Interpretation Of Patient Data Research Articles

Overcoming Barriers to Childhood and Adolescent Vaccination: Opportunities in Precision Health Promotion

Abstract Background Vaccination remains one of the greatest success stories in public health as cost-effective interventions to reduce morbidity and mortality from infectious diseases at the population level. However, the COVID-19 pandemic created unprecedented challenges to the immunization sector. Uptake of routine childhood and adolescent vaccinations was forestalled by challenges related to pandemic lockdowns/quarantine, reduced patient-provider interactions, parental reluctance to seek preventative services, poor access to health services, and loss of income and/or health insurance. Compared to pre-pandemic estimations, the pandemic era brought a consequential decline in coverage of all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This study sought to address suboptimal adolescent vaccine delivery systems and bolster uptake in the post-pandemic era with the introduction of precision health promotion strategies centered around the use of Personal Health Libraries (PHL). Methods Leveraging artificial intelligence (AI), and semantic web technologies to integrate contextual knowledge (i.e., clinical, biomedical, and SDoH data) with patient preferences, proposed PHL platforms could aid in generating personalized evidence-based recommendations useful to both care provider promotion of vaccination and mitigating patient and caregiver hesitancy. The proposed application stands to provide customized digital health interventions by 1) facilitating remote knowledge acquisition, exchange, and visualization of the benefits of on-time vaccination, 2) improving health information-seeking behaviors to reduce hesitancy, 3) bolstering patient reminder and recall systems for follow-up and series completion, and 4) learning usage patterns to incorporate end-user preferences to empower patients, promote best practices, and enable them to make informed health decisions. Results The proposed PHL would serve as an ecosystem to manage and deliver tailored vaccine-related information to inform health decision-making regarding ACIP-recommended immunizations. Such a resource could administer health education and promotion that addresses common misconceptions regarding vaccination, alleviate safety, efficacy, and side effect concerns, and deliver evidence-based support of vaccines as primary protective measures (i.e., cancer prevention). Conclusion The use of PHL would enable rapid and real-time collection and interpretation of patient data beyond the traditional clinical setting, supplying care providers with tools for optimal vaccination recommendation to bolster uptake in the post-pandemic era. Moreover, the application would enable patients and caregivers to readily access vital health information and play a crucial role in addressing the obstacles encountered when seeking accurate and dependable vaccine-related information.

Australia and New Zealand Clinical Motion Analysis Group (ANZ-CMAG) clinical practice recommendations

Clinical motion analysis involves quantitative measurement of gait patterns to identify gait anomalies that currently or have the potential to impact function, activities of daily living and participation. Clinical motion analysis services are equipped with motion capture technology and comprise specialised staff who deliver 3-dimensional motion analysis services to children and adults who present with varying levels of gait impairment. Data is then used to inform intervention recommendations to clinicians with a view to maintaining independent, functional and pain free walking (or appropriate mobility).The ANZ-CMAG (established in 2013) identified a need to establish recommendations to assist in standardising practice guidelines for both current and new clinical motion analysis services within the region. The group serves to promote collaboration between services in quality assurance processes, clinical practices, data sets and research activities. The clinical practice recommendations described in this paper cover: i) requirements for a motion analysis service (including staffing, facilities and equipment), ii) patient assessments (requirements, clinical information and data gathered, reporting and interpretation of patient data), iii) quality assurance processes (including motion capture system / biomechanical models & limitations, marker placement, data storage / record keeping, creation of normative dataset); iv) helpful resources.Better outcomes for children and adults with gait deviations is dependent upon accurate measurement and evaluation of walking and requires input from multidisciplinary clinical teams with specialist knowledge and skills. The ANZ-CMAG hopes these clinical practice recommendations are beneficial to motion analysis services with an aim to improve clinical practices, patient outcomes, and support research collaboration.

Key challenges for patient registries – A report from the 1st workshop of the EHC Think Tank Workstream on Registries

Abstract Introduction Patient registries are an invaluable resource for furthering the understanding of rare diseases such as bleeding disorders, providing large, pooled datasets not achievable by other means of data collection. As well as supporting clinical care and research, registries must also be able to answer questions that are important to the wider bleeding disorders community. However, there are challenges associated with the need for secure access, exchange of health data, quality and interoperability, and data delivery. Identifying key challenges As part of the EHC Think Tank Patient Registries Workstream, 17 stakeholders representing health care providers, patient groups, research and industry met in October 2021 to identify challenges to managing and utilising patient registries, from each of their stakeholder perspectives. This is a first step in a longer term process aiming to identify or co-create solutions that could improve access and interpretation of patient data. The challenges identified relate to five key categories which are interlinked in various ways: 1. The multiplicity of registries and datasets; 2. Data quality; 3. Data sharing; 4. Expanding the scope of registries; 5. The role of the patient in registries. Summary The heterogeneity in the way that registries are designed, funded and owned, the type of data collected, and the way data is collected are issues that must be addressed. Good, quality data is needed at all levels to ensure the provision and funding of effective care. Data quality will increase overall if it is possible to merge data from different registries. The value of patient participation in registries must also be acknowledged and built on to help ensure their quality, that they remain fit for purpose, and that data input is sustained over time.

