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Implementing a nutrition support protocol in critical care is a complex and dynamic process that involves the use of evidence, education programs and constant monitoring. To facilitate this task we developed a mnemonic tool called the Nutritional FAST HUG (F: feeding, A: analgesia, S: stools, T: trace elements, H: head of bed, U: ulcers, G: glucose control) with a process also internally developed (both modified from the mnemonic proposed by Jean Louis Vincent) called MIAR (M: measure, I: interpret, A: act, R: reanalysis) showing an easy form to perform medical rounds at the intensive care unit using a systematic process. © 2015 Grupo Aula Medica S.A. All rights reserved.

Navarro A.,Care Angel | Saldana M.T.,Primary Care Health Center Raices | Perez C.,Hospital Of La Princesa | Torrades S.,European Biometrics Institute | Rejas J.,Pfizer
BMC Neurology | Year: 2011

Background: Neuropathic pain (NeP) is a common symptom of a group of a variety of conditions, including diabetic neuropathy, trigeminal neuralgia, or postherpetic neuralgia. Prevalence of NeP has been estimated to range between 5-7.5%, and produces up to 25% of pain clinics consultations. Due to its severity, chronic evolution, and associated co-morbidities, NeP has an important individual and social impact. The objective was to analyze the effect of pregabalin (PGB) on pain alleviation and longitudinal health and non-health resources utilization and derived costs in peripheral refractory NeP in routine medical practice in primary care settings (PCS) in Spain.Methods: Subjects from PCS were older than 18 years, with peripheral NeP (diabetic neuropathy, post-herpetic neuralgia or trigeminal neuralgia), refractory to at least one previous analgesic, and included in a prospective, real world, and 12-week two-visit cost-of-illness study. Measurement of resources utilization included both direct healthcare and indirect expenditures. Pain severity was measured by the Short Form-McGill Pain Questionnaire (SF-MPQ).Results: One-thousand-three-hundred-fifty-four PGB-naive patients [58.8% women, 59.5 (12.7) years old] were found eligible for this secondary analysis: 598 (44%) switched from previous therapy to PGB given in monotherapy (PGBm), 589 (44%) received PGB as add-on therapy (PGB add-on), and 167 (12%) patients changed previous treatments to others different than PGB (non-PGB). Reductions of pain severity were higher in both PGBm and PGB add-on groups (54% and 51%, respectively) than in non-PGB group (34%), p < 0.001. Incremental drug costs, particularly in PGB subgroups [€34.6 (80.3), €160.7 (123.9) and €154.5 (133.0), for non-PGB, PGBm and PGBadd-on, respectively (p < 0.001)], were off-set by higher significant reductions in all other components of health costs yielding to a greater total cost reductions: -€1,045.3 (1,989.6),-€1,312.9 (1,543.0), and -€1,565.5 (2,004.1), for the three groups respectively (p = 0.03).Conclusion: In Spanish primary care settings, PGB given either add-on or in monotherapy in routine medical practice was associated with pain alleviation leading to significant longitudinal reductions in resource use and total costs during the 12-week period of the study compared with non-PGB-therapy of patients with chronic NeP of peripheral origin. The use of non-appropriate analgesic therapies for neuropathic pain in a portion of subjects in non-PGB group could explain partially such findings. © 2011 Navarro et al; licensee BioMed Central Ltd.

de Salas-Cansado M.,TFS | Perez C.,Hospital Of La Princesa | Saldana M.T.,Primary Care Health Center Raices | Navarro A.,Care Angel | Rejas J.,Pfizer
Pain Medicine (United States) | Year: 2012

Objective. The objective of this study was to estimate the cost-effectiveness of pregabalin vs usual care (UC) in outpatients with refractory neuropathic pain (NeP), treated according to routine medical practice in primary care settings in Spain. Methods. Patients were extracted from a 12-week noninterventional prospective study conducted to ascertain the costs of NeP. Pairs of pregabalin-naïve patients receiving UC or pregabalin, matched by age, gender, pain intensity, and refractory to previous treatment, were selected in a 1:1 ratio. Refractory was considered a patient with actual pain (scoring >40 in a 100mm in a pain visual analog scale) after receiving a course of a standard analgesic, at its recommended doses. Perspectives of the Spanish National Healthcare System and society were included in the analysis. Effectiveness was expressed as quality-adjusted life-year (QALY) gain. Results of the cost-effectiveness analysis were expressed as an incremental cost per QALY (ICER) gained. Probabilistic sensitivity analysis using bootstrapping techniques was also carried out. Results. A total of 160 pairs were extracted. Compared with UC, pregabalin was associated with significantly higher QALY gain; 0.0374±0.0367 vs 0.0224±0.0313 (P<0.001). Despite drug acquisition costs being higher for pregabalin (€251±125 vs €104±121; P<0.001), total and health care costs incurred for pregabalin were similar in both groups; €1,335±1,302 vs €1,387±1,489 (P=0.587) and €529±438 vs €560±672 (P=0.628), respectively, yielding a dominant ICER for both total and health care costs in the base case scenario; 95% confidence intervals, respectively, dominant to €17,268, and dominant to €6,508. Sensitivity analysis confirmed results of the basecase scenario. Conclusion. This study showed that pregabalin may be cost-effective in the treatment of refractory NeP patients when compared with UC in routine medical practice in Spain. Wiley Periodicals, Inc.

