Candida auris: An emerging multidrug-resistant pathogen Sears, David; Schwartz, Brian S.
International journal of infectious diseases,
October 2017, 2017-Oct, 2017-10-00, 20171001, 2017-10-01, Letnik:
63, Številka:
C
Journal Article
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Candida aurisis an emerging multidrug-resistant pathogen that can be difficult to identify using traditional biochemical methods. C. auris is capable of causing invasive fungal infections, ...particularly among hospitalized patients with significant medical comorbidities. Echinocandins are the empiric drugs of choice for C. auris, although not all isolates are susceptible and resistance may develop on therapy. Nosocomial C. auris outbreaks have been reported in a number of countries and aggressive infection control measures are paramount to stopping transmission.
The use and functionality of electronic health records (EHRs) have increased rapidly in the past decade. Although the primary purpose of EHRs is clinical, researchers have used them to conduct ...epidemiologic investigations, ranging from cross-sectional studies within a given hospital to longitudinal studies on geographically distributed patients. Herein, we describe EHRs, examine their use in population health research, and compare them with traditional epidemiologic methods. We describe diverse research applications that benefit from the large sample sizes and generalizable patient populations afforded by EHRs. These have included reevaluation of prior findings, a range of diseases and subgroups, environmental and social epidemiology, stigmatized conditions, predictive modeling, and evaluation of natural experiments. Although studies using primary data collection methods may have more reliable data and better population retention, EHR-based studies are less expensive and require less time to complete. Future EHR epidemiology with enhanced collection of social behavior measures, linkage with vital records, and integration of emerging technologies such as personal sensing could improve clinical care and population health.
The ability to extract critical information about an infectious disease in a timely manner is critical for population health research. The lack of procedures for mining large amounts of health data ...is a major impediment. The goal of this research is to use natural language processing (NLP) to extract key information (clinical factors, social determinants of health) from free text. The proposed framework describes database construction, NLP modules for locating clinical and non-clinical (social determinants) information, and a detailed evaluation protocol for evaluating results and demonstrating the effectiveness of the proposed framework. The use of COVID-19 case reports is demonstrated for data construction and pandemic surveillance. The proposed approach outperforms benchmark methods in F1-score by about 1-3%. A thorough examination reveals the disease's presence as well as the frequency of symptoms in patients. The findings suggest that prior knowledge gained through transfer learning can be useful when researching infectious diseases with similar presentations in order to accurately predict patient outcomes.
Objective: Thus far, most applications in precision mental health have not been evaluated prospectively. This article presents the results of a prospective randomized-controlled trial investigating ...the effects of a digital decision support and feedback system, which includes two components of patient-specific recommendations: (a) a clinical strategy recommendation and (b) adaptive recommendations for patients at risk for treatment failure. Method: Therapist-patient dyads (N = 538) in a cognitive behavioral therapy outpatient clinic were randomized to either having access to a decision support system (intervention group; n = 335) or not (treatment as usual; n = 203). First, treatment strategy recommendations (problem-solving, motivation-oriented, or a mix of both strategies) for the first 10 sessions were evaluated. Second, the effect of psychometric feedback enhanced with clinical problem-solving tools on treatment outcome was investigated. Results: The prospective evaluation showed a differential effect size of about 0.3 when therapists followed the recommended treatment strategy in the first 10 sessions. Moreover, the linear mixed models revealed therapist symptom awareness and therapist attitude and confidence as significant predictors of an outcome as well as therapist-rated usefulness of feedback as a significant moderator of the feedback-outcome and the not on track-outcome associations. However, no main effects were found for feedback. Conclusions: The results demonstrate the importance of prospective studies and the high-quality implementation of digital decision support tools in clinical practice. Therapists seem to be able to learn from such systems and incorporate them into their clinical practice to enhance patient outcomes, but only when implementation is successful.
What is the public health significance of this article?
This randomized clinical implementation trial provides insight into the evaluation of a clinical decision support and feedback system including personalized pretherapy recommendations and enhanced psychometric feedback during treatment. As it is one of the first decision systems to have been implemented and evaluated prospectively in mental health, this study helps to improve such systems designed to support and change the way psychotherapy is conducted. The results underscore the importance of high-quality implementation of digital decision support tools in clinical practice.
