fungal diseases in febrile neutropenic patients: a systematic review and network meta-analysis.

    Science.gov (United States)

    Chen, Ken; Wang, Qi; Pleasants, Roy A; Ge, Long; Liu, Wei; Peng, Kangning; Zhai, Suodi

    2017-02-20

    The most optimal antifungal agent for empiric treatment of invasive fungal diseases (IFDs) in febrile neutropenia is controversial. Our objective was evaluate the relative efficacy of antifungals for all-cause mortality, fungal infection-related mortality and treatment response in this population. Pubmed, Embase and Cochrane Library were searched to identify randomized controlled trials (RCTs). Two reviewers performed the quality assessment and extracted data independently. Pairwise meta-analysis and network meta-analysis were conducted to compare the antifungals. Seventeen RCTs involving 4583 patients were included. Risk of bias of included studies was moderate. Pairwise meta-analysis indicated the treatment response rate of itraconazole was significantly better than conventional amphotericin B (RR = 1.33, 95%CI 1.10-1.61). Network meta-analysis showed that amphotericin B lipid complex, conventional amphotericin B, liposomal amphotericin B, itraconazole and voriconazole had a significantly lower rate of fungal infection-related mortality than no antifungal treatment. Other differences in outcomes among antifungals were not statistically significant. From the rank probability plot, caspofungin appeared to be the most effective agent for all-cause mortality and fungal infection-related mortality, whereas micafungin tended to be superior for treatment response. The results were stable after excluding RCTs with high risk of bias, whereas micafungin had the lowest fungal infection-related mortality. Our results highlighted the necessity of empiric antifungal treatment and indicates that echinocandins appeared to be the most effective agents for empiric treatment of febrile neutropenic patients based on mortality and treatment response. However, more studies are needed to determine the best antifungal agent for empiric treatment. Our systematic review has been prospectively registered in PROSPERO and the registration number was CRD42015026629.

  9. Google goes cancer: improving outcome prediction for cancer patients by network-based ranking of marker genes.

    Directory of Open Access Journals (Sweden)

    Christof Winter

    Full Text Available Predicting the clinical outcome of cancer patients based on the expression of marker genes in their tumors has received increasing interest in the past decade. Accurate predictors of outcome and response to therapy could be used to personalize and thereby improve therapy. However, state of the art methods used so far often found marker genes with limited prediction accuracy, limited reproducibility, and unclear biological relevance. To address this problem, we developed a novel computational approach to identify genes prognostic for outcome that couples gene expression measurements from primary tumor samples with a network of known relationships between the genes. Our approach ranks genes according to their prognostic relevance using both expression and network information in a manner similar to Google's PageRank. We applied this method to gene expression profiles which we obtained from 30 patients with pancreatic cancer, and identified seven candidate marker genes prognostic for outcome. Compared to genes found with state of the art methods, such as Pearson correlation of gene expression with survival time, we improve the prediction accuracy by up to 7%. Accuracies were assessed using support vector machine classifiers and Monte Carlo cross-validation. We then validated the prognostic value of our seven candidate markers using immunohistochemistry on an independent set of 412 pancreatic cancer samples. Notably, signatures derived from our candidate markers were independently predictive of outcome and superior to established clinical prognostic factors such as grade, tumor size, and nodal status. As the amount of genomic data of individual tumors grows rapidly, our algorithm meets the need for powerful computational approaches that are key to exploit these data for personalized cancer therapies in clinical practice.

  10. Bladder Cancer Advocacy Network

    Science.gov (United States)

    ... Grants Bladder Cancer Think Tank Bladder Cancer Research Network Bladder Cancer Genomics Consortium Get Involved Ways to ... us? Who we are The Bladder Cancer Advocacy Network (BCAN) is a community of patients, caregivers, survivors, ...

  11. What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network.

    Science.gov (United States)

    LeBlanc, Thomas W; Abernethy, Amy P; Casarett, David J

    2015-03-01

    Although much is known about solid tumor patients who use hospice, the hematologic malignancies hospice population is inadequately described. To compare the characteristics and outcomes of hospice patients with hematologic malignancies to those with solid tumors. We extracted electronic patient data (2008-2012) from a large hospice network (Coalition of Hospices Organized to Investigate Comparative Effectiveness) and used bivariate analyses to describe between-group differences. In total, 48,147 patients with cancer were admitted during the study period; 3518 (7.3%) had a hematologic malignancy. These patients had significantly worse Palliative Performance Scale scores (32% vs. 24% were below 40; P < 0.001) and shorter lengths of stay (median 11 vs. 19 days; P < 0.001). They were more likely to die within 24 hours of hospice enrollment (10.9% vs. 6.8%; odds ratio [OR] 1.66; 95% CI 1.49, 1.86; P < 0.001) or within seven days (36% vs. 25.1%; OR 1.68; 95% CI 1.56, 1.81; P < 0.001) and were more likely to receive hospice services in an inpatient or nursing home setting (OR 1.34; 95% CI 1.16, 1.56 and OR 1.54; 95% CI 1.39, 1.72; both P < 0.001). Among hematologic malignancy patients, those with leukemia had the shortest survival (hazard ratio 1.23; 95% CI 1.13, 1.34; P < 0.001), and 40.3% used hospice for less than seven days (OR 1.31; 95% CI 1.11, 1.56; P = 0.002). Hospice patients with hematologic malignancies are more seriously ill at the time of admission, with worse functional status and shorter lengths of stay than other cancer patients. Differences in outcomes suggest the need for targeted interventions to optimize hospice services for the hematologic malignancies population, especially those with leukemia. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Interhemispheric motor networks are abnormal in patients with Gilles de la Tourette syndrome

    DEFF Research Database (Denmark)

    Bäumer, Tobias; Thomalla, Götz; Kroeger, Johan

    2010-01-01

    Brain imaging has shown altered corpus callosum (CC) morphology in patients with Gilles de la Tourette syndrome (GTS). Yet it is unclear whether these morphological changes are associated with altered interhemispheric interactions. Here, we combined transcranial magnetic stimulation (TMS) with di...

  13. 77 FR 23485 - Food and Drug Administration Patient Network Annual Meeting; Input Into Food and Drug...

    Science.gov (United States)

    2012-04-19

    ... registration information or problems with the Web site, call Cindy de Sales, 1-240-316-3200, ext. 207. If you... perspective is discussed outside of a specific product's marketing application review. The medical product... agreements for Prescription Drug User Fee Act (PDUFA) V, FDA plans to conduct meetings with patients and...

  14. The c-MET Network as Novel Prognostic Marker for Predicting Bladder Cancer Patients with an Increased Risk of Developing Aggressive Disease.

    Directory of Open Access Journals (Sweden)

    Young-Won Kim

    Full Text Available Previous studies have shown that c-MET is overexpressed in cases of aggressive bladder cancer (BCa. Identification of crosstalk between c-MET and other RTKs such as AXL and PDGFR suggest that c-MET network genes (c-MET-AXL-PDGFR may be clinically relevant to BCa. Here, we examine whether expression of c-MET network genes can be used to identify BCa patients at increased risk of developing aggressive disease. In vitro analysis, c-MET knockdown suppressed cell proliferation, invasion, and migration, and increased sensitivity to cisplatin-induced apoptosis. In addition, c-MET network gene (c-MET, AXL, and PDGFR expression allowed discrimination of BCa tissues from normal control tissues and appeared to predict poor disease progression in non-muscle invasive BCa patients and poor overall survival in muscle invasive BCa patients. These results suggest that c-MET network gene expression is a novel prognostic marker for predicting which BCa patients have an increased risk of developing aggressive disease. These genes might be a useful marker for co-targeting therapy, and are expected to play an important role in improving both response to treatment and survival of BCa patients.

  15. Disrupted small-world brain functional network topology in male patients with severe obstructive sleep apnea revealed by resting-state fMRI.

    Science.gov (United States)

    Chen, Li-Ting; Fan, Xiao-Le; Li, Hai-Jun; Nie, Si; Gong, Hong-Han; Zhang, Wei; Zeng, Xian-Jun; Long, Ping; Peng, De-Chang

    2017-01-01

    Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that can damage cognitive function. However, the functional network organization remains poorly understood. The aim of this study was to investigate the topological properties of OSA patients using a graph theoretical analysis. A total of 30 male patients with untreated severe OSA and 25 male education- and age-matched good sleepers (GSs) underwent functional magnetic resonance imaging (MRI) examinations. Clinical and cognitive evaluations were conducted by an experienced psychologist. GRETNA (a toolbox for topological analysis of imaging connectomics) was used to construct the brain functional network and calculate the small-world properties (γ, λ, σ, Eglob, and Eloc). Relationships between these small-world properties and clinical and neuropsychological assessments were investigated in OSA patients. The networks of both OSA patients and GSs exhibited efficient small-world topology over the sparsity range of 0.05-0.40. Compared with GSs, the OSA group had significantly decreased γ, but significantly increased λ and σ. The OSA group's brain network showed significantly decreased Eglob (Pworld properties may be the mechanism of cognitive impairment in OSA patients. In addition, σ, γ, and λ could be used as a quantitative physiological index for auxiliary clinical diagnoses.

  16. Default mode and task-positive networks connectivity during the N-Back task in remitted depressed patients with or without emotional residual symptoms.

    Science.gov (United States)

    Delaveau, Pauline; Arruda Sanchez, Tiago; Steffen, Ricardo; Deschet, Karine; Jabourian, Maritza; Perlbarg, Vincent; Gasparetto, Emerson Leandro; Dubal, Stéphanie; Costa E Silva, Jorge; Fossati, Philippe

    2017-04-08

    Clinical remission of depression may be associated with emotional residual symptoms. We studied the association of emotional blunting, rumination with neural networks dynamics in remitted depressed patients and cognitive performance during an N-Back task. Twenty-six outpatients in remission of depression (Hamilton Depressive rating scale score task during fMRI assessment. All patients had been treated by paroxetine for a minimum of 4 months. Two subgroups of patients [Nonemotionally blunted (NEB) = 14 and emotionally blunted (EB) = 12] were determined. To identify functional network maps across participants, the Network Detection using Independent Component Analysis approach was employed. Within and between Task Positive Network (TPN) and Default Mode Network (DMN) connectivity were assessed and related to variability of performance on the N-Back task and rumination. EB and NEB patients were not different for the level of accurate responses at the N-Back. However over the entire working memory task, the negative correlation between DMN and TPN was significantly lower in the EB than NEB group and was differently related to cognitive performance and rumination. The stronger the negative correlation between DMN and TPN was, the less variable the reaction time during 3-Back task in NEB patients. Moreover the greater the negative correlation between DMN and TPN was, the lower the rumination score in EB patients. Emotional blunting may be associated with compromised monitoring of rumination and cognitive functioning in remitted depressed patients through altered cooperation between DMN and TPN. The study suggests clinical remission in depression is associated with biological heterogeneity. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  17. Time-related patient data retrieval for the case studies from the pharmacogenomics research network.

    Science.gov (United States)

    Zhu, Qian; Tao, Cui; Ding, Ying; Chute, Christopher G

    2012-11-01

    There are lots of question-based data elements from the pharmacogenomics research network (PGRN) studies. Many data elements contain temporal information. To semantically represent these elements so that they can be machine processiable is a challenging problem for the following reasons: (1) the designers of these studies usually do not have the knowledge of any computer modeling and query languages, so that the original data elements usually are represented in spreadsheets in human languages; and (2) the time aspects in these data elements can be too complex to be represented faithfully in a machine-understandable way. In this paper, we introduce our efforts on representing these data elements using semantic web technologies. We have developed an ontology, CNTRO, for representing clinical events and their temporal relations in the web ontology language (OWL). Here we use CNTRO to represent the time aspects in the data elements. We have evaluated 720 time-related data elements from PGRN studies. We adapted and extended the knowledge representation requirements for EliXR-TIME to categorize our data elements. A CNTRO-based SPARQL query builder has been developed to customize users' own SPARQL queries for each knowledge representation requirement. The SPARQL query builder has been evaluated with a simulated EHR triple store to ensure its functionalities.

  18. Modular reorganization of brain resting state networks and its independent validation in Alzheimer's disease patients.

    Science.gov (United States)

    Chen, Guangyu; Zhang, Hong-Ying; Xie, Chunming; Chen, Gang; Zhang, Zhi-Jun; Teng, Gao-Jun; Li, Shi-Jiang

    2013-01-01

    Previous studies have demonstrated disruption in structural and functional connectivity occurring in the Alzheimer's Disease (AD). However, it is not known how these disruptions alter brain network reorganization. With the modular analysis method of graph theory, and datasets acquired by the resting-state functional connectivity MRI (R-fMRI) method, we investigated and compared the brain organization patterns between the AD group and the cognitively normal control (CN) group. Our main finding is that the largest homotopic module (defined as the insula module) in the CN group was broken down to the pieces in the AD group. Specifically, it was discovered that the eight pairs of the bilateral regions (the opercular part of inferior frontal gyrus, area triangularis, insula, putamen, globus pallidus, transverse temporal gyri, superior temporal gyrus, and superior temporal pole) of the insula module had lost symmetric functional connection properties, and the corresponding gray matter concentration (GMC) was significant lower in AD group. We further quantified the functional connectivity changes with an index (index A) and structural changes with the GMC index in the insula module to demonstrate their great potential as AD biomarkers. We further validated these results with six additional independent datasets (271 subjects in six groups). Our results demonstrated specific underlying structural and functional reorganization from young to old, and for diseased subjects. Further, it is suggested that by combining the structural GMC analysis and functional modular analysis in the insula module, a new biomarker can be developed at the single-subject level.

  19. Artificial neural networks versus bivariate logistic regression in prediction diagnosis of patients with hypertension and diabetes.

    Science.gov (United States)

    Adavi, Mehdi; Salehi, Masoud; Roudbari, Masoud

    2016-01-01

    Diabetes and hypertension are important non-communicable diseases and their prevalence is important for health authorities. The aim of this study was to determine the predictive precision of the bivariate Logistic Regression (LR) and Artificial Neutral Network (ANN) in concurrent diagnosis of diabetes and hypertension. This cross-sectional study was performed with 12000 Iranian people in 2013 using stratified- cluster sampling. The research questionnaire included information on hypertension and diabetes and their risk factors. A perceptron ANN with two hidden layers was applied to data. To build a joint LR model and ANN, SAS 9.2 and Matlab software were used. The AUC was used to find the higher accurate model for predicting diabetes and hypertension. The variables of gender, type of cooking oil, physical activity, family history, age, passive smokers and obesity entered to the LR model and ANN. The odds ratios of affliction to both diabetes and hypertension is high in females, users of solid oil, with no physical activity, with positive family history, age of equal or higher than 55, passive smokers and those with obesity. The AUC for LR model and ANN were 0.78 (p=0.039) and 0.86 (p=0.046), respectively. The best model for concurrent affliction to hypertension and diabetes is ANN which has higher accuracy than the bivariate LR model.

  20. Real-time self-regulation of emotion networks in patients with depression.

    Directory of Open Access Journals (Sweden)

    David E J Linden

    Full Text Available Many patients show no or incomplete responses to current pharmacological or psychological therapies for depression. Here we explored the feasibility of a new brain self-regulation technique that integrates psychological and neurobiological approaches through neurofeedback with functional magnetic resonance imaging (fMRI. In a proof-of-concept study, eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions (such as the ventrolateral prefrontal cortex (VLPFC and insula during four neurofeedback sessions. Their clinical symptoms, as assessed with the 17-item Hamilton Rating Scale for Depression (HDRS, improved significantly. A control group that underwent a training procedure with the same cognitive strategies but without neurofeedback did not improve clinically. Randomised blinded clinical trials are now needed to exclude possible placebo effects and to determine whether fMRI-based neurofeedback might become a useful adjunct to current therapies for depression.

  1. Structural alteration of the dorsal visual network in DLB patients with visual hallucinations: a cortical thickness MRI study.

    Directory of Open Access Journals (Sweden)

    Stefano Delli Pizzi

    Full Text Available Visual hallucinations (VH represent one of the core features in discriminating dementia with Lewy bodies (DLB from Alzheimer's Disease (AD. Previous studies reported that in DLB patients functional alterations of the parieto-occipital regions were correlated with the presence of VH. The aim of our study was to assess whether morphological changes in specific cortical regions of DLB could be related to the presence and severity of VH. We performed a cortical thickness analysis on magnetic resonance imaging data in a cohort including 18 DLB patients, 15 AD patients and 14 healthy control subjects. Relatively to DLB group, correlation analysis between the cortical thickness and the Neuropsychiatric Inventory (NPI hallucination item scores was also performed. Cortical thickness was reduced bilaterally in DLB compared to controls in the pericalcarine and lingual gyri, cuneus, precuneus, superior parietal gyrus. Cortical thinning was found bilaterally in AD compared to controls in temporal cortex including the superior and middle temporal gyrus, part of inferior temporal cortex, temporal pole and insula. Inferior parietal and supramarginal gyri were also affected bilaterally in AD as compared to controls. The comparison between DLB and AD evidenced cortical thinning in DLB group in the right posterior regions including superior parietal gyrus, precuneus, cuneus, pericalcarine and lingual gyri. Furthermore, the correlation analysis between cortical thickness and NPI hallucination item scores showed that the structural alteration in the dorsal visual regions including superior parietal gyrus and precuneus closely correlated with the occurrence and severity of VH. We suggest that structural changes in key regions of the dorsal visual network may play a crucial role in the physiopathology of VH in DLB patients.

  2. Artificial neural networks: Predicting head CT findings in elderly patients presenting with minor head injury after a fall.

    Science.gov (United States)

    Dusenberry, Michael W; Brown, Charles K; Brewer, Kori L

    2017-02-01

    To construct an artificial neural network (ANN) model that can predict the presence of acute CT findings with both high sensitivity and high specificity when applied to the population of patients≥age 65years who have incurred minor head injury after a fall. An ANN was created in the Python programming language using a population of 514 patients ≥ age 65 years presenting to the ED with minor head injury after a fall. The patient dataset was divided into three parts: 60% for "training", 20% for "cross validation", and 20% for "testing". Sensitivity, specificity, positive and negative predictive values, and accuracy were determined by comparing the model's predictions to the actual correct answers for each patient. On the "cross validation" data, the model attained a sensitivity ("recall") of 100.00%, specificity of 78.95%, PPV ("precision") of 78.95%, NPV of 100.00%, and accuracy of 88.24% in detecting the presence of positive head CTs. On the "test" data, the model attained a sensitivity of 97.78%, specificity of 89.47%, PPV of 88.00%, NPV of 98.08%, and accuracy of 93.14% in detecting the presence of positive head CTs. ANNs show great potential for predicting CT findings in the population of patients ≥ 65 years of age presenting with minor head injury after a fall. As a good first step, the ANN showed comparable sensitivity, predictive values, and accuracy, with a much higher specificity than the existing decision rules in clinical usage for predicting head CTs with acute intracranial findings. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Care for patients with chronic nonmalignant pain with and without chronic opioid prescriptions: a report from the Cincinnati Area Research Group (CARinG) network.