Faisy C.,University of Paris Descartes | Llerena M.C.,Care Angel | Savalle M.,University of Paris Descartes | Mainardi J.-L.,University of Paris Descartes | Fagon J.-Y.,University of Paris Descartes
Chest | Year: 2011

Background: Caloric insufficiency during the first week of ICU stay has been associated with increased infection rates. The connection between specific pathogens and host nutritional status in the ICU is not well known. This study was undertaken to determine the impact of patients'early in-ICU energy balance on the pathogens responsible for ventilator-associated pneumonia (VAP). Methods: In this prospective, observational, cohort study conducted in a teaching hospital ICU, energy balance (energy delivered - calculated resting energy expenditure) was compared according to the microbiologic results of the fiber-optic BAL cultures of 76 consecutive patients receiving acute prolonged (≥ 96 h) mechanical ventilation who developed VAP during their ICU stay. Results: Among the 76 BAL cultures, 22 contained significant Staphylococcus aureus concentrations. The cumulated energy deficit of patients with S aureus VAP was greater than those with VAP caused by other pathogens (-10,275 ± 4,211 kcal vs -7,376 ± 4,013 kcal from ICU admission to day of BAL, P < .01). ICU admission, nutritional status, and conditions potentially limiting feeding did not differ significantly between the two groups. Patients with S aureus VAP had lower prescribed and delivered energy, causing higher energy deficits. Multivariate analysis identified energy deficit as being independently associated with S aureus VAP. More-severe energy deficit and higher rate of S aureus -positive BAL cultures (P = .01 comparing quartiles) were observed. Conclusions: Early ICU energy deficit is an independent determinant for acquiring S aureus VAP in patients on acute prolonged mechanical ventilation. © 2011 American College of Chest Physicians.

Care Angel | Date: 2013-05-21

Herbs for medicinal purposes; Medicinal herb extracts; Medicinal herbal extracts for medical purposes; Medicinal herbs in dried or preserved form.

Care Angel | Date: 2016-01-08

Interactive care monitoring and notification system for care givers using audio and data communication, artificial intelligence, interactive voice recognition algorithms, and predictive analytics to monitor and report medication adherence, mental, physical and emotional well-being of a person under care.

Care Angel will present ANGEL, the world's first artificially intelligent caregiver. Her award winning, patent-pending, caring personality is infused into a Voice-Powered Telemonitoring platform that aims to give millions of family caregivers peace of mind by empowering them to more effectively participate in the caregiving & keeping aging loved ones safe while they age at home. ANGEL delivers high quality eldercare via simple check-in Care Calls on a regular phone. No Smartphone required.

News Article | August 11, 2015

Have you seen the show “Shark Tank”? I had the chance to act as a “shark” this week for an innovative challenge where entrepreneurs took to the stage to pitch their best health tech ideas. I have the privilege of representing the AMA as the secretary of the eHealth Initiative (eHi), a non-profit multi-stakeholder organization committed to improving health and healthcare through information technology. The group just held its iTHRIVE Challenge, receiving 60 “pitches” from entrepreneurs. The pitches were viewed online 15,000 times and 1,000 people voted on the pitches to select 12 finalists who presented them in Washington, D.C. Along with senior leaders from organizations such as Mayo Clinic, PriceWaterhouseCooper, United Healthcare, Accenture, Marshfield Clinic and Cerner Corporation, I had the novel experience to judge these proposals. As I journey now to my next destination, I’m still admiring the creativity of these entrepreneurs and thought I’d share some. If you have ever used Snapchat, you’ll be familiar with how EASE works. The mobile app enables operating room teams to send photos and text updates to family members of patients undergoing operative procedures. The information auto-deletes after 45 seconds. This communication relieves family anxiety and simplifies after-surgery discussions with family. EASE is already used in a number of prominent hospitals and ready for more. One of their founders is an AMA member and this is how they describe themselves: “EASE was created by doctors inside of an operating room.  We are not a tech company trying to make our way into an OR.  Our team consists of a business executive, two anesthesiologists and a cardiac surgeon.” The creator describes this as a “high-touch, low-tech” way to care for our aging loved ones. Using a mobile platform, families will schedule automated phone calls to isolated elderly family members. The calls can include a recorded message from family members and will ask questions to ascertain the wellness of the loved one. The loved one answers verbally (that’s the low-tech part). Care Angel collects the answers and makes them available to family members via the mobile platform. If the answers raise concern or there is no answer to repeated calls, the platform (the high-tech part) immediately notifies family members. There’s a lot more detail than I can cover here, but this looks to be a neat idea with much potential. Here is an example of the needle worth finding in an overwhelming haystack of useless data. Reliably tracking daily weight is an elegantly simple way to monitor fluid status for congestive heart failure and renal failure patients to identify patients at risk for distress and preventable hospitalization. Meerkat uses an ultra-thin wi-fi scale under a bathmat, measures and transmits daily weights, uses algorithms to identify patients with worrisome weight gain and alerts clinicians to intervene before decompensation occurs. The innovation here is creating a reliable end-to-end process that is effortless for the patient, inexpensive and easily actionable by clinicians. Okay, this wasn’t presented at the iTHRIVE challenge and is an add-on, but I want to call attention to STEPS Forward. It’s just one of the AMA’s many new innovation initiatives directly tailored to improving the satisfaction of physicians and the sustainability of their practices. This is a web-based platform of clinical practice solutions designed by physicians, for physicians. I strongly encourage physicians in small and mid-size practices to explore the modules to see if they can help you work smarter, not harder.  And I invite anyone with their own innovative solutions to clinical challenges to submit your own ideas to win a $10,000 prize and help us create the next round of solutions for STEPS Forward. As a practicing emergency physician married to an allergist who works in a two-physician office, I know our profession faces many challenges. Amidst these challenges, though, there is an exciting world of innovation in which we have more tools than ever to help our patients lead healthier, happier lives. I want to be a part of that bright future. I want to make it even brighter. And I look forward to joining many of you in the creation of it. Thank you for all you do, every day, for our patients and our profession.

