Utilization and outcomes of a Whole Health model of care by Veterans with psychiatric illness.

OBJECTIVES: The Veterans Health Administration (VHA) is implementing a model of healthcare known as Whole Health (WH). The goal of WH is to shift from a disease-oriented system to one that emphasizes health promotion and disease prevention as well as promotes the use of Complementary and Integrative Health. The aim of this project was to investigate utilization and outcomes of WH programming among Veterans with psychiatric disorders. DESIGN: This was a retrospective study. Subjects were 7138 Veterans who had a mental health diagnosis. Descriptive data, as well as within- and between-subjects analyses were conducted to investigate utilization and outcomes. SETTING: The study was conducted at a large VHA medical center. INTERVENTIONS: Whole health interventions considered in this study were mindfulness training, health education, wellbeing, and nutrition classes as well as health coaching. Other whole health interventions, such as acupuncture and message were not evaluated. MAIN OUTCOME MEASURES: Utilization of mental health treatment services, medication prescriptions, pain scores and suicide-related behaviors were the primary outcome measures. RESULTS: There were 305 Veterans with at least one WH appointment. The existence of several specific psychiatric disorders was associated with WH utilization. The mean number of appointments completed per individual was 6.9 for all WH programming. Finally, WH participation was associated with decreased risk of suicide as well as reduced use of mental health services. There were no significant changes to other outcome variables. CONCLUSIONS: WH programming shows promise to reduce suicide risk and the need for mental health services among this population. Additionally, WH services were underutilized and there was a lack of treatment engagement.

Development and implementation of a pharmacist-led telehealth medication management program for veterans receiving oral antineoplastic therapies through the MISSION Act.

PURPOSE: Veterans prescribed oral antineoplastic therapies (OATs) by community providers outside the Veterans Health Administration (VA) may lack access to comprehensive medication management. To address this, our multidisciplinary team developed and implemented a pharmacist-led telehealth medication management program for veterans prescribed OATs by community providers. SUMMARY: The program exclusively uses telehealth to connect veterans with a dedicated board-certified clinical oncology pharmacist who provides comprehensive medication management. The program is based on established pharmacy models found in the research literature. We developed a standard operating procedure, communication templates, patient education materials, and a suite of health information technology tools to help streamline pharmacy processes. The Consolidated Framework for Implementation Research was used to design implementation strategies to promote the adoption of the program. In the first year, 64 veterans from 3 VA medical centers were enrolled in the program. The oncology clinical pharmacist performed 342 encounters and 101 interventions. The program saved an estimated $200,724 in medication-related costs. The veterans we surveyed reported high levels of satisfaction with the pharmacy services provided by the program. CONCLUSION: The delivery of comprehensive medication management through telehealth is feasible from a healthcare system perspective and beneficial for patients. The board-certified oncology clinical pharmacist provided remote pharmacy services to Veterans across three sites in a large and rural service area for the VA. The program realized several benefits, including positive clinical outcomes, high levels of patient satisfaction, and cost savings on medication-related costs.

Data and Digital Solutions to Support Surveillance Strategies in the Context of the COVID-19 Pandemic.

Background: In order to prevent spread and improve control of infectious diseases, public health experts need to closely monitor human and animal populations. Infectious disease surveillance is an established, routine data collection process essential for early warning, rapid response, and disease control. The quantity of data potentially useful for early warning and surveillance has increased exponentially due to social media and other big data streams. Digital epidemiology is a novel discipline that includes harvesting, analysing, and interpreting data that were not initially collected for healthcare needs to enhance traditional surveillance. During the current COVID-19 pandemic, the importance of digital epidemiology complementing traditional public health approaches has been highlighted. Objective: The aim of this paper is to provide a comprehensive overview for the application of data and digital solutions to support surveillance strategies and draw implications for surveillance in the context of the COVID-19 pandemic and beyond. Methods: A search was conducted in PubMed databases. Articles published between January 2005 and May 2020 on the use of digital solutions to support surveillance strategies in pandemic settings and health emergencies were evaluated. Results: In this paper, we provide a comprehensive overview of digital epidemiology, available data sources, and components of 21st-century digital surveillance, early warning and response, outbreak management and control, and digital interventions. Conclusions: Our main purpose was to highlight the plausible use of new surveillance strategies, with implications for the COVID-19 pandemic strategies and then to identify opportunities and challenges for the successful development and implementation of digital solutions during non-emergency times of routine surveillance, with readiness for early-warning and response for future pandemics. The enhancement of traditional surveillance systems with novel digital surveillance methods opens a direction for the most effective framework for preparedness and response to future pandemics.

Examining the relationship between pain interference, pain intensity, and mental health symptoms among veterans receiv-ing long-term opioid therapy for chronic noncancer pain in primary care.

