Academic literature on the topic 'Patient Centric Agent'
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Journal articles on the topic "Patient Centric Agent"
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Uddin, Md Ashraf, Andrew Stranieri, Iqbal Gondal, and Venki Balasubramanian. "Continuous Patient Monitoring With a Patient Centric Agent: A Block Architecture." IEEE Access 6 (2018): 32700–32726. http://dx.doi.org/10.1109/access.2018.2846779.
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Munavalli, Jyoti R., Shyam Vasudeva Rao, Aravind Srinivasan, and GG van Merode. "Integral patient scheduling in outpatient clinics under demand uncertainty to minimize patient waiting times." Health Informatics Journal 26, no. 1 (March 8, 2019): 435–48. http://dx.doi.org/10.1177/1460458219832044.
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This study addressed the problem of scheduling walk-in patients in real time. Outpatient clinics encounter uncertainty in patient demand. In addition, the disparate departments are locally (department-centric) organized, leading to prolonged waiting times for patients. The proposed integral patient scheduling model incorporates the status and information of all departments in the outpatient clinic along with all possible pathways to direct patients, on their arrival, to the optimal path. The developed hybrid ant agent algorithm identifies the optimal path to reduce the patient waiting time and cycle time (time from registration to exit). An outpatient clinic in Aravind Eye Hospital, Madurai, has a huge volume of walk-in patients and was selected for this study. The simulation study was performed for diverse scenarios followed by implementation study. The results indicate that integral patient scheduling reduced waiting time significantly. The path optimization in real time makes scheduling effective and efficient as it captures the changes in the outpatient clinic instantly.
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Calvaresi, Davide, and Jean-Paul Calbimonte. "Real-Time Compliant Stream Processing Agents for Physical Rehabilitation." Sensors 20, no. 3 (January 29, 2020): 746. http://dx.doi.org/10.3390/s20030746.
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Digital rehabilitation is a novel concept that integrates state-of-the-art technologies for motion sensing and monitoring, with personalized patient-centric methodologies emerging from the field of physiotherapy. Thanks to the advances in wearable and portable sensing technologies, it is possible to provide patients with accurate monitoring devices, which simplifies the tracking of performance and effectiveness of physical exercises and treatments. Employing these approaches in everyday practice has enormous potential. Besides facilitating and improving the quality of care provided by physiotherapists, the usage of these technologies also promotes the personalization of treatments, thanks to data analytics and patient profiling (e.g., performance and behavior). However, achieving such goals implies tackling both technical and methodological challenges. In particular, (i) the capability of undertaking autonomous behaviors must comply with strict real-time constraints (e.g., scheduling, communication, and negotiation), (ii) plug-and-play sensors must seamlessly manage data and functional heterogeneity, and finally (iii) multi-device coordination must enable flexible and scalable sensor interactions. Beyond traditional top-down and best-effort solutions, unsuitable for safety-critical scenarios, we propose a novel approach for decentralized real-time compliant semantic agents. In particular, these agents can autonomously coordinate with each other, schedule sensing and data delivery tasks (complying with strict real-time constraints), while relying on ontology-based models to cope with data heterogeneity. Moreover, we present a model that represents sensors as autonomous agents able to schedule tasks and ensure interactions and negotiations compliant with strict timing constraints. Furthermore, to show the feasibility of the proposal, we present a practical study on upper and lower-limb digital rehabilitation scenarios, simulated on the MAXIM-GPRT environment for real-time compliance. Finally, we conduct an extensive evaluation of the implementation of the stream processing multi-agent architecture, which relies on existing RDF stream processing engines.
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Dotan, Efrat, Tianyu Li, Michael J. Hall, Neal J. Meropol, Robert J. Beck, and Yu-Ning Wong. "De-adoption of epidermal growth factor receptor (EGFR) inhibitors following recommendations for KRAS testing to guide treatment of metastatic colorectal cancer (mCRC)." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 191. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.191.
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191 Background: KRAS mutation status is a predictive biomarker for resistance to EGFR antibodies among mCRC pts, and is recommended for use by ASCO and the FDA. Little is known about the uptake of clinical recommendations in oncology practice. We sought to study the effect of ASCO and FDA guidelines on the use of EGFR antibodies among a commercially insured population. Methods: The LifeLink Health Plan Claims Database (formerly the PharMetrics Patient-Centric Database) was used to create a cohort of >18 yo mCRC pts treated between 2004-2010. We identified treatment and diagnosis using ICD-9 or HCPCS (J) codes. We defined 1st-line therapy as any chemotherapy +/- bevacizumab given after the pt had a claim for mCRC, excluding pts treated with EGFR antibodies in the 1st line. 2nd-line therapy was defined as the initiation of a new chemotherapy agent (irinotecan/oxaliplatin) +/- EGFR antibody. We examined pts in two-month time intervals and calculated the fraction of pts in each interval who received EGFR antibody at any point beyond their 1st-line treatment. Chi 2 tests were used to compare treatment rates at the time points shown in the Table. Results: 5,099 pts received 2nd-line therapy of which 2,603 pts received an EGFR antibody. Median age was 61 years, with 57% males. 59% received an EGFR antibody as a single agent. The remainder received this in combination with one or more of the following agents: fluorouracil 13.5%, irinotecan 36.7%, oxaliplatin 3.9%, and bevacizumab 6.1%. Rates of EGFR antibody use are outlined in the Table. Conclusions: The utilization of EGFR antibodies for mCRC treatment decreased following the presentation of clinical trial data, publication of ASCO guidelines and FDA label change. These data suggest that oncologists respond rapidly to new evidence and professional guidelines, and readily accept the use of predictive biomarkers in clinical practice. [Table: see text]
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Dotan, Efrat, Tianyu Li, Michael J. Hall, Neal J. Meropol, Robert J. Beck, and Yu-Ning Wong. "De-adoption of epidermal growth factor receptor (EGFR) inhibitors following recommendations for KRAS testing to guide treatment of metastatic colorectal cancer (mCRC)." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e14021-e14021. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e14021.
