Morrell S.,Health Level
British Journal of Cancer | Year: 2017
Background:This breast cancer mortality evaluation of service screening mammography in New Zealand, the first since commencement of screening in 1999, applies to the 1999–2011 diagnostic period. Individual-level linked information on mammography screening, breast cancer diagnosis and breast cancer mortality is used to analyse differences in breast cancer mortality according to participation in organised screening mammography, as provided by BreastScreen Aotearoa (BSA).Methods:Women were followed from the time they became eligible for screening, from age 50 years (1999–2004) and 45 years (⩾2004). Breast cancer mortality from cancers diagnosed during the screening period from 1999 to 2011 (n=4384) is examined in relation to individual screening participation or non-participation during preceding person-years of follow-up from the time of screening eligibility. To account for changes from never- to ever-screened status, breast cancer mortality is calculated for each year in relation to prior accumulated time of participation and non-participation in screening. Breast cancer mortality is also examined in regularly screened women (screened ⩾3 times and mean screening interval ⩽30 months), and irregularly screened women compared with never-screened women. Statistical analyses are by negative binomial and Poisson regression with adjustment for age and ethnic group (Māori, Pacific women) in a repeated-measures analysis. Relative risks for breast cancer mortality compared with never-screened women, are adjusted also for screening selection bias, to indicate the extent of breast cancer mortality reduction in a population offered and not offered mammography screening. Prognostic indicators at diagnosis of breast cancer are also compared between different screening participation groups, including by grade of tumour, extent of disease (spread), multiple tumour status and maximum tumour size using χ2 statistics, t-tests and two-sample median tests.Results:For 1999–2011, after adjusting for age and ethnicity, breast cancer mortality in ever-screened women is estimated to be 62% (95% CI: 51–70) lower than in never-screened women. After further adjustment for screening selection bias, the mortality reduction in NZ is estimated to be 29% (95% CI: 20–38) at an average screening coverage of 64% for 2001–2011, and 34% (95% CI: 25–43) for recent screening coverage (2012–13, 71%). For irregularly screened women, the mortality reduction is estimated to be 31% (95% CI: 21–40), and 39% (95% CI: 22–52) in regularly screened women compared with never-screened women, after adjusting for age, ethnicity and screening selection bias (using recent 2012–2013 screening coverage of 71%). Ever-screened women diagnosed with breast cancer have more favourable prognostic indicators than never-screened women, with a higher proportion of localised cancer (63 compared with 46%), a higher proportion with a well-differentiated tumour (30 compared with 18%), lower risk of multiple tumours (RR=0.48) and smaller median tumour size (15 mm compared with 20 mm)—all differences are statistically significant (P<0.0001).Conclusions:This is the first total population cohort study of an established nation-wide screening mammography programme using individual-level information on screening participation and mortality outcomes from breast cancer. The findings are in accord with other mammography screening service evaluations and with randomised trials of mammography screening.British Journal of Cancer advance online publication, 9 February 2017; doi:10.1038/bjc.2017.6 www.bjcancer.com. © 2017 The Author(s)
News Article | February 16, 2017
BOSTON--(BUSINESS WIRE)--CommonWell Health Alliance® today announced it has completed building the first set of The Argonaut Project’s FHIR specifications into its core services—making it the first national network to enable comprehensive FHIR-based-exchange at scale. CommonWell, recognizing its critical role in improving nationwide health data exchange, has been using FHIR since 2013 when it first developed its core interoperability services and person-centric national network. By building the latest set of FHIR specifications, all CommonWell Members will be able to leverage FHIR-based outbound query and retrieve capabilities to access data across the network. Brightree will be the first to deploy this capability to clients across the country this year and has already built FHIR-based workflows into their technology. By implementing the latest FHIR specifications, CommonWell and its members have made it simpler and faster for technology innovators