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1.
Antimicrob Agents Chemother ; 64(6)2020 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-32284379

RESUMEN

Bunyaviruses are significant human pathogens, causing diseases ranging from hemorrhagic fevers to encephalitis. Among these viruses, La Crosse virus (LACV), a member of the California serogroup, circulates in the eastern and midwestern United States. While LACV infection is often asymptomatic, dozens of cases of encephalitis are reported yearly. Unfortunately, no antivirals have been approved to treat LACV infection. Here, we developed a method to rapidly test potential antivirals against LACV infection. From this screen, we identified several potential antiviral molecules, including known antivirals. Additionally, we identified many novel antivirals that exhibited antiviral activity without affecting cellular viability. Valinomycin, a potassium ionophore, was among our top targets. We found that valinomycin exhibited potent anti-LACV activity in multiple cell types in a dose-dependent manner. Valinomycin did not affect particle stability or infectivity, suggesting that it may preclude virus replication by altering cellular potassium ions, a known determinant of LACV entry. We extended these results to other ionophores and found that the antiviral activity of valinomycin extended to other viral families, including bunyaviruses (Rift Valley fever virus, Keystone virus), enteroviruses (coxsackievirus, rhinovirus), flavirivuses (Zika virus), and coronaviruses (human coronavirus 229E [HCoV-229E] and Middle East respiratory syndrome CoV [MERS-CoV]). In all viral infections, we observed significant reductions in virus titer in valinomycin-treated cells. In sum, we demonstrate the importance of potassium ions to virus infection, suggesting a potential therapeutic target to disrupt virus replication.

2.
Med J Aust ; 212(8): 371-377, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32255520

RESUMEN

OBJECTIVES: To evaluate the impact of the Victorian Stroke Telemedicine (VST) program during its first 12 months on the quality of care provided to patients presenting with suspected stroke to hospitals in regional Victoria. DESIGN: Historical controlled cohort study comparing outcomes during a 12-month control period with those for the initial 12 months of full implementation of the VST program at each hospital. SETTING: 16 hospitals in regional Victoria that participated in the VST program between 1 January 2010 and 30 January 2016. PARTICIPANTS: Adult patients with suspected stroke presenting to the emergency departments of the participating hospitals. MAIN OUTCOME MEASURES: Indicators for key processes of care, including symptom onset-to-arrival, door-to-first medical review, and door-to-CT times; provision and timeliness of provision of thrombolysis to patients with ischaemic stroke. RESULTS: 2887 patients with suspected stroke presented to participating emergency departments during the control period, 3178 during the intervention period; the patient characteristics were similar for both periods. A slightly larger proportion of patients with ischaemic stroke who arrived within 4.5 hours of symptom onset received thrombolysis during the intervention than during the control period (37% v 30%). Door-to-CT scan time (median, 25 min [IQR, 13-49 min] v 34 min [IQR, 18-76 min]) and door-to-needle time for stroke thrombolysis (73 min [IQR, 56-96 min] v 102 min [IQR, 77-128 min]) were shorter during the intervention. The proportions of patients who received thrombolysis and had a symptomatic intracerebral haemorrhage (4% v 16%) or died in hospital (6% v 20%) were smaller during the intervention period. CONCLUSIONS: Telemedicine has provided Victorian regional hospitals access to expert care for emergency department patients with suspected acute stroke. Eligible patients with ischaemic stroke are now receiving stroke thrombolysis more quickly and safely.