News Article | June 30, 2015

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News Article | August 17, 2015

“This has been a phenominal experience. eHI is an extreme convener of ideas. The level of talent and expertise that shows up at eHI meetings is spectacular.” – Russ Thomas, CEO, Availity “This event has been spectacular, this has been refreshing – candid and genuine. There is a genuine want to help and interest. At other events we have pitched at, we have not felt that.” – Patrick de la Roza, MBA, EASE Applications On August 12 and 13, 2015 eHealth Initiative (eHI) convened over 150 c-level executives and promising health IT entrepreneurs at the iTHRIVE Innovation Challenge. Sam Ho, Chief Medical Officer and Executive Vice President at UnitedHealthcare stressed the importance of bringing together innovators and executives, saying “we want new energy and new ideas because we can’t solve the problems of today with the solutions of yesterday.” eHI CEO Jennifer Covich Bordenick kicked off the conference by facilitating a discussion with Karen DeSalvo, MD, MPH, MSc, National Coordinator for Health Information Technology (ONC) and Acting Assistant Secretary for Health, U.S. Department of Health and Human Services about the past, present, and future of healthcare innovation and what ONC has planned for the coming years. Another highlight of the first day was the innovator pitch panels in which start-up entrepreneurs shared ideas to an impressive group of C-Level executives. The innovations, which ranged from real-time emergency room updates and monitoring specific diseases to integrating test result reporting and neuro-cognitive screening, captivated both the audience and judges alike. Audience members were asked to vote online for their favorite idea, and three distinct winners were notified at the end of the day: The second and final day of the event began with a discussion between Jody Ranck, DrPH, Marketing and Communications Specialist, Co-CEO of Unison Health and VP of Strategy and Development at Health Bank and Grant Wood, Senior Information Technology Strategist (CGI), Intermountain Healthcare about the aesthetics of wearable devices and translating genomic research into clinical care. Pete Celano, MedStar Institute for Innovation, Navid Farzad, Partner, Morgan Noble Healthcare Partners, Gino Tenace, Chief Executive Officer, MOBĒ, and Mark Lutes, Partner at Epstein Becker Green spoke about the process of investing in new technologies and gave expert advice to the entrepreneurs. The judges then gave an overview on their discussions with the contestants and shared with the audience their plans moving forward. From mentorships and high level introductions to meetings and business development guidance, all of the contestants walked away with valuable new connections and a vision for the future of their ideas. The judges stressed the importance of eHI’s role in bringing together the two communities of innovators and executives. The audience then heard an engaging discussion from Bobby Jefferson, the Director of the Center for Development Informatics at The Futures Group on the use of medical drones to provide medical supplies and necessary care for patients in rural areas. The conference wrapped up with an interactive policy discussion from members of eHI’s Policy Steering Committee on incubating and supporting innovation on a policy level. While only three companies were chosen to answer questions about their ideas, it was overwhelming clear that the iTHRIVE Innovation Challenge provided a necessary platform to connect innovators, ideas, and executives to help shape the future of healthcare in the United States. Availity CEO Russ Thomas put it simply saying “this has been a phenomenal experience. eHI is an extreme convener of ideas. The level of talent and expertise that shows up at eHI meetings is spectacular.” eHI is proud to be a leader of this platform and looks forward to following these innovators as they make their mark on the industry. We look forward to keeping you informed on the progress of our innovators and hope you join us as we convene in Washington, DC on February 3-4 for our 2016 Annual Conference. We have big things to come!

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