    Science.gov (United States)

    Elder, Nancy C; Simmons, Todd; Regan, Saundra; Gerrety, Erica

    2012-01-01

    The use of chronic opioids for patients with chronic nonmalignant pain (CNMP) is a common problem for family physicians, yet little is known about the management of CNMP in family medicine offices. Twenty one physicians at 8 practices of the Cincinnati Area Research Group (CARinG) network completed 25 to 30 modified Primary Care Network Survey 2 surveys. Each survey contained the question, "To your knowledge, does this patient have chronic (>3 months) pain, even if they are not being seen for pain today?" Chart reviews of all patients identified as having chronic pain were performed to examine assessment, management, and monitoring of chronic opioids. Ten of these physicians and 10 office nurses or medical assistants were interviewed about caring for patients with chronic pain. Primary Care Network Survey 2 questionnaires were completed for 533 patients, 138 (26%) of which had CNMP, and 65 (47%) of those were taking chronic opioids; 25% of patients taking chronic opioids had a urine drug screen and 22% had an opioid contract in the chart. Patients with CNMP who were taking chronic opioids were more likely to be younger (54 vs 59 years; P = .003), have a coexisting mental health diagnosis (69% vs 44%; P = .005), and have assessments for pain (P = .031), function (P = .003), and psychological distress (P opioids. Physicians described suspicion of patients as a primary difficulty in prescribing or considering chronic opioids; they also expressed interest in practicing evidence-based CNMP care, but there was little teamwork between physicians and medical assistants caring for patients with CNMP who were taking chronic opioids. Chronic opioids are frequently prescribed to patients with CNMP. Although patients taking opioids have better documentation of pain assessments and management, care for all patients with CNMP fell short of evidence-based guidelines and was primarily performed by the physician alone.

  4. Classification of cirrhotic patients with or without minimal hepatic encephalopathy and healthy subjects using resting-state attention-related network analysis.

    Directory of Open Access Journals (Sweden)

    Hua-Jun Chen

    Full Text Available BACKGROUND: Attention deficit is an early and key characteristic of minimal hepatic encephalopathy (MHE and has been used as indicator for MHE detection. The aim of this study is to classify the cirrhotic patients with or without MHE (NMHE and healthy controls (HC using the resting-state attention-related brain network analysis. METHODS AND FINDINGS: Resting-state fMRI was administrated to 20 MHE patients, 21 NMHE patients, and 17 HCs. Three attention-related networks, including dorsal attention network (DAN, ventral attention network (VAN, and default mode network (DMN, were obtained by independent component analysis. One-way analysis of covariance was performed to determine the regions of interest (ROIs showing significant functional connectivity (FC change. With FC strength of ROIs as indicators, Linear Discriminant Analysis (LDA was conducted to differentiate MHE from HC or NMHE. Across three groups, significant FC differences were found within DAN (left superior/inferior parietal lobule and right inferior parietal lobule, VAN (right superior parietal lobule, and DMN (bilateral posterior cingulate gyrus and precuneus, and left inferior parietal lobule. With FC strength of ROIs from three networks as indicators, LDA yielded 94.6% classification accuracy between MHE and HC (100% sensitivity and 88.2% specificity and 85.4% classification accuracy between MHE and NMHE (90.0% sensitivity and 81.0% specificity. CONCLUSIONS: Our results suggest that the resting-state attention-related brain network analysis can be useful in classification of subjects with MHE, NMHE, and HC and may provide a new insight into MHE detection.

  5. A New Challenge to Research Ethics: Patients-Led Research (PLR) and the Role of Internet Based Social Networks.

    Science.gov (United States)

    Lamas, Eugenia; Salinas, Rodrigo; Vuillaume, Dominique

    2016-01-01

    A characteristic feature of the development of health-related social networks is the emergence of internet-based virtual communities, composed of patients. These communities go beyond the mere interchange of information concerning their conditions, intervening in the planning and execution of clinical research, including randomised controlled trials, in collaboration with health professionals. That was the case, in 2009, when patients suffering amyotrophic lateral sclerosis, a rare and severe disease, conducted a clinical trial in USA, organising themselves through an online platform. This initiative launched a new model for the planning and conduction of clinical research: "Participants-Led Research" (PLR). The distinctive particularities of this new research paradigm represent a challenge to the traditional standards used for judging the ethical soundness of clinical investigation. That is the case, for example, of informed consent. This article aims at identifying the ethical, legal, and social issues (ELSI) posed by PLR and the relevant concepts that may help in solving them. The following issues, in particular, are analysed, that may give place to a new social contract for the ethical assessment of clinical research: consent for participating in research and personal integrity; data protection and confidentiality; benefits sharing and intellectual property.

  6. Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases.

    Science.gov (United States)

    Gatica-Rojas, Valeska; Méndez-Rebolledo, Guillermo

    2014-04-15

    Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual reality interface devices such as the Nintendo® Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addition, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients' brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.

  7. Emerging patient-driven health care models: an examination of health social networks, consumer personalized medicine and quantified self-tracking.

    Science.gov (United States)

    Swan, Melanie

    2009-02-01

    A new class of patient-driven health care services is emerging to supplement and extend traditional health care delivery models and empower patient self-care. Patient-driven health care can be characterized as having an increased level of information flow, transparency, customization, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects. The potential exists to both improve traditional health care systems and expand the concept of health care though new services. This paper examines three categories of novel health services: health social networks, consumer personalized medicine and quantified self-tracking.

  8. A comparison of cangrelor, prasugrel, ticagrelor, and clopidogrel in patients undergoing percutaneous coronary intervention: A network meta-analysis.

    Science.gov (United States)

    Westman, Peter C; Lipinski, Michael J; Torguson, Rebecca; Waksman, Ron

    2017-03-01

    Newer P2Y12 inhibitors have more rapid onset of platelet inhibition compared with clopidogrel, especially the intravenous P2Y12 inhibitor cangrelor. Direct comparisons between cangrelor and oral P2Y12 inhibitors ticagrelor and prasugrel do not exist. Thus, we performed a network meta-analysis to directly and indirectly compare different P2Y12 inhibitors in patients undergoing percutaneous coronary intervention (PCI). MEDLINE/PubMed and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) that compared at least two P2Y12 inhibitors including cangrelor, clopidogrel, prasugrel, and ticagrelor. Network meta-analysis with a Bayesian approach was performed to directly and indirectly compare the effects of the aforementioned P2Y12 inhibitors on clinical outcomes. Odds ratios with credible intervals (OR [CrIs]) were generated with random-effects models to compare outcomes. This analysis included 15 RCTs with 54,025 patients randomized to cangrelor (n=12,475), clopidogrel (n=26,903), prasugrel (n=7455), or ticagrelor (n=7192) at time of PCI. Patients had a mean age of 63±10, 74% were male, and 82% underwent PCI for acute coronary syndrome. No significant differences between cangrelor and clopidogrel were found with respect to cardiovascular death (OR 1.01 [CrI 0.23-4.39]), myocardial infarction (OR 0.94 [CrI 0.69-1.25]), major adverse cardiac events (OR 0.91 [CrI 0.69-1.18]), stent thrombosis (OR 0.66 [CrI 0.37-1.19]), or major bleeding (OR 1.52 [CrI 0.79-2.98]). Rank probability data suggested that ticagrelor and prasugrel were better than cangrelor for reducing ischemic events, though these differences were not significant. Despite rapid platelet inhibition provided by cangrelor, newer oral P2Y12 inhibitors such as ticagrelor and prasugrel have comparable clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. SU-E-T-131: Artificial Neural Networks Applied to Overall Survival Prediction for Patients with Periampullary Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Gong, Y; Yu, J; Yeung, V; Palmer, J; Yu, Y; Lu, B; Babinsky, L; Burkhart, R; Leiby, B; Siow, V; Lavu, H; Rosato, E; Winter, J; Lewis, N; Sama, A; Mitchell, E; Anne, P; Hurwitz, M; Yeo, C; Bar-Ad, V [Thomas Jefferson University Hospital, Philadelphia, PA (United States); and others

    2015-06-15

    Purpose: Artificial neural networks (ANN) can be used to discover complex relations within datasets to help with medical decision making. This study aimed to develop an ANN method to predict two-year overall survival of patients with peri-ampullary cancer (PAC) following resection. Methods: Data were collected from 334 patients with PAC following resection treated in our institutional pancreatic tumor registry between 2006 and 2012. The dataset contains 14 variables including age, gender, T-stage, tumor differentiation, positive-lymph-node ratio, positive resection margins, chemotherapy, radiation therapy, and tumor histology.After censoring for two-year survival analysis, 309 patients were left, of which 44 patients (∼15%) were randomly selected to form testing set. The remaining 265 cases were randomly divided into training set (211 cases, ∼80% of 265) and validation set (54 cases, ∼20% of 265) for 20 times to build 20 ANN models. Each ANN has one hidden layer with 5 units. The 20 ANN models were ranked according to their concordance index (c-index) of prediction on validation sets. To further improve prediction, the top 10% of ANN models were selected, and their outputs averaged for prediction on testing set. Results: By random division, 44 cases in testing set and the remaining 265 cases have approximately equal two-year survival rates, 36.4% and 35.5% respectively. The 20 ANN models, which were trained and validated on the 265 cases, yielded mean c-indexes as 0.59 and 0.63 on validation sets and the testing set, respectively. C-index was 0.72 when the two best ANN models (top 10%) were used in prediction on testing set. The c-index of Cox regression analysis was 0.63. Conclusion: ANN improved survival prediction for patients with PAC. More patient data and further analysis of additional factors may be needed for a more robust model, which will help guide physicians in providing optimal post-operative care. This project was supported by PA CURE Grant.

  10. The contribution of social networks to the health and self-management of patients with long-term conditions: a longitudinal study.

    Directory of Open Access Journals (Sweden)

    David Reeves

    Full Text Available Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal. More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of resources needed for long-term condition self-management to be effective.To determine how the social networks of people with long-term conditions (diabetes and heart disease are associated with health-related outcomes and changes in outcomes over time.Patients with chronic heart disease (CHD or diabetes (n = 300 randomly selected from the disease registers of 19 GP practices in the North West of England. Data on personal social networks collected using a postal questionnaire, alongside face-to-face interviewing. Follow-up at 12 months via postal questionnaire using a self-report grid for network members identified at baseline.Multiple regression analysis of relationships between health status, self-management and health-economics outcomes, and characteristics of patients' social networks.Findings indicated that: (1 social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being; (2 support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; (3 network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs. Health service costs were significantly (p<0.01 reduced for patients receiving greater levels of illness work through their networks.Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon. This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community

  11. Altered dynamic functional connectivity in the default mode network in patients with cirrhosis and minimal hepatic encephalopathy

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Hua-Jun; Lin, Hai-Long [Fujian Medical University Union Hospital, Department of Radiology, Fuzhou (China); Chen, Qiu-Feng; Liu, Peng-Fei [Central South University, School of Information Science and Engineering, Changsha (China)

    2017-09-15

    Abnormal brain intrinsic functional connectivity (FC) has been documented in minimal hepatic encephalopathy (MHE) by static connectivity analysis. However, changes in dynamic FC (dFC) remain unknown. We aimed to identify altered dFC within the default mode network (DMN) associated with MHE. Resting-state functional MRI data were acquired from 20 cirrhotic patients with MHE and 24 healthy controls. DMN seed regions were defined using seed-based FC analysis (centered on the posterior cingulate cortex (PCC)). Dynamic FC architecture was calculated using a sliding time-window method. K-means clustering (number of clusters = 2-4) was applied to estimate FC states. When the number of clusters was 2, MHE patients presented weaker connectivity strengths compared with controls in states 1 and 2. In state 1, decreased FC strength was found between the PCC/precuneus (PCUN) and right medial temporal lobe (MTL)/bilateral lateral temporal cortex (LTC); left inferior parietal lobule (IPL) and right MTL/left LTC; right IPL and right MTL/bilateral LTC; right MTL and right LTC; and medial prefrontal cortex (MPFC) and right MTL/bilateral LTC. In state 2, reduced FC strength was observed between the PCC/PCUN and bilateral MTL/bilateral LTC; left IPL and left MTL/bilateral LTC/MPFC; and left LTC and right LTC. Altered connectivities from state 1 were correlated with patient cognitive performance. Similar findings were observed when the number of clusters was set to 3 or 4. Aberrant dynamic DMN connectivity is an additional characteristic of MHE. Dynamic connectivity analysis offers a novel paradigm for understanding MHE-related mechanisms. (orig.)

  12. Alterations of the microvascular network in the sclerotic hippocampus of patients with temporal lobe epilepsy.

    Science.gov (United States)

    Alonso-Nanclares, Lidia; DeFelipe, Javier

    2014-09-01

    Hippocampal sclerosis is the most frequent pathology encountered in resected tissue obtained from patients with temporal lobe epilepsy. The main hallmarks of hippocampal sclerosis are neuronal loss and gliosis. Several authors have proposed that an increase in blood vessel density is a further indicator, based on interpretations from staining of markers related to both blood-brain barrier disruption and the formation of new blood vessels. However, previous studies performed in our laboratory using correlative light and electron microscopy revealed that many of these "blood vessels" are in fact atrophic vascular structures with a reduced or virtually absent lumen and are often filled with processes of reactive astrocytes. Thus, "normal" vasculature within the sclerotic CA1 field is drastically reduced. Since this decrease is consistently observed in the human sclerotic CA1, this feature can be considered another key pathological indicator of hippocampal sclerosis associated with temporal lobe epilepsy. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Evaluation of resting state networks in patients with gliomas: connectivity changes in the unaffected side and its relation to cognitive function.

    Directory of Open Access Journals (Sweden)

    Satoshi Maesawa

    Full Text Available In this study, we investigated changes in resting state networks (RSNs in patients with gliomas located in the left hemisphere and its relation to cognitive function. We hypothesized that long distance connection, especially between hemispheres, would be affected by the presence of the tumor. We further hypothesized that these changes would correlate with, or reflect cognitive changes observed in patients with gliomas. Resting state functional MRI datasets from 12 patients and 12 healthy controls were used in the analysis. The tumor's effect on three well-known RSNs including the default mode network (DMN, executive control network (ECN, and salience network (SN identified using independent component analysis were investigated using dual regression analysis. Scores of neuropsychometric testing (WAIS-III and WMS-R were also compared. Compared to the healthy control group, the patient group showed significant decrease in functional connectivity in the right angular gyrus/inferior parietal lobe of the ventral DMN and in the dorsolateral prefrontal cortex of the left ECN, whereas a significant increase in connectivity in the right ECN was observed in the right parietal lobe. Changes in connectivity in the right ECN correlated with spatial memory, while that on the left ECN correlated with attention. Connectivity changes in the ventral DMN correlated with attention, working memory, full IQ, and verbal IQ measures. Although the tumors were localized in the left side of the brain, changes in connectivity were observed in the contralateral side. Moreover, these changes correlated with some aspects of cognitive function indicating that patients with gliomas may undergo cognitive changes even in the absence of or before the onset of major symptoms. Evaluation of resting state networks could be helpful in advancing our hodological understanding of brain function in glioma cases.

  14. Automated generation of patient-tailored electronic care pathways by translating computer-interpretable guidelines into hierarchical task networks.

    Science.gov (United States)

    González-Ferrer, Arturo; ten Teije, Annette; Fdez-Olivares, Juan; Milian, Krystyna

    2013-02-01

    This paper describes a methodology which enables computer-aided support for the planning, visualization and execution of personalized patient treatments in a specific healthcare process, taking into account complex temporal constraints and the allocation of institutional resources. To this end, a translation from a time-annotated computer-interpretable guideline (CIG) model of a clinical protocol into a temporal hierarchical task network (HTN) planning domain is presented. The proposed method uses a knowledge-driven reasoning process to translate knowledge previously described in a CIG into a corresponding HTN Planning and Scheduling domain, taking advantage of HTNs known ability to (i) dynamically cope with temporal and resource constraints, and (ii) automatically generate customized plans. The proposed method, focusing on the representation of temporal knowledge and based on the identification of workflow and temporal patterns in a CIG, makes it possible to automatically generate time-annotated and resource-based care pathways tailored to the needs of any possible patient profile. The proposed translation is illustrated through a case study based on a 70 pages long clinical protocol to manage Hodgkin's disease, developed by the Spanish Society of Pediatric Oncology. We show that an HTN planning domain can be generated from the corresponding specification of the protocol in the Asbru language, providing a running example of this translation. Furthermore, the correctness of the translation is checked and also the management of ten different types of temporal patterns represented in the protocol. By interpreting the automatically generated domain with a state-of-art HTN planner, a time-annotated care pathway is automatically obtained, customized for the patient's and institutional needs. The generated care pathway can then be used by clinicians to plan and manage the patients long-term care. The described methodology makes it possible to automatically generate

  15. Predictors of in-hospital mortality following major lower extremity amputations in type 2 diabetic patients using artificial neural networks

    Directory of Open Access Journals (Sweden)

    Ana Lopez-de-Andres

    2016-11-01

    Full Text Available Abstract Background Outcome prediction is important in the clinical decision-making process. Artificial neural networks (ANN have been used to predict the risk of post-operative events, including survival, and are increasingly being used in complex medical decision making. We aimed to use ANN analysis to estimate predictive factors of in-hospital mortality (IHM in patients with type 2 diabetes (T2DM after major lower extremity amputation (LEA in Spain. Methods We design a retrospective, observational study using ANN models. We used the Spanish National Hospital Discharge Database to select all hospital admissions of major LEA procedure in T2DM patients. Main outcome measures: Predictors of IHM using 4 ANN models: i with all discharge diagnosis included in the database; ii with all discharge diagnosis included in the database, excluding infectious diseases; iii comorbidities included in the Charlson Comorbidities Index; iv comorbidities included in the Elixhauser Comorbidity Index. Results From 2003 to 2013, 40,857 major LEAs in patients with T2DM were identified with a 10.0% IHM. We found that Elixhauser Comorbidity Index model performed better in terms of sensitivity, specificity and precision than Charlson Comorbidity Index model (0.7634 vs 0.7444; 0.9602 vs 0.9121; 0.9511 vs 0.888, respectively. The area under the ROC curve for Elixhauser comorbidity model was 91.7% (95% CI 90.3–93.0 and for Charlson comorbidity model was 88.9% (95% CI; 87.590.2 p = 0.043. Models including all discharge diagnosis with and without infectious diseases showed worse results. In the Elixhauser Comorbidity Index model the most sensitive parameter was age (variable sensitive ratio [VSR] 1.451 followed by female sex (VSR 1.433, congestive heart failure (VSR 1.341, renal failure (VSR 1.274 and chronic pulmonary disease (VSR 1.266. Conclusions Elixhauser Comorbidity Index is a superior comorbidity risk-adjustment model for major LEA survival prediction in

  16. Analysis of patient organizations' needs and ICT use--The APTIC project in Spain to develop an online collaborative social network.

    Science.gov (United States)

    Hernández-Encuentra, Eulàlia; Gómez-Zúñiga, Beni; Guillamón, Noemí; Boixadós, Mercè; Armayones, Manuel

    2015-12-01

    The purpose of this first part of the APTIC (Patient Organisations and ICT) project is to design and run an online collaborative social network for paediatric patient organizations (PPOs). To analyse the needs of PPOs in Spain to identify opportunities to improve health services through the use of ICT. A convenience sample of staff from 35 PPOs (54.68% response rate) participated in a structured online survey and three focus groups (12 PPOs). Paediatric patient organizations' major needs are to provide accredited and managed information, increase personal support and assistance and promote joint commitment to health care. Moreover, PPOs believe in the Internet's potential to meet their needs and support their activities. Basic limitations to using the Internet are lack of knowledge and resources. The discussion of the data includes key elements of designing an online collaborative social network and reflections on health services provided. © 2014 John Wiley & Sons Ltd.

  17. Th-17 related regulatory network in the pathogenesis of Arab patients with systemic lupus erythematosus and lupus nephritis.