3.
Clin Infect Dis ; 2020 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-32343766

RESUMEN

BACKGROUND: Revised clinical practice guidelines for Clostridium difficile infection (CDI) were published in February 2018. Our objective was to determine if oral vancomycin, fidaxomicin and oral metronidazole use in the United States (US) changed after publication of the revised guidelines. METHODS: We obtained US antibiotic prescription data (IQVIA, Durham, NC) from 2006-August 2019, and used vancomycin, fidaxomicin and metronidazole dosing regimens recommended against CDI to estimate monthly numbers of 10-day treatment courses of each drug. Interrupted time-series analyses were performed, adjusted by month for possible seasonality.  We compared linear trends for monthly numbers of treatment courses in different time periods. RESULTS: Cumulative treatment courses of oral vancomycin and fidaxomicin increased by 54% (n=226,166) and 48% (n=18,518), respectively, in 18 months following guidelines compared to 18 months before; those of oral metronidazole decreased by 3% (n=238,372). Monthly vancomycin and fidaxomicin use significantly increased throughout the period following revised guidelines (p<0.0001 and p=0.0002, respectively), whereas that of metronidazole decreased significantly (p<0.0001). Monthly vancomycin use increased and metronidazole use decreased to a significantly greater extent after publication of revised guidelines than after publication of Polymer Alternative for CDI Treatment studies establishing superiority of vancomycin over metronidazole (p-values<0.0001). CONCLUSIONS: Revised practice guidelines have had significant impact on CDI treatment in the US. Clinical trial data used for the revised guidelines were available since 2007-14 and 2011-12 for oral vancomycin and fidaxomicin, respectively. Guidelines or guidance documents for treating CDI and other infections should be updated in more timely fashion as new data emerge.

4.
J Telemed Telecare ; : 1357633X19899262, 2020 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937198

RESUMEN

INTRODUCTION: Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes. METHODS: An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers (n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email. RESULTS: Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme (n = 12), (2) details about initiating hospital (n = 10), (3) telestroke consultation (n = 17), (4) patient characteristics (n = 7), (5) presentation to hospital (n = 5), (6) general clinical care within first 24 hours (n = 10), (7) thrombolysis treatment (n = 10), (8) endovascular treatment (n = 13), (9) neurosurgery treatment (n = 8), (10) processes of care beyond 24 hours (n = 7), (11) discharge information (n = 5), (12) post-discharge and follow-up data (n = 6). DISCUSSION: The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services.

5.
Curr Hypertens Rep ; 22(1): 8, 2020 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-31938958

RESUMEN

PURPOSE OF REVIEW: We sought to summarize recent evidence regarding optimal blood pressure (BP) treatment targets and antihypertensive regimen intensity for nursing home (NH) residents and similar older, complex patients with hypertension. RECENT FINDINGS: Recent trials have demonstrated cardiovascular benefits from more intensive BP targets among ambulatory, less complex older adults, but generalizability to NH residents is questionable. Other trials have demonstrated that de-intensifying antihypertensives in frail, older patients is feasible, with no or modest increases in BP, but most have not assessed effects on patient-centered outcomes. Observational studies with patients more representative of NH residents suggest harms associated with more intensive BP treatment and reduction in fall risk associated with deintensification, but findings and potential for bias vary across studies. Randomized trials and rigorous observational studies examining effects of deintensified BP management on patient-centered outcomes in complex, older populations are needed to inform improved guidelines and treatment for NH residents.

6.
J Telemed Telecare ; 26(1-2): 79-91, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30193566

RESUMEN

INTRODUCTION: Technology-based innovation requires long-term changes to workforce routines, otherwise practices will not be sustained. The aim of this study was to identify influential factors in the ongoing use of an acute stroke telemedicine programme. METHODS: A new acute stroke telemedicine programme in a regional hospital receiving 375 patients with stroke or transient ischaemic attack per year was used as an exploratory case study. Semi-structured interviews with acute care and emergency department clinicians (n = 25) were conducted at two time-points: after a six-month pilot and then after a further 12-month implementation phase. Interviews (between 12-60 min) were recorded, transcribed and analysed inductively using descriptive thematic analysis. Reported barriers and facilitators were compared with those previously reported pre-implementation (deductive analysis) to identify changes over time. Using an implementation framework and a behaviour change taxonomy, strategies were developed to address influential factors on sustainability. RESULTS: New facilitators were identified including hospital system changes, benefits to clinicians and telemedicine becoming standard practice. New and ongoing barriers included infrequent use, competing demands and the continued resistance to a specific treatment. DISCUSSION: Understanding the factors supporting a health service in successfully implementing change can accelerate population benefits. The innovation itself may include barriers to be addressed, and barriers and facilitators can change over time. Individual attitudes remain critical to initial and ongoing success. Strategies proposed included promoting benefits across the organisation and allaying uncertainties with site-specific evidence. The effectiveness of these strategies, however, needs to be evaluated. Strategies sustaining change post-implementation should be considered.

