Collaborating toward equity in Pennsylvania: The Age-Friendly Care,PA project

Objective

To collaboratively implement the age-friendly health systems framework, known as the 4Ms: What Matters, Medication, Mentation, and Mobility, at The Primary Health Network (PHN), a federally qualified health center.

Data Sources

Data were collected from PHN electronic medical records (EMRs) for individuals over age 65 from December 30, 2019 to December 24, 2021 and from Project ECHO© attendance and evaluation surveys.

Study Design

The telementoring educational program, Project ECHO©, was used to engage PHN health care professionals working in rural areas of Pennsylvania to incorporate the 4Ms into their practice starting with the annual wellness visit (AWV). Project ECHO© was launched at three primary care sites. After 18 months, it was then disseminated to an additional 18 sites creating pilot and comparison groups. Outcomes included codesigned patient process metrics using EMR data and project ECHO© participant data.

Data Collection Methods

EMR data were generated by system reports created by PHN's quality assurance program manager. Project ECHO© data were collected and managed using REDCap electronic data capture tools. Outcomes were aggregated, analyzed for trends over time, and compared between groups.

Principal Findings

All nine process outcomes increased from baseline to follow-up at the three initial sites, ranging from 4% to 43% g. At year two, the three initial sites had higher rates on AWVs (pilot 24%, comparison 12%; p < 0.0001), Advance Care Planning (New on file, pilot 8%, comparison 2%; Discussed with patient, pilot 18%, comparison 13%; Patient declined, pilot 0%, comparison 0%; p = 0.0001), Dementia Screening (pilot 24%, comparison 12%; p < 0.0001), Fall Risk Management (pilot 43%, comparison 10%; p < 0.0001), and Mobility Goal (pilot 19%, comparison 9%; p < 0.0001); and lower rates on High-Risk Medication Elimination (pilot 54%, comparison, 63%, p < 0.02).

Conclusions

Access to high-quality geriatric care for rural older adults can be improved by increasing health care professionals' knowledge of the 4Ms, beginning with its incorporation into the AWV.     

European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.     

Exploring the potential of exosomes in diagnosis and drug delivery for pancreatic ductal adenocarcinoma

Pancreatic cancer (PC) is a cancer of the digestive system, and pancreatic ductal adenocarcinoma (PDAC) accounts for approximately 90% of all PC cases. Exosomes derived from PDAC (PDAC-exosomes) promote PDAC development and metastasis. Exosomes are nanoscale vesicles secreted by most cells, which can carry biologically active molecules and mediate communication and cargo transportation among cells. Recent studies have focused on transforming exosomes into good drug delivery systems (DDSs) to improve the clinical treatment of PDAC. This review considers PDAC as the main research object to introduce the role of PDAC-exosomes in PDAC development and metastasis. This review focuses on the following two themes: (a) the great potential of PDAC-exosomes as new diagnostic markers for PDAC, and (b) the transformation of exosomes into potential DDSs.     

基于分子对接和系统药理学探讨沙棘抗糖尿病的作用机制

目的通过分子对接和中药系统药理学平台探讨沙棘的物质基础及抗糖尿病作用机制。方法类药性评估筛选沙棘活性成分并查找相关靶点;通过OMIM、Genecards数据库搜索糖尿病相关靶点;将有效成分靶点和疾病靶点进行韦恩映射。借助Cytoscape构建药物、成分、靶点、疾病网络图;应用STRING数据库构建蛋白互作网络;筛选前5个核心基因与候选化合物利用Autodock vina做分子对接;利用Bioconductor对核心靶点进行GO和KEGG富集。结果从沙棘中获得33个候选成分,相关靶点蛋白170个;筛选糖尿病相关靶点9310个,韦恩映射得到159个交集基因,蛋白互作网络筛选5个关键靶标JUN、AKT1、MAPK1、RELA、IL-6,涉及AGE-RAGE、Fluid shear stress and atherosclerosis、TNF等通路发挥抗糖尿病作用。结论沙棘具有多成分、多靶点、多途径调节糖尿病的作用特点,为后续实验研究提供理论依据。     

浅谈人工智能对中医诊断的影响＊

中医药是中华民族的瑰宝，随着人工智能（Artificial Intelligence，AI）的迅猛发展，中医药与AI的结合将可以为中医药的传承和现代化提供助力。本研究将从搭建AI中医专家系统入手，阐述AI对提高中医诊断的作用，物联网搭建AI中医药服务，存在的问题和对策，以及中医药人工智能化的前景，以图为中医药的发展提供新的思路和方法。     

Objective and subjective measures of the neighbourhood environment: Associations with frailty levels

ObjectivesThe aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults.MethodsA cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents’ perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty.ResultsFrail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables.DiscussionNeighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment.     

A Simple Computational Theory of General Collective Intelligence

Researchers have recently demonstrated that group performance across tasks tends to be correlated, motivating the use of a single metric for the general collective intelligence of groups akin to general intelligence metrics for individuals. High general collective intelligence is achieved when a group performs well across a wide variety of tasks. A number of factors have been shown to be predictive of general collective intelligence, but there is sparse formal theory explaining the presence of correlations across tasks, betraying a fundamental gap in our understanding of what general collective intelligence is measuring. Here, we formally argue that general collective intelligence arises from groups achieving commitment to group goals, accurate shared beliefs, and coordinated actions. We then argue for the existence of generic mechanisms that help groups achieve these cognitive alignment conditions. The presence or absence of such mechanisms can potentially explain observed correlations in group performance across tasks. Under our view, general collective intelligence can be conceived as measuring group performance on classes of tasks that have particular combinations of cognitive alignment requirements.