Patient identified needs for chronic obstructive pulmonary disease versus billed services for care received

The American Lung Association of Minnesota (ALAMN) was granted access to a 2004 administrative claims data from an upper mid-Western, independent practice association model health plan. Claims information, including demographics, prevalence, medication and oxygen therapy, and health care utilization, was extracted for 7,782 patients with COPD who were 40 years of age and older. In addition, ALAMN conducted a survey of 1,911 patients from Minnesota diagnosed with COPD. The survey queried the patients about demographics, treatment, medications, limitations, wants, and needs. This article compares and contrasts the information gained through the health plan administrative claims database with the findings from the COPD patient survey in areas of age, gender, types of provider primarily responsible for COPD care, spirometry use, medication therapy, pulmonary rehabilitation, oxygen therapy, and health care utilization. Primary care practitioners provided a majority of the COPD-related care. The claims evidence of spirometry use was 16%–62% of COPD patients had claims evidence of COPD-related medications. 25% of patients reported, and 23% of patients had claims evidence of, a hospitalization during the observation year. 16% of patients reported using pulmonary rehabilitation programs. The results indicate there is an opportunity to improve COPD diagnosis and management

Pharmacy Practice in the South Dakota Correctional System: Discovery of an Unconventional Experiential Practice Site

Pharmacists must be prepared to care for populations where health disparities are greatest and their services can best impact public health needs. Such preparation requires that students have access to practice experiences in underserved environments where pharmacy practice, cultural competence and knowledge of population health are experienced simultaneously. The correctional facility is such a place. The American Society of Health-System Pharmacists recommends that students receive preceptorship opportunities within the correctional system.  The occasional collaboration or experiential opportunity, like Kingston’s early model, has occurred between health professional schools and correctional facilities. However, to date, the correctional facility-experiential site remains an untapped opportunity, at least in a complete, coordinated, pharmaceutical care, patient management framework. Consequently, a short research study asked: To what extent is there potential for correctional facilities to serve as experiential practice sites for pharmacy students? The research objective was to identify pharmaceutical practices within South Dakota correctional system and compare those practices to the guidelines established by the Association of American College of Pharmacy’s as optimal for student training. To understand medical and pharmaceutical practices in SDPS, three South Dakota Adult prison facilities were included in the exploratory study.  Data was collected through a mixed methods approach designed to obtain perspectives about the SDPS health care system from individuals representing the numerous job levels and roles that exist within the health care continuum. Interviews and a web-based surveys were used to collect data.  A review of a 36-page transcript along with 498 freeform survey comments revealed that while exact themes from the Exemplary Practice Framework may not have been evident, related words or synonyms for patient-centered care, informatics, public health, medication therapy management, and quality improvement appeared with great frequency.   Article type: Original Researc

Born to learn: The inspiration, progress, and future of evolved plastic artificial neural networks

Biological plastic neural networks are systems of extraordinary computational capabilities shaped by evolution, development, and lifetime learning. The interplay of these elements leads to the emergence of adaptive behavior and intelligence. Inspired by such intricate natural phenomena, Evolved Plastic Artificial Neural Networks (EPANNs) use simulated evolution in-silico to breed plastic neural networks with a large variety of dynamics, architectures, and plasticity rules: these artificial systems are composed of inputs, outputs, and plastic components that change in response to experiences in an environment. These systems may autonomously discover novel adaptive algorithms, and lead to hypotheses on the emergence of biological adaptation. EPANNs have seen considerable progress over the last two decades. Current scientific and technological advances in artificial neural networks are now setting the conditions for radically new approaches and results. In particular, the limitations of hand-designed networks could be overcome by more flexible and innovative solutions. This paper brings together a variety of inspiring ideas that define the field of EPANNs. The main methods and results are reviewed. Finally, new opportunities and developments are presented

CpG-creating mutations are costly in many human viruses.

Mutations can occur throughout the virus genome and may be beneficial, neutral or deleterious. We are interested in mutations that yield a C next to a G, producing CpG sites. CpG sites are rare in eukaryotic and viral genomes. For the eukaryotes, it is thought that CpG sites are rare because they are prone to mutation when methylated. In viruses, we know less about why CpG sites are rare. A previous study in HIV suggested that CpG-creating transition mutations are more costly than similar non-CpG-creating mutations. To determine if this is the case in other viruses, we analyzed the allele frequencies of CpG-creating and non-CpG-creating mutations across various strains, subtypes, and genes of viruses using existing data obtained from Genbank, HIV Databases, and Virus Pathogen Resource. Our results suggest that CpG sites are indeed costly for most viruses. By understanding the cost of CpG sites, we can obtain further insights into the evolution and adaptation of viruses

Physicians, Guidelines, and Cognitive Tasks

Using a case study analysis of the Expert Panel Report 3 ( EPR-3) : Guidelines for the Diagnosis and Treatment of Asthma, this article compares the workflows and knowledge requirements of primary care practice to the structure and content of a well-respected set of clinical guidelines. The authors show that there are discrepancies between physician workflow and the structure of the EPR-3, as well as between physicians’ knowledge requirements and the content of the EPR-3. The analysis suggests that closing the gap between medical knowledge and practice will require alternative ways to represent guidelines’ knowledge and recommendations. </jats:p

Patient Factors Affecting Surgeon Selection and the Decision to Delay Total Knee Arthroplasty

Background: Delaying total knee arthroplasty (TKA) carries an increased likelihood of poor rehabilitation outcomes.  Reasons behind choosing to delay surgery are under investigated. This study explores potential factors related to the decision to delay a TKA procedure and preferences for post-surgical pain management. Methods: A cross-sectional online survey was conducted among TKA candidates in the US. Results: 6,298 persons received a screening questionnaire; 2,571 (41%) completed screening with 680 (26%) meeting survey eligibility criteria. 654 of 680 persons (96%) completed surveys. 154 (24%) respondents had delayed TKA. Interference with work and concerns about insufficient post-discharge pain management were found to be significant factors in this decision. A one unit increase in the ten point interference with work scale was associated with a 22% increase in the odds of delaying surgery (OR: 1.219; 95%CI: 1.095-1.356). Surgical candidates concerned about experiencing pain during the first several weeks following surgery had significantly higher odds of delaying surgery (OR: 1.64, 95% CI: 0.881-3.06). Ninety-two percent of respondents indicated they would seek surgeons who offered effective non-opiate pain management options during the first several weeks of the rehabilitation period; 66 percent indicated they would likely switch surgeons for access to a non-opioid pain management approach. Conclusions: Delaying a TKA is significantly influenced by concerns about interference with work and experiencing an extended period of post-surgical pain during a potentially prolonged recovery period. Access to postoperative pain management methods that reduce or eliminate opioid use during post-discharge rehabilitation and recovery is an important factor in the selection of a joint replacement surgeon