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A look into Family Matters "Healthy at Home" medicine management program – Video

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A look into Family Matters "Healthy at Home" medicine management program
Family Matters, located in Center Township, is embarking on a new program called, "Healthy @ Home". By combing efforts of their home health agency and pharma...

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A look into Family Matters "Healthy at Home" medicine management program - Video

Teledermatology App System Offers Efficiencies and Can Reliably Prioritize Inpatient Consults

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PHILADELPHIA A new Penn Medicine study shows that remote consultations from dermatologists using a secure smart phone app are reliable at prioritizing care for hospitalized patients with skin conditions. Researchers in the Perelman School of Medicine at the University of Pennsylvania report in JAMA Dermatology that this teledermatology process is reliable and can help deliver care more efficiently in busy academic hospitals and potentially in community hospital settings.

A national shortage and uneven distribution of dermatologists in the United States has caused scheduling concerns in both the inpatient and outpatient settings. Many hospitals do not have inpatient dermatology consultative services, and those that do often have limited availability for consults after hours and on weekends.

"Dermatology support is essential for hospitalized patients, but unfortunately many hospitals lack dermatology coverage. Teledermatology may help optimize time spent by dermatologists in the inpatient setting by potentially reducing or eliminating trips to the hospital, and allowing some dermatologists to batch consultations or schedule non-urgent inpatients to be seen after discharge for outpatient appointments," said senior study author Misha Rosenbach, MD, assistant professor of Dermatology and director of the Dermatology inpatient dermatology service at Penn Medicine. "A substantial agreement between in-person and teledermatology consultants in this study demonstrates the reliability and potential of this platform."

The new study compared assessments of 50 hospitalized patients in a high acuity academic medical center, the Hospital of the University of Pennsylvania, between a face-to-face consultation with an inpatient dermatologist and a standardized teledermatology consultation with two experienced teledermatologists.

When the inpatient dermatologist recommended a patient be seen the same day, the teledermatologists independently suggested the same course of action in 90 percent of cases. The teledermatologists agreed in 95 percent of cases where the inpatient dermatologist had recommended a biopsy. The doctors completely agreed on a diagnosis 82 percent of the time, and partially agreed in 88 percent of cases, which is in line with the standard variation expected between providers.

The team used a secure store-and-forward teledermatology smart phone app, which was developed through Penn Medicine's teledermatology program, in concert with the American Academy of Dermatology (AAD). This initiative, co-led by Carrie Kovarik, MD, associate professor of Dermatology and William D. James, MD, professor of Dermatology and vice chair of the Department of Dermatology, works to improve specialty health care in underserved areas and expand dermatology access to patients locally, nationally and internationally. Dr. Kovarik has led efforts to connect doctors from around the world including those from Botswana, Uganda and Guatemala with Penn Dermatologists, to assist physicians in diagnosing and providing treatment recommendations for various skin conditions. In the United States, the Penn team works closely with the AAD to bridge dermatologists in states across the nation to nearby underserved areas nearby using the AccessDerm app. In Philadelphia, the Penn team now partners with 13 community clinics including Philadelphia Department of Health clinics; more than 400 patient consultations have been performed through the program in Philadelphia to date.

"Our study of this model demonstrated that teledermatology consultations are not only effective at distinguishing cases in need for an urgent consultation in a hospital environment, but can also streamline follow-up care for both patients and clinicians," said Dr. Kovarik.

"In addition to addressing physician shortages from a clinical standpoint, teledermatology programs are very important for vulnerable citizens in the United States and abroad," said James, past president of the American Academy of Dermatology. "It is wonderful that the impact of these teledermatology consultations continues to expand."

The Penn team also included John Barbieri, Caroline Nelson, David Margolis, MD, MSCE, PhD, and Ryan Littman-Quinn.

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Teledermatology App System Offers Efficiencies and Can Reliably Prioritize Inpatient Consults

Funding Basic Science to Revolutionize Medicine, 2013 FASEB Stand Up for Science Winner – Video

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Funding Basic Science to Revolutionize Medicine, 2013 FASEB Stand Up for Science Winner
Tell Congress that science funding is important: http://capwiz.com/faseb/issues/alert/?alertid=63078836 "Funding Basic Science to Revolutionize Medicine" was...

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Assassins Creed 4: Black Flag – Part 23 – Diving For Medicine (Xbox One Walkthrough) – Video

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Assassins Creed 4: Black Flag - Part 23 - Diving For Medicine (Xbox One Walkthrough)
"LIKE" for more Assassins Creed 4: Black Flag (Xbox One) Assassins Creed 4: Black Flag - Part 1 - Heroes Aren #39;t Born (Xbox One Walkthrough) http://youtu.be/Z...

