Parkview Health Research Repository
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Delivering Remote Monitoring Data to Patients with Implantable Cardioverter-Defibrillators: Does Medium Matter?
No full textBACKGROUND: This study presents findings on the impact of providing patients with their implantable device data on patients\u27 satisfaction, engagement, healthcare utilization and provider\u27s perceptions of this practice. Remote monitoring of implantable cardioverter defibrillators (ICDs) improves patient care through timely delivery of ICD data to the clinic. However, patients usually do not receive their ICD data. Providers are concerned that messaging patients with their device data could increase clinical workload.
METHODS: To evaluate the impact of sharing ICD data summary through the patient portal, 128 patients were randomized into two groups. Group A and B received their data through the patient portal and postal mail, respectively. Data were collected through surveys and medical record reviews. Forty-eight providers also completed a survey.
RESULTS: At the end of the study, at least two-thirds of patients were satisfied with the amount of information received through the electronic or paper ICD data summary. Additionally, providing patients with their device data did not increase ICD-specific clinical workload (e.g., calls or messages to provider). While providers did not foresee the provision of ICD data to patients as decreasing or improving clinical workload, they did see potential value in it for patients.
CONCLUSIONS: Providing patients with their ICD data (through paper or electronic means) might have the potential to improve patient satisfaction and enhance shared-decision making without adversely impacting clinical workload. This article is protected by copyright. All rights reserved
Questions and Closing - Mental Health Technology Conference
No full textQuestions and answers about conference topics
Updates in the Clinical Development of Epacadostat and Other Indoleamine 2,3-Dioxygenase 1 Inhibitors (IDO1) for Human Cancers.
No full textRecent application of immunotherapy in clinical oncology revolutionized our management of advanced human cancers. Check point inhibitors targeting CTLA4 and PD-1/PD-L1 axis are immunotherapeutic agents currently available to treat a variety of cancers. However, a novel therapeutic approach is needed to further improve patient outcome with these agents. Indoleamine 2,3-dioxygenase 1 (IDO1) is a rate-limiting enzyme in the metabolism of essential amino acid tryptophan in the peripheral tissue. IDO1 is overexpressed in human cancer cells and suppresses effector T cell function and promotes regulatory T cells (Tregs). Overexpression of IDO1 is associated with poor patient survival in several types of human cancer. These findings indicate that IDO1 is a promising target that can improve the treatment outcome in the field of Immuno-oncology. Several orally available IDO1 inhibitors including Epacadostat have entered human clinical trials over the last few years without a major safety concern. Although there is no objective response in single-agent trials, combination regimens with PD-1 inhibitors appear to exceed the activity of PD-1 inhibitors alone. Recent phase III ECHO 301 trial testing the combination of Epacadostat with Pembrolizumab in melanoma did not show superior outcome compared to Pembrolizumab alone. This lead to halting of other phase III trials using IDO1 inhibitors. In this minireview, we will discuss the recent clinical development of Epacadostat and other IDO1 inhibitors
Using Immediate Response Technology to Gather Electronic Health Data and Promote Telemental Health Among Youth
No full textIntroduction: A sizeable number of youth are currently struggling with anxiety, depression, and suicidal thoughts, yet many will not receive treatment. We sought to better understand if immediate response technology (IRT) could be used to gather mental health care data and educate youth on telemental health (TMH) resources.
Methods: Using an IRT imbedded within an interactive, media-rich school-based presentation, we gathered mental health history and preferences for TMH resources from 2,789 adolescents with a wide range of demographic and psychological characteristics.
Results: More than 80 percent of adolescents satisfied inclusion criteria for survey completion, and responses were statistically comparable across four diverse high school settings. Using Chi-squared analyses, we found that less than 10 percent of adolescents, especially girls and those with high depression/anxiety scores, had previously used TMH resources. After interacting with the IRT, many more (29 percent to 43 percent) expressed willingness to use these resources.
Discussion: The IRT system was effective in gathering mental electronic health data, delivering targeted mental health education, and promoting positive attitudes towards TMH among adolescents.
Conclusions: IRTs and other non-formalized technologies should be explored as cost-effective, easy-to-implement resources for electronic health data gathering and health care education
Playing it close to the VEST and the clinical guidelines: Clinical guideline compliance in HFrEF patients-Role of WCD.
No full textBACKGROUND: Guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) has been challenging to achieve universally. Healthcare providers who seek to achieve optimal medical therapy frequently consider either a wearable cardioverter defibrillator (WCD) or an implantable cardioverter defibrillator (ICD) as indicated. The dynamic process of communication and physician recommendations marks a setting to study the relative interdependence of medical therapies and best practice. The purpose of this study was to examine the long-term impact of the WCD on GDMT. We hypothesized the WCD serves as a gateway therapy, likely impacting other optimal strategies such that successful use of WCD improves GDMT adherence.
METHODS: Electronic medical records (EPIC) were manually reviewed to extract data elements in this observational study of 1289 HFrEF patients from 2013-2015. Data included demographics, comorbidities, and use of GDMT including an ICD use in persistently low ejection fraction (≤36%) patients after 90 days.
