Dictionary of Computer Science, Engineering, and Technology

3) Zaleski, JR, (contributing Author), Dictionary of Computer Science, Engineering, and Technology, (CRC Press, Phil Laplante, Editor-in-Chief).... Read More

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Integrating Device Data into the Electronic Medical Record | interoperability of device data

The first book on the interoperability of medical device data and health information technology systems. John Zaleski, Ph.D. A book on empirical practice of medical device interoperability, based on years of experience in the field. A Developer’s Guide to ... Read More

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Medical Device Data and Modeling for Clinical Decision Making

This work combines much of the experience learned in medical device interoperability and clinical informatics I have gained over the course of the past 20+ years. I have leveraged work from my  PhD and experience in product management of critical care. The... Read More

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Weaning from Postoperative Mechanical Ventilation

Modeling Post-Operative Respiratory State in Coronary Artery Bypass Graft Patients: A Method for Weaning Patients from Mechanical Ventilation. This PhD research developed a model for real-time assessment of patient postoperative recovery and viability for weaning ... Read More

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Sepsis Mortality in the United States

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An interesting article published in the May Edition of Critical Care Medicine (Gaieski et al., “Benchmarking the Incidence and Mortality of Severe Sepsis in the United States.” CCM May 2013. Volume 41. Number 5. DOI: 10.1097/CCM.0b013e31827c09f8) summarized a survey of sepsis reporting based upon ICD-9 codes established for sepsis, severe sepsis, and septic shock established in 2002-2003, and on the variability in reporting and rate of occurrence during the 6-year period from 2004-2009. Between 2002 and 2003, ICD-9 codes for sepsis, severe sepsis, and septic shock (995.91, 995.92, 785.52) were introduced.

Using ICD sepsis codes, the authors surveyed reports associated with these ICD-9 codes. What they found was that the average annual incidence of sepsis (ICD-9 Code 995.91) 231 cases of sepsis per 100,000 patients; 144 cases of severe sepsis (ICD-9 Code 995.92); and 95 cases of septic shock (ICD-9 Code 785.52) per 100,000 over this 6-year period.

Sepsis was identified as the 11th leading cause of death in US (Reference: CDC, 2009). Severe sepsis, defined as sepsis associated with new organ dysfunction, hypoperfusion or hypotension, has was estimated to cost U.S. healthcare system $24.3B in 2007.

Various studies considered:

Angus et al: 750,000 cases (300 / 100,000 population) and in-hospital mortality rate of 28.6% in 1995.

Martin et al.: 256,000 cases in 2000 (81 / 100,000).

Dombrovskiy et al.: 391,000 cases (134 / 100,000) with an in-hospital mortaility rate of 37.7% in 2003.

Wang et al.: 571,000 annual emergency department (ED) cases nationally between 2001 and 2003.

Gaieski et al. estimated that, for all sepsis codes, an annual increase in was observed and the rate of this increaase varied by ICD-9 code: 22.3% for sepsis, 25.3% for severe sepsis, 18.2% for septic shock.

 

 

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Breast Cancer and the BRCA 1 & BRCA2 Genes

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My mother died 20 years ago from a very virulent form of inflammatory breast cancer. From the time of diagnosis until her passing was approximately 18 months.

She was 54.

The recent reports about Angelina Jolie and her brave decision to undergo a double mastectomy helps shed some light and attention on breast cancer and on her knowledge that she had inherited the harmful form of the BRCA1 or BRCA2 mutation.

BRCA1, 2 stand for “breast cancer susceptibility gene 1 and 2″, respectively.
Statistics reported by LookingforCure.org indicate that individuals who carry the harmful mutation in BRCA1 or BRCA2 are from 50% – 80+% at risk for developing breast cancer over one’s lifetime, with a concomitant risk in developing ovarian cancer in 20%-40+% of those women who carry the mutation.
However, as this source points out, carrying BRCA1 or BRCA2 mutation does not “guarantee” that the individual will contract a form of breast cancer over one’s lifetime:
“5% of all breast cancers and 10% of all ovarian cancers are attributable to BRCA mutations”
The same reference also states that the approximate cost for testing currently stands at ~$3000. Over time, this should decrease.
LookingforCure.org carries more information on the topic. Notable are the following:
  • lifetime risk of breast cancer in patients diagnosed with the BRCA1 mutation ranges between 50-87%
  • lifetime risk of ovarian cancer in patients diagnosed with the BRCA1 mutation is between 20-45%.
  • BRCA2 mutations increase the lifetime risk for breast cancer to 45-84% and the risk of ovarian cancer to 10-20%.
  • Males with BRCA2 mutations have a 6% lifetime risk of developing breast cancer and an elevated risk of prostate cancer.
  • Both male and female BRCA2 carriers are at increased risk for pancreatic cancer, colon cancer, and melanoma.
The decision by Angelina Jolie to have a double mastectomy, as stated earlier, is a brave one, in my opinion. It required much soul searching and coming to grips with both physical and psychological trauma. Yet, the current costs associated with this testing may place it out of reach for a number of women, even if reimbursed in part by insurance. My mother’s passing from breast cancer was a life-changing event in that the helplessness we felt over battling the illness formed a resolve in her children. In my own case, it changed my professional focus.
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When it comes to mHealth, let physicians complete transactions from anywhere

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In the recent mHealth article “Mobility: Key to overcoming barriers to clinical transformation and ACOs“, Matt Patterson asserts that mobile health information technology (mobile health IT) interoperability and data access barriers need to be broken down to achieve the seemingly elusive transformation of care. I agree completely. Two of the key headlines within this article grabbed my attention:

“Bring data to physicians instead of forcing physicians to go to the data.”

Give the physician the data wherever he/she is, and provide this in a manner that makes it simple to interact. This does not mean simply taking the desktop and miniaturizing it for a smart phone. This means a transformation of the experience to support whatever form factor is available for use by the physician that is clear, simple, easy to use and does not cause frustration or impediment. Too often, the “mobile” solutions are nothing more than a miniaturization of the desktop. This miniaturization without proper architecture or adherence to workflow or the peculiarities of the experience can result in frustration and disuse.

“Let physicians close the transaction from wherever they are.”

Allow the complete workflow to be accomplished from wherever the physician is located in whatever form factor is available for use. Closing the loop and providing the capability to turn any geographic location into a working location from and with which orders, vitals, results, notes, images can be viewed, created, analyzed, and interacted is the key to flexibility. To achieve this, interoperability and access to data are essential within the mHealth space.

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