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Assassins Creed 4: Black Flag - Part 23 - Diving For Medicine (Xbox One Walkthrough) - Video

Penn Medicine, Teqqa LLC Developing New Software and App to Track Antibiotic Resistance

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Newswise PHILADELPHIAPenn Medicine today announced a collaboration with software and analytics company Teqqa, LLC that could revolutionize the way antibiotics are tracked and prescribed in clinical settings. The two will work together to develop a new software platform and mobile app that aims to encourage appropriate antibiotic use by providing real-time data to clinicians, and minimize the risk of dangerous pathogens developing resistance to life-saving antibiotics.

The resistance of bacteria to commonly-used antibiotics has been increasing at an alarming rate, and resistance patterns vary internationally, nationally, regionally, and locally. These differences matter a drug that is effective against a life-threatening bacterial infection at one hospital may be much less effective at another, and appropriate stewardship of antibiotic drugs is essential to slowing the growing resistance.

Understanding these patterns, particularly within a given hospital, is essential to determine the best methods to track, prevent, and treat these infections. Without a clear, real-time and accurate understanding of drug sensitivity and resistance patterns within individual hospitals and the community, however, physicians typically choose antibiotics empirically, potentially contributing to resistance and poor patient outcomes.

The appropriate use of antibiotics to treat infections depends on knowing what antibiotics kill which bacteria, said Keith Hamilton, MD, associate director of Healthcare Epidemiology, Infection Prevention and Control and director of Antimicrobial Stewardship at the Hospital of the University of Pennsylvania. Predicting and understanding the trends and patterns of resistance allows clinicians to choose appropriate medications to treat a patients infection, and provides the health system real, actionable data to make broad recommendations for use of these life-saving drugs.

As part of the collaboration, Penn Medicine and Teqqa will jointly develop the software to allow for real-time microbiology data analysis, as well as a mobile app giving the userprimarily prescribing physiciansimmediate access to this critical information, allowing them to choose the best antibiotics for their patients. This will replace the current practice of providing data to clinicians every 9 to 12 months, where data is nearly obsolete as soon as it is made available.

The project with Teqqa builds upon Penns successful Antimicrobial Stewardship Program, which since its inception in 1993 has been shown to improve appropriateness of antibiotic use and cure rates, decrease failure rates, and reduce healthcare-related costs with its multifaceted approach.

This innovative software has the potential to improve patient outcomes and resistance patterns in hospitals across the country by allowing practitioners to understand the behavior of infections locally, regionally and most importantly, within their healthcare facilities, said Patrick J. Brennan, MD, chief medical officer for the University of Pennsylvania Health System. This is an important step in more effectively designing interventions to control and treat these infections.

We are thrilled to be working together with Penn Medicine, a leader in antibiotic stewardship and innovation in health care delivery, to develop this novel solution to the growing problem of antibiotic resistance, said Dan Peterson, MD, CEO of Teqqa. "Penn Medicine's equity position in Teqqa demonstrates both their strong commitment to improving patient outcomes and novel approaches to care delivery, and their desire to benefit from Teqqa's expertise in data analytics and software development to achieve those goals. Its a great opportunity to work with Penn to develop applications for Penn Medicine and for use more broadly with other health systems."

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Penn Medicine, Teqqa LLC Developing New Software and App to Track Antibiotic Resistance

Medicine gets up close and personal

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Source: Institute for Systems Biology

Leroy Hood, president of the Institute for Systems Biology (ISB) in Seattle, Washington, likes to talk about what he calls P4 medicine: health care that is predictive, preventive, personalized and participatory. Medicine today is a string of infrequent interventions prompted mainly by symptoms of illness. Hood argues instead for continuous management of health, making full use of whole-genome sequencing and biomarkers to correct disease before it gains a foothold.

In March, Hood will embark on the first big test of his ideas: a nine-month pilot study, dubbed the Hundred Person Wellness Project, in which 100 healthy individuals will be intensively monitored (see An examined life), offered regular feedback and counselled on lifestyle changes such as shifts in their dietary or sleep habits. The effects of these behavioural changes on their health will, in turn, be tracked using a battery of diagnostic tests.

The study violates many rules of trial design: it dispenses with blinding and randomization, and will not even have a control group. But Hood is confident in its power to disrupt the conventional practice of medicine. We hope to develop a whole series of stories about how actionable opportunities have changed the wellness of individuals, or have made them aware of how they can avoid disease, he says.

If the pilot study works as hoped, it will expand in several phases until it encompasses 100,000 subjects monitored over 25 years. The ISB is paying for the first hundred people through private donations and has budgeted around US$10,000 per person. Hood expects those costs to drop drastically in a larger study, thanks to economies of scale and rapidly evolving diagnostic technologies. But he acknowledges the challenge of securing the hundreds of millions of dollars that a generation-long trial would require.

