Parkview Health Research Repository
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Machine Learning and Grounded Theory Method: Convergence, Divergence, and Combination
No full textGROUP \u2716: Proceedings of the 2016 ACM International Conference on Supporting Group Work.
Grounded Theory Method (GTM) and Machine Learning (ML) are often considered to be quite different. In this note, we explore unexpected convergences between these methods. We propose new research directions that can further clarify the relationships between these methods, and that can use those relationships to strengthen our ability to describe our phenomena and develop stronger hybrid theories
The Black Esophagus: A Rare But Deadly Disease
No full textWe present a series of cases of acute esophageal necrosis along with a video demonstration. The video captures a case showing the severity of necrosis of the esophageal mucosa; an orogastric tube easily passed through the esophageal lumen and into the right hemithorax. The series also demonstrates the severity of this illness, with an associated high mortality rate
“Hunger Hurts but Starving Works”: Characterizing the Presentation of Eating Disorders Online
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CSCW \u2716: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing
Within the CSCW community, little has been done to systematically analyze online eating disorder (ED) user generated content. In this paper, we present the results of a cross-platform content analysis of ED-related posts. We analyze the way that hashtags are used in ad-hoc ED- focused networks and present a comprehensive corpus of ED-terminology that frequently accompanies ED activities online. We provide exemplars of the types of ED-related content found online. Through this characterization of activities, we draw attention to the increasingly important role that these platforms play and how they are used and misappropriated for negative health purposes. We also outline specific challenges associated with researching these types of networks online. CAUTION: This paper includes media that could potentially be a trigger to those dealing with an eating disorder or with other self-injury illnesses. Please use caution when reading, printing, or disseminating this paper
Missing links: challenges in engaging the underserved with health information and communication technology
Get PDFPervasiveHealth \u2716: Proceedings of the 10th EAI International Conference on Pervasive Computing Technologies for Healthcare
We sought to understand underserved patients\u27 preferences for health information technology (HIT) and examine the current use of personal health records (PHRs) in Community Health Centers (CHCs) serving low-income, uninsured, and underinsured patients. Forty-three patients and 49 clinic staff, administrators, and providers from these CHC systems were interviewed using open-ended questions assessing patient experience, perceptions of the CHC, access barriers, strategies used to overcome access barriers, technology access and use, and clinic operations and workflow. All seven CHC systems were at some stage of implementing PHRs, with two clinics having already completed implementation. Indiana CHCs have experienced barriers to implementing and using PHRs in a way that provides value for patients or providers/staff There was a general lack of awareness among patients regarding the existence of PHRs, their benefits and a lack of effective promotion to patients. Most patients have access to the internet, primarily through mobile phones, and desire greater functionality in order to communicate with CHCs and manage their health conditions. Despite decades of research, there remain barriers to the adoption and use of PHRs. Novel approaches must be developed to achieve the desired impact of PHRs on patient engagement, communication and satisfaction. Our findings provide a roadmap to greater engagement of patients via PHRs by expanding functionality, training both patients and clinic providers/staff, and incorporating adult learning strategies
Access Is Meaningful (AIM): Working with Community Health Centers to Improve Access to Care.
Get PDFPresented in 9th Annual Conference on the Science of Dissemination and Implementation
Background:
We are partnering with community health centers (CHCs) and their patients to redesign systems to deliver timely care to underserved populations in Indiana. Our Delphi study was designed to address two questions: 1) what solutions (e.g. organizational factors, processes, procedures) serve as facilitators to accessing care?; and 2) what organizational strategies might work to implement solutions in CHC environments?
Methods:
We used a modified Delphi method, bringing experts together in one room for a face-to-face meeting to prioritize solutions for reducing access barriers and strategies to implement the solutions. We invited clinicians, operational leaders, staff and patients to participate. Including patients, rarely done with underserved populations, required us to modify the traditional Delphi method. Mailing multiple rounds of surveys was unlikely to give us the robust feedback from patients due to the transient nature of this population and potential to not understand the materials. Our modified Delphi approach, which included a patient orientation session, allowed patients to participate as equals among other experts.