    Science.gov (United States)

    AlFadhli, Suad; AlFailakawi, Asma'a; Ghanem, Aqeel A M

    2016-05-01

    The present study aimed to identify the genes involved in the pathogenesis of systemic lupus erythematosus (SLE) in Arabs by investigating a panel of 84 genes related to the t helper (Th)17-related regulatory network and to further explore the expression levels of serum interleukin (IL)-17A and IL-17F in a studied cohort. A comparative analysis of gene expression profile in SLE and lupus nephritis (LN) patients against that of healthy controls (HC) was performed. A quantitative real-time polymerase chain reaction (PCR) (Th17 autoimmunity and inflammation) array analysis was performed in peripheral white blood cells of 66 SLE patients under specific medical treatment and 30 age/gender/ethnically matched healthy controls. Statistical analysis was carried out using the RT(2) Profiler TM PCR Data Analysis tool. The analysis of Th17 pathway revealed 14 genes (IL-17A, IL-17C, IL-17D, IL-17F, IL-18, IL-12RB2, IL-23R, CCL2, CCL20, CXCL5, MMP3, RORC, STAT4 and TRAF6) that are differentially expressed in SLE and HC (fold change [FC] < 2, P < 0.0006). No significant difference in expression profiles was observed between SLE and LN. A significant difference in serum concentration of IL-17A (P = 0.002) and IL-17F (P = 0.002) was observed between SLE (13.91 ± 4.25) and LN (18.26 ± 4.24). Our study is the first to investigate a panel of 84 genes related to Th17 regulatory pathway in Arab SLE subjects and the first to explore the effect of current immunosuppression regimens on Th17 regulatory pathway. It paves the way for understanding the etiology of SLE and autoimmune diseases in general. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  18. Survival of cardiac arrest patients on ski slopes: A 10-year analysis of the Northern French Alps Emergency Network.

    Science.gov (United States)

    Viglino, Damien; Maignan, Maxime; Michalon, Arnaud; Turk, Julien; Buse, Sarah K; Blancher, Marc; Aufderheide, Tom P; Belle, Loïc; Savary, Dominique; Ageron, François-Xavier; Debaty, Guillaume

    2017-10-01

    Intense physical activity, cold and altitude make mountain sports a cause of increased risk of out-of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40-65] vs. 66 [52-79] years, pski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases

    Science.gov (United States)

    Gatica-Rojas, Valeska; Méndez-Rebolledo, Guillermo

    2014-01-01

    Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual reality interface devices such as the Nintendo® Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addition, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients’ brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies. PMID:25206907

  20. Human iPSC-Derived Cerebellar Neurons from a Patient with Ataxia-Telangiectasia Reveal Disrupted Gene Regulatory Networks

    Directory of Open Access Journals (Sweden)

    Sam P. Nayler

    2017-10-01

    Full Text Available Ataxia-telangiectasia (A-T is a rare genetic disorder caused by loss of function of the ataxia-telangiectasia-mutated kinase and is characterized by a predisposition to cancer, pulmonary disease, immune deficiency and progressive degeneration of the cerebellum. As animal models do not faithfully recapitulate the neurological aspects, it remains unclear whether cerebellar degeneration is a neurodevelopmental or neurodegenerative phenotype. To address the necessity for a human model, we first assessed a previously published protocol for the ability to generate cerebellar neuronal cells, finding it gave rise to a population of precursors highly enriched for markers of the early hindbrain such as EN1 and GBX2, and later more mature cerebellar markers including PTF1α, MATH1, HOXB4, ZIC3, PAX6, and TUJ1. RNA sequencing was used to classify differentiated cerebellar neurons generated from integration-free A-T and control induced pluripotent stem cells. Comparison of RNA sequencing data with datasets from the Allen Brain Atlas reveals in vitro-derived cerebellar neurons are transcriptionally similar to discrete regions of the human cerebellum, and most closely resemble the cerebellum at 22 weeks post-conception. We show that patient-derived cerebellar neurons exhibit disrupted gene regulatory networks associated with synaptic vesicle dynamics and oxidative stress, offering the first molecular insights into early cerebellar pathogenesis of ataxia-telangiectasia.

  1. Lack of "obesity paradox" in patients presenting with ST-segment elevation myocardial infarction including cardiogenic shock: a multicenter German network registry analysis.

    Science.gov (United States)

    Akin, Ibrahim; Schneider, Henrik; Nienaber, Christoph A; Jung, Werner; Lübke, Mike; Rillig, Andreas; Ansari, Uzair; Wunderlich, Nina; Birkemeyer, Ralf

    2015-07-11

    Studies have associated obesity with better outcomes in comparison to non-obese patients after elective and emergency coronary revascularization. However, these findings might have been influenced by patient selection. Therefore we thought to look into the obesity paradox in a consecutive network STEMI population. The database of two German myocardial infarction network registries were combined and data from a total of 890 consecutive patients admitted and treated for acute STEMI including cardiogenic shock and cardiopulmonary resuscitation according to standardized protocols were analyzed. Patients were categorized in normal weight (≤24.9 kg/m(2)), overweight (25-30 kg/m(2)) and obese (>30 kg/m(2)) according to BMI. Baseline clinical parameters revealed a higher comorbidity index for overweight and obese patients; 1-year follow-up comparison between varying groups revealed similar rates of all-cause death (9.1 % vs. 8.3 % vs. 6.2 %; p = 0.50), major adverse cardiac and cerebrovascular [MACCE (15.1 % vs. 13.4 % vs. 10.2 %; p = 0.53)] and target vessel revascularization in survivors [TVR (7.0 % vs. 5.0 % vs. 4.0 %; p = 0.47)] with normal weight when compared to overweight or obese patients. These results persisted after risk-adjustment for heterogeneous baseline characteristics of groups. An analysis of patients suffering from cardiogenic shock showed no impact of BMI on clinical endpoints. Our data from two network systems in Germany revealed no evidence of an "obesity paradox"in an all-comer STEMI population including patients with cardiogenic shock.

  2. Comparison of adaptive neuro-fuzzy inference system and artificial neutral networks model to categorize patients in the emergency department.

    Science.gov (United States)

    Azeez, Dhifaf; Ali, Mohd Alauddin Mohd; Gan, Kok Beng; Saiboon, Ismail

    2013-01-01

    Unexpected disease outbreaks and disasters are becoming primary issues facing our world. The first points of contact either at the disaster scenes or emergency department exposed the frontline workers and medical physicians to the risk of infections. Therefore, there is a persuasive demand for the integration and exploitation of heterogeneous biomedical information to improve clinical practice, medical research and point of care. In this paper, a primary triage model was designed using two different methods: an adaptive neuro-fuzzy inference system (ANFIS) and artificial neural network (ANN).When the patient is presented at the triage counter, the system will capture their vital signs and chief complains beside physiology stat and general appearance of the patient. This data will be managed and analyzed in the data server and the patient's emergency status will be reported immediately. The proposed method will help to reduce the queue time at the triage counter and the emergency physician's burden especially duringdisease outbreak and serious disaster. The models have been built with 2223 data set extracted from the Emergency Department of the Universiti Kebangsaan Malaysia Medical Centre to predict the primary triage category. Multilayer feed forward with one hidden layer having 12 neurons has been used for the ANN architecture. Fuzzy subtractive clustering has been used to find the fuzzy rules for the ANFIS model. The results showed that the RMSE, %RME and the accuracy which evaluated by measuring specificity and sensitivity for binary classificationof the training data were 0.14, 5.7 and 99 respectively for the ANN model and 0.85, 32.00 and 96.00 respectively for the ANFIS model. As for unseen data the root mean square error, percentage the root mean square error and the accuracy for ANN is 0.18, 7.16 and 96.7 respectively, 1.30, 49.84 and 94 respectively for ANFIS model. The ANN model was performed better for both training and unseen data than ANFIS model in

  3. Learning Networks, Networked Learning

    NARCIS (Netherlands)

    Sloep, Peter; Berlanga, Adriana

    2010-01-01

    Sloep, P. B., & Berlanga, A. J. (2011). Learning Networks, Networked Learning [Redes de Aprendizaje, Aprendizaje en Red]. Comunicar, XIX(37), 55-63. Retrieved from http://dx.doi.org/10.3916/C37-2011-02-05

  4. Teleradiotherapy Network: Applications and Feasibility for Providing Cost-Effective Comprehensive Radiotherapy Care in Low- and Middle-Income Group Countries for Cancer Patients.

    Science.gov (United States)

    Datta, Niloy Ranjan; Heuser, Michael; Samiei, Massoud; Shah, Ragesh; Lutters, Gerd; Bodis, Stephan

    2015-07-01

    Globally, new cancer cases will rise by 57% within the next two decades, with the majority in the low- and middle-income countries (LMICs). Consequently, a steep increase of about 40% in cancer deaths is expected there, mainly because of lack of treatment facilities, especially radiotherapy. Radiotherapy is required for more than 50% of patients, but the capital cost for equipment often deters establishment of such facilities in LMICs. Presently, of the 139 LMICs, 55 do not even have a radiotherapy facility, whereas the remaining 84 have a deficit of 61.4% of their required radiotherapy units. Networking between centers could enhance the effectiveness and reach of existing radiotherapy in LMICs. A teleradiotherapy network could enable centers to share and optimally utilize their resources, both infrastructure and staffing. This could be in the form of a three-tier radiotherapy service consisting of primary, secondary, and tertiary radiotherapy centers interlinked through a network. The concept has been adopted in some LMICs and could also be used as a "service provider model," thereby reducing the investments to set up such a network. Teleradiotherapy networks could be a part of the multipronged approach to address the enormous gap in radiotherapy services in a cost-effective manner and to support better accessibility to radiotherapy facilities, especially for LMICs.

  5. Social by default : the default-mode network and social cognition in healthy volunteers and siblings of schizophrenia patients

    NARCIS (Netherlands)

    van Buuren, M.

    2012-01-01

    During rest, a set of brain areas shows increased activity compared to when people are performing complex tasks. This network is commonly referred to as the default-mode network (DMN) and includes the ventral and dorsal medial prefrontal cortex, posterior cingulate cortex and lateral posterior

  6. Altered Functional Connectivity of the Default Mode Network in Patients With Schizo-obsessive Comorbidity: A Comparison Between Schizophrenia and Obsessive-compulsive Disorder

    DEFF Research Database (Denmark)

    Wang, Yongming; Zou, Lai-quan; Xie, Wen-lan

    2018-01-01

    Clinical and neuroimaging data support the idea that schizo-obsessive comorbidity (SOC), similar to obsessive-compulsive disorder (OCD) and schizophrenia (SCZ), may be a distinct brain disorder. In this study, we examined the strength of resting-state functional connectivity (rsFC) between 19...... subregions of the default mode network (DMN) and whole brain voxels in 22 patients with SOC features, 20 patients with SCZ alone, 22 patients with OCD, and 22 healthy controls (HC). The main results demonstrated that patients with SOC exhibited the highest rsFC strength within subregions of the DMN...... increased rsFC between subregions of the DMN and the middle temporal gyrus, but the OCD group exhibited decreased rsFC between them. These findings highlight a specific alteration in functional connectivity in the DMN in patients with SOC, and provide new insights into the dysfunctional brain organization...

  7. A network of networks.

    Science.gov (United States)

    Iedema, Rick; Verma, Raj; Wutzke, Sonia; Lyons, Nigel; McCaughan, Brian

    2017-04-10

    Purpose To further our insight into the role of networks in health system reform, the purpose of this paper is to investigate how one agency, the NSW Agency for Clinical Innovation (ACI), and the multiple networks and enabling resources that it encompasses, govern, manage and extend the potential of networks for healthcare practice improvement. Design/methodology/approach This is a case study investigation which took place over ten months through the first author's participation in network activities and discussions with the agency's staff about their main objectives, challenges and achievements, and with selected services around the state of New South Wales to understand the agency's implementation and large system transformation activities. Findings The paper demonstrates that ACI accommodates multiple networks whose oversight structures, self-organisation and systems change approaches combined in dynamic ways, effectively yield a diversity of network governances. Further, ACI bears out a paradox of "centralised decentralisation", co-locating agents of innovation with networks of implementation and evaluation expertise. This arrangement strengthens and legitimates the role of the strategic hybrid - the healthcare professional in pursuit of change and improvement, and enhances their influence and impact on the wider system. Research limitations/implications While focussing the case study on one agency only, this study is unique as it highlights inter-network connections. Contributing to the literature on network governance, this paper identifies ACI as a "network of networks" through which resources, expectations and stakeholder dynamics are dynamically and flexibly mediated and enhanced. Practical implications The co-location of and dynamic interaction among clinical networks may create synergies among networks, nurture "strategic hybrids", and enhance the impact of network activities on health system reform. Social implications Network governance requires more

  8. Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene citrate-resistant polycystic ovary syndrome: a network meta-analysis

    OpenAIRE

    Yu, Yiping; Fang, Lanlan; Zhang, Ruizhe; He, Jingyan; Xiong, Yujing; Guo, Xiaoyi; Du, Qingyun; Huang, Yan; Sun, Yingpu

    2017-01-01

    The comparative efficacies of ovulation-induction treatments in patients with clomiphene citrate-resistant (CCR) polycystic ovary syndrome (PCOS) are not well known. Therefore, we conducted a network meta-analysis to rank the reproductive efficacies of these treatments. We ultimately included 26 randomized clinical trials with 2722 participants and 9 types of therapies: clomiphene citrate (CC), metformin, letrozole, follicle stimulating hormone (FSH), human menopausal gonadotropin (hMG), unil...

  9. Effect of narrative reports about vaccine adverse events and bias-awareness disclaimers on vaccine decisions: a simulation of an online patient social network.

    Science.gov (United States)

    Betsch, Cornelia; Renkewitz, Frank; Haase, Niels

    2013-01-01

    As the number of individuals who search for health information in interactive online environments is increasing, patient networks deserve more scientific attention. To quantitatively examine if and how reading statistical and/or narrative information as typically displayed in patient networks (e.g., patientslikeme.com) affects decisions for pharmaceuticals. Previous work suggests that narrative information (e.g., about vaccine adverse events, VAE) affects risk perceptions and intentions. The authors compare the effect of narrative and statistical information about VAE on vaccination decisions and examine if a disclaimer reduces the narrative bias as well as if low numeracy leads to increased use of the narratives. In an online experiment, 458 participants were randomly assigned to a 3 (relative frequency of vaccine adverse events in 1, 7, or 17 of 20 cases) × 3 (type of information: narratives, summary statistics, or both) × 2 (bias awareness v. control disclaimer) between-subjects design. Measurements. Perceived risk, vaccination intention, and subjective numeracy. A higher relative frequency of cases reporting VAE decreased the intention to get vaccinated. This relation was mediated by increased risk perception. The type of information moderated the contents' impact: Summary statistics had the smallest impact, whereas narrative information was more influential, and the presence of both types of information had the greatest impact on risk perception. Individuals who received the bias-awareness disclaimer were less influenced by the patient network. Highly numerate individuals were generally more sensitive to the provided information independent of its format. Patient networks can influence vaccination decisions by delivering risk-related information. Disclaimers may help to reduce the influence if desired.

  10. What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis.

    Science.gov (United States)

    Ribassin-Majed, Laureen; Marguet, Sophie; Lee, Anne W M; Ng, Wai Tong; Ma, Jun; Chan, Anthony T C; Huang, Pei-Yu; Zhu, Guopei; Chua, Daniel T T; Chen, Yong; Mai, Hai-Qiang; Kwong, Dora L W; Cheah, Shie-Lee; Moon, James; Tung, Yuk; Chi, Kwan-Hwa; Fountzilas, George; Bourhis, Jean; Pignon, Jean Pierre; Blanchard, Pierre

    2017-02-10

    Purpose The role of adjuvant chemotherapy (AC) or induction chemotherapy (IC) in the treatment of locally advanced nasopharyngeal carcinoma is controversial. The individual patient data from the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma database were used to compare all available treatments. Methods All randomized trials of radiotherapy (RT) with or without chemotherapy in nonmetastatic nasopharyngeal carcinoma were considered. Overall, 20 trials and 5,144 patients were included. Treatments were grouped into seven categories: RT alone (RT), IC followed by RT (IC-RT), RT followed by AC (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concomitant chemoradiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). P-score was used to rank the treatments. Fixed- and random-effects frequentist network meta-analysis models were applied. Results The three treatments with the highest probability of benefit on overall survival (OS) were CRT-AC, followed by CRT and IC-CRT, with respective hazard ratios (HRs [95% CIs]) compared with RT alone of 0.65 (0.56 to 0.75), 0.77 (0.64 to 0.92), and 0.81 (0.63 to 1.04). HRs (95% CIs) of CRT-AC compared with CRT for OS, progression-free survival (PFS), locoregional control, and distant control (DC) were, respectively, 0.85 (0.68 to 1.05), 0.81 (0.66 to 0.98), 0.70 (0.48 to 1.02), and 0.87 (0.61 to 1.25). IC-CRT ranked second for PFS and the best for DC. CRT never ranked first. HRs of CRT compared with IC-CRT for OS, PFS, locoregional control, and DC were, respectively, 0.95 (0.72 to 1.25), 1.13 (0.88 to 1.46), 1.05 (0.70 to 1.59), and 1.55 (0.94 to 2.56). Regimens with more chemotherapy were associated with increased risk of acute toxicity. Conclusion The addition of AC to CRT achieved the highest survival benefit and consistent improvement for all end points. The addition of IC to CRT achieved the highest effect on DC.

  11. Measuring the sympathetic skin response on body and using as diagnosis-purposed for lung cancer patients by artificial neural networks.

    Science.gov (United States)

    Ozkan, Ozhan; Yildiz, Murat; Bilgin, Süleyman; Köklükaya, Etem

    2010-06-01

    In this study, the points of Sympathetic skin response that can be measured from different zones on body of healthy and patient subjects are determined. The Sympathetic skin responses on these points are obtained using a measurement device that is called Grass Model 7 Polygraph 1. The database is formed in Cerrahpaşa University, Faculty of Medicine and data is taken from healthy and patient subjects who are volunteer. Some parameters of the subjects which are more effective on SSR such as height, weight, age must be chosen between the specific limits to obtain results more clearly. The symmetric points on human body are chosen for the measurement. After that, the Sympathetic skin response values which are measured from a human body are simulated and tested by using artificial neural network toolbox on Matlab software. The structure of the chosen neural network is a multilayer feedforward neural network. According to simulation results, the application method as diagnosis-purposed of the lung cancer patients is explained by using the differences related to these values on the skin.

  12. Online social networking services in the management of patients with diabetes mellitus: systematic review and meta-analysis of randomised controlled trials.

    Science.gov (United States)

    Toma, Tania; Athanasiou, Thanos; Harling, Leanne; Darzi, Ara; Ashrafian, Hutan

    2014-11-01

    Social networking services (SNS) can facilitate real-time communication and feedback of blood glucose and other physiological data between patients and healthcare professionals. This systematic review and meta-analysis aims to summarise the current evidence surrounding the role of online social networking services in diabetes care. We performed a systematic literature review of the Medline, EMBASE and PsychINFO databases of all studies reporting HbA1c (glycated haemoglobin) as a measure of glycaemic control for social networking services in diabetes care. HbA1c, clinical outcomes and the type of technology used were extracted. Study quality and publication bias were assessed. SNS interventions beneficially reduced HbA1c when compared to controls, which was confirmed by sensitivity analysis. SNS interventions also significantly improved systolic and diastolic blood pressure, triglycerides and total cholesterol. Subgroup analysis according to diabetes type demonstrated that Type 2 diabetes patients had a significantly greater reduction in HbA1c than those with Type 1 diabetes. Online SNS provide a novel, feasible approach to improving glycaemic control, particularly in patients with Type 2 diabetes. Further mechanistic and cost-effectiveness studies are required to improve our understanding of SNS and its efficacy in diabetes care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Social support network to family caregiver of a patient with Spinal Muscular Atrophy I and II - doi:10.5020/18061230.2010.p126

    Directory of Open Access Journals (Sweden)

    Cláudia Viot de Albuquerque Moura

    2012-01-01

    Full Text Available Objective: To assess the formal and informal support given to the family caregiver of a patient with Spinal Muscular Atrophy I and II. Method: This was a study with a qualitative approach developed in 2008 in the homes of informants and in the premises of the Hospital Infantil Albert Sabin in Fortaleza, Ceara, conducted with 13 mothers, primary caregivers for their ill children. For data collection we used both the interview and the instrument generator of the names and qualifier of the relations, adapted for this study. Quantitative data were processed using the programs UCINET NetDraw 6.123 and 2.38, while the qualitative data were organized based on the technique of the Collective Subject Discourse. The analyses were conducted by means of network maps and collective discourses raised by central ideas. Results: The formal social network of family caregivers was composed of 72 actors, among professionals in the areas of health, education and others, linked to 12 institutions. The informal network was comprised of 83 actors. It was found that the management of care, even when the caregiver has support from other people is a cause of stress and overload. Conclusion: It is evident the importance of applying Social Network Analysis as a tool for understanding structural features and the dynamics of social relations of family caregiver. Of a patient with spinal muscular atrophy. The analysis suggests the need for intervention in the study group as a way to contribute to the recognition and use of existing services, increasing the significance of the help provided by network interactions.