OBJECTIVE: As part of the evaluation of the Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP), we examined the relationship between pain intensity, pain interference, and mental health symptoms among PC-POP enrollees. DESIGN/METHODS: Retrospective cohort study examining self-reported symptoms of pain intensity, pain interference, anxiety, depression, substance use, and quality of life. Data were retrieved through a combination of chart review and data extracted from the VA Informatics and Computing Infrastructure. SETTING: Veterans Health Administration Health Care System Primary Care -service. SUBJECTS: Adult veterans with chronic noncancer pain receiving opioid therapy >3 months being managed in primary care and enrolled in PC-POP between August 1, 2018 and April 1, 2019. RESULTS: A total of 439 participants were included in the final analysis. Results showed that anxiety has a unique relationship to pain intensity and that depression and quality of life have unique relationships to pain interference when relevant covariates, eg, gender, age, pain diagnosis, and predictors are examined among this unique sample of veterans enrolled in a pain and opioid education and monitoring program. CONCLUSIONS: Given that primary care is the dominant healthcare setting in which opioids are prescribed for chronic noncancer pain, further research is needed to examine factors that influence pain management in this setting. This study examined the role mental health factors have on pain intensity and pain interference among patients enrolled in an opioid monitoring program and found that anxiety and depression appear to uniquely predict how intensely and impactful these veterans experience their pain. This study extends the literature by examining such factors among a unique population that has yet to be studied and offers some recommendations for monitoring and practice.

Evaluation of Metabolic Monitoring and Diabetes Incidence in the First Year for Veterans Newly Started on an Atypical Antipsychotic.

PURPOSE: This retrospective chart review is an evaluation of patient and health care provider adherence to a metabolic monitoring protocol as well as progression to type 2 diabetes mellitus (T2DM) in the first year after atypical antipsychotic initiation. METHODS: Patient (N = 1,651) data from February 2014 to February 2019 were collected from the US Department of Veterans Affairs (VA) Corporate Data Warehouse for 8 VA medical centers within Veterans Integrated Service Network (VISN) 21. Collected data included patient demographic, laboratory results, and medication history. RESULTS: In the final cohort, 6% of patients were found to have progressed to T2DM. Adherence to appropriate metabolic monitoring was found to be overall suboptimal. CONCLUSIONS: The findings of this project demonstrate that patients in VISN 21 who were previously antipsychotic-naïve and nondiabetic may be at increased risk of progression to T2DM when compared with the general population. To effectively manage patient risk, health care providers and patients should improve adherence to metabolic monitoring.

Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online, Crowdsourced WHO Technical Consultation.

BACKGROUND: An infodemic is an overabundance of information-some accurate and some not-that occurs during an epidemic. In a similar manner to an epidemic, it spreads between humans via digital and physical information systems. It makes it hard for people to find trustworthy sources and reliable guidance when they need it. OBJECTIVE: A World Health Organization (WHO) technical consultation on responding to the infodemic related to the coronavirus disease (COVID-19) pandemic was held, entirely online, to crowdsource suggested actions for a framework for infodemic management. METHODS: A group of policy makers, public health professionals, researchers, students, and other concerned stakeholders was joined by representatives of the media, social media platforms, various private sector organizations, and civil society to suggest and discuss actions for all parts of society, and multiple related professional and scientific disciplines, methods, and technologies. A total of 594 ideas for actions were crowdsourced online during the discussions and consolidated into suggestions for an infodemic management framework. RESULTS: The analysis team distilled the suggestions into a set of 50 proposed actions for a framework for managing infodemics in health emergencies. The consultation revealed six policy implications to consider. First, interventions and messages must be based on science and evidence, and must reach citizens and enable them to make informed decisions on how to protect themselves and their communities in a health emergency. Second, knowledge should be translated into actionable behavior-change messages, presented in ways that are understood by and accessible to all individuals in all parts of all societies. Third, governments should reach out to key communities to ensure their concerns and information needs are understood, tailoring advice and messages to address the audiences they represent. Fourth, to strengthen the analysis and amplification of information impact, strategic partnerships should be formed across all sectors, including but not limited to the social media and technology sectors, academia, and civil society. Fifth, health authorities should ensure that these actions are informed by reliable information that helps them understand the circulating narratives and changes in the flow of information, questions, and misinformation in communities. Sixth, following experiences to date in responding to the COVID-19 infodemic and the lessons from other disease outbreaks, infodemic management approaches should be further developed to support preparedness and response, and to inform risk mitigation, and be enhanced through data science and sociobehavioral and other research. CONCLUSIONS: The first version of this framework proposes five action areas in which WHO Member States and actors within society can apply, according to their mandate, an infodemic management approach adapted to national contexts and practices. Responses to the COVID-19 pandemic and the related infodemic require swift, regular, systematic, and coordinated action from multiple sectors of society and government. It remains crucial that we promote trusted information and fight misinformation, thereby helping save lives.

Worsening Choreoathetosis in Huntington's Disease with Fluoxetine, Lisdexamfetamine, and Melatonin: A Case Report.