7.
J Pharm Pract ; : 897190019857409, 2019 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-31238785

RESUMEN

OBJECTIVE: To evaluate the effectiveness of a student pharmacist-led telephone follow-up intervention to improve hemoglobin A1c (HbA1c) in diabetic patients. METHODS: This was a prospective, randomized, pilot study to implement a telephone follow-up intervention for diabetic patients with HbA1c ≥7%. Patients were recruited and randomized into intervention and control groups. All patients received standard of care. Patients in the intervention group additionally received weekly phone calls from a student pharmacist for 12 weeks to encourage medication adherence. HbA1c at baseline and end of study were measured and the data were analyzed using SAS version 9.4. Analysis included descriptive statistics and a multiple regression model to assess the association between the end of study and baseline HbA1c while controlling for demographics. RESULTS: Seventy-eight patients participated and the average age was 62 (±11) years. Baseline HbA1c was 8.2% (±1.4%) in the intervention group and 7.9% (±1.3%) in the control group. HbA1c decreased by 0.35% in the intervention group (P = .027) and increased by 0.338% in the control group (P = .013). The end of study HbA1c were higher in the control group even after controlling for baseline HbA1cs (0.5547, P value .002) in the regression model. CONCLUSION: Incorporating student pharmacists in physician offices to provide clinical care services could lead to improved patient outcomes and students' clinical and research skills.

8.
PLoS One ; 14(4): e0213499, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31034485

RESUMEN

BACKGROUND: Although influenza vaccination has been shown to reduce the incidence of major adverse cardiac events (MACE) among those with existing cardiovascular disease (CVD), in the 2015-16 season, coverage for persons with heart disease was only 48% in the US. METHODS: We built a Monte Carlo (probabilistic) spreadsheet-based decision tree in 2018 to estimate the cost-effectiveness of increased influenza vaccination to prevent MACE readmissions. We based our model on current US influenza vaccination coverage of the estimated 493,750 US acute coronary syndrome (ACS) patients from the healthcare payer perspective. We excluded outpatient costs and time lost from work and included only hospitalization and vaccination costs. We also estimated the incremental cost/MACE case averted and incremental cost/QALY gained (ICER) if 75% hospitalized ACS patients were vaccinated by discharge and estimated the impact of increasing vaccination coverage incrementally by 5% up to 95% in a sensitivity analysis, among hospitalized adults aged ≥ 65 years and 18-64 years, and varying vaccine effectiveness from 30-40%. RESULT: At 75% vaccination coverage by discharge, vaccination was cost-saving from the healthcare payer perspective in adults ≥ 65 years and the ICER was $12,680/QALY (95% CI: 6,273-20,264) in adults 18-64 years and $2,400 (95% CI: -1,992-7,398) in all adults 18 + years. These resulted in ~ 500 (95% CI: 439-625) additional averted MACEs/year for all adult patients aged ≥18 years and added ~700 (95% CI: 578-825) QALYs. In the sensitivity analysis, vaccination becomes cost-saving in adults 18+years after about 80% vaccination rate. To achieve 75% vaccination rate in all adults aged ≥ 18 years will require an additional cost of $3 million. The effectiveness of the vaccine, cost of vaccination, and vaccination coverage rate had the most impact on the results. CONCLUSION: Increasing vaccination rate among hospitalized ACS patients has a favorable cost-effectiveness profile and becomes cost-saving when at least 80% are vaccinated.


Asunto(s)
Análisis Costo-Beneficio , Vacunas contra la Influenza/economía , Gripe Humana/prevención & control , Vacunación/economía , Adolescente , Adulto , Femenino , Hospitalización/economía , Humanos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/economía , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Modelos Económicos , Readmisión del Paciente , Cobertura de Vacunación/economía , Adulto Joven
9.
Circulation ; 139(20): 2326-2338, 2019 05 14.
Artículo en Inglés | MEDLINE | ID: mdl-30755025