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e14021 Background: KRAS mutation status is a predictive biomarker for resistance to EGFR antibodies among mCRC pts, and is recommended for use by ASCO and the FDA. Little is known about the uptake of clinical recommendations in oncology practice. We sought to study the effect of ASCO and FDA guidelines on the use of EGFR antibodies among a commercially insured population. Methods: The LifeLink Health Plan Claims Database (formerly the PharMetrics Patient-Centric Database) was used to create a cohort of >18 yo mCRC pts treated between 2004-2010. We identified treatment and diagnosis using ICD-9 or HCPCS (J) codes. We defined 1st line therapy as any chemotherapy +/- bevacizumab given after the pt had a claim for mCRC, excluding pts treated with EGFR antibodies in the 1st line. 2nd line therapy was defined as the initiation of a new chemotherapy agent (irinotecan/oxaliplatin) +/- EGFR antibody. We examined pts in two-month time intervals and calculated the fraction of pts in each interval who received EGFR antibody at any point beyond their 1st line treatment. Chi2 tests were used to compare treatment rates at the time points shown in the Table. Results: 5099 pts received 2nd line therapy of which 2603 pts received an EGFR antibody. Median age was 61 years, with 57% males. 59% received an EGFR antibody as a single agent. The remainder received this in combination with one or more of the following agents: fluorouracil 13.5%, irinotecan 36.7%, oxaliplatin 3.9%, and bevacizumab 6.1%. Rates of EGFR antibody use are outlined in the Table. Conclusions: The utilization of EGFR antibodies for mCRC treatment decreased following the presentation of clinical trial data, publication of ASCO guidelines and FDA label change. These data suggest that oncologists respond rapidly to new evidence and professional guidelines, and readily accept the use of predictive biomarkers in clinical practice. [Table: see text]
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Levi, Jelena, Timothy Perk, Lyna Huynh, Juliet Packiasamy, Serena Cheng, John Sunwoo, and A. Dimitrios Colevas. "45 AI-assisted whole-body assessment of immunotherapy response using [18F]F-AraG, a PET agent for activated T cells." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A52. http://dx.doi.org/10.1136/jitc-2021-sitc2021.045.
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BackgroundPatterns of response to immunotherapy differ from traditional cytotoxic drugs, making clinical decisions concerning response evaluation more challenging. Radiological response criteria, such as iRECIST, updated to address response patterns unique to immunotherapeutics, focus only on changes in the tumor burden.1 An 18F labeled nucleoside analog, [18F]F-AraG was developed as a PET agent for imaging activated T cells,2–5 critical components of immune response and the common target of immunotherapies. Whole body assessment of [18F]F-AraG uptake that indicates presence of activated T cells might allow for analysis of complex immunologic processes and provide early indication of treatment response as well as off-target side effects. Here, we employ AIQ Solutions’ TRAQinform IQ software to analyze [18F]F-AraG scans and assess activation of T cells in head and neck squamous cell carcinoma (HNSCC) patients undergoing anti-PD-1 therapy.MethodsFour treatment-naïve HNSCC patients were imaged using [18F]F-AraG before and 2–3 weeks after a single dose of anti-PD-1 antibody. [18F]F-AraG PET scans of six healthy subjects were used to define areas of increased [18F]F-AraG uptake in patients. The regions of uptake in the baseline and on-treatment scans were registered and matched using articulated registration.6 7 Standardized uptake values, SUVmax, SUVmean and SUVtotal were extracted from all areas of tracer uptake in both scans and changes in signal calculated to assess therapy effects. The change in signal was analyzed in the context of the patient‘s clinical status and changes in T cell infiltration in the primary lesion when biopsy specimens were available.ResultsTRAQinform IQ whole body evaluation of [18F]F-AraG PET revealed heterogeneity in the signal range and extent of signal change both between different patients and between different areas of tracer uptake within the same patient (figure 1). The post-therapy whole-body [18F]F-AraG signal change trended with patients‘ outcome. The patients with areas where the signal disappeared or decreased post therapy, indicative of the lack of T cell activation, had shorter overall survival than the patients with areas with stable and increasing signal. The change in infiltration of activated T cells in the primary lesion tissue did not correspond to the patient survival, reflecting limitations of serial biopsy in evaluating therapy response.Abstract 45 Figure 1TRAQinform IQ assessment of the SUVmean [18F]F-AraG signal change in a HNSCC patient two weeks after a single dose of anti-PD-1 antibody. Quantification of the differences in the [18F]F-AraG uptake in the baseline and on-treatment scan revealed 17 hotspots with disappearing or decreasing signal, 22 hotpots with the stable signal and 11 hotspots with increasing or new signal post therapy.ConclusionsTRAQinform IQ analysis and quantification of [18F]F-AraG PET provides patient-level assessment of tracer uptake and may allow for better understanding of heterogeneity of T cell activation and potentially offer a more comprehensive evaluation of response to immunotherapy than the standard, tumor-centric, radiologic methods.ReferencesNishino M, et al. Monitoring immune-checkpoint blockade: response evaluation and biomarker development. Nat Rev Clin Oncol, 2017.Namavari M, et al. Synthesis of 2’-deoxy-2’-[18F]fluoro-9-beta-D-arabinofuranosylguanine: a novel agent for imaging T-cell activation with PET. Mol Imaging Biol 2011; 13(5):812–8.Ronald JA, et al. A PET imaging strategy to visualize activated T cells in acute graft-versus-host disease elicited by allogenic hematopoietic cell transplant. Cancer Res 2017; 77(11):2893–2902.Levi J, et al. Imaging of activated T cells as an early predictor of immune response to anti-PD-1 Therapy. Cancer Research 2019; 79(13):3455–3465.Levi J, et al. (18)F-AraG PET for CD8 profiling of tumors and assessment of immunomodulation by chemotherapy. J Nucl Med 2021; 62(6):802–807.Yip S, T Perk, and R Jeraj, Development and evaluation of an articulated registration algorithm for human skeleton registration. Phys Med Biol 2014; 59(6):1485–99.Yip S. and R Jeraj. Use of articulated registration for response assessment of individual metastatic bone lesions. Phys Med Biol 2014; 59(6): 1501–14.Ethics ApprovalThe study was approved by Stanford University Ethics Board, approval number 40425.
