Health Apps and Health Policy: What Is Needed? Bates, David W; Landman, Adam; Levine, David M
JAMA : the journal of the American Medical Association,
11/2018, Letnik:
320, Številka:
19
Journal Article
Recenzirano
The article discusses the potential that health apps have to improve efficiency and value and lowering costs when it comes to health care in the U.S. Four major policy issues that need to be ...addressed when it comes to medical apps are highlighted.
Background
Substitutive hospital-level care in a patient’s home (“home hospital”) has been shown to lower cost, utilization, and readmission compared to traditional hospital care. However, patients’ ...perspectives to help explain how and why interventions like home hospital accomplish many of these results are lacking.
Objective
Elucidate and explain patient perceptions of home hospital versus traditional hospital care to better describe the different perceptions of care in both settings.
Design
Qualitative evaluation of a randomized controlled trial.
Participants
36 hospitalized patients (19 home; 17 control).
Intervention
Traditional hospital (“control”) versus home hospital (“home”), including nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing.
Approach
We conducted a thematic content analysis of semi-structured interviews. Team members developed a coding structure through a multiphase approach, utilizing a constant comparative method.
Key results
Themes clustered around 3 domains: clinician factors, factors promoting healing, and systems factors. Clinician factors were similar in both groups; both described beneficial interactions with clinical staff; however, home patients identified greater continuity of care. For factors promoting healing, home patients described a locus of control surrounding their sleep, activity, and environmental comfort that control patients lacked. For systems factors, home patients experienced more efficient processes and logistics, particularly around admission and technology use, while both noted difficulty with discharge planning.
Conclusions
Compared to control patients, home patients had better experiences with their care team, had more experiences promoting healing such as better sleep and physical activity, and had better experiences with systems factors such as the admission processes. Potential explanations include continuity of care, the power and familiarity of the home, and streamlined logistics. Future improvements include enhanced care transitions and ensuring digital interfaces are usable.
Trial Registration
NCT03203759
Genome-wide transcriptional profiling was used to characterize the molecular underpinnings of neocortical organization in rhesus macaque, including cortical areal specialization and laminar cell-type ...diversity. Microarray analysis of individual cortical layers across sensorimotor and association cortices identified robust and specific molecular signatures for individual cortical layers and areas, prominently involving genes associated with specialized neuronal function. Overall, transcriptome-based relationships were related to spatial proximity, being strongest between neighboring cortical areas and between proximal layers. Primary visual cortex (V1) displayed the most distinctive gene expression compared to other cortical regions in rhesus and human, both in the specialized layer 4 as well as other layers. Laminar patterns were more similar between macaque and human compared to mouse, as was the unique V1 profile that was not observed in mouse. These data provide a unique resource detailing neocortical transcription patterns in a nonhuman primate with great similarity in gene expression to human.
► Discrete layers of primate neocortex display distinct transcriptional profiles ► Neighboring cortical layers and areas show the strongest transcriptional similarities ► Primate primary visual cortex has the most distinctive areal molecular profile ► Laminar and areal cellular expression patterns are conserved between macaque, human
Transcriptional profiling provides abundant information for understanding functional differentiation of brain regions and constituent cell types. Bernard et al. use high-resolution transcriptome analysis to probe the molecular underpinnings of neocortical laminar and areal identity in rhesus macaque.
The Safety of Inpatient Health Care Bates, David W.; Levine, David M.; Salmasian, Hojjat ...
The New England journal of medicine,
01/2023, Letnik:
388, Številka:
2
Journal Article
Recenzirano
Odprti dostop
A retrospective cohort study assessed patient safety in 11 Massachusetts hospitals in 2018. Adverse events were identified in 24% of hospital admissions and preventable adverse events in 7%.
While experimental studies of local election officials have found evidence of racial discrimination, we know little about whether these biases manifest in bureaucracies that provide access to ...valuable government programs and are less tied to politics. We address these issues in the context of affordable housing programs using a randomized field experiment. We explore responsiveness to putative white, black, and Hispanic requests for aid in the housing application process. In contrast to prior findings, public housing officials respond at equal rates to black and white email requests. We do, however, find limited evidence of responsiveness discrimination toward Hispanics. Moreover, we observe substantial differences in email tone. Hispanic housing applicants were 20 percentage points less likely to be greeted by name than were their black and white counterparts. This disparity in tone is somewhat more muted in more diverse locations, but it does not depend on whether a housing official is Hispanic.
Acquired mutations are pervasive across normal tissues. However, understanding of the processes that drive transformation of certain clones to cancer is limited. Here we study this phenomenon in the ...context of clonal hematopoiesis (CH) and the development of therapy-related myeloid neoplasms (tMNs). We find that mutations are selected differentially based on exposures. Mutations in ASXL1 are enriched in current or former smokers, whereas cancer therapy with radiation, platinum and topoisomerase II inhibitors preferentially selects for mutations in DNA damage response genes (TP53, PPM1D, CHEK2). Sequential sampling provides definitive evidence that DNA damage response clones outcompete other clones when exposed to certain therapies. Among cases in which CH was previously detected, the CH mutation was present at tMN diagnosis. We identify the molecular characteristics of CH that increase risk of tMN. The increasing implementation of clinical sequencing at diagnosis provides an opportunity to identify patients at risk of tMN for prevention strategies.
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