A combined disease management and process modeling approach for assessing and improving care processes: A fall management case-study

ObjectivesTo propose a combined disease management and process modeling approach for evaluating and improving care processes, and demonstrate its usability and usefulness in a real-world fall management case study.MethodsWe identified essential disease management related concepts and mapped them into explicit questions meant to expose areas for improvement in the respective care processes. We applied the disease management oriented questions to a process model of a comprehensive real world fall prevention and treatment program covering primary and secondary care. We relied on interviews and observations to complete the process models, which were captured in UML activity diagrams. A preliminary evaluation of the usability of our approach by gauging the experience of the modeler and an external validator was conducted, and the usefulness of the method was evaluated by gathering feedback from stakeholders at an invitational conference of 75 attendees.ResultsThe process model of the fall management program was organized around the clinical tasks of case finding, risk profiling, decision making, coordination and interventions. Applying the disease management questions to the process models exposed weaknesses in the process including: absence of program ownership, under-detection of falls in primary care, and lack of efficient communication among stakeholders due to missing awareness about other stakeholders’ workflow.The modelers experienced the approach as usable and the attendees of the invitational conference found the analysis results to be valid.ConclusionsThe proposed disease management view of process modeling was usable and useful for systematically identifying areas of improvement in a fall management program. Although specifically applied to fall management, we believe our case study is characteristic of various disease management settings, suggesting the wider applicability of the approach.     

Different patterns of fibrinolytic abnormalities and lipid profile in hypothyroid and hyperthyroid patients

Altered fibrinolytic parameters and serum lipid profile are strongly related to thyroid dysfunction. To investigate the patterns of the fibrinolytic abnormalities and serum lipid profile in the hypo- and hyperthyroid patients. We also took an aim at studying the relationships between free T4 levels (FT4) and these parameters. Hyperthyroid (n?=?30), hypothyroid (n?=?20) patients and euthyroid control subjects (n?=?30) were evaluated for several fibrinolytic parameters including plasma plasminogen activator inhibitor-1 (PAI-1) and D-dimer (D-D). Serum lipid profile and lipoprotein(a) (Lp(a)) were also measured. We found different patterns of fibrinolytic abnormalities and lipid profile in hypo- and hyperthyroid patients. The hypothyroid patients had low plasma PAI-1 levels and high D-D values as compared to hyperthyroid patients (p?<?0.001) and euthyroid control subjects (p?<?0.05 and 0.001, respectively). In sharp contrast, the hyperthyroid patients had high plasma PAI-1 levels (p?<?0.001) but without concomitant change in plasma D-D values, as compared to the euthyroid control subjects. Hypothyroidism was associated with high total cholesterol, triglycerides, LDL-C and Lp(a) levels and low HDL-C levels as compared to both hyperthyroid and euthyroid states (p?<?0.001). FT4 levels were correlated positively with HDL-C but negatively with total cholesterol, triglycerides, LDL-C and Lp(a) levels in both hypo- and hyperthyroid patients. Also FT4 levels were correlated positively with PAI-1 but negatively with D-D in both hypo- and hyperthyroid patients (p?<?0.02, 0.01, 0.001 and 0.03 respectively). We found hyperfibrinolytic, and hypofibrinolytic patterns in hypothyroid, hyperthyroid patients, respectively. The hypothyroid patients had atherogenic lipid profile. These variations indicate possible pathophysiologic roles for thyroid hormones in the regulation of the fibrinolytic system and lipid profile. Mechanisms of these variations are open for future investigations.     

A three-dimensional finite element analysis of the effects of restorative materials and post geometry on stress distribution in mandibular molar tooth restored with post-core crown

This study investigated the effects of crown material, post material, and post geometry on stress distribution in molar tooth restored with post-core crown. A three-dimensional solid model consisting of the mandibular second molar tooth, periodontal ligament, cortical bone, and spongy bone was generated. Finite element analysis results showed that prefabricated posts with a composite resin core increased stress concentration at the cementoenamel junction (CEJ), while cast posts induced high stress at post-dentin interface. Increase in the elastic modulus of crown material also increased the stress concentration, especially at CEJ.     

Nano targeted Therapies Made of Lipids and Polymers have Promising Strategy for the Treatment of Lung Cancer

The introduction of nanoparticles made of polymers, protein, and lipids as drug delivery systems has led to significant progress in modern medicine. Since the application of nanoparticles in medicine involves the use of biodegradable, nanosized materials to deliver a certain amount of chemotherapeutic agents into a tumor site, this leads to the accumulation of these nanoencapsulated agents in the right region. This strategy minimizes the stress and toxicity generated by chemotherapeutic agents on healthy cells. Therefore, encapsulating chemotherapeutic agents have less cytotoxicity than non-encapsulation ones. The purpose of this review is to address how nanoparticles made of polymers and lipids can successfully be delivered into lung cancer tumors. Lung cancer types and their anatomies are first introduced to provide an overview of the general lung cancer structure. Then, the rationale and strategy applied for the use of nanoparticle biotechnology in cancer therapies are discussed, focusing on pulmonary drug delivery systems made from liposomes, lipid nanoparticles, and polymeric nanoparticles. Many nanoparticles fabricated in the shape of liposomes, lipid nanoparticles, and polymeric nanoparticles are summarized in our review, with a focus on the encapsulated chemotherapeutic molecules, ligand–receptor attachments, and their targets. Afterwards, we highlight the nanoparticles that have demonstrated promising results and have been delivered into clinical trials. Recent clinical trials that were done for successful nanoparticles are summarized in our review.     

Biliary tract variants in potential right lobe living donors for liver transplantation: Evaluation with MR cholangiopancreatography (MRCP)

Living donor liver transplantation is increasingly being used to help compensate for the increasing shortage of cadaveric liver grafts. However, the extreme variability of the hepatic vascular and biliary systems can impede this surgical procedure. The aim of the study is to demonstrate the role of MR cholangiopancreatography (MRCP) in the evaluation of anatomical biliary variants in potential living donors for liver transplantation.     

Rosiglitazone ameliorates the histological parameters of the dorsal root ganglion and functional assessment after sciatic nerve injury in the rat

Background  

This study investigates the effects of rosiglitazone (a peroxisome proliferator-activated receptor-gamma) on the histological parameters of the dorsal root ganglion (DRG) and the recovery potential of the injured sciatic nerve in rats using stereological methods.     

Radiofrequency ablation of primary and metastatic liver tumors: a critical review of the literature

BACKGROUND: Surgical resection is the treatment of choice for hepatic tumors; however, for various reasons, the vast majority of patients are not operative candidates. As a result, several local ablative therapies have emerged as alternatives to resection or as adjuncts in total oncologic care. Presently, the most widely employed liver-directed treatment is radiofrequency thermal ablation. METHODS: To define the current status of radiofrequency ablation (RFA), the authors reviewed available safety and efficacy data from select studies on RFA. A MEDLINE search was performed using the keywords "tumor type" + "radiofrequency ablation" + "survival." Only those studies containing long-term survival data on greater than 50 patients were included in this analysis. CONCLUSIONS: Although RFA has been readily adopted into treatment paradigms, more rigorous trials are needed to solidify its place in the armamentarium of therapeutic strategies for hepatic malignancy.