RESULTS: WCD use was significantly associated with prescribing adherence to GDMT, χ
CONCLUSIONS: This study demonstrates the use of the WCD correlates with improved clinician use of GDMT, follow-up echocardiographic studies, and appropriate use of primary prevention ICD. Thus, the potential benefits of the WCD and its care processes may extend beyond prevention of sudden cardiac death to enhanced optimization of GDMT
The Efficacy of Neutral Position Beractant Administration in Neonates.
No full textOBJECTIVE: The objective was to compare the efficacy and adverse effects of beractant administration in neonates via a single aliquot in a neutral position versus positioning the neonates on their left then right side and two aliquots administration.
STUDY DESIGN: This was a retrospective cohort chart review of neonates who were diagnosed with respiratory distress syndrome and received beractant during two 15-month periods between 2013 and 2015 and 2015 and 2016 to compare the change in the fraction of inspired oxygen (FiO
RESULTS: There were no differences in FiO
CONCLUSION: Changing administration of beractant from two aliquots and positions to a neutral position resulted in no significant change in Fi
Psychopharmacology: Psychologists as Prescribers and Collaborators. Exploring Opportunities for Psychologists to Provide High-quality Psychopharmacological Care From a Fundamentally Different Perspective
No full textPresentation DescriptionBeginning in the 1970’s, prescriptive authority has rapidly evolved into the non-physician health care disciplines. Nurse practitioners, optometrists, podiatrists, and physician assistants are among those professions who have seen a dramatic expansion of their scope of practice, largely due to the ability to prescribe medications. Psychologists are among the only doctoral-level providers who do not universally have the authority to prescribe drugs. Prescriptive authority offers the opportunity to psychologists to address comprehensive unmet health care needs. Evidenced based studies continue to clearly suggest that properly trained psychologists not only are quality prescriptive providers, they are uniquely positioned to raise the standard of health care treatment as a viable and alternative to traditional medically dominated mental health care. Several graduate programs have implemented or are developing prescriptive training. Several states have recently passed legislation and are implementing psychology prescribing laws. Learn why it is time for Indiana to move forward in the future of comprehensive mental health care services. This intermediate presentation has been developed for clinicians, researchers, residents, interns, and students. . Learning ObjectivesBy attending this presentation, participants will be able to: Summarize Indiana\u27s current law regarding prescriptive-authority. Describe progress being made, along with APA\u27s leadership, in the national movement for prescribing psychologists. Utilize literature that supports and does not support prescriptive-authority for psychologists, and to assess literature that addresses implications of prescribing for psychologists. Prepare to become involved in public policy as momentum grows in Indiana
Bivalirudin Anticoagulation Dosing Protocol for Extracorporeal Membrane Oxygenation: A Retrospective Review.
No full textAnticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis. Clinical characteristics and changes in activated partial thromboplastin time (aPTT) were evaluated from medical records to determine the efficacy of the dosing protocol. ECMO was initiated for acute respiratory distress syndrome in eight (72.7%) patients and for cardiac arrest in three (27.3%) patients. A total of 178 protocol guided dose adjustments were made during the study. Among the dose adjustments, 56 (31.5%) attained the protocol predicted aPTT level change, 96 (53.9%) of the measured aPTT changes were less than predicted, and 26 (14.6%) of the measured aPTT changes were more than predicted. On average, patients were within their defined therapeutic aPTT target range 66.3% of the time. All patients reached their designated aPTT target range within the first 24 hours of therapy. Significant bleeding was documented in eight (72.7%) patients. No clinically evident thromboembolic events were identified in vivo while cannulated. This analysis suggests that bivalirudin can be managed using a dosing protocol to provide anticoagulation therapy to patients during ECMO and can provide foundational guidance for dose adjustment and monitoring for other institutions
Team Based Approach to Fall Prevention in Elderly Population: A Four Year Review
No full textPoster Presentation
“The research reported on this poster was supported by Parkview Health, Indiana University School of Medicine, and Aging & In-Home Services of NE Indiana. The investigators retained full independence in the conduct of this research”
Methods:
The Fall Prevention Clinic was established 4 years ago as an outpatient service within a community hospital. The patient completes a series of two appointments after a physician referral is received • 1st Visit – Composed of evaluation by a multi-disciplinary team: Neurologist (Neuro),RN Care Advisor (RN), Physical Therapist (PT), Pharmacist (RPh), Occupational Therapist (OT), and Aging & In-Home Services (AIHS) • 2nd Visit – Provides personalized recommendations to the patient and family members from each team member Patients are instructed to call the clinic and report any falls and are contacted by RN at 1 month intervals to discuss patient status, care plan compliance, and further recommendations Follow up with patient occurs every 6 months Total of 590 patients age 65 years or above were included in this study
Evaluation of bleeding and thrombotic risk in patients receiving triple antithrombotic therapy
No full text2018 ASHP Midyear Clinical Meeting / Anaheim, California / Poster # 11-309
Objective: Evaluate bleeding and thrombotic risk of patients receiving triple antithrombotic therapy (TAT) versus dual antithrombotic therapy (DAT) and characterize prescribing patterns