The Influence of Cataract on Fluorescence Lifetime Imaging Ophthalmoscopy (FLIO).

PurposeTo investigate the influence of lens opacifications on fluorescence lifetime imaging ophthalmoscopy (FLIO).MethodsForty-seven eyes of 45 patients were included. Mean fluorescence lifetimes (Tm) were recorded with a fluorescence lifetime imaging ophthalmoscope in a short spectral channel (SSC) and a long spectral channel (LSC). Retinal and lens autofluorescence lifetimes were measured in subjects before and after cataract surgery. Lens opacification was graded using the Lens Opacities Classification System III (LOCS III) classification.ResultsThe retinal Tm decreased significantly after cataract surgery in both spectral channels (SSC: –53%, P < 0.0001; LSC: –26%, P = 0.0041). The lens Tm differed significantly between the crystalline and the artificial lens in both spectral channels (P < 0.0001). The “nuclear opacity” and “nuclear color” score of the LOCS III classification correlated significantly with the mean Tm difference in both spectral channels (P < 0.0001).ConclusionsLens opacification results in significantly longer retinal Tm. Therefore the lens status has to be considered when performing cross-sectional fluorescence lifetime analysis. Cataract-formation and cataract-surgery needs to be considered when conducting longitudinal studies. Grading of nuclear opacity following the LOCS III classification provides an approximate conversion formula for the mean change of lifetimes, which can be helpful in the interpretation of data in patients with lens opacities.Translational RelevanceFLIO is significantly influenced by lens opacities. Using a lens opacity grading scheme and measuring fluorescence lifetimes before and after cataract surgery, an approximative conversion formula can be calculated, which enables the comparison of lifetimes after cataract surgery or over the course of time.

Prognostic factors for TB-associated uveitis in the Asia-Pacific Region: results of a modified Delphi survey.

BackgroundPrognostic factors for TB-associated uveitis (TBU) remain mostly unknown, due to the challenges in interpretation of patient data. We present consensus list of prognostic factors for resolution of inflammation in TBU, by experts across the Asia-Pacific region.MethodsWe applied a modified Delphi technique to generate consensus on prognostic factors influencing the resolution of inflammation in TB-associated: anterior uveitis (AU), retinal vasculitis (RV), and multifocal serpiginoid choroiditis (MSC). The initial questionnaire was developed through a face-to-face meeting. Sixteen uveitis experts from eleven Asia-Pacific countries were included. A single investigator circulated the questionnaire electronically and received the responses. Participants scored each item on 4-point Likert scale, in three successive rounds. After each round, a number of items were reduced based on response, and summary of responses was provided to participants. At the end of Round 3, items were considered significant if they: (1) achieved a median ≥2, and interquartile range ≤1, and (2) ≥75% of the respondents agreed on whether the item was a positive or negative prognostic factor.ResultsForty-two putative questionnaire items were considered. At the end of Rounds 3, 4, 9, and 8 items in AU, RV, and MSC, respectively, met significance criteria. These included duration of disease, previous corticosteroid/immunosuppressive therapy, co-existent HIV, disease-specific imaging features, multidrug resistant TB, and duration of anti-TB therapy.ConclusionsConsensus were achieved on multiple ocular and systemic factors that influence resolution of inflammation in TBU. These will form the groundwork for validation in prospective clinical trials.

Using neurostimulation to understand the impact of pre-morbid individual differences on post-lesion outcomes

Neuropsychological data have proven invaluable in advancing our understanding of higher cognition. The interpretation of such data is, however, complicated by the fact that post-lesion behavioral abnormalities could reflect pre-morbid individual differences in the cognitive domain of interest. Here we exploited the virtual lesion methodology offered by transcranial magnetic stimulation (TMS) to explore the impact of pre-morbid individual differences on post-lesion performance. We applied this approach to the domain of reading, a crucial ability in which there are known to be considerable individual differences in the normal population. As predicted by neuropsychological studies of surface dyslexia in semantic dementia and the connectionist triangle model of reading, previous empirical work has shown that healthy participants vary in their reliance on meaning for reading words with atypical correspondences between spelling and sound. We therefore selected participants who varied along this dimension and applied a virtual lesion to the left anterior temporal lobe. As expected, we observed a significant three-way interaction between "pre-morbid" reading status, stimulation, and word type, such that TMS increased the disadvantage for spelling-sound atypical words more for the individuals with stronger semantic reliance. This successful test-case study provides an approach to understanding the impact of pre-morbid individual variation on post-lesion outcomes that could be fruitfully applied to a variety of cognitive domains.