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Feinberg, Bruce A., Richard Sweat, Yolaine Jeune-Smith, and Ajeet Gajra. "Potential of 2018 ASH CLL Data to Alter Standard of Care for Initial CLL Treatment." Blood 134, Supplement_1 (November 13, 2019): 5816. http://dx.doi.org/10.1182/blood-2019-129029.
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Introduction In the past 5 years, four drugs have received approval for the treatment of Chronic lymphocytic leukemia (CLL), with most of the data supporting their approvals presented at an ASH meeting. How treating hematologists and oncologists (H/O) incorporate these agents into their practice has implications for all stakeholders. We conducted market research with H/O to understand how CLL data presented at ASH 2018 might alter their treatment preferences. Methods A live meeting in February 2019 convened H/O. The participants were shown data from selected oral and/or poster presentations from the 2018 ASH Annual Meeting and responded to questions regarding their perceptions on the data and its potential impact on current practice. The presentations used included the following: 1) Alliance A041202: a phase III, randomized study in older patients with untreated CLL comparing ibrutinib ± rituximab with bendamustine + rituximab (BR) (Woyach JA, et al. Blood. 2018;132[Suppl 1]:6); and 2) E1912: a phase III, randomized study in younger patients with untreated CLL comparing ibrutinib + rituximab with fludarabine + cyclophosphamide + rituximab (FCR) (Shanafelt TD, et al. Blood. 2018;132[Suppl 1]:LBA-4). Participants submitted their demographic responses via a web-based survey and data impression responses via an audience response system at the live meeting. Results 59 H/O participated in this live market research on February 22-23, 2019 and identified their primary specialty as 61% hematologist/oncologist and 34% medical oncologist. The participants were mostly community-based physicians, 50% in private community and 45% in community practices owned by a hospital or academic center. Over one-third have been in practice >20 years and see an average of 20+ patients per day. In the prior 3 months, 31%, 27%, and 18% of the participants initiated first-line treatment on 1, 2, or 3 CLL patients, respectively. The most commonly preferred first-line treatments for CLL patients ≥65 years without del(17p) were: BR (38%), ibrutinib (34%), anti-CD20 monotherapy (17%), and FCR (7%). Based on the results of the Alliance A041202 trial, 88% are likely to use single-agent ibrutinib as their preferred first-line therapy for older CLL patients, 45% very likely and 43% moderately likely. The most commonly preferred first-line treatments for CLL patients <65 years without del(17p) were: FCR (37%), BR (30%), ibrutinib (18%), and ibrutinib + anti-CD20 monotherapy (13%). Based on the results of the E1912 trial, the participants are likely to adopt ibrutinib + CD20 monoclonal antibody (51%), single-agent ibrutinib (20%), FCR (16%), or BR (13%) as their preferred first-line therapy for younger CLL patients. Conclusion Studies of newer mechanism of action drugs like Bruton's tyrosine kinase (BTK) inhibitors are perceived as compelling by treating oncologists and appear likely to replace more traditional chemotherapy-based regimens. The clinical, financial, and patient-centric outcomes of such rapid changes to standard of practice warrant further research. Disclosures Feinberg: Cardinal Health: Employment. Sweat:Cardinal Health: Employment. Jeune-Smith:Cardinal Health: Employment. Gajra:Cardinal Health: Employment.
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Lassau, Nathalie, Serge Koscielny, Sophie Taieb, Joelle Lacroix, Richard Aziza, Florence Joly, Christine Chevreau, Sylvie Negrier, Gwenaelle Gravis, and Bernard J. Escudier. "Validation of imaging biomarker in a multicentric study to predict PFS in mRCC treated with TKI." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 526. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.526.
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526 Background: Tyrosine kinase inhibitors including sunitinib are the most effective treatments of metastatic renal cell carcinoma (mRCC). A multi-centric study of 539 patients (different tumors treated anti-angiogenic treatments) evaluating dynamic contrast-enhanced ultrasound (DCE-US), showed that a decrease of AUC (Area under the curve) correlated to the blood volume at one month is predictive of response. Our first objective was to validate the correlation between this parameter and the PFS in a sub-group of mRCC treated with Sunitinib The second objective was to study the variability of AUC. Methods: Each Patient had CT-scan every 2 months in order to evaluate the Response assessment using the Response Evaluation Criteria in Solid Tumors (RECIST 1.1).DCE-US were performed at baseline and at D30. At each examination, we quantified 7 DCE-US parameters after bolus injection of contrast agent and mathematical modelization of raw linear data recorded during 3 minutes. We also estimated the variation between baseline and D30. The main endpoint was progression free survival assessed according to RECIST. We first selected the best parameters. We studied the trend between the parameter value and freedom from progression. After, the best cut-points were searched through a grid search. The best single cut-point was that with the lowest P-value for progression free survival. We performed this analysis in the sub-group of patients with mRCC treated with sunitinib. Morever, we studied the variability of AUC in 30 other patients treated with TKI . We performed in this group 2 DCE-US the same day before and after lunch. Results: A total of 81 mRCC patients treated with sunitinib were selected. All had DCE-US at baseline and one month. The median of follow-up was 18 months. For DCE-US, the decrease of 90 % of AUC at D 30 was correlated to the PFS (p =0.03). The difference of PFS between the groups defined by this cut-point was 4 months (bad responders) and 14 months (good responders). The results of variability are on-going. Conclusions: The decrease of more than 90% of AUC with DCE-US at one month is a potential predictive biomarker of response in mRCC patients treated with sunitinib. The results of variability of this parameter will be also presented. Clinical trial information: no. 912346.