Even in its pilot phase, the project is unusually thorough. The ISB will sequence the whole genome of each participant at the outset. And in later phases, Hood says, the study team will also examine epigenetics: methylation and other modifications to DNA that can reflect environmental exposures. But that is just the tip of the data-collection iceberg.

Institute for Systems Biology

Leroy Hood: We hope to develop a whole series of stories about how actionable opportunities have changed the wellness of individuals.

Participants will be asked to wear digital devices that will continuously record their physical activity, heart rate and sleep patterns; subjects will periodically upload those data to the institutes systems. Every three months, researchers will gather samples of participants blood, urine, saliva and stool. They will measure five biochemicals in saliva and urine, and sequence the stool samples to track the ecology of major microbial species in the gut. Blood-chemistry screens will extend well beyond the usual tests for cholesterol and glucose to include 20less-commonly monitored variables, such as C-reactive protein which signals inflammation at high levels. Hoods teams will also monitor about 100 organ-specific proteins that, he says, are sensitive markers for transitions from health to disease in mouse and cell models.

The point of the study and of P4 medicine in general is to detect those transitions and respond to them before symptoms appear. To that end, participants (mostly residents of the Seattle area, invited through social media) will have full access to their personal cloud of data points. Some will have enough scientific training to dive into the literature and interpret their data themselves. But Hood expects most to rely on ISB-provided wellness coaches and their own physicians to interpret the results and recommend medical treatment or changes in diet or behaviour.

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Medicine gets up close and personal

Study Suggests "Growth Charts" for Cognitive Development May Lead to Earlier Diagnosis and Treatment for Children with …

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Newswise PHILADELPHIA -- Penn Medicine researchers have developed a better way to assess and diagnose psychosis in young children. By growth charting cognitive development alongside the presentation of psychotic symptoms, they have demonstrated that the most significant lags in cognitive development correlate with the most severe cases of psychosis. Their findings are published online this month in JAMA Psychiatry.

We know that disorders such as schizophrenia come with a functional decline as well as a concurrent cognitive decline, says Ruben Gur, PhD, director of the Brain Behavior Laboratory and professor of Neuropsychology at the Perelman School of Medicine of the University of Pennsylvania. Most physicians have a clinical basis from which to assess psychosis, but less idea as to how to best assess and measure a decline in cognitive function. To make this easier and to aid in early diagnosis and treatment, we created growth charts of cognitive development to integrate brain behavior into the diagnostic process.

Psychosis is a severe mental illness, characterized by hallucinations, delusions, social withdrawal and a loss of contact with reality. Genetics and environment, including emotional or physical trauma, can both play a role in its development.

The Penn researchers assessed the brain behavior of a cohort of about 10,000 patients between the ages of eight and 21 at Childrens Hospital of Philadelphia from November 2009 to November 2011, including 2,321 who reported psychotic symptoms. Of those, 1,423 reported significant psychotic symptoms, 898 had limited psychotic symptoms, and 1,963 were typically developing children with no psychotic, mental or any medical disorders.

Researchers administered a structured psychiatric evaluation, looking for symptoms of psychosis, anxiety, mood, attention-deficit, disruptive behavior and eating disorders; for the younger children, independent interviews with their caregivers were also conducted. The team also administered 12 computerized neurocognitive tests to evaluate each childs brain development across five domains: executive function, testing abstraction and mental flexibility, attention and working memory; episodic memory, testing knowledge of words, faces and shapes; complex cognition, evaluating verbal and nonverbal reasoning and spatial processing; social cognition, looking at emotion identification, intensity differentiation and age estimation; and sensorimotor speed, to understand the workings of their motor and sensorimotor skills.

The results were analyzed to predict chronological age for each child.

They showed that those with the most extreme psychotic symptoms had a lower chronological than predicted age, compared with the typically-developing group and the group with other psychiatric symptoms. They also had a greater developmental lag than the psychosis-limited group, with the lags most pronounced for complex cognition and social cognition and smallest for sensorimotor speed.

Broken down further, we found that boys on the psychosis spectrum showed an early decline in memory, complex and social understanding, compared with typically developing children, while girls showed minimal lag in memory across all ages groups, with a lag in complex cognition appearing later in development, explains Gur. This seems to follow the differences in how disorders such as schizophrenia manifest themselves across the sexes.

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Genomic Medicine in Pediatric Patients – Obstacles & Future Directions (Reaction) – Robert Nussbaum – Video

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Genomic Medicine in Pediatric Patients - Obstacles Future Directions (Reaction) - Robert Nussbaum
January 22, 2014 - Future Directions for the eMERGE Network More: http://www.genome.gov/27555919.

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