  14. [Sharing patient information using iPads in the introduction of IT for home medical care-construction of a network for home care].

    Science.gov (United States)

    Morishima, Atsutomo; Kijima, Yasuaki

    2012-12-01

    In hospitals, information technology(IT)has been a natural part of care for some time. However, IT has not yet been widely introduced into home care. While performing home care, healthcare providers must carry numerous patients' medical records, and are unable to share the information included in those records with other providers. Thus, we introduced the system of sharing patient information using iPads. This system enables access to patient information regardless of time and place. In addition, we can share information such as X-ray images and computed tomography(CT)scans between different clinics. Thus, we are able to give clearer instructions to patients and other providers in a smoother way. This system could be used to construct a network for home care. In the future, we could aim to share patient information within a much wider network, including families and other kinds of organizations, for optimal care. This system will aid in the development of IT use in home care.

  15. Functional connectivity of motor cortical network in patients with brachial plexus avulsion injury after contralateral cervical nerve transfer: a resting-state fMRI study

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Aihong; Cheng, Xiaoguang; Liang, Wei; Bai, Rongjie [The 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Xicheng Qu, Beijing (China); Wang, Shufeng; Xue, Yunhao; Li, Wenjun [The 4th Medical College of Peking University, Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing (China)

    2017-03-15

    The purpose of this study is to assess the functional connectivity of the motor cortical network in patients with brachial plexus avulsion injury (BPAI) after contralateral C7 nerve transfer, using resting-state functional magnetic resonance imaging (RS-fMRI). Twelve patients with total brachial plexus root avulsion underwent RS-fMRI after contralateral C7 nerve transfer. Seventeen healthy volunteers were also included in this fMRI study as controls. The hand motor seed regions were defined as region of interests in the bilateral hemispheres. The seed-based functional connectivity was calculated in all the subjects. Differences in functional connectivity of the motor cortical network between patients and healthy controls were compared. The inter-hemispheric functional connectivity of the M1 areas was increased in patients with BPAI compared with the controls. The inter-hemispheric functional connectivity between the supplementary motor areas was reduced bilaterally. The resting-state inter-hemispheric functional connectivity of the bilateral M1 areas is altered in patients after contralateral C7 nerve transfer, suggesting a functional reorganization of cerebral cortex. (orig.)

  16. The Effect of Souvenaid on Functional Brain Network Organisation in Patients with Mild Alzheimer's Disease: A Randomised Controlled Study

    NARCIS (Netherlands)

    de Waal, H.; Stam, C.J.; Lansbergen, M.M.; Wieggers, R.L.; Kamphuis, P.J.G.H.; Scheltens, P.; Maestu, F.; van Straaten, E.C.W.

    2014-01-01

    Background: Synaptic loss is a major hallmark of Alzheimer's disease (AD). Disturbed organisation of large-scale functional brain networks in AD might reflect synaptic loss and disrupted neuronal communication. The medical food Souvenaid, containing the specific nutrient combination Fortasyn

  17. Quality assurance of teleconsultations in a store-and-forward telemedicine network - obtaining patient follow-up data and user feedback

    Directory of Open Access Journals (Sweden)

    Richard eWootton

    2014-11-01

    Full Text Available User surveys in telemedicine networks confirm that follow up data are essential, both for the specialists who provide advice and for those running the system. We have examined the feasibility of a method for obtaining follow-up data automatically in a store-and-forward network. We distinguish between follow-up, which is information about the progress of a patient and is based on outcomes, and user feedback, which is more general information about the telemedicine system itself, including user satisfaction and the benefits resulting from the use of telemedicine. In the present study, we were able to obtain both kinds of information using a single questionnaire. During a 9-month pilot trial in the MSF telemedicine network, an email request for follow-up was sent automatically by the telemedicine system to each referrer exactly 21 days after the initial submission of the case. A total of 201 requests for follow-up were issued by the system and these elicited 41 responses (a response rate of 20%. The responses were largely positive. For example, 95% of referrers found the advice helpful, 90% said that it clarified their diagnosis, 94% said that it assisted with management of the patient and 95% said that the telemedicine response was of educational benefit to them. Analysis of the characteristics of the referrers who did not respond, and their cases, did not suggest anything different about them in comparison with referrers who did respond. We were not able to identify obvious factors associated with a failure to respond. Obtaining data by automatic request is feasible. It provides useful information for specialists and for those running the network. Since obtaining follow-up data is essential to best practice, one proposal to improve the response rate is to simplify the automatic requests so that only patient follow-up information is asked for, and to restrict user feedback requests to the cases being assessed each month by the quality assurance

  18. Patients with alcohol use disorder: initial results from a prospective multicenter registry in the Spanish Network on Addiction Disorders. CohRTA Study.

    Science.gov (United States)

    Sanvisens, Arantza; Zuluaga, Paola; Rivas, Inmaculada; Rubio, Gabriel; Gual, Antoni; Torrens, Marta; Short, Antoni; Álvarez, Francisco Javier; Tor, Jordi; Farré, Magí; Rodríguez de Fonseca, Fernando; Muga, Roberto

    2017-07-14

    The Alcohol Program of the Spanish Network on Addictive Disorders-RTA requires a longitudinal study to address different research questions related to alcoholism. The cohort study (CohRTA) focuses on patients seeking treatment for alcohol use disorder, as a multicentre, collaborative research project aimed to improve secondary prevention and early diagnosis of pathological processes associated with the disorder. multicentre cohort study in adults (>18 years) seeking their first treatment of the disorder. Patients sign an informed consent and data is collected in an online platform specifically designed for the study; patients are also requested to provide biological samples that are stored in a biobank. Baseline and prospective, socio-demographic, epidemiological, clinical and treatment data are collected. Currently there are 10 participating centres that expect to recruit more than 1,000 patients. As of December 2015, 344 patients (77% men) were included. Median age at admission was 50 years (IQR: 43-55 years). Median age at the start of alcohol consumption was 15 years (IQR: 14-18 years) and 61% of cases reported antecedents of alcohol use disorder in the family. During the 30 days prior to admission, alcohol consumption amounted to 12.5 SDU/day (IQR: 7.1-20 SDU/day), 72% of the patients were tobacco smokers and 30% currently used cocaine. Organising an open cohort of patients with alcohol use disorder may be crucial to better understand the clinical consequences of alcoholism in Spain. This cohort may potentiate quantitative and qualitative research within the Spanish Network on Addictive Disorders-RTA/RETICS. Having a well-established, representative cohort of patients will increase translational research on consequences of alcoholism in our country.

  19. Patterns of drug resistance among newly diagnosed HIV-1 infected patients in Greece during the last decade: the crucial role of transmission networks

    Directory of Open Access Journals (Sweden)

    Dimitrios Paraskevis

    2014-11-01

    Full Text Available Introduction: The prevalence of drug resistance is approximately 10% in Europe and North America among newly infected patients. We aim to investigate the temporal patterns of resistance among drug naive HIV-infected individuals in Greece and also to determine transmission networking among those with resistant strains. Materials and Methods: Protease (PR and partial reverse transcriptase (RT sequences were determined from 2499 newly diagnosed HIV-1 patients, in Greece, during 2003–2013. Genotypic drug resistance was estimated using the HIVdb: Genotypic Resistance Interpretation Algorithm. We identified transmission clusters of resistant strains on the basis of a large collection of HIV-1 sequences from 4024 seropositives in Greece. Phylodynamic analysis was performed using a Bayesian method. Results: We estimated drug resistance levels among naïve patients on the basis of all resistance mutations in PR and partial RT. The overall prevalence of resistance was 19.6% (490/2499. Resistance to NNRTIs was the most common (397/2499, 15.9% followed by PIs (116/2499, 4.6% and NRTIs (79/2499, 3.2%. We found a significant trend for decreasing resistance to NRTIs over time (6.7%–1.6%. There was no time trend for the overall PI and NNRTI resistance. The most frequently observed major resistant sites in PR were V82 (2.0% and L90 (1.8%. In RT, we found E138 (58.6%, K103 (13.1%, V179 (8.4% and T215 (7.1%, M41 (4.7% associated with resistance to NNRTIs and NRTIs, respectively. The prevalence of K103N and E138Q were significantly increased during 2003–2013. Crucially, we found that both K103N, E138Q are associated with transmission networking within men having sex with men (MSM and intravenous drug user (IDU local networks. The K103N network included seropositives across Greece, while the latter only from the recent IDU outbreak in Athens metropolitan area (1. Phylodynamic analyses revealed that the exponential growth for K103N network started in 2009

  20. Application of Neural Networks for classification of Patau, Edwards, Down, Turner and Klinefelter Syndrome based on first trimester maternal serum screening data, ultrasonographic findings and patient demographics.

    Science.gov (United States)

    Catic, Aida; Gurbeta, Lejla; Kurtovic-Kozaric, Amina; Mehmedbasic, Senad; Badnjevic, Almir

    2018-02-13

    feedback was 98.8%. The results presented in this paper prove that an expert diagnostic system based on neural networks can be efficiently used for classification of five aneuploidy syndromes, covered with this study, based on first trimester maternal serum screening data, ultrasonographic findings and patient demographics. Developed Expert System proved to be simple, robust, and powerful in properly classifying prenatal aneuploidy syndromes.

  1. Implementation and Operational Research: Pulling the Network Together: Quasiexperimental Trial of a Patient-Defined Support Network Intervention for Promoting Engagement in HIV Care and Medication Adherence on Mfangano Island, Kenya.

    Science.gov (United States)

    Hickey, Matthew D; Salmen, Charles R; Omollo, Dan; Mattah, Brian; Fiorella, Kathryn J; Geng, Elvin H; Bacchetti, Peter; Blat, Cinthia; Ouma, Gor B; Zoughbie, Daniel; Tessler, Robert A; Salmen, Marcus R; Campbell, Harold; Gandhi, Monica; Shade, Starley; Njoroge, Betty; Bukusi, Elizabeth A; Cohen, Craig R

    2015-08-01

    Despite progress in the global scale-up of antiretroviral therapy, sustained engagement in HIV care remains challenging. Social capital is an important factor for sustained engagement, but interventions designed to harness this powerful social force are uncommon. We conducted a quasiexperimental study evaluating the impact of the Microclinic Social Network intervention on engagement in HIV care and medication adherence on Mfangano Island, Kenya. The intervention was introduced into 1 of 4 similar communities served by this clinic; comparisons were made between communities using an intention-to-treat analysis. Microclinics, composed of patient-defined support networks, participated in 10 biweekly discussion sessions covering topics ranging from HIV biology to group support and group HIV status disclosure. Nevirapine concentrations in hair were measured before and after study. One hundred thirteen (74%) intervention community participants joined a microclinic group, 86% of whom participated in group HIV status disclosure. Over 22-month follow-up, intervention community participants experienced one-half the rate of ≥ 90-day clinic absence as those in control communities (adjusted hazard ratio: 0.48; 95% confidence interval: 0.25 to 0.92). Nevirapine hair levels declined in both study arms; in adjusted linear regression analysis, the decline was 6.7 ng/mg less severe in the intervention arm than control arm (95% confidence interval: -2.7 to 16.1). The microclinic intervention is a promising and feasible community-based strategy to improve long-term engagement in HIV care and possibly medication adherence. Reducing treatment interruptions using a social network approach has important implications for individual patient virologic suppression, morbidity, and mortality and for broader community empowerment and engagement in healthcare.

  2. Patient and clinician perspectives of an integrated electronic medication prescribing and dispensing system: A qualitative study at a multisite Australian hospital network.

    Science.gov (United States)

    Lau, Grace; Ho, Jayde; Lin, Susan; Yeoh, Karen; Wan, Tiffany; Hodgkinson, Marisa

    2017-01-01

    While clinician attitudes towards electronic prescribing (e-prescribing) systems have been widely studied, little is known about the perspectives of patients, despite being the primary beneficiaries of these systems. The objective of this study is to explore and compare patient and clinician attitudes towards an integrated e-prescribing and dispensing system, in order to guide improvements in system implementation, service delivery and enhancements to system functionality. A cross-sectional survey was developed and administered to patients and multidisciplinary clinicians at a multisite Australian metropolitan teaching hospital network in all areas where e-prescribing was fully implemented. Participants' views on perceived impact and valued features of the e-prescribing system were elucidated. Overall, 783 participants (400 patients and 383 clinicians) completed the survey. Although 98% of clinicians were aware of the transition to e-prescriptions, only 36% of patients were aware prior to the study. Over 80% of patients and clinicians perceived improvements in prescribing and dispensing safety and clinician workflow; 90% of patients were comfortable with information privacy associated with e-prescriptions; and 86% of patients preferred e-prescriptions to handwritten prescriptions. Although over 80% of patients valued features that improved access to information and medication safety, clinicians were more discerning about valued system features. The majority of patients and clinicians reported a positive impact of e-prescribing on safety and efficiency. Both groups valued safe and effective use of medicines, although differences existed in the importance placed on key system features. A greater focus on patient engagement and communication is needed to optimise the delivery of patient-centred care.

  3. An infectious disease/fever screening radar system which stratifies higher-risk patients within ten seconds using a neural network and the fuzzy grouping method.

    Science.gov (United States)

    Sun, Guanghao; Matsui, Takemi; Hakozaki, Yukiya; Abe, Shigeto

    2015-03-01

    To classify higher-risk influenza patients within 10 s, we developed an infectious disease and fever screening radar system. The system screens infected patients based on vital signs, i.e., respiration rate measured by a radar, heart rate by a finger-tip photo-reflector, and facial temperature by a thermography. The system segregates subjects into higher-risk influenza (HR-I) group, lower-risk influenza (LR-I) group, and non-influenza (Non-I) group using a neural network and fuzzy clustering method (FCM). We conducted influenza screening for 35 seasonal influenza patients and 48 normal control subjects at the Japan Self-Defense Force Central Hospital. Pulse oximetry oxygen saturation (SpO2) was measured as a reference. The system classified 17 subjects into HR-I group, 26 into LR-I group, and 40 into Non-I group. Ten out of the 17 HR-I subjects indicated SpO2 Non-I group. The combination of neural network and FCM achieved efficient detection of higher-risk influenza patients who indicated SpO2 96% within 10 s. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  4. Alteration of functional connectivity within visuospatial working memory-related brain network in patients with right temporal lobe epilepsy: a resting-state fMRI study.

    Science.gov (United States)

    Lv, Zong-xia; Huang, Dong-Hong; Ye, Wei; Chen, Zi-rong; Huang, Wen-li; Zheng, Jin-ou

    2014-06-01

    This study aimed to investigate the resting-state brain network related to visuospatial working memory (VSWM) in patients with right temporal lobe epilepsy (rTLE). The functional mechanism underlying the cognitive impairment in VSWM was also determined. Fifteen patients with rTLE and 16 healthy controls matched for age, gender, and handedness underwent a 6-min resting-state functional MRI session and a neuropsychological test using VSWM_Nback. The VSWM-related brain network at rest was extracted using multiple independent component analysis; the spatial distribution and the functional connectivity (FC) parameters of the cerebral network were compared between groups. Behavioral data were subsequently correlated with the mean Z-value in voxels showing significant FC difference during intergroup comparison. The distribution of the VSWM-related resting-state network (RSN) in the group with rTLE was virtually consistent with that in the healthy controls. The distribution involved the dorsolateral prefrontal lobe and parietal lobe in the right hemisphere and the partial inferior parietal lobe and posterior lobe of the cerebellum in the left hemisphere (p<0.05, AlphaSim corrected). Between-group differences suggest that the group with rTLE had a decreased FC within the right superior frontal lobe (BA8), right middle frontal lobe, and right ventromedial prefrontal lobe compared with the controls (p<0.05, AlphaSim corrected). The regions of increased FC in rTLE were localized within the right superior frontal lobe (BA11), right superior parietal lobe, and left posterior lobe of the cerebellum (p<0.05, AlphaSim corrected). Moreover, patients with rTLE performed worse than controls in the VSWM_Nback test, and there were negative correlations between ACCmeanRT (2-back) and the mean Z-value in the voxels showing decreased or increased FC in rTLE (p<0.05). The results suggest that the alteration of the VSWM-related RSN might underpin the VSWM impairment in patients with rTLE and

  5. Clinical significance of increased cerebellar default-mode network connectivity in resting-state patients with drug-naive somatization disorder.

    Science.gov (United States)

    Wang, Houliang; Guo, Wenbin; Liu, Feng; Chen, Jindong; Wu, Renrong; Zhang, Zhikun; Yu, Miaoyu; Li, Lehua; Zhao, Jingping

    2016-07-01

    The cerebellum has been proven to be connected to the brain network, as in the default-mode network (DMN), among healthy subjects and patients with psychiatric disorders. However, whether or not abnormal cerebellar DMN connectivity exists and what its clinical significance is among drug-naive patients with somatization disorder (SD) at rest remain unclear.A total of 25 drug-naive patients with SD and 28 healthy controls were enrolled for a resting-state scan. The imaging data were analyzed using the seed-based functional connectivity (FC) method.Compared with the controls, patients with SD showed increased left/right Crus I-left/right angular gyrus (AG) connectivity and Lobule IX-left superior medial prefrontal cortex (MPFC) connectivity. The FC values of the left/right Crus I-right AG connectivity of the patients were positively correlated with their scores in the somatization subscale of the symptom checklist-90 (Scl-90). A trend level of correlations was observed between the FC values of the left Crus I-left AG connectivity of the patients and their scores for the somatization subscale of Scl-90, as well as between the FC values of their Lobule IX-left superior MPFC connectivity and their scores for the Eysenck personality questionnaire (EPQ) extraversion.Our findings show the increased cerebellar DMN connectivity in patients with SD and therefore highlight the importance of the DMN in the neurobiology of SD. Increased cerebellar DMN connectivities are also correlated with their somatization severity and personality, both of which bear clinical significance.

  6. Comparative safety and effectiveness of cognitive enhancers for Alzheimer's dementia: protocol for a systematic review and individual patient data network meta-analysis

    Science.gov (United States)

    Veroniki, Areti Angeliki; Straus, Sharon E; Ashoor, Huda M; Hamid, Jemila S; Hemmelgarn, Brenda R; Holroyd-Leduc, Jayna; Majumdar, Sumit R; McAuley, Glenn; Tricco, Andrea C

    2016-01-01

    Introduction Alzheimer's dementia (AD) is the most common cause of dementia, and several organisations, such as the National Institute for Health and Care Excellence, suggest that management of patients with AD should be tailored to their needs. To date, little research has been conducted on the treatment effect in different subgroups of patients with AD. The aim of this study is to examine the comparative effectiveness and safety of cognitive enhancers for different patient characteristics. Methods and analysis We will update our previous literature search from January 2015 forward, using the same terms and electronic databases (eg, MEDLINE) from our previous review. We will additionally search grey literature and scan the reference lists of the included studies. Randomised clinical trials of any duration conducted at any time comparing cognitive enhancers alone or in any combination against other cognitive enhancers, or placebo in adults with AD will be eligible. The outcomes of interest are cognition according to the Mini-Mental State Examination, and overall serious adverse events. For each outcome and treatment comparison, we will perform a Bayesian hierarchical random-effects meta-analysis combining the individual patient data (IPD) from each eligible study. If the identified treatment comparisons form a connected network diagram, we will perform an IPD network meta-analysis (NMA) to estimate subgroup effects for patients with different characteristics, such as AD severity and sex. We will combine aggregated data from studies that we will not be able to obtain IPD, with the IPD provided by the original authors, in a single model. We will use the PRISMA-IPD and PRISMA-NMA statements to report our findings. Ethics and dissemination The findings of this study will be of interest to stakeholders, including decision makers, guideline developers, clinicians, methodologists and patients, and they will help to improve guidelines for the management of patients with AD

  7. The effects of CPAP treatment on task positive and default mode networks in obstructive sleep apnea patients: an fMRI study.