Neuropsychology's Role in Pediatric Epilepsy Surgery

Neuropsychology plays an essential role in pediatric epilepsy surgery. Evaluations provide information to inform presurgical decision-making by addressing localization and lateralization of deficits and by informing risk of postsurgical decline. The pediatric neuropsychologist also assists with multiple additional procedures, including the Wada or Intracarotid amobarbital procedure, functional magnetic resonance imaging, and brain mapping (on the ward and in the operating room), to measure localization and lateralization of eloquent cortex as well as adequacy of brain tissue to be resected and risk of resection of specific cortex. Neuropsychology provides postsurgical outcome information not only for individual patients, but as “quality control” for epilepsy surgery. Multiple factors complicate individual patient data interpretation, and these factors are essential to understand and consider. Developmental considerations are paramount. Although methodological differences between studies can also make surgical outcome studies challenging to interpret, neuropsychological data suggest that pediatric surgery can improve developmental outcomes and trajectories, particularly if resection is done early and without lengthy presurgical seizure duration, although longer seizure duration and polypharmacy, more widespread disease, and larger areas of resection, particularly of critical eloquent cortex, can be costly to the individual patient. Additional and more refined research is needed.

Visual Enhancement of MR Angiography Images to Facilitate Planning of Arteriovenous Malformation Interventions

The primary purpose of medical image visualization is to improve patient outcomes by facilitating the inspection, analysis, and interpretation of patient data. This is only possible if the users’ perceptual and cognitive limitations are taken into account during every step of design, implementation, and evaluation of interactive displays. Visualization of medical images, if executed effectively and efficiently, can empower physicians to explore patient data rapidly and accurately with minimal cognitive effort. This article describes a specific case study in biomedical visualization system design and evaluation, which is the visualization of MR angiography images for planning arteriovenous malformation (AVM) interventions. The success of an AVM intervention greatly depends on the surgeon gaining a full understanding of the anatomy of the malformation and its surrounding structures. Accordingly, the purpose of this study was to investigate the usability of visualization modalities involving contour enhancement and stereopsis in the identification and localization of vascular structures using objective user studies. Our preliminary results indicate that contour enhancement, particularly when combined with stereopsis, results in improved performance enhancement of the perception of connectivity and relative depth between different structures.

Pitfalls of the interpretation of myocardial infarction data in patients on dabigatran treatment

Pitfalls of the interpretation of myocardial infarction data in patients on dabigatran treatment

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

BackgroundResidents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.MethodSystematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.ResultsTwenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.ConclusionsMost assessment tools are not comprehensive and do not take into account residents’ individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

Exploiting causal functional relationships in Bayesian network modelling for personalised healthcare

Bridging the gap between the theory of Bayesian networks and solving an actual problem is still a big challenge and this is in particular true for medical problems, where such a gap is clearly evident. We argue that Bayesian networks offer appropriate technology for the successful modelling of medical problems, including the personalisation of healthcare. Personalisation is an important aspect of remote disease management systems. It involves the forecasting of progression of a disease based on the interpretation of patient data by a disease model. A natural foundation for disease models is physiological knowledge, as such knowledge facilitates building clinically understandable models. This paper proposes ways to represent such knowledge as part of engineering principles employed in building clinically practical probabilistic models. The methodology has been used to construct a temporal Bayesian network model for preeclampsia – a pregnancy-related disorder. The model is the first of its kind and an integral part of a mobile home-monitoring system intended for use in daily pregnancy care. We conducted an evaluation study with actual patient data to obtain insight into the model’s performance and suitability. The results obtained are encouraging and show the potential of exploiting physiological knowledge for personalised decision-support systems.

G-path pylorus-preserving pancreaticoduodenectomy

For a matured digestive surgeon,pancreaticoduodenectomy (PD) is regarded as one of the most complicated and technically challenging surgical procedure.Based on the accurate interpretation of patient's preoperative imageologic data,we advocate a novel procedure which is called as G-path pylorus-preserving pancreatoduodenectomy (G-path PPPD).We deen G-path PPPD as a standardized procedure for resectable pancreatic head cancer or periampullary carcinoma,which definitely simplify the procedure,save the operative time,achieve R0 resection through en-bloc resection without interruptedly intraoperative exploration and reduce the risk of iatrogenic tumor metastasis.This article introduced the program of G-path PPPD in detail by taking a patient as an example who suffered from pancreatic head cancer accompanied with obstructive jaundice,and discussed the relevant points. Key words: Pancreatic neoplasms ; Pancreaticoduodenectomy, pylorus-preserving

Interpretation of data in patients with enteral and parenteral nutrition

Abstract Multivariate statistical analysis is performed using clinical data characterizing the state of patients subject to early enteral (EEN) and pareneteral (PN) nutrition after major gastrointestinal surgery. Several patterns of linkage, between the clinical parameters for both groups of observed patients (with mixed (EEN+PN) and with parenteral nutrition only (TPN)), were found and interpreted. Discriminating indices for the internal grouping of patients were found related to the type of nutrition and the clinical status of the patients. It was found that the mixed (enteral and parenteral) nutrition offers better options for the overcoming of the metabolic stress after the surgery.