Findings:
We invited 46 experts from across Indiana. Thirty-six attended the event but only 33 voted (11 patients). We aggregated a list of 39 solutions and 8 implementation strategies from 89 key informant interviews of CHC patients, staff, clinicians and administrators completed in an earlier phase of our study. Delphi participants contributed an additional 11 solutions and 3 strategies that were included in the ranking activity.
After three rounds of ranking:Top ten solutions for improving access to care: 1) ‘Modified Open Access\u27 scheduling; 2) Reduced costs for uninsured patients; 3) Extended hours; 4) Enhanced customer service; 5) Offer dental services; 6) Coordinated follow-up care; 7) ‘Walk-in” urgent care; 8) Improved telephone process; 9) Enhancement to Medicaid; 10) Lower cost insurance.Top five operational strategies: 1) Form a planning team; 2) Develop an assessment plan; 3) Communication with staff; 4) Communication with patients and community; 5) Team-based care.
Implications for D&I Research:
Others working with CHCs to change health care delivery may find the emergent prioritized lists useful. We used to these findings to shape the intervention offered in the final phase of our larger study currently underway in three intervention CHCs
Initial experience with a novel EUS-guided core biopsy needle (SharkCore): results of a large North American multicenter study
No full textBACKGROUND AND AIMS:
The ability to safely and effectively obtain sufficient tissue for pathologic evaluation by using endoscopic ultrasound (EUS) guidance remains a challenge. Novel designs in EUS needles may provide for improved ability to obtain such corebiopsies. The aim of this study was to evaluate the diagnostic yield of core biopsy specimens obtained using a novel EUS needle specifically designed to obtain core biopsies. PATIENTS AND METHODS:
Multicenter retrospective review of all EUS-guided fine-needle biopsies obtained using a novel biopsy needle(SharkCore FNB needle, Medtronic, Dublin, Ireland). Data regarding patient demographics, lesion type/location, technical parameters, and diagnostic yield was obtained. RESULTS:
A total of 250 lesions were biopsied in 226 patients (Median age 66 years; 113 (50 %) male). Median size of all lesions (mm): 26 (2 - 150). Overall, a cytologic diagnosis was rendered in 81 % specimens with a median number of 3 passes. When rapid onsite cytologic evaluation (ROSE) was used, cytologic diagnostic yield was 126/149 (85 %) with a median number of 3 passes; without ROSE, cytologic diagnostic yield was 31/45 (69 %, P = 0.03) with a median number of 3 passes. Overall, a pathologic diagnosis was rendered in 130/147 (88 %) specimens with a median number of 2 passes. Pathologic diagnostic yield for specific lesion types: pancreas 70/81 (86 %), subepithelial lesion 13/15 (87 %), lymph node 26/28 (93 %). Ten patients (10/226, 4 %) experienced adverse events: 4 acute pancreatitis, 5 pain, 1 fever/cholangitis. CONCLUSIONS:
Initial experience with a novel EUS core biopsy needle demonstrates excellent pathologic diagnostic yield with a minimum number of passes
Prognostic and Predictive Value of KRAS Mutation in NSCLC.
No full text...we suggest another biological pathway that is associated with EGFR/KRAS signaling.
Liver kinase B1 gene (LKB1), a serine/threonine kinase, is a frequently mutated tumor suppressor gene in NSCLC... Refers to: Alona Zer, Keyue Ding, Siow Ming Lee, Glenwood D. Goss, Lesley Seymour, Peter M. Ellis, Allan Hackshaw, Penelope A. Bradbury, Lei Han, Christopher J. O’Callaghan, Ming-Sound Tsao, Frances A. Shepherd
Pooled Analysis of the Prognostic and Predictive Value of KRAS Mutation Status and Mutation Subtype in Patients with Non–Small Cell Lung Cancer Treated with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors
Journal of Thoracic Oncology, Volume 11, Issue 3, March 2016, Pages 312-32
“Technoference”: The interference of technology in couple relationships and implications for women’s personal and relational well-being.