RESUMEN

BACKGROUND: Group B enteroviruses are common causes of acute myocarditis, which can be a precursor of chronic myocarditis and dilated cardiomyopathy, leading causes of heart transplantation. To date, the specific viral functions involved in the development of dilated cardiomyopathy remain unclear. METHODS: Total RNA from cardiac tissue of patients with dilated cardiomyopathy was extracted, and sequences corresponding to the 5' termini of enterovirus RNAs were identified. After next-generation RNA sequencing, viral cDNA clones mimicking the enterovirus RNA sequences found in patient tissues were generated in vitro, and their replication and impact on host cell functions were assessed on primary human cardiac cells in culture. RESULTS: Major enterovirus B populations characterized by 5' terminal genomic RNA deletions ranging from 17 to 50 nucleotides were identified either alone or associated with low proportions of intact 5' genomic termini. In situ hybridization and immunohistological assays detected these persistent genomes in clusters of cardiomyocytes. Transfection of viral RNA into primary human cardiomyocytes demonstrated that deleted forms of genomic RNAs displayed early replication activities in the absence of detectable viral plaque formation, whereas mixed deleted and complete forms generated particles capable of inducing cytopathic effects at levels distinct from those observed with full-length forms alone. Moreover, deleted or full-length and mixed forms of viral RNA were capable of directing translation and production of proteolytically active viral proteinase 2A in human cardiomyocytes. CONCLUSIONS: We demonstrate that persistent viral forms are composed of B-type enteroviruses harboring a 5' terminal deletion in their genomic RNAs and that these viruses alone or associated with full-length populations of helper RNAs could impair cardiomyocyte functions by the proteolytic activity of viral proteinase 2A in cases of unexplained dilated cardiomyopathy. These results provide a better understanding of the molecular mechanisms that underlie the persistence of EV forms in human cardiac tissues and should stimulate the development of new therapeutic strategies based on specific inhibitors of the coxsackievirus B proteinase 2A activity for acute and chronic cardiac infections.


Asunto(s)
Regiones no Traducidas 5'/genética , Cardiomiopatía Dilatada/virología , Cisteína Endopeptidasas/genética , Enterovirus Humano B/aislamiento & purificación , Miocitos Cardíacos/virología , ARN Viral/genética , Proteínas Virales/genética , Cardiomiopatía Dilatada/etiología , Cardiomiopatía Dilatada/patología , Células Cultivadas , Cisteína Endopeptidasas/biosíntesis , Efecto Citopatogénico Viral , ADN Complementario/genética , Enterovirus Humano B/genética , Enterovirus Humano B/fisiología , Infecciones por Enterovirus/complicaciones , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Miocarditis/complicaciones , Miocarditis/virología , Eliminación de Secuencia , Transfección , Proteínas Virales/biosíntesis , Latencia del Virus , Replicación Viral
10.
Pediatr Pulmonol ; 53(12): 1611-1618, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30381911

RESUMEN

OBJECTIVES: Published cost estimates for cystic fibrosis (CF) are based on older data and do not reflect increased use of specialty drugs in recent years. We assessed recent trends in healthcare expenditures for CF patients in the United States (US) with employer-sponsored health insurance. METHODS: The study is a retrospective analysis of claims data for privately insured individuals aged 0-64 years who were continuously enrolled in non-capitated plans for at least 1 calendar year during 2010-2016. Mean annual expenditures during a calendar year were calculated for individuals who met a claims-based CF case definition. Average annual growth rates were calculated through linear regression of the natural logarithm of annual expenditures. RESULTS: The annual CF prevalence was 1.1-1.4 per 10 000 adults and 2.9-3.0 per 10 000 children. Average spending adjusted for inflation nearly doubled from roughly $67 000 per patient in 2010 and 2011 to approximately $131 000 per patient in 2016. Inflation-adjusted spending on outpatient and inpatient care increased by 0.5% and 2.5% per year, respectively, whereas pharmaceutical spending increased by 20.2% per year. Virtually all of the growth in pharmaceutical spending was accounted for by spending on specialty drugs; inflation-adjusted spending on other medications increased by 1.3% per year. The annual growth rate in pharmaceutical spending rose by 33.1% during 2014-2016, the years during which lumacaftor/ivacaftor was introduced. CONCLUSIONS: Per-patient expenditures for privately-insured patients with CF almost doubled during 2010-2016; specialty drugs were largely responsible for this increase, with a major contribution from new, genotype-targeted CFTR modulator medications.