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Roberts, Holly, Karthik Ravi, Cassie Kline, Sabine Mueller, Carl Johannes Koschmann, Bernard Marini, and Andrea Franson. "Targeted agents recommended by the CNS TAP tool compared to those selected by a tumor board in a molecularly-driven clinical trial in children and young adults with DIPG." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 2048. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.2048.
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2048 Background: Genetic sequencing of diffuse intrinsic pontine glioma (DIPG) and diffuse midline glioma (DMG) biopsy specimens has revealed genomic heterogeneity, fueling an interest in individualized, targeted treatment options. The Pacific Pediatric Neuro-Oncology Consortium recently completed a feasibility study PNOC003: Molecular Profiling for Individualized Treatment Plan for DIPG (NCT02274987), in which a multidisciplinary tumor board recommended targeted agents based on the molecular and genetic profiling of each patient’s tumor. Separately, our group developed a numeric scoring tool of targeted anticancer agents, the Central Nervous System Targeted Agent Prediction (CNS TAP) tool, which combines pre-clinical, clinical, and CNS penetration data with patient-specific genomic information to generate a numeric score for each agent to objectively evaluate these targeted therapies for use in patients with CNS tumors. We hypothesized that highly-scored agents within the CNS-TAP tool would overlap, at least in part, with the agents recommended by the molecular tumor board in PNOC003. Methods: For each study participant (n=28), a retrospective analysis was completed, utilizing the genomic report to identify actionable genetic alterations and to input patient-specific data into CNS TAP to identify the highest scoring agents. We compared high-scoring agents within the CNS TAP tool with recommendations from the PNOC003 tumor board for each of the enrolled 28 patients. Results: Overall, 93% (26/28) of patients had at least one agent recommended by both the tumor board and CNS TAP. Additionally, 39% (37/95) of all agents recommended by the tumor board were also selected by CNS TAP, with additional analysis ongoing. Conclusions: There was significant overlap between the highest-scoring and selected agents via CNS TAP compared with those chose by the molecular tumor board. Through this work, we also identified factors that likely contributed to the discordance in choice of targeted therapies. Without clinician input, the CNS TAP tool is unable to account for drug-drug interactions, includes only designated anticancer agents, and cannot easily be updated in real time, requiring extensive manual literature review for each included agent. However, CNS TAP provides an objective evaluation of targeted therapies, in contrast to inherently subjective recommendations of a tumor board. Given the discordance identified between these methods and the strengths of each, a prospective study incorporating both CNS TAP and a molecular tumor board for targeted therapy selection in patients with high grade glioma is warranted.
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Yılmaz, Fatih, Havva Kaya, and Mehmet Özdemir. "Investigation of Children with Acute Gastroenteritis by Multiplex PCR Method in Central Part of Turkey." Journal of Pediatric Infectious Diseases 17, no. 01 (January 2022): 048–52. http://dx.doi.org/10.1055/s-0041-1740372.
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Abstract Objective Gastroenteritis is a disease that affects all age groups, especially children, and causes high mortality and morbidity in all countries. The most common agents of acute gastroenteritis are viral agents. As a result, millions of diarrhea attacks and hospital admissions occur worldwide every year due to viral gastroenteritis. This study uses the multiplex polymerase chain reaction (PCR) method to investigate the viruses that are the causative agents of viral gastroenteritis in the pediatric patient group in Konya, Turkey. Methods Stool samples of 94 patients aged 0 to 18 years sent from Emergency clinics and Pediatric outpatient clinics, Meram Medical Faculty Hospital Pediatric clinics, Konya Necmettin Erbakan University to Medical Microbiology Laboratory with a diagnosis of gastroenteritis between February and December 2018 were included in the study. Stool samples were stored at –80°C until the time of the analysis. Deoxyribonucleic acid/ribonucleic acid isolation from stool samples was performed with EZ1 Virus Mini Kit v2.0 (Qiagen, Hilden, Germany) using an automatic extraction system (BioRobot EZ1 system, Qiagen). The presence of astrovirus, rotavirus, adenovirus, norovirus (GI, GII), and sapovirus agents was investigated by the multiplex PCR method (Fast Track Diagnostics, Luxembourg) viral gastroenteritis kit. Results Viral gastroenteritis agents were detected in 56.3% of the patients. One viral agent was detected in 47 (50%) of these patients and at least two viral agents in 6 (6.3%) of them. Norovirus GII was detected in 20 (21.2%) of the children included in the study, adenovirus in 13 (13.8%), rotavirus in 11 (12.8%), astrovirus in 11 (11.7%), sapovirus in 4 (4.2%), and norovirus GI in 1 (1.06%). When the distribution of viral agents was examined by months, the most number of agents were observed (21; 35%) in May, followed by April and June (12; 20%). Considering the distribution of the prevalence of the agents by age, it was seen to be mainly between 0 and 12 months (42%). Conclusion Considering that the most common viral agent in our region is norovirus GII, it will be useful to investigate the norovirus that is not routinely examined in children who are admitted to clinics with the complaint of gastroenteritis. It will be appropriate to examine routinely adenovirus, rotavirus, and norovirus in the laboratory, especially in children with diarrhea and vomiting in the winter and spring months.
Dissertations / Theses on the topic "Patient Centric Agent"
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Uddin, Md Ashraf. "A patient agent controlled customized blockchain based framework for internet of things." Thesis, Federation University Australia, 2021. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/177119.