to exchange health data. The latest specifications rely on more modern architecture which makes it easier for developers—both inside and outside the EHR industry—to connect to the information they are trying to access. Additionally, it creates the stepping stones for more widespread sharing of discrete segments of data, as opposed to the comprehensive summary of care documents that are shared today. CommonWell is implementing the Find Document References and Retrieve Document resources and corresponding OAuth2 security specifications for Document Responders, as profiled by the Argonaut Project in a release issued yesterday. CommonWell will also utilize Argonaut specifications for provider directories in order to enhance the network with directed query capabilities. CommonWell is bridging these specifications to the existing IHE XCA specifications that many major EHR vendors have already built in the past. This allows CommonWell Members to use either the more modern FHIR-based or the older XCA-based specifications. This bridging highlights the unique ability of CommonWell services to consolidate and deliver queries from multiple EHRs to a single endpoint. “CommonWell has been using FHIR for patient identity management purposes since it first built its core interoperability services, even before the launch of the Argonaut Project,” said Jitin Asnaani, executive director of CommonWell Health Alliance. “By leveraging these latest FHIR specifications, CommonWell is taking the first of many steps to leverage FHIR for clinical interoperability, and plans to support additional FHIR specifications later this year.” Brightree, the first solely post-acute focused member of CommonWell, has enabled FHIR-based exchange per the specifications of the Argonaut Project to query and retrieve clinical documents through Alliance services to enable better patient care in the post-acute market. “Our initial reason for joining CommonWell was to gain access to a national network that could solve for interoperability issues inhibiting the providers we serve. By combining our cloud-based architecture with FHIR-based exchange, we will be able to more efficiently leverage the CommonWell network and provide even more value for our providers and the patients they serve,” said Matt Mellott, chief executive officer of Brightree. The Alliance officially became a member of Health Level Seven International (HL7)—an industry driver of FHIR—earlier this year. This further symbolizes the Alliance’s commitment to work collaboratively across the health IT landscape and to leverage existing standards where possible. To see CommonWell FHIR-based exchange in action, visit Brightree as they give live demonstrations of their Home Health Solutions, alongside Cerner, at the CommonWell Care Transition area of the HIMSS Interoperability Showcase (Booth #9000) during the exhibition hall hours Monday, Feb. 20-Wednesday, Feb. 22. CommonWell Health Alliance is a not-for-profit trade association of health IT companies working together to create universal access to health data nationwide. CommonWell members represent two-thirds of the acute care EHR market1 and more than one-third of the ambulatory care EHR market2, as well as market leaders and technology innovators supporting care settings such as post-acute care, imaging, perinatal, laboratory, retail pharmacy, oncology, population health, emergency services and more. CommonWell and its members are committed to the belief that provider access to health data must be built into information technologies at a reasonable cost for use by a broad range of health care providers and the populations and people they serve. To learn more about CommonWell Health Alliance, visit www.commonwellalliance.org. Engage with CommonWell on our Blog, as well as through Facebook, LinkedIn and Twitter using the handle, @CommonWell. CommonWell Health Alliance® and the CommonWell Logo are registered trademarks of CommonWell Health Alliance Inc. Brightree is the leading provider of cloud-based software to improve clinical and business performance in the post-acute care industry. The company serves more than 2,500 organizations in the HME, home health, hospice, orthotic and prosthetic, HME pharmacy, home infusion and rehabilitation home care segments. Brightree's solutions follow the natural workflow of providers to automate and improve how they manage their businesses, serve patients and protect reimbursements. The company is ranked one of the top 100 healthcare IT companies in the U.S. on the prestigious Healthcare Informatics 100 (HCI 100) list. For more information, visit www.brightree.com or call 1.888.598.7797.