    Directory of Open Access Journals (Sweden)

    Olga Prilipko

    Full Text Available INTRODUCTION: Functional magnetic resonance imaging studies enable the investigation of neural correlates underlying behavioral performance. We investigate the effect of active and sham Continuous Positive Airway Pressure (CPAP treatment on working memory function of patients with Obstructive Sleep Apnea Syndrome (OSAS considering Task Positive and Default Mode networks (TPN and DMN. METHODS: An experiment with 4 levels of visuospatial n-back task was used to investigate the pattern of cortical activation in 17 men with moderate or severe OSAS before and after 2 months of therapeutic (active or sub-therapeutic (sham CPAP treatment. RESULTS: Patients with untreated OSAS had significantly less deactivation in the temporal regions of the DMN as compared to healthy controls, but activation within TPN regions was comparatively relatively preserved. After 2 months of treatment, active and sham CPAP groups exhibited opposite trends of cerebral activation and deactivation. After treatment, the active CPAP group demonstrated an increase of cerebral activation in the TPN at all task levels and of task-related cerebral deactivation in the anterior midline and medial temporal regions of the DMN at the 3-back level, associated with a significant improvement of behavioral performance, whereas the sham CPAP group exhibited less deactivation in the temporal regions of Default Mode Network and less Task Positive Network activation associated to longer response times at the 3-back. CONCLUSION: OSAS has a significant negative impact primarily on task-related DMN deactivation, particularly in the medial temporal regions, possibly due to nocturnal hypoxemia, as well as TPN activation, particularly in the right ventral fronto-parietal network. After 2 months of active nasal CPAP treatment a positive response was noted in both TPN and DMN but without compete recovery of existing behavioral and neuronal deficits. Initiation of CPAP treatment early in the course of the

  8. Elevated Admission Base Deficit Is Associated with a Complex Dynamic Network of Systemic Inflammation Which Drives Clinical Trajectories in Blunt Trauma Patients

    Directory of Open Access Journals (Sweden)

    Othman Abdul-Malak

    2016-01-01

    Full Text Available We hypothesized that elevated base deficit (BD ≥ 4 mEq/L upon admission could be associated with an altered inflammatory response, which in turn may impact differential clinical trajectories. Using clinical and biobank data from 472 blunt trauma survivors, 154 patients were identified after excluding patients who received prehospital IV fluids or had alcohol intoxication. From this subcohort, 84 patients had a BD ≥ 4 mEq/L and 70 patients with BD < 4 mEq/L. Three samples within the first 24 h were obtained from all patients and then daily up to day 7 after injury. Twenty-two cytokines and chemokines were assayed using Luminex™ and were analyzed using two-way ANOVA and dynamic network analysis (DyNA. Multiple mediators of the innate and lymphoid immune responses in the BD ≥ 4 group were elevated differentially upon admission and up to 16 h after injury. DyNA revealed a higher, sustained degree of interconnectivity of the inflammatory response in the BD ≥ 4 patients during the initial 16 h after injury. These results suggest that elevated admission BD is associated with differential immune/inflammatory pathways, which subsequently could predispose patients to follow a complicated clinical course.

  9. Improving adequacy of hemodialysis in Northern California ESRD patients: a final project report. Provider Participants and Medical Review Board of the TransPacific Renal Network.

    Science.gov (United States)

    Brown, J; Josephson, M

    2000-10-01

    The National Core Indicators Project, initiated in 1994, has brought progressive changes in adequacy of dialysis for end-stage renal disease (ESRD) patients in the TransPacific Renal Network and across the United States. The 1998 Core Indicator Project showed each Network's standing for percentage of patients with urea reduction ratio (URR) > or = 0.65 and average URR. The TransPacific Renal Network ranked 12(th) among the 18 Networks for this adequacy measure. The goals of this project were to improve the Network standing in the United States for the percent of patients with URR > or = 0.65, eliminate or reduce the barriers to achieving adequate dialysis, and evaluate URR versus KT/V data and the variances occurring with these measures. In January 1999, data were collected from all 113 Northern California hemodialysis facilities for quarter 4, 1998, to evaluate adequacy. Each facility provided patient population (N) for KT/V and URR samples, facility averages for KT/V and URR, number of patients with KT/V > or = 1.2 and URR > or = 0.65, and data on post-blood-urea-nitrogen (BUN) sampling methods. A random selection of 10% (12) providers with data below the US and Network standards was selected for an intensive assessment. Using baseline measurements, on-site data were collected from a random selection of the patient population. Chart data were reviewed, analyzed, and discussed in an exit interview with the facility management. On-site visits were performed in July/June 1999. The primary focus included adequacy data and process of care that affect adequacy outcomes, concurrent review of patients receiving treatment at the time of the site visit, and general medical record review. In Phase I, only 12 facilities showed an average URR below 0.65. All facilities reported an average KT/V greater than the DOQI target of 1.2. Forty-two facilities had their percentage of patients with a URR below the national benchmark; only 18 facilities had their percentage of patients

  10. Gene identification for risk of relapse in stage I lung adenocarcinoma patients: a combined methodology of gene expression profiling and computational gene network analysis.

    Science.gov (United States)

    Ludovini, Vienna; Bianconi, Fortunato; Siggillino, Annamaria; Piobbico, Danilo; Vannucci, Jacopo; Metro, Giulio; Chiari, Rita; Bellezza, Guido; Puma, Francesco; Della Fazia, Maria Agnese; Servillo, Giuseppe; Crinò, Lucio

    2016-05-24

    Risk assessment and treatment choice remains a challenge in early non-small-cell lung cancer (NSCLC). The aim of this study was to identify novel genes involved in the risk of early relapse (ER) compared to no relapse (NR) in resected lung adenocarcinoma (AD) patients using a combination of high throughput technology and computational analysis. We identified 18 patients (n.13 NR and n.5 ER) with stage I AD. Frozen samples of patients in ER, NR and corresponding normal lung (NL) were subjected to Microarray technology and quantitative-PCR (Q-PCR). A gene network computational analysis was performed to select predictive genes. An independent set of 79 ADs stage I samples was used to validate selected genes by Q-PCR.From microarray analysis we selected 50 genes, using the fold change ratio of ER versus NR. They were validated both in pool and individually in patient samples (ER and NR) by Q-PCR. Fourteen increased and 25 decreased genes showed a concordance between two methods. They were used to perform a computational gene network analysis that identified 4 increased (HOXA10, CLCA2, AKR1B10, FABP3) and 6 decreased (SCGB1A1, PGC, TFF1, PSCA, SPRR1B and PRSS1) genes. Moreover, in an independent dataset of ADs samples, we showed that both high FABP3 expression and low SCGB1A1 expression was associated with a worse disease-free survival (DFS).Our results indicate that it is possible to define, through gene expression and computational analysis, a characteristic gene profiling of patients with an increased risk of relapse that may become a tool for patient selection for adjuvant therapy.

  11. Professional social networking.

    Science.gov (United States)

    Rowley, Robert D

    2014-12-01

    We review the current state of social communication between healthcare professionals, the role of consumer social networking, and some emerging technologies to address the gaps. In particular, the review covers (1) the current state of loose social networking for continuing medical education (CME) and other broadcast information dissemination; (2) social networking for business promotion; (3) social networking for peer collaboration, including simple communication as well as more robust data-centered collaboration around patient care; and (4) engaging patients on social platforms, including integrating consumer-originated data into the mix of healthcare data. We will see how, as the nature of healthcare delivery moves from the institution-centric way of tradition to a more social and networked ambulatory pattern that we see emerging today, the nature of health IT has also moved from enterprise-centric systems to more socially networked, cloud-based options.

  12. Effect of Chinese tuina massage therapy on resting state brain functional network of patients with chronic neck pain

    Directory of Open Access Journals (Sweden)

    Hua Zhang

    2015-01-01

    Conclusion: Chronic neck pain caused by cervical radiculopathy may influence the DMN, which plays an important role in emotion, cognition, and memory, by stimulating the sensory afferent network. Tuina not only significantly relieves pain and discomfort, but also reverses the causality between aDMN and SMN.

  13. Replicability and generalizability of PTSD networks: A cross-cultural multisite study of PTSD symptoms in four trauma patient samples

    DEFF Research Database (Denmark)

    Fried, Eiko I.; Eidhof, Marloes B.; Palic, Sabina

    2018-01-01

    The growing literature conceptualizing mental disorders like Posttraumatic Stress Disorder (PTSD) asnetworks of interacting symptoms faces three key challenges. Prior studies predominantly used (a)small samples with low power for precise network estimation, (b) non-clinical samples, and (c...

  14. Disrupted brain network functional dynamics and hyper-correlation of structural and functional connectome topology in patients with breast cancer prior to treatment.

    Science.gov (United States)

    Kesler, Shelli R; Adams, Marjorie; Packer, Melissa; Rao, Vikram; Henneghan, Ashley M; Blayney, Douglas W; Palesh, Oxana

    2017-03-01

    Several previous studies have demonstrated that cancer chemotherapy is associated with brain injury and cognitive dysfunction. However, evidence suggests that cancer pathogenesis alone may play a role, even in non-CNS cancers. Using a multimodal neuroimaging approach, we measured structural and functional connectome topology as well as functional network dynamics in newly diagnosed patients with breast cancer. Our study involved a novel, pretreatment assessment that occurred prior to the initiation of any cancer therapies, including surgery with anesthesia. We enrolled 74 patients with breast cancer age 29-65 and 50 frequency-matched healthy female controls who underwent anatomic and resting-state functional MRI as well as cognitive testing. Compared to controls, patients with breast cancer demonstrated significantly lower functional network dynamics (p = .046) and cognitive functioning (p cancer group also showed subtle alterations in structural local clustering and functional local clustering (p cancer may directly and/or indirectly affect the brain via mechanisms such as tumor-induced neurogenesis, inflammation, and/or vascular changes, for example. Our results also have broader implications concerning the importance of the balance between structural and functional connectome properties as a potential biomarker of general neurologic deficit.

  15. Online social support networks.

    Science.gov (United States)

    Mehta, Neil; Atreja, Ashish

    2015-04-01

    Peer support groups have a long history and have been shown to improve health outcomes. With the increasing familiarity with online social networks like Facebook and ubiquitous access to the Internet, online social support networks are becoming popular. While studies have shown the benefit of these networks in providing emotional support or meeting informational needs, robust data on improving outcomes such as a decrease in health services utilization or reduction in adverse outcomes is lacking. These networks also pose unique challenges in the areas of patient privacy, funding models, quality of content, and research agendas. Addressing these concerns while creating patient-centred, patient-powered online support networks will help leverage these platforms to complement traditional healthcare delivery models in the current environment of value-based care.

  16. Practitioner, patient and carious lesion characteristics associated with type of restorative material: findings from The Dental Practice-Based Research Network.

    Science.gov (United States)

    Makhija, Sonia K; Gordan, Valeria V; Gilbert, Gregg H; Litaker, Mark S; Rindal, D Brad; Pihlstrom, Daniel J; Qvist, Vibeke

    2011-06-01

    The authors conducted a study to identify factors associated with the materials that dentists in The Dental Practice-Based Research Network (DPBRN) use when placing the first restoration on permanent posterior tooth surfaces. A total of 182 DPBRN practitioner-investigators provided data regarding 5,599 posterior teeth with caries. Practitioner-investigators completed an enrollment questionnaire that included the dentist's age, sex, practice workload, practice type and number of years since graduation. When patients who had provided informed consent to participate in the investigation sought treatment for a previously unrestored carious surface, the practitioner-investigator recorded patient and tooth characteristics. Practitioner-investigators used amalgam more often than they used direct resin-based composite (RBC) for posterior carious lesions. Practitioner and practice characteristics (years since graduation and type of practice); patient characteristics (sex, race, age and dental insurance status); and lesion characteristics (tooth location and surface, preoperative and postoperative lesion depth) were associated with the type of restorative material used. Several practitioner and practice, patient and lesion characteristics were associated significantly with use of amalgam and RBC: geographical region, years since dentist's graduation, patient's dental insurance status, tooth location and surface, and preoperative and postoperative lesion depth. Despite advances in esthetic dentistry, U.S. dentists still are placing amalgam on posterior teeth with carious lesions. Amalgam was used more often than RBC in older patients, who may have had deeper carious lesions.

  17. Connectedness of healthcare professionals involved in the treatment of patients with Parkinson's disease: a social networks study

    NARCIS (Netherlands)

    Wensing, M.J.P.; Eijk, M. van der; Koetsenruijter, J.; Bloem, B.R.; Munneke, M.; Faber, M.J.

    2011-01-01

    ABSTRACT: BACKGROUND: Patients with chronic illness typically receive ambulatory treatment from multiple health professionals. Connectedness between these professionals may influence their clinical decisions and the coordination of patient care. We aimed to describe and analyze connectedness in a

  18. Characteristics of patients patch tested in the European Surveillance System on Contact Allergies (ESSCA) network, 2009-2012

    DEFF Research Database (Denmark)

    Uter, Wolfgang; Gefeller, Olaf; Giménez-Arnau, Ana

    2015-01-01

    BACKGROUND: Patch test results often vary between departments, and also between countries. Such variation may be partly attributable to systematic effects introduced by patient characteristics, differing exposures, patient selection, or methodological differences. OBJECTIVE: To examine the amount...

  19. The impact of telenursing consultation by using the social networks to promote the self- efficacy and weight control in patients treating with hemodialysis

    Directory of Open Access Journals (Sweden)

    Marzieh Sadat Hosseini

    2016-12-01

    Full Text Available Hemodialysis as the most common renal replacement therapy alone cannot ensure the health and survival of the patient's life and along with it, training and consulting about self-care and adherence is one of the fundamental pillars of treatment. This study was conducted to determine the impact of telenursing consultation by using networks to promote the self-efficacy and weight control in patients treating with hemodialysis. This study was a clinical trial for two groups and had a pre-test and two post-test. 52 patients under treatment by hemodialysis were divided randomly into two groups of experimental and control groups. The experimental group received consultations by using the telegram software and the control group received usual nursing care for a month. The data were collected by the weight control of the patients before and after the sessions of hemodialysis and general self-efficacy questionnaire and were analyzed by SPSS software version 20, and using descriptive statistics and analytical tests. The two groups did not have a significant statistically differences in demographic variables. The average rates of the self-efficacy after intervention in the experimental group was significantly more than the control group and also the average overweight after the intervention was significantly lower. telenursing consultation by using the social networks is effective on the improvement of self-efficacy and weight control in patients treating with hemodialysis and due to the shortage of nurses and their high volume of work it can be used as a new way for training.

  20. Declarative Networking

    CERN Document Server

    Loo, Boon Thau

    2012-01-01

    Declarative Networking is a programming methodology that enables developers to concisely specify network protocols and services, which are directly compiled to a dataflow framework that executes the specifications. Declarative networking proposes the use of a declarative query language for specifying and implementing network protocols, and employs a dataflow framework at runtime for communication and maintenance of network state. The primary goal of declarative networking is to greatly simplify the process of specifying, implementing, deploying and evolving a network design. In addition, decla

  1. The development and implementation of a regional network of physiotherapists for exercise therapy in patients with peripheral arterial disease, a preliminary report

    Directory of Open Access Journals (Sweden)

    Prins MH

    2005-07-01

    Full Text Available Abstract Background Exercise therapy (ET is the main conservative and proven effective treatment of patients with intermittent claudication. Currently, the most frequent exercise prescription is a single 'go home and walk' advise, without supervision or follow-up. There is no evidence to support the efficacy of this advise and compliance is known to be low. Therefore, a systematic approach was used to guarantee quality and standardisation of treatment, optimal guideline adherence and improved of inter-professional communication between vascular surgeons and physiotherapists. In this preliminary report we would like to outline the steps taken for the development and implementation of the Network Exercise Therapy Parkstad Methods In October 2003 all 59 regional physiotherapy practices were invited to attend a symposium regarding ET in a physiotherapeutic setting. Attending physiotherapists interested in providing ET and willing to follow a certified course on ET, were asked to register. Three tastkgroups were formed to accomplish the set targets: Exercise therapy education, Exercise therapy implementation and continuity, and Inter-professional communication in the Parkstad region. Results In total 27 physiotherapists, from 22 different practices followed the educational program and are now trained and accredited to provide ET according to the guideline of the Royal Dutch Society for Physiotherapy. A web-based database wasdesigned to contain information on disease specific items provided by the vascular surgery department, and aspects with respect to ET registered by the physiotherapist. The information is regularly updated and available online. Access tothe database is restricted to vascular surgeons and physiotherapists in the network. The secondary purpose of the database is to register essential benchmark data for future analysis of ET in a physiotherapeutic setting in the Netherlands and to enable physiotherapists continuous feedback on

  2. Feasibility of predicting tumor motion using online data acquired during treatment and a generalized neural network optimized with offline patient tumor trajectories.

    Science.gov (United States)

    Teo, Troy P; Ahmed, Syed Bilal; Kawalec, Philip; Alayoubi, Nadia; Bruce, Neil; Lyn, Ethan; Pistorius, Stephen

    2018-02-01

    The accurate prediction of intrafraction lung tumor motion is required to compensate for system latency in image-guided adaptive radiotherapy systems. The goal of this study was to identify an optimal prediction model that has a short learning period so that prediction and adaptation can commence soon after treatment begins, and requires minimal reoptimization for individual patients. Specifically, the feasibility of predicting tumor position using a combination of a generalized (i.e., averaged) neural network, optimized using historical patient data (i.e., tumor trajectories) obtained offline, coupled with the use of real-time online tumor positions (obtained during treatment delivery) was examined. A 3-layer perceptron neural network was implemented to predict tumor motion for a prediction horizon of 650 ms. A backpropagation algorithm and batch gradient descent approach were used to train the model. Twenty-seven 1-min lung tumor motion samples (selected from a CyberKnife patient dataset) were sampled at a rate of 7.5 Hz (0.133 s) to emulate the frame rate of an electronic portal imaging device (EPID). A sliding temporal window was used to sample the data for learning. The sliding window length was set to be equivalent to the first breathing cycle detected from each trajectory. Performing a parametric sweep, an averaged error surface of mean square errors (MSE) was obtained from the prediction responses of seven trajectories used for the training of the model (Group 1). An optimal input data size and number of hidden neurons were selected to represent the generalized model. To evaluate the prediction performance of the generalized model on unseen data, twenty tumor traces (Group 2) that were not involved in the training of the model were used for the leave-one-out cross-validation purposes. An input data size of 35 samples (4.6 s) and 20 hidden neurons were selected for the generalized neural network. An average sliding window length of 28 data samples was

  3. The Community Health Applied Research Network (CHARN) Data Warehouse: a Resource for Patient-Centered Outcomes Research and Quality Improvement in Underserved, Safety Net Populations.