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Although Blockchain implementations have emerged as revolutionary technologies for various industrial applications including cryptocurrencies, they have not been widely deployed to store data streaming from sensors to remote servers in architectures known as Internet of Things. New Blockchain for the Internet of Things models promise secure solutions for eHealth, smart cities, and other applications. These models pave the way for continuous monitoring of patient’s physiological signs with wearable sensors to augment traditional medical practice without recourse to storing data with a trusted authority. However, existing Blockchain algorithms cannot accommodate the huge volumes, security, and privacy requirements of health data. In this thesis, our first contribution is an End-to-End secure eHealth architecture that introduces an intelligent Patient Centric Agent. The Patient Centric Agent executing on dedicated hardware manages the storage and access of streams of sensors generated health data, into a customized Blockchain and other less secure repositories. As IoT devices cannot host Blockchain technology due to their limited memory, power, and computational resources, the Patient Centric Agent coordinates and communicates with a private customized Blockchain on behalf of the wearable devices. While the adoption of a Patient Centric Agent offers solutions for addressing continuous monitoring of patients’ health, dealing with storage, data privacy and network security issues, the architecture is vulnerable to Denial of Services(DoS) and single point of failure attacks. To address this issue, we advance a second contribution; a decentralised eHealth system in which the Patient Centric Agent is replicated at three levels: Sensing Layer, NEAR Processing Layer and FAR Processing Layer. The functionalities of the Patient Centric Agent are customized to manage the tasks of the three levels. Simulations confirm protection of the architecture against DoS attacks. Few patients require all their health data to be stored in Blockchain repositories but instead need to select an appropriate storage medium for each chunk of data by matching their personal needs and preferences with features of candidate storage mediums. Motivated by this context, we advance third contribution; a recommendation model for health data storage that can accommodate patient preferences and make storage decisions rapidly, in real-time, even with streamed data. The mapping between health data features and characteristics of each repository is learned using machine learning. The Blockchain’s capacity to make transactions and store records without central oversight enables its application for IoT networks outside health such as underwater IoT networks where the unattended nature of the nodes threatens their security and privacy. However, underwater IoT differs from ground IoT as acoustics signals are the communication media leading to high propagation delays, high error rates exacerbated by turbulent water currents. Our fourth contribution is a customized Blockchain leveraged framework with the model of Patient-Centric Agent renamed as Smart Agent for securely monitoring underwater IoT. Finally, the smart Agent has been investigated in developing an IoT smart home or cities monitoring framework. The key algorithms underpinning to each contribution have been implemented and analysed using simulators.Doctor of Philosophy
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Castiblanco, Claudia Patricia Munoz. "Visual acuity and central macular thickness in patients treated with anti-angiogenic agents for age-related macular degeneration." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-11212008-115007/.
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Mugomeri, Eltony. "The effect of tenofovir on renal function and immunological response in HIV-positive patients in Lesotho." Thesis, Bloemfontein : Central University of Technology, Free State, 2013. http://hdl.handle.net/11462/206.
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Thesis (M. Tech. (Biomedical technology)) - Central University of technology, Free State, 2013INTRODUCTION: The renal effects of Tenofovir Disoproxil Fumarate (TDF) and antiretroviral treatment (ART) outcomes remain under-reported in African settings. The study sought to assess immunological outcomes and to compare renal function outcomes between patients exposed to TDF and unexposed patient group. METHODS: Phase 1 of the study was a retrospective case control analysis of serum creatinine data for 312 ART naïve adult patients exposed to TDF and 173 unexposed patients enrolled on ART between Dec 2006 and Jan 2011 at Roma Health Service Area in Lesotho. Sub-optimal renal function outcomes were serum creatinine clearance values <50 ml/min calculated using the Cockcroft-Gault equation. Phase 2 was based on re-sampling of the study population and analysis of CD4 counts of 516 adult naïve HIV-positive patients. Univariate logistic regression (p<0.1) and multivariate analyses (p<0.05) were performed using STATA® version 11 software. RESULTS: Overall, 153 (31.5%) patients had moderate baseline (30-60 ml/min) renal insufficiency. Renal function improved by +2 ml/min at 24 months. Almost 18% (n=312) of the patients on TDF were erroneously put on TDF. The use of TDF was a marginally significant factor (p=0.054) associated with CrCl<50 ml/min outcomes in univariate analysis but was insignificant (p=0.122) in multivariate analysis. Female gender (p=0.016), high blood pressure (p=0.009), ages over 60 (p=0.004), and underweight (p<0.001) were significantly associated with CrCl<50 ml/min outcomes. The proportion of patients who developed immunological failure in this study was low (6.8%, n=516). The mean CD4 count increased significantly after treatment (p<0.001). Baseline CD4 count below 50 cells/mm3 (p=0.049) and male gender (p=0.005) were significantly associated with sub-optimal immunological outcomes. CONCLUSIONS: TDF is a weak contributing factor associated with renal impairment outcomes compared to other variables such as hypertension, older age, underweight and female gender. More research on long term effects of TDF is recommended. Baseline renal function screening should be improved to minimise leakages of patients contraindicated of TDF. Although the patients’ immunological status generally improved, males and patients with low baseline CD4 counts should be monitored closely while on ART.
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Haque, Monirul. "Barriers to initiating insulin therapy for patients with poorly controlled type 2 diabetes mellitus on maximum dose of oral agents in public sector primary health care centres in Cape Town, South Africa." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/9374.
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Includes bibliographical references.Most patients with type 2 diabetes in Cape Town are attending at primary care community health centers (CHCS) and have unsatisfactory glycaemic control. Insulin therapy is indicated in patients with type 2 diabetes, with inadequate metabolic control on maximum oral therapy. Insulin can be initiated in these CHCs.
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Lekubu, Gloria Stephinah Sebaetseng. "Exploring the experiences of adult offenders living with HIV on pre-antiretroviral therapy program at the Losperfontein Correctional Centre." Diss., 2016. http://hdl.handle.net/10500/22274.