News Article | February 22, 2017
NEEDHAM, Mass.--(BUSINESS WIRE)--The Object Management Group® (OMG®), an international, open membership, not-for-profit technology standards consortium, today announced it will hold the Business Process Modeling in Healthcare Workshop on March 20 from 8:45 a.m. to 5:00 p.m. at the Hyatt Regency Hotel in Reston, Virginia. The workshop is focused on establishing an approach to allow for workflows – specifically clinical workflows – to be shared among provider organizations allowing them to ingest, adapt, and evolve those processes to embrace emerging best clinical practice, and to perform continuous improvement. Exploring the specific and unique needs of the clinical health landscape, Workshop speakers will investigate usage of existing modeling languages (including BPMN™) to determine the viability, coverage, and gaps to meeting health industry needs. Keynote speaker Dr. Hammond will present “ The Tensions between Workflow, Status Quo, and Keeping up with Technology (and the Times).” He will focus on the changes being “forced” on the health system as a consequence of advances in technology, as well as the impacts of changing health best practices and the industry’s ability to adopt them. Registration costs $149 USD. Media admission is complimentary using the code TCVAP17. Recognized for his pioneering work in the HL7 standards community, Dr. Hammond’s academic and industry leadership experience includes roles as past President and Board member of the American Medical Informatics Association (AMIA); President and Fellow of the American College of Medical Informatics; three terms as Chair of Health Level Seven; two terms as the Convenor of ISO Technical Committee 215, Working Group 2; and current Ambassador to Developing Countries and Chair of the Joint Initiative Council of ISO/CEN/HL7. The event also features Shane McNamee, M.D., US Department of Veterans Affairs, who will present “Interoperable Healthcare Workflows: Goals and Vision.” Currently, healthcare delivery is disconnected and inefficient. Dr. McNamee will discuss some of the challenges of disconnected and inefficient delivery, and set the stage for how OMG Business Process Modeling Notation™ (BPMN) standard offers potential to stabilize health care processes that support both patients and providers as organizations strive toward improved efficacy and high reliability. A foremost expert in BPM standards, Denis Gagné, CEO/CTO of Trisotech and Chair of the OMG BPMN Interchange Working Group, will explain how to leverage the OMG business process modeling standards—BPMN, Case Management Model and Notation™ and Decision Model Notation™—to improve business improvement, innovation and transformation, and how these can be used in tandem to meet the needs of the health vertical market segment. The remainder of the day will focus on breakout sessions, presenting working group activities to develop a pilot implementation and a Health BPM Modeling “Field Guide.” The sessions will brief attendees on what has been done since the December workshop, and present opportunities to directly contribute and evolve the work. Workshop attendees are invited to join the OMG Healthcare Committee Meeting on March 21 for an in-depth discussion about OMG’s healthcare standards work. Or they can participate in the Committee Meeting for two days from March 21-22. The one-day add-in option costs an additional $99 USD and the two-day add-in option costs an extra $198 USD. The Workshop is a special event of the OMG Technical Meeting from March 20-24, 2017 in Reston, Virginia. Attendees who register for the Technical Meeting week do not have to pay the additional fee to attend the Workshop. OMG Social Media Channels To learn about becoming an OMG member, click on http://www.omg.org or visit us on Facebook, follow us on Twitter or connect with us on LinkedIn. About OMG The Object Management Group® (OMG®) is an international, open membership, not-for-profit technology standards consortium with representation from government, industry and academia. OMG Task Forces develop enterprise integration standards for a wide range of technologies and an even wider range of industries. OMG's modeling standards enable powerful visual design, execution and maintenance of software and other processes. Visit http://www.omg.org for more information. Note to editors: For a listing of all OMG trademarks, visit http://www.omg.org/legal/tm_list.htm. All other trademarks are the property of their respective owners.
Laba T.-L.,Health Level
Arthritis Research and Therapy | Year: 2014
Osteoporosis is a disease that increases skeletal fracture risk and places a significant health and economic burden on patients, families, and health systems. Many treatment options exist, but patient use is suboptimal, thus undermining the potential cost-effectiveness of treatments. In the previous issue of Arthritis Research & Therapy, Hiligsmann and colleagues expanded the findings of previous studies to report, from a sample of 257 patients with osteoporosis, the preference to trade off clinical outcomes for the amenity provided by convenient dosing regimens. This editorial critiques the strengths and limitations of the methods, discusses the potential utility of patient treatment preferences, and suggests avenues for further research. © 2014 BioMed Central Ltd.
Hale L.,Health Level |
Guan S.,Health Level
Sleep Medicine Reviews | Year: 2015
We systematically examined and updated the scientific literature on the association between screen time (e.g., television, computers, video games, and mobile devices) and sleep outcomes among school-aged children and adolescents. We reviewed 67 studies published from 1999 to early 2014. We found that screen time is adversely associated with sleep outcomes (primarily shortened duration and delayed timing) in 90% of studies. Some of the results varied by type of screen exposure, age of participant, gender, and day of the week. While the evidence regarding the association between screen time and sleep is consistent, we discuss limitations of the current studies: 1) causal association not confirmed; 2) measurement error (of both screen time exposure and sleep measures); 3) limited data on simultaneous use of multiple screens, characteristics and content of screens used. Youth should be advised to limit or reduce screen time exposure, especially before or during bedtime hours to minimize any harmful effects of screen time on sleep and well-being. Future research should better account for the methodological limitations of the extant studies, and seek to better understand the magnitude and mechanisms of the association. These steps will help the development and implementation of policies or interventions related to screen time among youth. © 2014 Elsevier Ltd.
