Coordinated care for patients with cirrhosis: fewer liver-related emergency admissions and improved survival.

OBJECTIVES: To compare the incidence of liver-related emergency admissions and survival of patients after hospitalisation for decompensated cirrhosis at two major hospitals, one applying a coordinated chronic disease management model (U1), the other standard care (U2); to examine predictors of mortality for these patients. DESIGN: Retrospective observational cohort study. SETTING: Two major tertiary hospitals in an Australian capital city. PARTICIPANTS: Patients admitted with a diagnosis of decompensated cirrhosis during October 2013 - October 2014, identified on the basis of International Classification of Diseases (ICD-10) codes. MAIN OUTCOME MEASURES: Incident rates of liver-related emergency admissions; survival (to 3 years). RESULTS: Sixty-nine patients from U1 and 54 from U2 were eligible for inclusion; the median follow-up time was 530 days (range, 21-1105 days). The incidence of liver-related emergency admissions was lower for U1 (mean, 1.14 admissions per person-year; 95% CI, 0.95-1.36) than for U2 (mean, 1.55 admissions per person-year; 95% CI, 1.28-1.85; adjusted incidence rate ratio [U1 v U2], 0.52; 95% CI, 0.28-0.98; P = 0.042). The adjusted probabilities of transplantation-free survival at 3 years were 67.7% (U1) and 37.2% (U2) (P = 0.009). Independent predictors of reduced transplantation-free free survival were Charlson comorbidity index score (per point: hazard ratio [HR], 1.27; 95% CI, 1.05-1.54, P = 0.014), liver-related emergency admissions within 90 days of discharge (HR, 3.60; 95% CI, 1.87-6.92; P < 0.001), and unit (U2 v U1: HR, 2.54, 95% CI, 1.26-5.09; P = 0.009). CONCLUSIONS: A coordinated care model for managing patients with decompensated cirrhosis was associated with improved survival and fewer liver-related emergency admissions than standard care.

Multidisciplinary team meetings appear to be effective in inflammatory bowel disease management: an audit of process and outcomes.

BACKGROUND: Multidisciplinary team meetings (MDTM) have proven efficacy in cancer management. Whilst widely implemented in inflammatory bowel disease (IBD) care, their value is yet to be investigated. We reviewed the performance of MDTM for IBD patients. METHODS: Retrospective review of MDTM from March 2013 to July 2016. Each patient's first MDTM was considered. Data collected included: report production and location, disease factors, recommendation(s), implementation and barriers to implementation. The MDTM process was considered successful when at least top-level recommendations were implemented within 6 months. RESULTS: MDTM attendance included an IBD gastroenterologist, surgeons, a radiologist, nurses, dieticians, psychologists and clinical trial staff. Initial MDTM encounters of 166 patients were reviewed: 86 females, mean age 40 years, 140 (84.3%) with Crohn disease and mean disease duration of 10.8 years (interquartile range 15 years). Electronic reports were filed for all patients, with hard copies in 84%. In 151 of 166 episodes, all (n = 127) or top-line (n = 24) recommendations were implemented, although there was a delay beyond 6 months in 5. Of 146 patients with a successful MDTM, 85 (58.2%) were in clinical remission at last review (median follow up: 27 months). Amongst patients with unsuccessful MDTM (n = 13), only two (15.4%) were in clinical remission at follow up. Barriers to implementation included patients declining recommendations and loss to follow up. CONCLUSION: The majority of MDTM encounters were successful from both a process and clinical outcome perspective. System opportunities to improve the process include ensuring that 100% of reports are available and addressing implementation delays. Patient factors that require addressing include improved engagement and understanding reasons for declining recommendations.

Towards detecting cocaine use using smartwatches in the NIDA clinical trials network: Design, rationale, and methodology.

Cocaine use in clinical trials is often measured via self-report, which can be inaccurate, or urine drug screens, which can be intrusive and burdensome. Devices that can automatically detect cocaine use and can be worn conveniently in daily life may provide several benefits. AutoSense is a wearable, physiological-monitoring suite that can detect cocaine use, but it may be limited as a method for monitoring cocaine use because it requires wearing a chestband with electrodes. This paper describes the design, rationale, and methodology of a project that seeks to build upon and extend previous work in the development of methods to detect cocaine use via wearable, unobtrusive mobile sensor technologies. To this end, a wrist-worn sensor suite (i.e., MotionSense HRV) will be developed and evaluated. Participants who use cocaine (N = 25) will be asked to wear MotionSense HRV and AutoSense for two weeks during waking hours. Drug use will be assessed via thrice-weekly urine drug screens and self-reports, and will be used to isolate periods of cocaine use that will be differentiated from other drug use. The present study will provide information on the feasibility and acceptability of using a wrist-worn device to detect cocaine use.

Application of the hybrid ANFIS models for long term wind power density prediction with extrapolation capability.

In this paper, the suitability and performance of ANFIS (adaptive neuro-fuzzy inference system), ANFIS-PSO (particle swarm optimization), ANFIS-GA (genetic algorithm) and ANFIS-DE (differential evolution) has been investigated for the prediction of monthly and weekly wind power density (WPD) of four different locations named Mersing, Kuala Terengganu, Pulau Langkawi and Bayan Lepas all in Malaysia. For this aim, standalone ANFIS, ANFIS-PSO, ANFIS-GA and ANFIS-DE prediction algorithm are developed in MATLAB platform. The performance of the proposed hybrid ANFIS models is determined by computing different statistical parameters such as mean absolute bias error (MABE), mean absolute percentage error (MAPE), root mean square error (RMSE) and coefficient of determination (R2). The results obtained from ANFIS-PSO and ANFIS-GA enjoy higher performance and accuracy than other models, and they can be suggested for practical application to predict monthly and weekly mean wind power density. Besides, the capability of the proposed hybrid ANFIS models is examined to predict the wind data for the locations where measured wind data are not available, and the results are compared with the measured wind data from nearby stations.

Electrospun scaffolds for tissue engineering of vascular grafts.

There is a growing demand for off-the-shelf tissue engineered vascular grafts (TEVGs) for the replacement or bypass of damaged arteries in various cardiovascular diseases. Scaffolds from the decellularized tissue skeletons to biopolymers and biodegradable synthetic polymers have been used for fabricating TEVGs. However, several issues have not yet been resolved, which include the inability to mimic the mechanical properties of native tissues, and the ability for long-term patency and growth required for in vivo function. Electrospinning is a popular technique for the production of scaffolds that has the potential to address these issues. However, its application to human TEVGs has not yet been achieved. This review provides an overview of tubular scaffolds that have been prepared by electrospinning with potential for TEVG applications.