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Text in EnglishThe aim of the study was to explore the experiences of adult offenders living with HIV (OLWHIV) not qualifying for antiretroviral therapy (ART). Such offenders are put on the pre-antiretroviral therapy (pre-ART) program after HIV diagnosis. Follow up of OLWHIV is done every six months to ensure prompt treatment. Research objectives include exploration of experiences of OLWHIV on the pre-ART program, the accessibility of the program and the challenges thereof. An exploratory, qualitative study with face-to-face interviews was conducted. Purposive sampling of the eight participants was done to conduct the study. Seven out of eight participants accessed the pre-ART program well but had little knowledge of the pre-ART program. Furthermore, participants experienced little support from partners and health care workers. The study showed institutional constraints such as poor diet, shortage of staff and humiliation from Correctional officers. Participants portrayed commitment in the support group irrespective of the challenges experienced. The study further showed that the self-care theory could enhance the pre-ART program but that institutional constraints deterred the progress. Participants made recommendations such as strengthening of partnerships for support groups, good diet, and an increase of staff capacity. Overall study recommendations include implementation of universal test and treat and mixed methods for future studies.
Sociology
M.A. (Social Behaviour Studies in HIV/AIDS)
Books on the topic "Patient Centric Agent"
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Kelly, John. Principles of CNS drug development: From test tube to patient. Chichester, West Sussex: J. Wiley, 2009.
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Kelly, John. Principles of CNS drug development: From test tube to patient. Chichester, UK: Wiley-Blackwell, 2009.
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Principles of CNS drug development: From test tube to patient. Chichester, West Sussex: J. Wiley, 2009.
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Sullivan MD, PhD, Mark. From Patient to Agent. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780195386585.001.0001.
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In the 21st century, the primary challenge for health care is chronic illness. To meet this challenge, we need to think anew about the role of the patient in health and health care. There have been widespread calls for patient-centered care, but this model of care does not question deeply enough the goals of health care, the nature of the clinical problem, and the definition of health itself. We must instead pursue patient-centered health, which is a health perceived and produced by patients. We should not only respect, but promote patient autonomy as an essential component of this health. Objective health measures cannot capture the burden of chronic illness, so we need to draw on the patient's perspective to help define the clinical problem. We require a new definition of health as the capacity for meaningful action. It is recognized that patients play a central role in chronic illness care, but the concept of health behavior retards innovation. We seek not just an activated patient, but an autonomous patient who sets and pursues her own vital goals. To fully enlist patients, we must bridge the gap between impersonal disease processes and personal processes. This requires understanding how the roots of patient autonomy lie in the biological autonomy that allows organisms to carve their biological niche. It is time for us to recognize the patient as the primary customer for health care and the primary producer of health. Patient agency is both the primary means and primary end of health care.
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Gill, Steven J., and Michael H. Nathanson. Central nervous system pathologies and anaesthesia. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0081.
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Anaesthesia induces changes in many organ systems within the body, though clearly none more so than the central nervous system. The physiology of the normal central nervous system is complex and the addition of chronic pathology and polypharmacy creates a significant challenge for the anaesthetist. This chapter demonstrates a common approach for the anaesthetist and specific considerations for a wide range of neurological conditions. Detailed preoperative assessment is essential to gain understanding of the current symptomatology and neurological deficit, including at times restrictions on movement and position. Some conditions may pose challenges relating to communication, capacity, and consent. As part of the consent process, patients may worry that an anaesthetic may aggravate or worsen their neurological disease. There is little evidence to support this understandable concern; however, the risks and benefits must be considered on an individual patient basis. The conduct of anaesthesia may involve a preference for general or regional anaesthesia and requires careful consideration of the pharmacological and physiological impact on the patient and their disease. Interactions between regular medications and anaesthetic drugs are common. Chronically denervated muscle may induce hyperkalaemia after administration of succinylcholine. Other patients may have an altered response to non-depolarizing agents, such as those suffering from myasthenia gravis. The most common neurological condition encountered is epilepsy. This requires consideration of the patient’s antiepileptic drugs, often relating to hepatic enzyme induction or less commonly inhibition and competition for protein binding, and the effect of the anaesthetic technique and drugs on the patient’s seizure risk. Postoperative care may need to take place in a high dependency unit, especially in those with limited preoperative reserve or markers of frailty, and where the gastrointestinal tract has been compromised, alternative routes of drug delivery need to be considered. Overall, patients with chronic neurological conditions require careful assessment and preparation, a considered technique with attention to detail, and often higher levels of care during their immediate postoperative period.
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Young, Raymond. Infection in the Patient with Sickle Cell Anemia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0060.
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This chapter provides a brief overview of the clinical manifestations of and management strategies for infectious complications in the immunocompromised sickle cell disease patient. The chapter discusses infections in various organ systems, including the respiratory tract, central nervous system, bone, hematopoietic cell lineage, and blood-borne infections. Differentiating infections from noninfectious processes that often have similar presentations in the sickle cell patient may at times be difficult, and clinicians managing sickle cell patients should be keenly aware of this fact. This chapter discusses the common bacterial pathogens associated with infection and a notable viral agent known to profoundly worsen anemia in the sickle cell host, parvovirus B19. Additionally, fundamental antimicrobial regimens and primary and secondary prophylactic strategies are included in this concise summary prepared for clinicians involved in the acute care management of the sickle cell patient.
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Walen, Alec D. The Mechanics of Claims and Permissible Killing in War. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190872045.001.0001.
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This book operates on two levels. On the more practical level, its overarching concern is to answer the question, When is it permissible to use lethal force to defend people against threats? The deeper concern of the book, however, is to lay out and defend a new account of rights, the mechanics of claims. This framework constructs rights from the premise that rights provide a normative space in which people can pursue their own ends while treating each other as free and equal fellow-agents whose welfare morally matters. According to the mechanics of claims, rights result from first weighing competing patient-claims on an agent, then determining if the agent has a strong enough agent-claim to act contrary to the balance of patient-claims on her, and then looking to see if special claims limit her freedom. The strength of claims in this framework reflects not just the interest in play but the nature of the claims. Threats who have no right to threaten have weaker claims not to be harmed than bystanders who might be harmed as a side effect, all else equal. With this model, a central problem in just war theory can be pushed to the margins: determining when people have forfeited their rights and are liable to harm. Threats may lack a right not to be killed even if they have done nothing to forfeit it.