Flenady V.,Health Level
The Cochrane database of systematic reviews | Year: 2013
The aetiology of preterm birth is complex and there is evidence that subclinical genital tract infection influences preterm labour in some women but the role of prophylactic antibiotic treatment in the management of preterm labour is controversial. Since rupture of the membranes is an important factor in the progression of preterm labour, it is important to see if the routine administration of antibiotics confers any benefit or causes harm, prior to membrane rupture. To assess the effects of prophylactic antibiotics administered to women in preterm labour with intact membranes, on maternal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2013). Randomised trials that compared antibiotic treatment with placebo or no treatment for women in preterm labour (between 20 and 36 weeks' gestation) with intact membranes. Two review authors independently assessed trial eligibility, and undertook quality assessment and data extraction. We contacted study authors for additional information. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for data measured on a continuous scale with their respective 95% confidence intervals (CI). The number needed to treat to benefit (NNTB) and the number needed to treat to harm (NNTH) was calculated where appropriate. In this update (2013), with the addition of three trials (305 women), the large ORACLE II 2001 trial continues to dominate the results of this review. This review now includes a total of 14 studies randomising 7837 women. No significant difference was shown in perinatal or infant mortality for infants of women allocated to any prophylactic antibiotics compared with no antibiotics. However, an increase in neonatal deaths was shown for infants of women receiving any prophylactic antibiotics when compared with placebo (RR 1.57, 95% CI 1.03 to 2.40; NNTH 149, 95% CI 2500 to 61). No reduction in preterm birth or other clinically important short-term outcomes for the infant were shown.Long-term child outcomes to seven years of age were available for infants in the UK enrolled in the ORACLE II trial. Comparing any antibiotics with placebo, a marginally non-statistically significant increase was shown in any functional impairment (RR 1.10, 95% CI 0.99 to 1.23) and cerebral palsy (CP) (RR 1.82, 95% CI 0.99 to 3.34). In subgroup analysis, CP was statistically significantly increased for infants of women allocated to macrolide and beta-lactam antibiotics combined compared with placebo (RR 2.83, 95% CI 1.02 to 7.88; NNTH 35, 95% CI 333 to 9).Further, exposure to any macrolide antibiotics (including erythromycin alone or erythromycin plus co-amoxiclav) versus no macrolide antibiotics (including placebo and co-amoxiclav alone) was shown to increase neonatal death (RR 1.52, 95% CI 1.05 to 2.19; NNTH 139, 95% CI 1429 to 61), any functional impairment (RR 1.11, 95% CI 1.01 to 1.20; NNTH 24, 95% CI 263 to 13) and CP (RR 1.90, 95% CI 1.20 to 3.01; NNTH 64, 95% CI 286 to 29). Exposure to any beta-lactam (beta-lactam alone or in combination with macrolide antibiotics) versus no beta-lactam antibiotics resulted in more neonatal deaths (RR 1.51, 95% CI 1.06 to 2.15; NNTH 143, 95% CI 1250 to 63) and CP (RR 1.67, 95% CI 1.06 to 2.61; NNTH 79, 95% CI 909 to 33), however no difference was shown in functional impairment.Maternal infection was reduced with the use of any prophylactic antibiotics compared with placebo (RR 0.74, 95% CI 0.63 to 0.86; NNTB 34, 95% CI 24 to 63) and any beta-lactam compared with no beta-lactam antibiotics (RR 0.80, 95% CI 0.69 to 0.92; NNTB 47, 95% CI 31 to 119). However, caution should be exercised with this finding due to the possibility of bias shown by funnel plot asymmetry. Any beta-lactam compared with no beta-lactam antibiotics was associated with an increase in maternal adverse drug reaction (RR 1.61, 95% CI 1.02 to 2.54; NNTH 17, 95% CI 526 to 7). This review did not demonstrate any benefit in important neonatal outcomes with the use of prophylactic antibiotics for women in preterm labour with intact membranes, although maternal infection may be reduced. Of concern, is the finding of short- and longer-term harm for children of mothers exposed to antibiotics. The evidence supports not giving antibiotics routinely to women in preterm labour with intact membranes in the absence of overt signs of infection.Further research is required to develop sensitive markers of subclinical infection for women in preterm labour with intact membranes, as this is a group that might benefit from future novel interventions, including new modalities of antibiotic therapy. The results of this review demonstrate the need for future trials in the area of preterm birth to include assessment of long-term neurodevelopmental outcome.