    Science.gov (United States)

    Laws, Reesa; Gillespie, Suzanne; Puro, Jon; Van Rompaey, Stephan; Quach, Thu; Carroll, Joseph; Weir, Rosy Chang; Crawford, Phil; Grasso, Chris; Kaleba, Erin; McBurnie, Mary Ann

    2014-01-01

    The Community Health Applied Research Network, funded by the Health Resources and Services Administration, is a research network comprising 18 Community Health Centers organized into four Research Nodes (each including an academic partner) and a data coordinating center. The network represents more than 500,000 diverse safety net patients across 11 states. The primary objective of this paper is to describe the development and implementation process of the CHARN data warehouse. The methods involved regulatory and governance development and approval, development of content and structure of the warehouse and processes for extracting the data locally, performing validation, and finally submitting data to the data coordinating center. Version 1 of the warehouse has been developed. Tables have been added, the population and the years of electronic health records (EHR) have been expanded for Version 2. It is feasible to create a national, centralized data warehouse with multiple Community Health Center partners using different EHR systems. It is essential to allow sufficient time: (1) to develop collaborative, trusting relationships among new partners with varied technology, backgrounds, expertise, and interests; (2) to complete institutional, business, and regulatory review processes; (3) to identify and address technical challenges associated with diverse data environments, practices, and resources; and (4) to provide continuing data quality assessments to ensure data accuracy.

  4. "Apraxic dysgraphia" in a 15-year-old left-handed patient: disruption of the cerebello-cerebral network involved in the planning and execution of graphomotor movements.

    Science.gov (United States)

    Mariën, Peter; de Smet, Eric; de Smet, Hyo Jung; Wackenier, Peggy; Dobbeleir, Andre; Verhoeven, Jo

    2013-02-01

    Apraxic agraphia is a peripheral writing disorder caused by neurological damage. It induces a lack or loss of access to the motor engrams that plan and programme the graphomotor movements necessary to produce written output. The neural network subserving handwriting includes the superior parietal region, the dorsolateral and medial premotor cortex and the thalamus of the dominant hemisphere. Recent studies indicate that the cerebellum may be involved as well. To the best of our knowledge, apraxic agraphia has not been described on a developmental basis. This paper reports the clinical, neurocognitive and (functional) neuroimaging findings of a 15-year-old left-handed patient with an isolated, non-progressive developmental handwriting disorder consistent with a diagnosis of "apraxic dysgraphia". Gross motor coordination problems were objectified as well but no signs of cerebellar, sensorimotor or extrapyramidal dysfunction of the writing limb were found to explain the apraxic phenomena. Brain MRI revealed no supra- and infratentorial damage but quantified Tc-99m-ECD SPECT disclosed decreased perfusion in the anatomoclinically suspected prefrontal and cerebellar brain regions crucially involved in the planning and execution of skilled motor actions. This pattern of functional depression seems to support the hypothesis that "apraxic dysgraphia" might reflect incomplete maturation of the cerebello-cerebral network involved in handwriting. In addition, it is hypothesized that "apraxic dysgraphia" may have to be considered to represent a distinct nosological category within the group of the developmental dyspraxias following dysfunction of the cerebello-cerebral network involved in planned actions.

  5. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study

    NARCIS (Netherlands)

    Guérin, C.; Beuret, P.; Constantin, J. M.; Bellani, G.; Garcia-Olivares, P.; Roca, O.; Meertens, J. H.; Maia, P. Azevedo; Becher, T.; Peterson, J.; Larsson, A.; Gurjar, M.; Hajjej, Z.; Kovari, F.; Assiri, A. H.; Mainas, E.; Hasan, M. S.; Morocho-Tutillo, D. R.; Baboi, L.; Chrétien, J. M.; François, G.; Ayzac, L.; Chen, L.; Brochard, L.; Mercat, A.; Hajjej, Zied; Sellami, Walid; Ferjani, M.; Gurjar, Mohan; Assiri, Amer; Al Bshabshe, Ali; Almekhlafi, Ghaleb; Mandourah, Yasser; Hasan, Mohd Shahnaz; Rai, Vineya; Marzida, M.; Corcoles Gonzalez, Virgilio; Sanchez Iniesta, Rafael; Garcia, Pablo; Garcia-Montesinos de La Peña, Manuel; Garcia Herrera, Adriana; Roca, Oriol; Garcia-de-Acilu, Marina; Masclans Enviz, Joan Ramon; Mancebo, Jordi; Heili, Sarah; Artigas Raventos, Antonio; Blanch Torra, Lluís; Roche-Campo, Ferran; Rialp, Gemma; Forteza, Catalina; Berrazueta, Ana; Martinez, Esther; Penuelas, Oscar; Jara-Rubio, Ruben; Mallat, Jihad; Thevenin, D.; Zogheib, Elie; Mercat, Alain; Levrat, Albrice; Porot, Veronique; Bedock, B.; Grech, Ludovic; Plantefeve, Gaetan; Badie, Julio; Besch, Guillaume; Pili-Floury, Sébastien; Guisset, Olivier; Robine, Adrien; Prat, Gwenael; Doise, Jean-Marc; Badet, Michel; Thouret, J. M.; Just, Bernard; Perbet, Sébastien; Lautrette, Alexandre; Souweine, B.; Chabanne, Russell; Danguy des Déserts, Marc; Rigaud, Jean-Philippe; Marchalot, Antoine; Rigaud, J. P.; Bele, Nicolas; Beague, Sébastien; Hours, Sandrine; Marque, Sophie; Durand, Michel; Payen, J. F.; Stoclin, Annabelle; Gaffinel, Alain; Winer, Arnaud; Chudeau, Nicolas; Tirot, Patrice; Thyrault, Martial; Paulet, Rémi; Thyrault, M.; Aubrun, Frederic; Guerin, Claude; Floccard, Bernard; Rimmele, T.; Argaud, Laurent; Hernu, Romain; Crozon Clauzel, Jullien; Wey, Pierre-François; Bourdin, Gael; Pommier, C.; Cueuille, Nadège; de Varax, N. N.; Marchi, Elisa; Papazian, L.; Jochmans, Sebastien; Monchi, M.; Jaber, Samir; de Jong, Audrey; Moulaire, Valerie; Capron, Matthieu; Jarrige, L.; Barberet, Guillaume; Lakhal, Karim; Rozec, B.; Dellamonica, Jean; Robert, Alexandre; Bernardin, G.; Danin, Pierre-Eric; Raucoules, M.; Runge, Isabelle; Foucrier, Arnaud; Hamada, Sophie; Tesniere, Antoine; Fromentin, Mélanie; Samama, C. M.; Mira, Jean-Paul; Diehl, Jean-Luc; Mekontso Dessap, Armand; Arbelot, Charlotte; Demoule, Alexandre; Roche, Anne; Similowski, T.; Ricard, Jean-Damien; Gaudry, Stéphane; Dreyfuss, D.; de Montmolin, Etienne; Da Silva, Daniel; Verdiere, B.; Ardisson, Fanny; Lemiale, Virginie; Azoulay, Elie; Bruel, Cédric; Tiercelet, Kelly; Fartoukh, Muriel; Voiriot, Guillaume; Hoffmann, Clement; Leclerc, T.; Thille, Arnaud; Robert, Réné; Beuret, Pascal; Beduneau, Gaëtan; Beuzelin, Marion; Tamion, F.; Morel, Jérôme; Tremblay, Aymeric; Molliex, S.; Amal, Jean-Michel; Meaudre, Eric; Goutorbe, Philippe; Laffon, Marc; Gros, Antoine; Nica, Alexandru; Barjon, Genevieve; Dahyot-Fizelier, Claire; Imzi, Nadia; Gally, Josette; Real, N. N.; Sauneuf, Bertrand; Souloy, Xavier; Girbes, Armand; Tuinman, Pieter Roel; Schultz, Marcus; Winters, Tineke; Mijzen, Lisa; Roekaerts, P. M. H. J.; Vermeijden, Wytze; Beishuizen, Albertus; Trof, R.; Corsten, Stijn; Kesecioglu, Jozef; Meertens, John; Dieperink, Wim; Pickers, Peter; Roovers, Noortje; Maia, Paulo; Duque, Melanie; Rua, Fernando; Pereira de Figueired, António Manuel; Ramos, Armindo; Fragoso, Elsa; Azevedo, Pilar; Gouveia, Joao; Costa E Silva, Zélia; Silva, Goncalo; Chaves, Susana; Nobrega, J. J.; Lopes, Luís; Valerio, Bernardino; Araujo, Ana Carolina; de Freitas, Paulo Telles; Bouw, Maria Jose; Melao, Maria; Granja, C.; Marcal, Paulo; Fernandes, Antero; Joao, Gonçalves Pereira; Maia, Dionísio Faria; Spadaro, Savino; Volta, Carlo Alberto; Bellani, Giacomo; Citerio, G.; Mauri, Tommaso; Alban, Laura; Pesenti, A.; Mistraletti, Giovanni; Formenti, Paolo; Tommasino, C.; Tardini, Francesca; Fumagalli, R.; Colombo, Riccardo; Fossali, Tommaso; Catena, E.; Todeschini, Manuel; Gnesin, Paolo; Cracchiolo, Andrea Neville; Palma, Daniela; Tetamo, R.; Albiero, Daniela; Costantini, Elena; Raimondi, F.; Coppadoro, Andrea; Vascotto, Ettore; Lusenti, F.; Becher, Tobias; Schädler, Dirk; Weiler, N.; Karagiannidis, Christian; Petersson, Johan; Konrad, D.; Kawati, Rafael; Wessbergh, Joanna; Valtysson, J.; Rockstroh, Matthias; Borgstrom, Sten; Larsson, Niklas; Thunberg, J.; Camsooksai, Julie; Briggs, N. N.; Kovari, Ferenc; Cuesta, J.; Anwar, Sibs; O'Brien, B.; Barberis, Luigi; Sturman, J.; Mainas, Efstratios; Karatzas, S.; Piza, Petr; Sottiaux, Thierry; Adam, J. F.; Gawda, Ryszard; Gawor, Maen; Alqdah, M.; Cohen, D.; Brochard, Laurent; Baker, A.; Ñamendys-Silva, Silvio Antonio; Garcia-Guillen, Francisco Javier; Morocho Tutillo, Diego Rolando; Jibaja Vega, Manuel; Zakalik, Graciela; Pagella, Gonzalo; Marengo, J.

    2018-01-01

    While prone positioning (PP) has been shown to improve patient survival in moderate to severe acute respiratory distress syndrome (ARDS) patients, the rate of application of PP in clinical practice still appears low. This study aimed to determine the prevalence of use of PP in ARDS patients (primary

  6. Reorganization of the Cerebro-Cerebellar Network of Language Production in Patients with Congenital Left-Hemispheric Brain Lesions

    Science.gov (United States)

    Lidzba, K.; Wilke, M.; Staudt, M.; Krageloh-Mann, I.; Grodd, W.

    2008-01-01

    Patients with congenital lesions of the left cerebral hemisphere may reorganize language functions into the right hemisphere. In these patients, language production is represented homotopically to the left-hemispheric language areas. We studied cerebellar activation in five patients with congenital lesions of the left cerebral hemisphere to assess…

  7. The use of nutritional guidance within chiropractic patient management: a survey of 333 chiropractors from the ACORN practice-based research network.

    Science.gov (United States)

    Lee, Mi Kyung; Amorin-Woods, Lyndon; Cascioli, Vincenzo; Adams, Jon

    2018-01-01

    Food consumption and nutritional status affect an individual's health throughout their life-course and an unhealthy diet is a major risk factor for the current global burden of chronic disease. The promotion of health and good nutrition through healthy eating requires the active involvement of all health professionals including chiropractors. This paper reports findings from the first nationally representative examination of the use of nutritional guidance within chiropractic patient management in Australia. A sample of 1000 practising chiropractors was randomly selected from the Australian Chiropractic Research Network (ACORN) practice-based research network database for a cross-sectional study and 33% participated in the online survey in November 2016. The questionnaire, based on previous designs used in similar surveys and nutrition resources developed by the National Health and Medical Research Council, was pretested prior to the survey. Pearson's Chi square and bivariate logistic regression were undertaken to explore relationships with variables of interest. The demographic details of the respondents are similar to those of the chiropractic workforce registered in Australia. Most chiropractors provided nutritional advice as part of their patient care and around a quarter provided specific dietary advice to their patients, including the use of nutrition supplements. Nutrition-related conditions most commonly encountered by the chiropractors were musculoskeletal, usually inflammatory in origin. Common nutritional assessment methods used included questioning patients to assess their nutritional and health status and physical appearance. Most of the participants provided nutritional resources to their patients in their clinics. However, the Australian Dietary Guidelines and the accompanying Australian Guide to Healthy Eating were not well utilised by the respondents. Australian chiropractors often referred patients with nutrition issues to qualified dietitians and

  8. Using Coexpression Protein Interaction Network Analysis to Identify Mechanisms of Danshensu Affecting Patients with Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Mengqi Huo

    2017-06-01

    Full Text Available Salvia miltiorrhiza, known as Danshen, has attracted worldwide interest for its substantial effects on coronary heart disease (CHD. Danshensu (DSS is one of the main active ingredients of Danshen on CHD. Although it has been proven to have a good clinical effect on CHD, the action mechanisms remain elusive. In the current study, a coexpression network-based approach was used to illustrate the beneficial properties of DSS in the context of CHD. By integrating the gene expression profile data and protein-protein interactions (PPIs data, two coexpression protein interaction networks (CePIN in a CHD state (CHD CePIN and a non-CHD state (non-CHD CePIN were generated. Then, shared nodes and unique nodes in CHD CePIN were attained by conducting a comparison between CHD CePIN and non-CHD CePIN. By calculating the topological parameters of each shared node and unique node in the networks, and comparing the differentially expressed genes, target proteins involved in disease regulation were attained. Then, Gene Ontology (GO enrichment was utilized to identify biological processes associated to target proteins. Consequently, it turned out that the treatment of CHD with DSS may be partly attributed to the regulation of immunization and blood circulation. Also, it indicated that sodium/hydrogen exchanger 3 (SLC9A3, Prostaglandin G/H synthase 2 (PTGS2, Oxidized low-density lipoprotein receptor 1 (OLR1, and fibrinogen gamma chain (FGG may be potential therapeutic targets for CHD. In summary, this study provided a novel coexpression protein interaction network approach to provide an explanation of the mechanisms of DSS on CHD and identify key proteins which maybe the potential therapeutic targets for CHD.

  9. Comparison of Artificial Neural Network with Logistic Regression as Classification Models for Variable Selection for Prediction of Breast Cancer Patient Outcomes

    Directory of Open Access Journals (Sweden)

    Valérie Bourdès

    2010-01-01

    Full Text Available The aim of this study was to compare multilayer perceptron neural networks (NNs with standard logistic regression (LR to identify key covariates impacting on mortality from cancer causes, disease-free survival (DFS, and disease recurrence using Area Under Receiver-Operating Characteristics (AUROC in breast cancer patients. From 1996 to 2004, 2,535 patients diagnosed with primary breast cancer entered into the study at a single French centre, where they received standard treatment. For specific mortality as well as DFS analysis, the ROC curves were greater with the NN models compared to LR model with better sensitivity and specificity. Four predictive factors were retained by both approaches for mortality: clinical size stage, Scarff Bloom Richardson grade, number of invaded nodes, and progesterone receptor. The results enhanced the relevance of the use of NN models in predictive analysis in oncology, which appeared to be more accurate in prediction in this French breast cancer cohort.

  10. Feasibility Study of a Wearable System Based on a Wireless Body Area Network for Gait Assessment in Parkinson’s Disease Patients

    Directory of Open Access Journals (Sweden)

    Jorge Cancela

    2014-03-01

    Full Text Available Parkinson’s disease (PD alters the motor performance of affected individuals. The dopaminergic denervation of the striatum, due to substantia nigra neuronal loss, compromises the speed, the automatism and smoothness of movements of PD patients. The development of a reliable tool for long-term monitoring of PD symptoms would allow the accurate assessment of the clinical status during the different PD stages and the evaluation of motor complications. Furthermore, it would be very useful both for routine clinical care as well as for testing novel therapies. Within this context we have validated the feasibility of using a Body Network Area (BAN of wireless accelerometers to perform continuous at home gait monitoring of PD patients. The analysis addresses the assessment of the system performance working in real environments.

  11. Network pharmacology-based and clinically relevant prediction of the active ingredients and potential targets of Chinese herbs in metastatic breast cancer patients.

    Science.gov (United States)

    Mao, Yu; Hao, Jian; Jin, Zi-Qi; Niu, Yang-Yang; Yang, Xue; Liu, Dan; Cao, Rui; Wu, Xiong-Zhi

    2017-04-18

    Chinese Herbal Medicine (CHM) plays a significant role in breast cancer treatment. We conduct the study to ascertain the relative molecular targets of effective Chinese herbs in treating stage IV breast cancer.Survival benefit of CHM was verified by Kaplan-Meier method and Cox regression analysis. A bivariate correlation analysis was used to find and establish the effect of herbs in complex CHM formulas. A network pharmacological approach was adopted to explore the potential mechanisms of CHM.Patients in the CHM group had a median survival time of 55 months, which was longer than the 23 months of patients in the non-CHM group. Cox regression analysis indicated that CHM was an independent protective factor. Correlation analysis showed that 10 herbs were strongly correlated with favorable survival outcomes (Pherbs might achieve anti-breast cancer activity primarily through inhibiting HSP90, ERα and TOP-II related pathways.

  12. All-Cause Mortality in Patients With Diabetes Under Treatment With Dapagliflozin: A Population-Based, Open-Cohort Study in The Health Improvement Network Database.

    Science.gov (United States)

    Toulis, Konstantinos A; Willis, Brian H; Marshall, Tom; Kumarendran, Balachadran; Gokhale, Krishna; Ghosh, Sandip; Thomas, G Neil; Cheng, Kar Keung; Narendran, Parth; Hanif, Wasim; Nirantharakumar, Krishnarajah

    2017-05-01

    Empagliflozin was found to decrease mortality in patients with type 2 diabetes mellitus (T2DM) and a prior cardiovascular disease (CVD) event. To establish whether these benefits can be replicated in a real-world setting, should be expected with the use of dapagliflozin, and apply to T2DM patients at low risk of CVD. General practice, population-based, retrospective cohort study (January 2013 to September 2015). The Health Improvement Network database. A total of 22,124 T2DM patients (4444 exposed to dapagliflozin; 17,680 unexposed T2DM patients) matched for age, sex, body mass index, T2DM duration, and smoking. The primary outcome was all-cause mortality (high and low risk for CVD) in the total study population, expressed as the adjusted incidence rate ratio (aIRR) with 95% confidence intervals (CIs). As a secondary analysis in the low-risk population, all-cause mortality and incident CVD were considered. Patients with T2DM exposed to dapagliflozin were significantly less likely to die of any cause (aIRR: 0.50; 95% CI: 0.33 to 0.75; P = 0.001). Similarly, in low-risk patients, death from any cause was significantly lower in the cohort exposed to dapagliflozin (aIRR: 0.44; 95% CI: 0.25 to 0.78; P = 0.002). The difference in the risk of incident CVD did not reach statistical significance between groups in low-risk patients (aIRR: 0.89; 95% CI: 0.61 to 1.31; P = 0.546). Patients with T2DM who were exposed to dapagliflozin had a lower risk of death from any cause irrespective of baseline CVD status.

  13. Time Interval from Symptom Onset to Hospital Care in Patients with Acute Heart Failure: A Report from the Tokyo Cardiac Care Unit Network Emergency Medical Service Database.