Asunto(s)
Fibrosis Quística/economía , Planes de Asistencia Médica para Empleados , Gastos en Salud , Adolescente , Adulto , Niño , Preescolar , Costo de Enfermedad , Fibrosis Quística/tratamiento farmacológico , Honorarios Farmacéuticos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos , Adulto Joven
13.
J Am Pharm Assoc (2003) ; 58(2): 191-198.e2, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29249652

RESUMEN

OBJECTIVES: A free mobile application (app), Know Your Numbers (KYN), was developed by student pharmacists to assist underserved community members to track their health numbers. The study objectives included creating a health app, implementing a pilot program, and analyzing the frequency of app use and perceptions of community members toward their health numbers, pharmacists, and health apps. SETTING: Student pharmacists recruited participants at the community clinics and health fairs organized in underserved communities of the Atlanta metropolitan area. PRACTICE DESCRIPTION: This study used a pre- and post-survey study design to compare perceptions before and after use of a health app. Eligible participants completed a 22-item pre-survey that assessed understanding of their health numbers, previous health app use, and perceptions of pharmacists. EVALUATION: Frequency of app use and change in perceptions of community members toward health numbers, pharmacists, and health apps before and after enrolling in KYN were analyzed with the use of descriptive statistics and Wilcoxon signed rank tests for matched pre- and post-surveys. RESULTS: Thirty-three participants were enrolled for 56 days. African American participants (93.9%) earned less than $25,000 annually (56.7%). On average, participants had 3.98 interactions per week. Before using the mobile health app, 84.8% of users felt comfortable using a health app, but only 9% used one regularly. The post-survey response rate was 27.2% (n = 9). More participants agreed that a health app helped them to meet their health goals after the program (24.4% to 100%; P = 0.0006). More than 90% of participants agreed in both surveys that it is important to check their health numbers regularly and that they trust pharmacists to provide accurate information. CONCLUSION: KYN is a novel mobile tool that promotes chronic disease self-management and the profession of pharmacy. These findings support the benefits of mobile health app's usability and its ability to assist in achieving personal health goals.


Asunto(s)
Aplicaciones Móviles/estadística & datos numéricos , Farmacéuticos/estadística & datos numéricos , Salud Pública/estadística & datos numéricos , Estudiantes de Farmacia/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Percepción , Proyectos Piloto , Encuestas y Cuestionarios
14.
BMC Health Serv Res ; 17(1): 751, 2017 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-29157233

RESUMEN

BACKGROUND: Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. METHODS: Specialist participants were identified using purposive sampling from two new services: Australia's Victorian Stroke Telemedicine Program (n = 6; 2010-13) and the United Kingdom's Cumbria and Lancashire telestroke network (n = 5; 2010-2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. RESULTS: Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. CONCLUSION: Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.


Asunto(s)
Pautas de la Práctica en Medicina , Consulta Remota , Especialización , Accidente Cerebrovascular/terapia , Adulto , Prestación de Atención de Salud/métodos , Disentimientos y Disputas , Inglaterra , Femenino , Humanos , Masculino , Percepción , Proyectos Piloto , Derivación y Consulta , Apoyo Social , Accidente Cerebrovascular/diagnóstico , Telemedicina/métodos , Victoria
15.
Sci Rep ; 7(1): 16351, 2017 11 27.
Artículo en Inglés | MEDLINE | ID: mdl-29180648

RESUMEN

Many Crohn's disease (CD) patients develop intestinal strictures, which are difficult to prevent and treat. Cationic steroid antimicrobial 13 (CSA13) shares cationic nature and antimicrobial function with antimicrobial peptide cathelicidin. As many functions of cathelicidin are mediated through formyl peptide receptor-like 1 (FPRL1), we hypothesize that CSA13 mediates anti-fibrogenic effects via FPRL1. Human intestinal biopsies were used in clinical data analysis. Chronic trinitrobenzene sulfonic acid (TNBS) colitis-associated intestinal fibrosis mouse model with the administration of CSA13 was used. Colonic FPRL1 mRNA expression was positively correlated with the histology scores of inflammatory bowel disease patients. In CD patients, colonic FPRL1 mRNA was positively correlated with intestinal stricture. CSA13 administration ameliorated intestinal fibrosis without influencing intestinal microbiota. Inhibition of FPRL1, but not suppression of intestinal microbiota, reversed these protective effects of CSA13. Metabolomic analysis indicated increased fecal mevalonate levels in the TNBS-treated mice, which were reduced by the CSA13 administration. CSA13 inhibited colonic HMG-CoA reductase activity in an FPRL1-dependent manner. Mevalonate reversed the anti-fibrogenic effect of CSA13. The increased colonic FPRL1 expression is associated with severe mucosal disease activity and intestinal stricture. CSA13 inhibits intestinal fibrosis via FPRL1-dependent modulation of HMG-CoA reductase pathway.