No full textTechnology use has proliferated in family life; everyday intrusions and interruptions due to technology devices, which we term “technoference,” will likely occur. We examine the frequency of technoference in romantic relationships and whether these everyday interruptions relate to women’s personal and relational well-being. Participants were 143 married/cohabiting women who completed an online questionnaire. The majority perceived that technology devices (such as computers, cell or smartphones, or TV) frequently interrupted their interactions, such as couple leisure time, conversations, and mealtimes, with their partners. Overall, participants who rated more technoference in their relationships also reported more conflict over technology use, lower relationship satisfaction, more depressive symptoms, and lower life satisfaction. We tested a structural equation model of technoference predicting conflict over technology use, which then predicted relationship satisfaction, which finally predicted depression and life satisfaction. By allowing technology to interfere with or interrupt conversations, activities, and time with romantic partners—even when unintentional or for brief moments—individuals may be sending implicit messages about what they value most, leading to conflict and negative outcomes in personal life and relationships
Young children’s tablet use and associations with maternal well-being
Get PDFWhile recent research has documented a rapid increase in the use of new technologies such as touchscreen tablets early in life, little is known about how young children use tablets, what activities they engage in, and whether family demographic and maternal well-being are associated with early use. Guided by Bronfenbrenner’s bioecological theory of human development, the current study addressed these questions with a cross-sectional, online survey of mothers with children between 12 and 48 months of age. Mothers reported on their child’s tablet use as well as their own personal well-being (depressive symptoms and role overload) and relational well-being (relationship satisfaction, coparenting quality, conflict frequency). Nearly 63 % of all mothers owned a tablet. Approximately 46 % of children with access typically use a tablet in an average day, with the majority using for 15 min or less. For families who owned a tablet, child’s frequency of use was positively associated with child’s age and mother’s use and negatively associated with mother’s relational well-being. Despite the American Academy of Pediatrics recommendation that screen media be avoided for children under 24 months, children in our study used tablets, albeit infrequently. Our findings suggest that it is important for researchers to consider the relationship between contextual factors within the family and child media use. Refining their focus for families with particular needs may allow child advocates and policy makers to develop more beneficial media recommendations for families with a variety of circumstances
Dexmedetomidine for Alcohol Withdrawal Syndrome
No full textOBJECTIVE:
To review available evidence evaluating dexmedetomidine in alcohol withdrawal syndrome (AWS) while identifying gaps in evidence for its use in this setting. DATA SOURCES:
A MEDLINE search (1966-August 2015) to identify English-language articles evaluating the efficacy and safety of dexmedetomidine in alcohol withdrawal. Key words included alcohol, withdrawal, delirium tremens, and dexmedetomidine. Additional references were identified from a review of literature citations. STUDY SELECTION AND DATA EXTRACTION:
All English-language observational studies, retrospective reviews, and clinical trials were included. Case reports and case series describing the use of dexmedetomidine in 10 or fewer patients were excluded. DATA SYNTHESIS:
One randomized, controlled trial, 1 prospective observational study, and 6 retrospective reviews were identified. The only randomized, controlled trial identified showed that the addition of dexmedetomidine decreases benzodiazepine requirements more than placebo in the first 24 hours after initiation compared with the 24 hours prior to initiation (-56.8 mg vs -8 mg; P = 0.037). Overall, dexmedetomidine appears to lower benzodiazepine requirements in patients with AWS and decreases the sympathomimetic response seen in these patients. There was no convincing evidence that dexmedetomidine improves clinical endpoints in patients with AWS, such as need for mechanical ventilation or intensive care unit or hospital length of stay. CONCLUSIONS:
Dexmedetomidine reduces hypertension and tachycardia in AWS and also reduces benzodiazepine requirements; however, the impact of these findings on important clinical endpoints is yet to be determined. Dexmedetomidine may be useful as adjunctive therapy; however, it cannot be recommended as a single agent in the management of AWS