Cognitive, affective, and sleep disturbances can be found in patients with Huntington's disease (HD), and medications used to treat these HD-related sequela can also impact HD-related movement disorders. We present the case of a 52-year-old Caucasian man with previously undiagnosed HD who exhibited significant choreoathetoid movements that improved with discontinuation of fluoxetine and lisdexamfetamine upon hospital admission. Following diagnosis of HD through genetic testing, he was administered 5mg of oral melatonin on two consecutive evenings, which resulted in worsening choreoathetosis. We calculated Naranjo adverse event scores of 5, 5, and 2 for fluoxetine, lisdexamfetamine, and melatonin, respectively, based on our assessment, review of outpatient medical records, and available literature. We review the literature surrounding these possible adverse drug events and their mechanisms regarding dopaminergic modulation in early-middle stages of HD. Our report indicates that caution should be exercised when initiating psychostimulants, fluoxetine, and melatonin in patients with early-middle stage HD. Screening for HD might be warranted for patients who develop choreoathetosis after initiation of the aforementioned medications. We recommend ascertaining baseline level of chorea before initiating these medications in patients with known HD and closely monitoring for exacerbation during therapy.

Телемедицина в Казахстане: преодоление разрыва между городскими и сельскими районами в обеспечении профилактики, диагностики, лечения и контроля за неинфекционными заболеваниями: информационный обзор по передовому опыту

С момента создания в 2004 году сети телемедицины, Казахстан постепенно выстраивает платформу по оказанию медицинских услуг, отвечающую всем мировым стандартам и являющуюся ключевым компонентом национального подхода к укреплению системы предоставления медицинских услуг в сельских районах и достижению цели обеспечения всеобщего охвата услугами здравоохранения. Сеть телемедицины, созданная для обеспечения доступности специализированной медицинской помощи населению сельских районов, предоставляет ряд телемедицинских консультаций, в том числе разработанных специально для диагностирования и лечения неинфекционных заболеваний (НИЗ). Через национальную сеть телемедицины правительство Казахстана успешно реализует свое видение «эффективной и доступной системы здравоохранения, отвечающей потребностям населения», закрепленное в стратегическом плане действий Министерства здравоохранения на 2017–2021 годы. Правительство считает, что расширение сети телемедицины будет иметь решающее значение для дальнейшего повышения качества медицинской помощи в сельских районах к 2050 году.

Telemedicine in Kazakhstan: bridging the urban–rural divide in delivering prevention, diagnosis, and treatment of noncommunicable diseases: good practice brief

Since the inception of a telemedicine network in 2004, Kazakhstan has progressively built a world-class service platform as a key component of the national approach to strengthening health care delivery in rural settings and achieving the country’s goal of universal health coverage. The telemedicine network, which was established to ensure the accessibility of specialized medical care for rural populations, provides a range of tele-consultation services, including some designed specifically to support the diagnosis and treatment of noncommunicable diseases (NCDs). Through the national telemedicine network, the Government of Kazakhstan is successfully realizing its vision of “an effective and accessible health system that meets the needs of the population”, as embodied in the strategic plan of the Ministry of Health for 2017–2021. It considers that expansion of the telemedicine network will be pivotal to further improving the quality of medical care in rural areas by 2050.

Fluorinated benzalkylsilane molecular rectifiers.

We report on the synthesis and electrical properties of nine new alkylated silane self-assembled monolayers (SAMs) - (EtO)3Si(CH2)nN = CHPhX where n = 3 or 11 and X = 4-CF3, 3,5-CF3, 3-F-4-CF3, 4-F, or 2,3,4,5,6-F, and explore their rectification behavior in relation to their molecular structure. The electrical properties of the films were examined in a metal/insulator/metal configuration, with a highly-doped silicon bottom contact and a eutectic gallium-indium liquid metal (EGaIn) top contact. The junctions exhibit high yields (>90%), a remarkable resistance to bias stress, and current rectification ratios (R) between 20 and 200 depending on the structure, degree of order, and internal dipole of each molecule. We found that the rectification ratio correlates positively with the strength of the molecular dipole moment and it is reduced with increasing molecular length.

The WHO-ITU national eHealth strategy toolkit as an effective approach to national strategy development and implementation.

With few exceptions, national eHealth strategies are the pivotal tools upon which the launch or refocusing of national eHealth programmes is hinged. The process of their development obviates cross-sector ministerial commitment led by the Ministry of Health. Yet countries often grapple with the task of strategy development and best efforts frequently fail to address strategic components of eHealth key to ensure successful implementation and stakeholder engagement. This can result in strategies that are narrowly focused, with an overemphasis placed on achieving technical outcomes. Without a clear link to a broader vision of health system development and a firm commitment from partners, the ability of a strategy to shape development of a national eHealth framework will be undermined and crucial momentum for implementation will be lost. WHO and ITU have sought to address this issue through the development of the National eHealth Strategy Toolkit that provides a basis for the components and processes to be considered in a strategy development or refocusing exercise. We look at this toolkit and highlight those areas which the countries should consider in formulating their national eHealth strategy.