Asunto(s)
Antibacterianos/farmacología , Colitis/metabolismo , Colitis/patología , Hidroximetilglutaril-CoA Reductasas/metabolismo , Receptores de Formil Péptido/metabolismo , Receptores de Lipoxina/metabolismo , Transducción de Señal/efectos de los fármacos , Animales , Colitis/etiología , Modelos Animales de Enfermedad , Fibrosis , Microbioma Gastrointestinal/efectos de los fármacos , Expresión Génica , Humanos , Enfermedades Inflamatorias del Intestino/metabolismo , Enfermedades Inflamatorias del Intestino/patología , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/microbiología , Mucosa Intestinal/patología , Metaboloma , Metabolómica/métodos , Ratones , ARN Mensajero/genética , ARN Mensajero/metabolismo , Receptores de Formil Péptido/genética , Receptores de Lipoxina/genética
17.
J Telemed Telecare ; 23(10): 850-855, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29081268

RESUMEN

Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes.


Asunto(s)
Accidente Cerebrovascular/terapia , Telemedicina/organización & administración , Práctica Clínica Basada en la Evidencia , Humanos , Liderazgo , Evaluación de Necesidades , Estudios de Casos Organizacionales , Proyectos Piloto , Telemedicina/economía , Victoria
19.
J Telemed Telecare ; 22(8): 489-494, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27799453

RESUMEN

We undertook a qualitative analysis to identify the broader benefits of a state-wide acute stroke telemedicine service beyond the patient-clinician consultation. Since 2010, the Victorian Stroke Telemedicine (VST) programme has provided a clinical service for regional hospitals in Victoria, Australia. The benefits of the Victorian Stroke Telemedicine programme were identified through document analysis of governance activities, including communications logs and reports from hospital co-ordinators of the programme. Discussions with the Victorian Stroke Telemedicine management were undertaken and field notes were also reviewed. Several benefits of telemedicine were identified within and across participating hospitals, as well as for the state government and community. For hospitals, standardisation of clinical processes was reported, including improved stroke care co-ordination. Capacity building occurred through professional development and educational workshops. Enhanced networking, and resource sharing across hospitals was achieved between hospitals and organisations. Governments leveraged the Victorian Stroke Telemedicine programme infrastructure to provide immediate access to new treatments for acute stroke care in regional areas. Standardised data collection allowed routine quality of care monitoring. Community awareness of stroke symptoms occurred with media reports on the novel technology and improved patient outcomes. The value of telemedicine services extends beyond those involved in the clinical consultation to healthcare funders and the community.


Asunto(s)
Accidente Cerebrovascular/terapia , Telemedicina , Creación de Capacidad , Humanos , Evaluación de Programas y Proyectos de Salud , Consulta Remota/métodos , Accidente Cerebrovascular/diagnóstico , Telemedicina/instrumentación , Telemedicina/métodos , Telemedicina/organización & administración , Victoria
20.
Am Health Drug Benefits ; 9(5): 269-78, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27625744

RESUMEN

BACKGROUND: The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care. OBJECTIVE: To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature. METHOD: We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms "corporate," "health and wellness program," "health plan," "insurance plan," "hospital," "joint venture," and "vertical merger." Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated. RESULTS: A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness programs have varying components, but all include monetary incentives and documented outcomes. CONCLUSION: The concurrent growth of hospital health plans (especially those emerging from vertical mergers and partnerships) and wellness programs in the United States provides a unique opportunity for employees and patient populations to promote wellness and achieve the Triple Aim goals as initiated by CMS.

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