Peeters A.,Health Level
Systematic reviews | Year: 2014
Obesity is a significant public health issue and is socially patterned, with greater prevalence of obesity observed in the most socioeconomically disadvantaged groups. Recent evidence suggests that the prevalence of childhood obesity is levelling off in some countries. However, this may not be the case across all socioeconomic strata. The aim of this review is to examine whether trends in child and adolescent obesity prevalence since 1990 differ according to socioeconomic position in developed countries. An electronic search will be conducted via Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Collaboration to identify articles that report trends in obesity prevalence in children and adolescents according to socioeconomic position. We will also search grey literature databases including the Virtual Library for Public Health and the System for Information on Grey Literature, as well as websites from relevant organisations. Articles that report on a series of cross sectional studies; describe one or more measure of obesity with data recorded at two or more time points since 1990; and report trends by at least one indicator of socioeconomic position will be included. Quality of included studies will be evaluated according to criteria that consider both internal and external validity. Descriptive analysis will be performed to examine trends since 1990 in childhood obesity prevalence according to socioeconomic position. The review will provide a picture of change over time in developed countries of childhood obesity prevalence across socioeconomic strata and identify whether changes in childhood obesity prevalence are experienced equally across socioeconomic groups. PROSPERO CRD42014007625.
Magee L.,Health Level |
Hale L.,Health Level
Sleep Medicine Reviews | Year: 2012
Objective: To systematically examine the relationship between sleep duration and subsequent weight gain in observational longitudinal human studies. Methods: Systematic review of twenty longitudinal studies published from 2004-October 31, 2010. Results: While adult studies (. n = 13) reported inconsistent results on the relationship between sleep duration and subsequent weight gain, studies with children (. n = 7) more consistently reported a positive relationship between short sleep duration and weight gain. Conclusion: While shorter sleep duration consistently predicts subsequent weight gain in children, the relationship is not clear in adults. We discuss possible limitations of the current studies: 1) the diminishing association between short sleep duration on weight gain over time after transition to short sleep, 2) lack of inclusion of appropriate confounding, mediating, and moderating variables (i.e., sleep complaints and sedentary behavior), and 3) measurement issues. © 2011 Elsevier Ltd.
Thromboembolism in pregnancy: Challenges and controversies in the prevention of pregnancy-associated venous thromboembolism and management of anticoagulation in women with mechanical prosthetic heart valves
McLintock C.,Health Level
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2014
Thromboembolism in pregnancy is an important clinical issue. Despite identification of maternal and pregnancy-specific risk factors for development of pregnancy-associated venous thromboembolism, limited data are available to inform on optimal approaches for prevention. The relatively low overall prevalence of pregnancy-associated venous thromboembolism has prompted debate about the validity of recommendations, which are mainly based on expert opinion, and have resulted in an increased use of pharmacological thromboprophylaxis in pregnancy and postpartum. A pragmatic approach is required in the absence of more robust data. Anticoagulation management of pregnant women with mechanical prosthetic heart valves is particularly challenging. Continuation of therapeutic anticoagulation during pregnancy is essential to prevent valve thrombosis. Warfarin, the most effective anticoagulant, is associated with adverse fetal outcomes, including embryopathy and stillbirth. Fetal outcome is improved with therapeutic-dose low-molecular-weight heparin, but there may be more thromboembolic complications. More intensive anticoagulation, targeting higher trough anti-Xa levels, may reduce the risk of valve thrombosis. © 2014 Elsevier Ltd. All rights reserved.
Dowson N.,Health Level |
Salvado O.,Health Level
IEEE Transactions on Pattern Analysis and Machine Intelligence | Year: 2011
Denoising algorithms can alleviate the trade-off between noise-level and acquisition time that still exists for certain image types. Nonlocal means, a recently proposed technique, outperforms other methods in removing noise while retaining image structure, albeit at prohibitive computational cost. Modifications have been proposed to reduce the cost, but the method is still too slow for practical filtering of 3D images. This paper proposes a hashed approach to explicitly represent two summed frequency (hash) functions of local descriptors (patches), utilizing all available image data. Unlike other approaches, the hash spaces are discretized on a regular grid, so primarily linear operations are used. The large memory requirements are overcome by recursing the hash spaces. Additional speed gains are obtained by using a marginal linear interpolation method. Careful choice of the patch features results in high computational efficiency, at similar accuracies. The proposed approach can filter a 3D image in less than a minute versus 15 minutes to 3 hours for existing nonlocal means methods. © 2011 IEEE.