    Science.gov (United States)

    Shiraishi, Yasuyuki; Kohsaka, Shun; Harada, Kazumasa; Sakai, Tetsuro; Takagi, Atsutoshi; Miyamoto, Takamichi; Iida, Kiyoshi; Tanimoto, Shuzou; Fukuda, Keiichi; Nagao, Ken; Sato, Naoki; Takayama, Morimasa

    2015-01-01

    There seems to be two distinct patterns in the presentation of acute heart failure (AHF) patients; early- vs. gradual-onset. However, whether time-dependent relationship exists in outcomes of patients with AHF remains unclear. The Tokyo Cardiac Care Unit Network Database prospectively collects information of emergency admissions via EMS service to acute cardiac care facilities from 67 participating hospitals in the Tokyo metropolitan area. Between 2009 and 2011, a total of 3811 AHF patients were registered. The documentation of symptom onset time was mandated by the on-site ambulance team. We divided the patients into two groups according to the median onset-to-hospitalization (OH) time for those patients (2h); early- (presenting ≤2h after symptom onset) vs. gradual-onset (late) group (>2h). The primary outcome was in-hospital mortality. The early OH group had more urgent presentation, as demonstrated by a higher systolic blood pressure (SBP), respiratory rate, and higher incidence of pulmonary congestion (48.6% vs. 41.6%; P<0.001); whereas medical comorbidities such as stroke (10.8% vs. 7.9%; P<0.001) and atrial fibrillation (30.0% vs. 26.0%; P<0.001) were more frequently seen in the late OH group. Overall, 242 (6.5%) patients died during hospitalization. Notably, a shorter OH time was associated with a better in-hospital mortality rate (odds ratio, 0.71; 95% confidence interval, 0.51-0.99; P = 0.043). Early-onset patients had rather typical AHF presentations (e.g., higher SBP or pulmonary congestion) but had a better in-hospital outcome compared to gradual-onset patients.

  14. Association of Toll-like receptor 4 polymorphisms with diabetic foot ulcers and application of artificial neural network in DFU risk assessment in type 2 diabetes patients.

    Science.gov (United States)

    Singh, Kanhaiya; Singh, Vivek Kumar; Agrawal, Neeraj K; Gupta, Sanjeev K; Singh, Kiran

    2013-01-01

    The Toll-Like receptor 4 (TLR4) plays an important role in immunity, tissue repair, and regeneration. The objective of the present work was to evaluate the association of TLR4 single nucleotide polymorphisms (SNPs) rs4986790, rs4986791, rs11536858 (merged into rs10759931), rs1927911, and rs1927914 with increased diabetic foot ulcer (DFU) risk in patients with type 2 diabetes mellitus (T2DM). PCR-RFLP was used for genotyping TLR4 SNPs in 125 T2DM patients with DFU and 130 controls. The haplotypes and linkage disequilibrium between the SNPs were determined using Haploview software. Multivariate linear regression (MLR) and artificial neural network (ANN) modeling was done to observe their predictability for the risk of DFU in T2DM patients. Risk genotypes of all SNPs except rs1927914 were significantly associated with DFU. Haplotype ACATC (P value = 9.3E - 5) showed strong association with DFU risk. Two haplotypes ATATC (P value = 0.0119) and ATGTT (P value = 0.0087) were found to be protective against DFU. In conclusion TLR4 SNPs and their haplotypes may increase the risk of impairment of wound healing in T2DM patients. ANN model (83%) is found to be better than the MLR model (76%) and can be used as a tool for the DFU risk assessment in T2DM patients.

  15. Association of Toll-Like Receptor 4 Polymorphisms with Diabetic Foot Ulcers and Application of Artificial Neural Network in DFU Risk Assessment in Type 2 Diabetes Patients

    Directory of Open Access Journals (Sweden)

    Kanhaiya Singh

    2013-01-01

    Full Text Available The Toll-Like receptor 4 (TLR4 plays an important role in immunity, tissue repair, and regeneration. The objective of the present work was to evaluate the association of TLR4 single nucleotide polymorphisms (SNPs rs4986790, rs4986791, rs11536858 (merged into rs10759931, rs1927911, and rs1927914 with increased diabetic foot ulcer (DFU risk in patients with type 2 diabetes mellitus (T2DM. PCR-RFLP was used for genotyping TLR4 SNPs in 125 T2DM patients with DFU and 130 controls. The haplotypes and linkage disequilibrium between the SNPs were determined using Haploview software. Multivariate linear regression (MLR and artificial neural network (ANN modeling was done to observe their predictability for the risk of DFU in T2DM patients. Risk genotypes of all SNPs except rs1927914 were significantly associated with DFU. Haplotype ACATC (P value = 9.3E-5 showed strong association with DFU risk. Two haplotypes ATATC (P value = 0.0119 and ATGTT (P value = 0.0087 were found to be protective against DFU. In conclusion TLR4 SNPs and their haplotypes may increase the risk of impairment of wound healing in T2DM patients. ANN model (83% is found to be better than the MLR model (76% and can be used as a tool for the DFU risk assessment in T2DM patients.

  16. Difficult encounters with psychiatric patients: a South Texas Psychiatry Practice-based Re search Network (PBRN) study

    Science.gov (United States)

    Sellers, Randall V.; Salazar, Ricardo; Martinez, Cervando; Gelfond, Stephen D.; Deuter, Melissa; Hayes, Holly G.; Ketchum, Norma; Pollock, Brad H.

    2012-01-01

    Purpose To examine the prevalence of difficult psychiatrist-patient interactions of 20 psychiatrists in the South Texas Psychiatric PBRN, determine what characteristics were associated with “difficult” patients, and compare findings with previous studies in primary care. Methods During a 2-month observational study, psychiatrists collected patient information on setting, demographics, diagnoses, medications and rated the patients using a Difficult Doctor Patient Relationship Questionnaire (DDPRQ-10) which had previously been used and validated in the primary care setting. Results A total of 905 valid data cards were collected. Difficult patients were identified in 15% of the sample. Diagnoses of schizophrenia, alcohol/substance abuse, and personality disorder were associated with difficulty. Psychiatrists least burdened by difficult patients were older, in solo practice, and worked 51-55 hours per week. Conclusions This cross-sectional study demonstrates that psychiatrists encounter difficult patients at a similar rate (15%) as do primary care physicians. Mentoring programs and structured treatment interventions for the most difficult patient groups may assist all physicians who treat psychiatric patients whether in specialty, family medicine, or other primary care settings. PMID:22956702

  17. Long-term test-retest reliability of resting-state networks in healthy elderly subjects and with amnestic mild cognitive impairment patients.

    Science.gov (United States)

    Blautzik, Janusch; Keeser, Daniel; Berman, Albert; Paolini, Marco; Kirsch, Valerie; Mueller, Sophia; Coates, Ute; Reiser, Maximilian; Teipel, Stefan J; Meindl, Thomas

    2013-01-01

    The investigation of cerebral resting-state networks (RSNs) by functional magnetic resonance imaging (fMRI) is a promising tool for the early diagnosis and follow-up of neuropsychiatric and neurodegenerative disorders like Alzheimer's disease (AD). In this context, the determination of inter-session reliability of these networks is crucial. However, data on network reliability in healthy elderly subjects is rare and does not exist for patients with amnestic mild cognitive impairment (aMCI), a prodromal stage of AD. Therefore, the aim of this study was to investigate the long-term test-retest reliability of RSNs in both groups. Twelve healthy controls (HC) and 13 aMCI patients underwent resting-state fMRI and neuropsychological testing (CERAD test battery) twice, at baseline and after 13-16 months. Resting-state fMRI data was decomposed into independent components using independent component analysis. Inter-session test-retest reliability of the resulting RSNs was determined by calculating voxel-wise intra-class correlation coefficients. Overall test-retest reliability of corresponding RSNs was moderate to high in both groups, but significantly higher in the HC group compared to the aMCI group (p < 0.001), while the cognitive performance within the CERAD test battery remained stable over time in either group. Most reliable RSNs derived from the HC group and were associated with sensory and motor as well as higher order cognitive and the default-mode function. Particularly low reliability was found in basal frontal regions, which are known to be prone to susceptibility-induced noise. We conclude that stable RSNs may represent healthy aging, whereas decreased RSN reliability may indicate progressive neuro-functional alterations before the actual manifestation of clinical symptoms.

  18. The Effectiveness of Reality Therapy on Anxiety and Increase of Hope in Patient with HIV-positive Referred to the Disease Behavioral Center Shemiran’s Health Network

    Directory of Open Access Journals (Sweden)

    Soheila Asadi

    2016-05-01

    Full Text Available Background and Objective: AIDs is disease that can to have various psychological problems. However, reality therapy is amongst therapies that were used for treatment of behavioral disease patients. So, the aim of present study was determinant of effectiveness of reality therapy on reduce of anxiety and increase of hope in patient with HIV-positive refereed to the disease behavioral center Shemiran’s Health Network.Materials and Methods: The study Done Semi experimental in partnership with population the patient with HIV-positive refereed to the disease behavioral center Shemiran’s Health Network that their anxiety range is middle anxiety (22 and above and upper who in this population. 30 individual was selected by voluntary available sampling and were replaced randomly 15 individual in experimental group and control group. The experimental group was received reality therapy during 10 sessions and per week one session, but control group wasn’t received any intervention. Both experimental group and control group was collated to the Miller Hope Questionnaire and Beck Anxiety Inventory. Collected data were analyzed used covariance analysis (ANCOVA and by SPSS-16.Results: The mean (SD of participants age in experimental group equal to were 38.9 (6.9 and in control group equal to were 39.5 (5.2. The mean (SD of anxiety of pretest in experimental group(16.5 (7.5 was lower than control group(24.0 (2.8; p<0.001 and Hope of pretest in experimental group(122.5 (14.7 was higher than control group(98.9 (13.3; p<0.001Conclusion: The Study showed Reality Therapy Training had effects on reduce of anxiety and increase of hope patient with HIV-positive in experimental group. 

  19. Does antimicrobial lock solution reduce catheter-related infections in hemodialysis patients with central venous catheters? A Bayesian network meta-analysis.

    Science.gov (United States)

    Zhang, Jun; Wang, Bo; Li, Rongke; Ge, Long; Chen, Kee-Hsin; Tian, Jinhui

    2017-04-01

    The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial lock solutions (ALS) for prevention of catheter-related infections (CRI) in patients with hemodialysis (HD) and ranking these ALS for practical consideration. We searched six electronic databases, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared ALS for preventing episodes of CRI in patients with HD either head-to-head or against control interventions using non-ALS. Two authors independently assessed the methodological quality of included studies using the Cochrane risk of bias tool and extracted relevant information according to a predesigned extraction form. Data were analysed using the WinBUGS (V.1.4.3) and the Stata (V.13.0). Finally, 18 studies involving 2395 patients and evaluating 9 ALS strategies were included. Network meta-analysis showed that gentamicin plus citrate (OR 0.07, 95% CrI 0.00-0.48) and gentamicin plus heparin (OR 0.04, 95% CrI 0.00-0.23) were statistically superior to heparin alone in terms of reducing CRBSI. For exit site infection and all-cause mortality, no significant difference in the intervention effect (p > 0.05) was detected for all included ALS when compared to heparin. Moreover, all ALS were similar in efficacy (p > 0.05) from each other for CRBSI, exit site infection and all-cause mortality. Our findings indicated that gentamicin plus heparin may be selected for the prophylaxis of CRI in patients undergoing HD with CVCs. Whether this strategy will lead to antimicrobial resistance remains unclear in view of the relatively short duration of included studies. More attentions should be made regarding head-to-head comparisons of the most commonly used ALS in this field.

  20. Southern African Treatment Resistance Network (SATuRN) RegaDB HIV drug resistance and clinical management database: supporting patient management, surveillance and research in southern Africa.

    Science.gov (United States)

    Manasa, Justen; Lessells, Richard; Rossouw, Theresa; Naidu, Kevindra; Van Vuuren, Cloete; Goedhals, Dominique; van Zyl, Gert; Bester, Armand; Skingsley, Andrew; Stott, Katharine; Danaviah, Siva; Chetty, Terusha; Singh, Lavanya; Moodley, Pravi; Iwuji, Collins; McGrath, Nuala; Seebregts, Christopher J; de Oliveira, Tulio

    2014-01-01

    Substantial amounts of data have been generated from patient management and academic exercises designed to better understand the human immunodeficiency virus (HIV) epidemic and design interventions to control it. A number of specialized databases have been designed to manage huge data sets from HIV cohort, vaccine, host genomic and drug resistance studies. Besides databases from cohort studies, most of the online databases contain limited curated data and are thus sequence repositories. HIV drug resistance has been shown to have a great potential to derail the progress made thus far through antiretroviral therapy. Thus, a lot of resources have been invested in generating drug resistance data for patient management and surveillance purposes. Unfortunately, most of the data currently available relate to subtype B even though >60% of the epidemic is caused by HIV-1 subtype C. A consortium of clinicians, scientists, public health experts and policy markers working in southern Africa came together and formed a network, the Southern African Treatment and Resistance Network (SATuRN), with the aim of increasing curated HIV-1 subtype C and tuberculosis drug resistance data. This article describes the HIV-1 data curation process using the SATuRN Rega database. The data curation is a manual and time-consuming process done by clinical, laboratory and data curation specialists. Access to the highly curated data sets is through applications that are reviewed by the SATuRN executive committee. Examples of research outputs from the analysis of the curated data include trends in the level of transmitted drug resistance in South Africa, analysis of the levels of acquired resistance among patients failing therapy and factors associated with the absence of genotypic evidence of drug resistance among patients failing therapy. All these studies have been important for informing first- and second-line therapy. This database is a free password-protected open source database available on

  1. Induction regimens for transplant-eligible patients with newly diagnosed multiple myeloma: a network meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Zeng ZH

    2017-07-01

    Full Text Available Zi-Hang Zeng,1,2 Jia-Feng Chen,1,2 Yi-Xuan Li,1,2 Ran Zhang,1,2 Ling-Fei Xiao,1,2 Xiang-Yu Meng1,2 1Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, 2Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College of Wuhan University, Wuhan, People’s Republic of China Objective: The aim of this study was to compare the early efficacy and survivals of induction regimens for transplant-eligible patients with untreated multiple myeloma. Materials and methods: A comprehensive literature search in electronic databases was conducted for relevant randomized controlled trials (RCTs. Eligible studies were selected according to the predefined selection criteria, before they were evaluated for methodological quality. Basic characteristics and data for network meta-analysis (NMA were extracted from included trials and pooled in our meta-analysis. The end points were the overall response rate (ORR, progression-free survival (PFS, and overall survival (OS. Results: A total of 14 RCTs that included 4,763 patients were analyzed. The post-induction ORR was higher with bortezomib plus thalidomide plus dexamethasone (VTD regimens, and VTD was better than the majority of other regimens. For OS, VTD plus cyclophosphamide (VTDC regimens showed potential superiority over other regimens, but the difference was not statistically significant. The PFS was longer with thalidomide plus doxorubicin plus dexamethasone (TAD regimens for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM. Conclusion: The NMA demonstrated that the VTD, VTDC, and TAD regimens are most beneficial in terms of ORR, OS, and PFS for transplant-eligible patients with NDMM, respectively. Keywords: multiple myeloma, newly diagnosed, transplant-eligible, induction therapies, network meta-analysis

  2. The OCHIN community information network: bringing together community health centers, information technology, and data to support a patient-centered medical village.

    Science.gov (United States)

    Devoe, Jennifer E; Sears, Abigail

    2013-01-01

    Creating integrated, comprehensive care practices requires access to data and informatics expertise. Information technology (IT) resources are not readily available to individual practices. One model of shared IT resources and learning is a "patient-centered medical village." We describe the OCHIN Community Health Information Network as an example of this model; community practices have come together collectively to form an organization that leverages shared IT expertise, resources, and data, providing members with the means to fully capitalize on new technologies that support improved care. This collaborative facilitates the identification of "problem sheds" through surveillance of network-wide data, enables shared learning regarding best practices, and provides a "community laboratory" for practice-based research. As an example of a community of solution, OCHIN uses health IT and data-sharing innovations to enhance partnerships between public health leaders, clinicians in community health centers, informatics experts, and policy makers. OCHIN community partners benefit from the shared IT resource (eg, a linked electronic health record, centralized data warehouse, informatics, and improvement expertise). This patient-centered medical village provides (1) the collective mechanism to build community-tailored IT solutions, (2) "neighbors" to share data and improvement strategies, and (3) infrastructure to support innovations based on electronic health records across communities, using experimental approaches.

  3. A comparative study of generalized linear mixed modelling and artificial neural network approach for the joint modelling of survival and incidence of Dengue patients in Sri Lanka

    Science.gov (United States)

    Hapugoda, J. C.; Sooriyarachchi, M. R.

    2017-09-01

    Survival time of patients with a disease and the incidence of that particular disease (count) is frequently observed in medical studies with the data of a clustered nature. In many cases, though, the survival times and the count can be correlated in a way that, diseases that occur rarely could have shorter survival times or vice versa. Due to this fact, joint modelling of these two variables will provide interesting and certainly improved results than modelling these separately. Authors have previously proposed a methodology using Generalized Linear Mixed Models (GLMM) by joining the Discrete Time Hazard model with the Poisson Regression model to jointly model survival and count model. As Aritificial Neural Network (ANN) has become a most powerful computational tool to model complex non-linear systems, it was proposed to develop a new joint model of survival and count of Dengue patients of Sri Lanka by using that approach. Thus, the objective of this study is to develop a model using ANN approach and compare the results with the previously developed GLMM model. As the response variables are continuous in nature, Generalized Regression Neural Network (GRNN) approach was adopted to model the data. To compare the model fit, measures such as root mean square error (RMSE), absolute mean error (AME) and correlation coefficient (R) were used. The measures indicate the GRNN model fits the data better than the GLMM model.

  4. Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene citrate-resistant polycystic ovary syndrome: a network meta-analysis.

    Science.gov (United States)

    Yu, Yiping; Fang, Lanlan; Zhang, Ruizhe; He, Jingyan; Xiong, Yujing; Guo, Xiaoyi; Du, Qingyun; Huang, Yan; Sun, Yingpu

    2017-06-19

    The comparative efficacies of ovulation-induction treatments in patients with clomiphene citrate-resistant (CCR) polycystic ovary syndrome (PCOS) are not well known. Therefore, we conducted a network meta-analysis to rank the reproductive efficacies of these treatments. We ultimately included 26 randomized clinical trials with 2722 participants and 9 types of therapies: clomiphene citrate (CC), metformin, letrozole, follicle stimulating hormone (FSH), human menopausal gonadotropin (hMG), unilateral laparoscopic ovarian drilling (ULOD), bilateral laparoscopic ovarian drilling (BLOD), the combination of metformin with letrozole (metformin+letrozole), and the combination of metformin with CC (metformin+CC). The network meta-analysis demonstrates that hMG therapy result in higher pregnancy rates than BLOD, ULOD and CC therapies. Pregnancy, live birth and ovulation rates are significantly higher in metformin+letrozole and FSH groups than CC group. The abortion rate in the metformin+letrozole group is significantly lower than that in the metformin+CC group. Ranking probabilities show that, apart from gonadotropin (FSH and hMG), metformin+letrozole is also potentially more effective in improving reproductive outcomes than other therapies. In conclusion, owing to the low quality of evidence and the wide confidence intervals, no recommendation could be made for the treatment of ovulation-induction in patients with CCR PCOS.

  5. Supporting cancer patients through the continuum of care: a view from the age of social networks and computer-mediated communication.

    Science.gov (United States)

    Bender, J L; O'Grady, L; Jadad, A R

    2008-08-01

    Almost since its inception, the Internet has been used by ordinary people to connect with peers and to exchange health-related information and support. With the rapid development of software applications deliberately designed to facilitate social interaction, a new era is dawning in which patients and their loved ones can collaboratively build knowledge related to coping with illness, while meeting their mutual supportive care needs in a timely way, regardless of location. In this article, we provide background information on the use of "one-to-one" (for example, e-mail), "one-to-many" (for example, e-mail lists), and "many-to-many" (for example, message boards and chat rooms, and more recently, applications associated with Web 2.0) computer-mediated communication to nurture health-related social networks and online supportive care. We also discuss research that has investigated the use of social networks by patients, highlight opportunities for health professionals in this area, and describe new advances that are fuelling this new era of collaboration in the management of cancer.