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Mythen, Monty, and Michael P. W. Grocott. Peri-operative optimization of the high risk surgical patient. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0361.
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Flow-based cardiovascular variables, such as cardiac output and oxygen delivery predict peri-operative outcome better than alternative, predominantly pressure-based measures. Targeting flow-based goals, using fluid boluses with or without additional blood or vasoactive agents in patients undergoing major surgery has been shown to improve outcome in some studies. However, the literature is limited due to a large number of small single-centre studies, and heterogeneity of interventions and outcomes evaluated. Early studies used pulmonary artery catheters to monitor blood flow, but newer studies have used less invasive techniques, such as oesophageal Doppler monitoring or pulse contour analysis. Meta-analysis of the current evidence base suggests that this approach is unlikely to cause harm and may not reduce mortality, but reduces complications and duration of hospital stay. Goal-directed therapy is considered an important element of enhanced recovery packages that have been shown to improve outcome after several types of major elective surgery.
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Bleck, Thomas P. Assessment and management of seizures in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0232.
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In previously conscious patients seizures are usually easily detected. Critically-ill patients are frequently sedated and a proportion are paralysed with neuromuscular blocking agents, in such patients it may be hard or impossible to detect seizures clinically. An urgent electroencephalogram (EEG) should be obtained whenever seizures are witness or suspected, especially if the patient does not rapidly return to baseline, when non-convulsive status epilepticus must be excluded. Unless the cause of the seizure activity is already known, an urgent CT, or MRI is indicated. If central nervous system infection is suspected a lumbar puncture may be needed. Status epilepticus is diagnosed when there is recurrent or continued seizure activity without intervening recovery. Most seizures are self-limiting and stop after 1–2 minutes, seizures that continue for more than 5 minutes should be treated. Treatment priorities for any seizure are to stop the patient hurting either themselves or anyone else. General supportive measures include attention to the airway, breathing, circulation, exclusion of hypoglycaemia and an EEG to exclude non-convulsive status epilepticus. A variety of drugs can be used to terminate seizures; parenteral benzodiazepines are the most commonly used agents although propofol and barbiturates are alternatives. Emergent endotracheal intubation may well be necessary, hypotension can be expected and may need treatment with intravenous fluids and vasopressors.
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van Hooijdonk, Roosmarijn T. M., and Marcus J. Schultz. Insulin and oral anti-hyperglycaemic agents in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0050.
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Dysglycaemia is frequently seen in the intensive care unit (ICU). Hyperglycaemia, hypoglycaemia and glycaemic variability are all independently associated with mortality and morbidity in critically-ill patients. It is common practice to treat hypergycaemia in these patients, while at the same time preventing hypoglycaemia and glycaemic variability. Insulin infusion is preferred over oral anti–hyperglycaemic agents for glucose control in the ICU because of the highly unpredictable biological availability of oral anti-hyperglycaemic agents during critical illness. Many oral anti–hyperglycaemic agents are relatively contraindicated in critically-ill patients. Intravenously-administered insulin has a predictable effect on blood glucose levels, in particular because of its short half-life. Notably, effective and safe insulin titration requires frequent blood glucose measurements, a dedicated lumen of a central venous catheter for infusion of insulin, an accurate syringe pump, and trained nurses for delicate adoptions of the infusion rate. Insulin infusion increases the risk of hypoglycaemia, which should be prevented at all times. In addition, precautions should be taken against overcorrection of hypoglycaemia, using only small amounts of glucose. Whether glycaemic variability can be kept minimal is uncertain. Use of continuous glucose measuring devices has the potential to improve glycaemic control in critically-ill patients.
Book chapters on the topic "Patient Centric Agent"
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Gómez-Sebastià, Ignasi, Frank Dignum, Javier Vázquez-Salceda, and Ulises Cortés. "Modelling Patient-Centric Healthcare Using Socially Intelligent Systems: The AVICENA Experience." In Coordination, Organizations, Institutions, and Norms in Agent Systems XII, 22–41. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-66595-5_2.
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Ruan, Ji, Wendy MacCaull, and Heather Jewers. "Agent-Based Careflow for Patient-Centred Palliative Care." In Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, 285–94. Berlin, Heidelberg: Springer Berlin Heidelberg, 2011. http://dx.doi.org/10.1007/978-3-642-23635-8_36.
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Godly, Cinthia J., Venki Balasubramanian, Ram Srinivasan, and Bevish Y. Jinila. "Adaptation of Blockchain in Internet of Medical Things for Remote Patient Monitoring." In Artificial Intelligence for Smart Cities and Villages: Advanced Technologies, Development, and Challenges, 67–84. BENTHAM SCIENCE PUBLISHERS, 2022. http://dx.doi.org/10.2174/9789815049251122010007.
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IoT has been transforming the world of information significantly. It has allowed administration services without human interventions for a range of applications including healthcare with Remote Patient Monitoring (RPM). Blockchain is broadly utilized in IoT applications like smart health monitoring that provides privacy and security. Blockchain innovation presents freedom for the medical services industry, for example, reduced transaction costs, transparency for reporting regulatory entities, productive medical care information, privacy, confidentiality and universality of healthcare records. This chapter deals with the collaboration of blockchain innovation in IoT security in terms of the RPM framework. A Patient Centric Agent is used for end-to-end design for nonstop tolerant checking. The patient agent deals with a segment of blockchain to provide protection when streaming information from body area sensors that need to be securely stored and DQDO\]HG critical parts of blockchain to a wellbeing application network where patient's information can be utilized to make alarms that are essential to validate medical services suppliers in a protected way. This methodology is valuable as they assemble information for longer time frames. The access control manager stores and safely accesses information needed by the classifier during retraining progressively in realtime from an external data storage.
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Winocour, Peter, and Sagen Zac-Varghese. "Strategies for the Management of Type 2 Diabetes." In Oxford Textbook of Endocrinology and Diabetes 3e, edited by John A. H. Wass, Wiebke Arlt, and Robert K. Semple, 2045–52. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198870197.003.0259.