Extracting relevant information about infectious diseases is an essential task. However, a significant obstacle in supporting public health research is the lack of methods for effectively mining ...large amounts of health data.
This study aims to use natural language processing (NLP) to extract the key information (clinical factors, social determinants of health) from published cases in the literature.
The proposed framework integrates a data layer for preparing a data cohort from clinical case reports; an NLP layer to find the clinical and demographic-named entities and relations in the texts; and an evaluation layer for benchmarking performance and analysis. The focus of this study is to extract valuable information from COVID-19 case reports.
The named entity recognition implementation in the NLP layer achieves a performance gain of about 1-3% compared to benchmark methods. Furthermore, even without extensive data labeling, the relation extraction method outperforms benchmark methods in terms of accuracy (by 1-8% better). A thorough examination reveals the disease's presence and symptoms prevalence in patients.
A similar approach can be generalized to other infectious diseases. It is worthwhile to use prior knowledge acquired through transfer learning when researching other infectious diseases.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Department chairs and division chiefs at research-intensive academic medical centers often find mentoring clinician educators challenging. These faculty constitute the majority of academic ...physicians. Supporting excellent clinician educators is key to ensuring high-quality patient care and developing tomorrow’s physicians. Little has been written for leaders on strategies to advance academic clinician educators’ career success. We present a framework to guide chairs, chiefs, and mentors seeking to address clinician educator retention and satisfaction in academic medical centers.
During human CMV infection, there is a preferential expansion of natural killer (NK) cells expressing the activating CD94–NKG2C receptor complex, implicating this receptor in the recognition of ...CMV-infected cells. We hypothesized that NK cells expanded in response to pathogens will be marked by expression of CD57, a carbohydrate antigen expressed on highly mature cells within the CD56dimCD16+ NK cell compartment. Here we demonstrate the preferential expansion of a unique subset of NK cells coexpressing the activating CD94–NKG2C receptor and CD57 in CMV+ donors. These CD57+NKG2Chi NK cells degranulated in response to stimulation through their NKG2C receptor. Furthermore, CD57+NKG2Chi NK cells preferentially lack expression of the inhibitory NKG2A receptor and the inhibitory KIR3DL1 receptor in individuals expressing its HLA-Bw4 ligand. Moreover, in solid-organ transplant recipients with active CMV infection, the percentage of CD57+NKG2Chi NK cells in the total NK cell population preferentially increased. During acute CMV infection, the NKG2C+ NK cells proliferated, became NKG2Chi, and finally acquired CD57. Thus, we propose that CD57 might provide a marker of "memory" NK cells that have been expanded in response to infection.
Emergencies and disasters impact population health. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared. ...There is a knowledge gap in that existing frameworks lack consideration for complexity relevant to health systems and the emergency context. The objective of this study is to describe the essential elements of a resilient public health system and how the elements interact as a complex adaptive system.
This study used a qualitative design employing the Structured Interview Matrix facilitation technique in six focus groups across Canada. Focus group participants were practitioners from public health and related sectors. Data collection generated qualitative data on the essential elements, and interactions between elements, for a resilient public health system. Data analysis employed qualitative content analysis and the lens of complexity theory to account for the complex nature of public health emergency preparedness (PHEP). The unit of study was the local/regional public health agency. Ethics and values were considered in the development of the framework.
A total of 130 participants attended the six focus groups. Urban, urban-rural and rural regions from across Canada participated and focus group size ranged from 15 to 33 across the six sites. Eleven elements emerged from the data; these included one cross-cutting element (Governance and leadership) and 10 distinct but interlinked elements. The essential elements define a conceptual framework for PHEP. The framework was refined to ensure practice and policy relevance for local/regional public health agencies; the framework has ethics and values at its core.
This framework describes the complexity of the system yet moves beyond description to use tenets of complexity to support building resilience. This applied public health framework for local/regional public health agencies is empirically-derived and theoretically-informed and represents a complex adaptive systems approach to upstream readiness for PHEP.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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