  6. The Role of Health Literacy and Social Networks in Arthritis Patients' Health Information-Seeking Behavior: A Qualitative Study

    OpenAIRE

    Ellis, Janette; Mullan, Judy; Worsley, Anthony; Pai, Nagesh

    2012-01-01

    Background. Patients engage in health information-seeking behaviour to maintain their wellbeing and to manage chronic diseases such as arthritis. Health literacy allows patients to understand available treatments and to critically appraise information they obtain from a wide range of sources. Aims. To explore how arthritis patients' health literacy affects engagement in arthritis-focused health information-seeking behaviour and the selection of sources of health information available through ...

  7. Prevalence of pain in the orofacial regions in patients visiting general dentists in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry research network.

    Science.gov (United States)

    Horst, Orapin V; Cunha-Cruz, Joana; Zhou, Lingmei; Manning, Walter; Mancl, Lloyd; DeRouen, Timothy A

    2015-10-01

    This study aimed to measure prevalence of pain in the orofacial regions and determine association with demographics, treatment history, and oral health conditions in dental patients visiting clinics in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) research network. Data were recorded in a survey with systematic random sampling of patients (n = 1,668, 18 to 93 years old, 56% female) visiting 100 general dentists in the Northwest PRECEDENT research network. Prevalence ratios (PR) of orofacial pain by each variable were estimated by generalized estimating equations for Poisson regression. The prevalence of orofacial pain during the past year was 16.1% (95% confidence interval [CI], 13.4-18.9), of which the most prevalent pain locations were dentoalveolar (9.1%; 95% CI, 7.0-11.2) and musculoligamentous tissues (6.6%; 95% CI, 4.5-8.7). Other locations included soft tissues (0.5%; 95% CI, 0.2-0.8) and nonspecific areas (0.6%; 95% CI, 0.2-1.0). The prevalence of dentoalveolar but not musculoligamentous pain decreased with age. When comparing the 18- to 29-year-old patients, dentoalveolar pain decreased significantly in 45- to 64-year-old patients (PR, 0.59; 95% CI, 0.4-0.9) and in those 65 years or older (PR, 0.5; 95% CI, 0.3-0.9). Sex significantly affected the prevalence of musculoligamentous but not dentoalveolar pain. Women (PR, 3.2; 95% CI, 2.0-5.1) were more likely to have musculoligamentous pain. The prevalence of dentoalveolar and musculoligamentous pain did not vary significantly by ethnicity. Dentoalveolar pain was reported more frequently in patients who did not receive dental maintenance (PR, 2.9; 95% CI, 2.1-4.2) and those visiting community-based public health clinics (PR, 2.2; 95% CI, 1.2-3.7). One in 6 patients visiting a general dentist had experienced orofacial pain during the past year. Dentoalveolar and musculoligamentous pains were the most prevalent types of pain. Pain in the muscles and

  8. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis.

    Science.gov (United States)

    Guo, Lei; Wang, Weiwei; Zhao, Nana; Guo, Libo; Chi, Chunjie; Hou, Wei; Wu, Anqi; Tong, Hongshuang; Wang, Yue; Wang, Changsong; Li, Enyou

    2016-07-22

    It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published up to July 2015 in which pulmonary compliance or the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio was assessed in ICU patients without ALI or ARDS, who received mechanical ventilation via different strategies. The data for study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used a Bayesian fixed-effects model to combine direct comparisons with indirect evidence. Seventeen randomized controlled trials including a total of 575 patients who received one of six ventilation strategies were included for network meta-analysis. Among ICU patients without ALI or ARDS, strategy C (lower tidal volume (VT) + higher positive end-expiratory pressure (PEEP)) resulted in the highest PaO2/FIO2 ratio; strategy B (higher VT + lower PEEP) was associated with the highest pulmonary compliance; strategy A (lower VT + lower PEEP) was associated with a shorter length of ICU stay; and strategy D (lower VT + zero end-expiratory pressure (ZEEP)) was associated with the lowest PaO2/FiO2 ratio and pulmonary compliance. For ICU patients without ALI or ARDS, strategy C (lower VT + higher PEEP) was associated with the highest PaO2/FiO2 ratio. Strategy B (higher VT + lower PEEP) was superior to the other strategies in improving pulmonary

  9. Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: Results of the IN-HF (Italian Network on Heart Failure) Outcome registry.

    Science.gov (United States)

    Targher, Giovanni; Dauriz, Marco; Tavazzi, Luigi; Temporelli, Pier Luigi; Lucci, Donata; Urso, Renato; Lecchi, Gabriella; Bellanti, Giancarlo; Merlo, Marco; Rossi, Andrea; Maggioni, Aldo P

    2016-01-15

    Although diabetes mellitus is frequently associated with heart failure (HF), the association between elevated admission glucose levels and adverse outcomes has not been well established in hospitalized patients with acute HF. We prospectively evaluated in-hospital mortality, post-discharge 1-year mortality and 1-year re-hospitalization rates in the Italian Network on Heart Failure (IN-HF) Outcome registry cohort of 1776 patients hospitalized with acute HF and stratified by their admission glucose levels (i.e., known diabetes, newly diagnosed hyperglycemia, no diabetes). Compared with those without diabetes (n = 586), patients with either known diabetes (n = 749) (unadjusted-odds ratio [OR] 1.64, 95%CI 0.99–2.70) or newly diagnosed hyperglycemia (n = 441) (unadjusted-OR 2.34, 95%CI 1.39–3.94) had higher in-hospital mortality, but comparable post-discharge 1-year mortality rates. After adjustment for age, sex, systolic blood pressure, estimated glomerular filtration rate, left ventricular ejection fraction, HF etiology and HF worsening/de novo presentation, the results remained unchanged in patients with known diabetes (adjusted-OR 1.86, 95%CI 1.01–3.42), while achieved borderline significance in those with newly diagnosed hyperglycemia (adjusted-OR 1.81, 95%CI 0.95–3.45). One-year re-hospitalization rates were lower in patients with newly diagnosed hyperglycemia (adjusted-hazard ratio 0.74, 95%CI 0.56–0.96) than in other groups. Elevated admission blood glucose levels are associated with poorer in-hospital survival outcomes in patients with acute HF, especially in those with previously known diabetes. This finding further highlights the importance of tight glycemic control during hospital stay and address the need of dedicated intervention studies to identify customized clinical protocols to improve in-hospital survival of these high-risk patients.

  10. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for predicting hospital mortality in critically ill patients with multi-organ dysfunction syndrome.

    Science.gov (United States)

    Ratanarat, Ranistha; Skulratanasak, Peenida; Tangkawattanakul, Nattakarn; Hantaweepant, Chattree

    2013-02-01

    The Acute Dialysis Quality Initiative (ADQI) group developed RIFLE criteria and the Acute Kidney Injury Network published AKIN classification that modified form RIFLE criteria. The authors aimed to compare the ability of RIFLE and AKIN criteria to measure the incidence of acute kidney injury (AKI) and to predict clinical outcomes in critically illpatients. A retrospective cohort study, in Siriraj Hospital, Bangkok. The critically ill patients admitted to medical intensive care unit (ICU) during January 2006-December 2008 were classified according to the maximum RIFLE and AKIN classification reached during their hospital stay Demographic data, hospital mortality, hospital length of stay, need of renal replacement therapy was collected. Three hundred patients were included in this study, AKI occurred in 200 (66.7%) patients: Risk 12.7%, Injury 20.7%, Failure 33.3% defined by RIFLE criteria. According to AKIN criteria, AKI occurred 230 (76.7%) patients: stage 1 16%, stage 2 13.3% and stage 3 47.3%. AKIN classification was diagnosed AKI, approximately 10% more than RIFLE (p < 0.001). The hospital mortality was 51.7% and the mortality in patients with AKI was significantly higher than patients without AKI (p < 0.001). The predictive ability using the AUC-ROC showed poor discrimination for the prediction of mortality of both RIFLE and AKIN: 0.63 and 0.69, respectively. However, AKIN showed superior prediction of mortality than RIFLE (p = 0.003). The APACHE II had the best discriminative accuracy for mortality (AUC = 0.80), followed by the SAPS3 scores (AUC = 0.77) and SAPS2 (AUC = 0.76). AKIN criteria improved sensitivity for detection of AKI and its discrimination for prediction of in-hospital mortality was better than that of RIFLE criteria. However, APACHE II had the best discriminative value for prediction of mortality in the critically ill patients.

  11. An assessment of PKI and networked electronic patient record system: lessons learned from real patient data exchange at the platform of OCHIS (Osaka Community Healthcare Information System).

    Science.gov (United States)

    Takeda, Hiroshi; Matsumura, Yasushi; Kuwata, Shigeki; Nakano, Hirohiko; Shanmai, Ji; Qiyan, Zhang; Yufen, Chen; Kusuoka, Hideo; Matsuoka, Masaki

    2004-03-31

    To enhance medical cooperation between the hospitals and clinics around Osaka local area, the healthcare network system, named Osaka Community Healthcare Information System (OCHIS), was established with support of a supplementary budget from the Japanese government in fiscal year 2002. Although the system has been based on healthcare public key infrastructure (PKI), there remain security issues to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority in contract with the Japanese Medical Information Systems Organization (MEDIS) in 2003. This paper describes the experimental design and the results of the study concerning message security.

  12. The network researchers' network

    DEFF Research Database (Denmark)

    Henneberg, Stephan C.; Jiang, Zhizhong; Naudé, Peter

    2009-01-01

    The Industrial Marketing and Purchasing (IMP) Group is a network of academic researchers working in the area of business-to-business marketing. The group meets every year to discuss and exchange ideas, with a conference having been held every year since 1984 (there was no meeting in 1987). In thi......The Industrial Marketing and Purchasing (IMP) Group is a network of academic researchers working in the area of business-to-business marketing. The group meets every year to discuss and exchange ideas, with a conference having been held every year since 1984 (there was no meeting in 1987......). In this paper, based upon the papers presented at the 22 conferences held to date, we undertake a Social Network Analysis in order to examine the degree of co-publishing that has taken place between this group of researchers. We identify the different components in this database, and examine the large main...

  13. Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN)

    DEFF Research Database (Denmark)

    Palumbo, Antonio; Bringhen, Sara; Ludwig, Heinz

    2011-01-01

    Most patients with newly diagnosed multiple myeloma (MM) are aged > 65 years with 30% aged > 75 years. Many elderly patients are also vulnerable because of comorbidities that complicate the management of MM. The prevalence of MM is expected to rise over time because of an aging population. Most e...

  14. Recognising patients who will die in the near future: a nationwide study via the Dutch Sentinel Network of GPs

    NARCIS (Netherlands)

    Abarshi-Fatiregun, E.A.B.; Echteld, M.A.; van den Block, L.; Donker, G.A.; Deliens, L.; Onwuteaka-Philipsen, B.D.

    2011-01-01

    Background: Recognising patients who will die in the near future is important for adequate planning and provision of end-of-life care. GPs can play a key role in this. Aim: To explore the following questions: How long before death do GPs recognise patients likely to die in the near future? Which

  15. Validation of the Self-Efficacy for Managing Chronic Disease Scale: A Scleroderma Patient-Centered Intervention Network cohort study

    NARCIS (Netherlands)

    Riehm, K.E.; Kwakkenbos, C.M.C.; Carrier, M.E.; Bartlett, S.J.; Malcarne, V.L.; Mouthon, L.; Nielson, W.R.; Poiraudeau, S.; Nielsen, K.; Baron, M.; Frech, T.; Hudson, M.; Pope, J.; Sauvé, M.; Suarez-Almazor, M.E.; Wigley, F.M.; Thombs, B.D.

    2016-01-01

    Objective: Self-management programs for patients with chronic illnesses, including rheumatic diseases, seek to enhance self-efficacy for performing health management behaviors. No measure of self-efficacy has been validated for patients with systemic sclerosis (SSc; scleroderma). The objective of

  16. Proposed diagnostic algorithm for patients with suspected mastocytosis : a proposal of the European Competence Network on Mastocytosis

    NARCIS (Netherlands)

    Valent, P.; Escribano, L.; Broesby-Olsen, S.; Hartmann, K.; Grattan, C.; Brockow, K.; Niedoszytko, M.; Nedoszytko, B.; Oude Elberink, J.N.G.O.; Kristensen, T.; Butterfield, J. H.; Triggiani, M.; Alvarez-Twose, I.; Reiter, A.; Sperr, W. R.; Sotlar, K.; Yavuz, S.; Kluin-Nelemans, H.C.; Hermine, O.; Radia, D.; van Doormaal, J.J.; Gotlib, J.; Orfao, A.; Siebenhaar, F.; Schwartz, L. B.; Castells, M.; Maurer, M.; Horny, H. -P.; Akin, C.; Metcalfe, D. D.; Arock, M.

    2014-01-01

    Mastocytosis is an emerging differential diagnosis in patients with more or less specific mediator-related symptoms. In some of these patients, typical skin lesions are found and the diagnosis of mastocytosis can be established. In other cases, however, skin lesions are absent, which represents a

  17. Abnormal functional network connectivity among resting-state networks in children with frontal lobe epilepsy.

    Science.gov (United States)

    Widjaja, E; Zamyadi, M; Raybaud, C; Snead, O C; Smith, M L

    2013-12-01

    Epilepsy is considered a disorder of neural networks. The aims of this study were to assess functional connectivity within resting-state networks and functional network connectivity across resting-state networks by use of resting-state fMRI in children with frontal lobe epilepsy and to relate changes in resting-state networks with neuropsychological function. Fifteen patients with frontal lobe epilepsy and normal MR imaging and 14 healthy control subjects were recruited. Spatial independent component analysis was used to identify the resting-state networks, including frontal, attention, default mode network, sensorimotor, visual, and auditory networks. The Z-maps of resting-state networks were compared between patients and control subjects. The relation between abnormal connectivity and neuropsychological function was assessed. Correlations from all pair-wise combinations of independent components were performed for each group and compared between groups. The frontal network was the only network that showed reduced connectivity in patients relative to control subjects. The remaining 5 networks demonstrated both reduced and increased functional connectivity within resting-state networks in patients. There was a weak association between connectivity in frontal network and executive function (P = .029) and a significant association between sensorimotor network and fine motor function (P = .004). Control subjects had 79 pair-wise independent components that showed significant temporal coherence across all resting-state networks except for default mode network-auditory network. Patients had 66 pairs of independent components that showed significant temporal coherence across all resting-state networks. Group comparison showed reduced functional network connectivity between default mode network-attention, frontal-sensorimotor, and frontal-visual networks and increased functional network connectivity between frontal-attention, default mode network-sensorimotor, and frontal

  18. Comparison of pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a protocol for a systematic review incorporating network meta-analyses.

    Science.gov (United States)

    Burry, L D; Hutton, B; Guenette, M; Williamson, D; Mehta, S; Egerod, I; Kanji, S; Adhikari, N K; Moher, D; Martin, C M; Rose, L

    2016-09-08

    Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium prevention is that interventions were considered in isolation and only direct evidence was used. Our systematic review will synthesize all existing data using network meta-analysis, a powerful statistical approach that enables synthesis of both direct and indirect evidence. We will search Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science from 1980 to March 2016. We will search the PROSPERO registry for protocols and the Cochrane Library for published systematic reviews. We will examine reference lists of pertinent reviews and search grey literature and the International Clinical Trials Registry Platform for unpublished studies and ongoing trials. We will include randomized and quasi-randomized trials of critically ill adults evaluating any pharmacological, non-pharmacological, or multi-component intervention for delirium prevention, administered in or prior to (i.e., peri-operatively) transfer to the ICU. Two authors will independently screen search results and extract data from eligible studies. Risk of bias assessments will be completed on all included studies. To inform our network meta-analysis, we will first conduct conventional pair-wise meta-analyses for primary and secondary outcomes using random-effects models. We will generate our network meta-analysis using a Bayesian framework, assuming a common heterogeneity parameter across all comparisons, and accounting for correlations in multi-arm studies. We will perform analyses using WinBUGS software. This systematic review

  19. Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis.

    Science.gov (United States)

    Jung, Su Young; Lee, Seung Hee; Lee, Soo Young; Yang, Seungwon; Noh, Hayeon; Chung, Eun Kyoung; Lee, Jangik I

    2017-12-20

    An optimal therapy for the treatment of pneumonia caused by drug-resistant Acinetobacter baumannii remains unclear. This study aims to compare various antimicrobial strategies and to determine the most effective therapy for pneumonia using a network meta-analysis. Systematic search and quality assessment were performed to select eligible studies reporting one of the following outcomes: all-cause mortality, clinical cure, and microbiological eradication. The primary outcome was all-cause mortality. A network meta-analysis was conducted with a Bayesian approach. Antimicrobial treatments were ranked based on surface under the cumulative ranking curve (SUCRA) value along with estimated median outcome rate and corresponding 95% credible intervals (CrIs). Two treatments were considered significantly different if a posterior probability of superiority (P) was greater than 97.5%. Twenty-three studies evaluating 15 antimicrobial treatments were included. Intravenous colistin monotherapy (IV COL) was selected as a common comparator, serving as a bridge for developing the network. Five treatments ranked higher than IV COL (SUCRA, 57.1%; median all-cause mortality 0.45, 95% CrI 0.41-0.48) for reducing all-cause mortality: sulbactam monotherapy (SUL, 100.0%; 0.18, 0.04-0.42), high-dose SUL (HD SUL, 85.7%; 0.31, 0.07-0.71), fosfomycin plus IV COL (FOS + IV COL, 78.6%; 0.34, 0.19-0.54), inhaled COL plus IV COL (IH COL + IV COL, 71.4%; 0.39, 0.32-0.46), and high-dose tigecycline (HD TIG, 71.4%; 0.39, 0.16-0.67). Those five treatments also ranked higher than IV COL (SUCRA, 45.5%) for improving clinical cure (72.7%, 72.7%, 63.6%, 81.8%, and 90.9%, respectively). Among the five treatments, SUL (P = 98.1%) and IH COL + IV COL (P = 99.9%) were significantly superior to IV COL for patient survival and clinical cure, respectively. In terms of microbiological eradication, FOS + IV COL (P = 99.8%) and SUL (P = 98.9%) were significantly superior to IV COL

  20. Use of mobile health (mHealth) tools by primary care patients in the WWAMI region Practice and Research Network (WPRN).

    Science.gov (United States)

    Bauer, Amy M; Rue, Tessa; Keppel, Gina A; Cole, Allison M; Baldwin, Laura-Mae; Katon, Wayne

    2014-01-01

    The purpose of this study was to determine the prevalence of mobile health (mHealth) use among primary care patients and examine demographic and clinical correlates. Adult patients who presented to 1 of 6 primary care clinics in a practice-based research network in the northwest United States during a 2-week period received a survey that assessed smartphone ownership; mHealth use; sociodemographic characteristics (age, sex, race/ethnicity, health literacy); chronic conditions; and depressive symptoms (2-item Patient Health Questionnaire). Data analysis used descriptive statistics and mixed logistic regression. Of 918 respondents (estimated response rate, 67.4%), 55% owned a smartphone, among whom 70% were mHealth users. In multivariate analyses, smartphone ownership and mHealth use were not associated with health literacy, chronic conditions, or depression but were less common among adults >45 years old (adjusted odds ratio, 0.07-0.39; P mHealth tools from their physician, and few (31%) prioritized their provider's involvement. Use of mHealth technologies is lower among older adults but otherwise is common among primary care patients, including those with limited health literacy and those with chronic conditions. Findings support the potential role of mHealth in improving disease management among certain groups in need; however, greater involvement of health care providers may be important for realizing this potential. © Copyright 2014 by the American Board of Family Medicine.