Sterol profiles in plasma and erythrocyte membranes in patients with Smith-Lemli-Opitz syndrome: a six-year experience

This study reports our experience over the last six years in the diagnosis of Smith-Lemli-Opitz syndrome and other inborn errors of cholesterol biosynthesis. Gas chromatography/mass spectrometry was used to obtain sterol profiles in plasma and erythrocyte membranes of suspected patients. Plasma sterol reference values calculated in unaffected subjects (n=276) were in agreement with those previously reported. Among patients investigated from 2005 to 2010, we report 16 patients affected by Smith-Lemli-Opitz syndrome, three of whom represent new cases and 13 of whom were follow-up patients. In this period we also identified a new case of chondrodysplasia punctata 2 X-linked. The estimated incidence obtained for Smith-Lemli-Opitz syndrome was 1:93 suspected patients (1.08%). We also studied the effect of storage on the dehydrocholesterols/cholesterol ratio in plasma and erythrocyte membranes of patients affected by Smith-Lemli-Opitz syndrome stored at -20°C for up to 22 and 20 months, respectively. A significant negative linear correlation between storage time and the dehydrocholesterols/cholesterol ratio was identified in both plasma and erythrocyte membranes. The decrease in the dehydrocholesterols/cholesterol ratio in erythrocyte membranes was at least two-fold higher than in plasma. The results of this study may be helpful for diagnosis and interpretation of data in patients with findings suggestive of a cholesterol biosynthesis defect.

A computer program for registering all daily accumulated data at a school for vision disorders

Despite increasing medical use of the computer, many clinics have experienced only limited success (or none at all) in computerized registration of patient data. One important reason for this lies in the complicated user interfaces of most programs. The clinician has no time to familiarize himself with the complicated command sequences involved, while necessary acceptance of the new technology by administrative staff is often lacking. This paper shows that computerized registration and interpretation of patient data are well within the bounds of possibility, given the use of newly-developed user-friendly operating systems and suitable personal computers. A concrete example of computerized registration of data in a remedial center is given: a case with squint symptoms for which 176 parameters can be entered.

Health informatics.

Health informatics is the development and assessment of methods and systems for the acquisition, processing and interpretation of patient data with the help of knowledge from scientific research. This definition implies that health informatics is not tied to the application of computers but more generally to the entire management of information in healthcare. The focus is the patient and the process of care. The apparent information overload and the imperfection of medical decision making motivate the use of information systems for medical decision support. Health informatics provides tools to control processes in healthcare, acquire medical knowledge and communicate information between all people and organisations involved with healthcare. Although the development of medical information systems may often lag behind the available possibilities, the technological state of the current medical information systems is better than it is generally held to be. Health informatics should help healthcare professionals to provide better and more cost-effective care and enable healthcare systems to be more efficient and to adapt better to our patients' needs. Health informatics may reshape the way we deliver care to meet the demands of the future.

Reproducibility of abnormal heart rate variability indices: the case of hypertensive sleep apnoea syndrome.

Before heart rate variability can be used as an investigational tool in the clinical setting, its reproducibility must be known. We studied heart rate variability four times during 44 weeks in 15 hypertensive patients with sleep apnoea syndrome. Time and frequency domain analytical approaches were used during the spontaneous and controlled breathing tests, orthostatic manoeuvre and the cold pressor test. Alterations in resting heart rate were taken into account using the coefficient of component variance. In general, the response of heart rate variability was abnormal and variability was reduced in the hypertensive patients with sleep apnoea syndrome compared with reference data. Time domain measures of heart rate variability demonstrated generally better reproducibility over four recordings than frequency domain measures in these hypertensive patients with sleep apnoea syndrome. On the other hand, the reproducibility of frequency domain measures depended on the specific conditions: during orthostatic manoeuvre and cold pressor test the best reproducibility was found using normalized units. In the reference data set, there were no significant differences between the two heart rate variability recordings during any of the autonomic nervous function tests. In this follow-up study we found that simple procedures such as the controlled breathing test show good reproducibility. More complex tests such as the orthostatic manoeuvre require special attention in order to obtain acceptable reproducibility of heart rate variability measurements. Quantitatively minor changes in the variability indices when the overall variability is reduced exert major effects on the results. Therefore we suggest that reproducibility data obtained in healthy volunteers are not valid for the interpretation of data in patients with damaged cardiovascular autonomic control.