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The approach to the management of hyperglycaemia in type 2 diabetes has become increasingly complex with a widening armamentarium of available antihyperglycaemic agents. It is well recognized that several agents have additional benefits (outside of glucose control), for example, on weight management and on cardiovascular and renal outcomes. Recent cardiovascular outcome trial data has had an impact on treatment algorithms. This chapter looks at strategies for deploying the various agents. The initiation of therapy, intensification of therapy, and combination of agents is discussed. The choice of agent in particular circumstances, in cardiovascular disease, renal disease, and hepatic impairment is discussed. Successful management requires a patient-centred approach with careful consideration of the risks and benefits of the treatment options.
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Peng, Q., Q. Niu, Y. Xie, and T. ElMekkawy. "Operating Room Simulation and Agent-Based Optimization." In Multi-Agent Systems for Healthcare Simulation and Modeling, 69–89. IGI Global, 2010. http://dx.doi.org/10.4018/978-1-60566-772-0.ch005.
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Healthcare systems are characterized by uncertainty, variability, complexity, and human roles. Simulation can test scenarios of changes in processes, resources, and schedules without major physical investment or risk. Agent-based technology can model systems with autonomous and interacting activities. This chapter introduces the method of using simulation and agent-based technologies to enable a better understanding of the patient flow to improve the process performance in healthcare. The proposed method is used to identify the existing problem and to evaluate proposed solutions for the problem of the operating room (OR) at Winnipeg Health Sciences Centre. Issues are identified including patient flows, operation schedules, demand and capacity of the system and the configuration of resources required. An optimum scheduling is proposed for the OR operation to shorten the patient waiting time.
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Di Liso, Elisabetta. "Chemotherapy-Induced Nausea and Vomiting." In Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care [Working Title]. IntechOpen, 2021. http://dx.doi.org/10.5772/intechopen.96194.
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Chemotherapy-induced nausea and vomiting is a common adverse effect in cancer patients that not only impacts quality of life, but also treatment outcomes. The prevalence of nausea and vomiting is related to several factors, including the emetogenicity of the chemotherapy regimen, the dose and rate of administration of the chemotherapy agents, various environmental triggers and patient-related factors. The pathogenesis involves multiple organ systems, central nervous system, gastrointestinal tract and neurotransmitters. Clinical management should include a complete assessment of nausea and vomiting to investigate the possible etiology and the pharmacologic approach should involve agents that target each of these pathways and neurotransmitters. Various national guidelines provide recommendations for the prevention and management of CINV and combining these evidence-based strategies into clinical practice is crucial l to improve morbidity and quality-of-life outcomes among cancer patients.
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Miller, Aaron E., Tracy M. DeAngelis, Michelle Fabian, and Ilana Katz Sand. "A Case of Intractable Vomiting." In Neuroimmunology, 157–62. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190693190.003.0030.
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Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder affecting the central nervous system, with clinical, imaging, and laboratory characteristics that are distinct from multiple sclerosis. It presents most commonly with optic neuritis, myelitis, or an area postrema syndrome consisting of intractable nausea, vomiting, or hiccups. Most patients are positive for serum antibodies to aquaporin 4. Prompt treatment with corticosteroids and/or plasma exchange is critical for recovery, as is the initiation of disease-modifying therapy with an immunomodulatory agent to prevent future attacks. First-line disease-modifying therapies for NMOSD include rituximab, mycophenolate mofetil, and azathioprine. Several additional agents are used less commonly, and others are currently in clinical trials.
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Witham, Miles, Jacob George, and Denis O’Mahony. "Drugs and prescribing in the older patient." In Oxford Textbook of Medicine, edited by Finbarr C. Martin, 571–78. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0058.
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The use of pharmacological agents is often a central component of medical therapy for older people. Medications can relieve symptoms, improve function, and prevent illness, but they also have the capacity to inflict great harm. Older people are at particular risk of such harms as a result of impaired homeostatic reserve, of altered drug metabolism, the presence of multimorbidity and consequent polypharmacy, which increases both exposure to potentially harmful agents and the chance of drug–drug interactions. The therapeutic priorities for older, frail people may differ when compared to younger, robust patients; limited life expectancy means that attempts to prolong life may become relatively less important than the relief of symptoms and avoidance of side effects and medication burden.
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Staab, Jared. "Respiratory Acidosis in the Intensive Care Unit." In Cardiothoracic Critical Care, 73–84. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190082482.003.0007.
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This chapter explains that the interpretation of acid–base abnormalities is an essential skill required when caring for critically ill patients. The differential causes of respiratory acidosis include central nervous system depression, upper and lower airway obstruction, and hypermetabolic states with increased production of CO2, such as malignant hyperthermia and thyroid storm. The treatment for hypoxic and hypercarbic respiratory failure involves reversing the offending agents if applicable, treatment of the underlying cause, and mechanical ventilation. The 2 commonly used strategies for mechanical ventilation are non-invasive ventilation with a mask and endotracheal intubation. The selection of ventilation strategy is dependent on numerous patient factors. Clinicians must set respiratory rate, tidal volume, positive end-expiratory pressure, inspiratory flow, fraction of inspired oxygen, mode (volume versus pressure control), and the amount of assistance per breath. All need to be tailored toward each patient’s specific goals. In patients with severe acidosis, there may be a temptation to hyperventilate in order to treat the hypercarbia and hypoxia as quickly as possible. This can be deleterious as high tidal volumes may lead to ventilator-induced lung injury due to volutrauma, cytotrauma, and barotrauma.
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Ghaemi, S. Nassir. "Older Persons." In Clinical Psychopharmacology, edited by S. Nassir Ghaemi, 342–51. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199995486.003.0029.
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In the older patient population, some special considerations are entailed for clinical psychopharmacology. This age group can be defined as persons at age 70 and above, although some of these principles may apply to individuals in their 60s or even their 50s, if they are medically compromised or otherwise fragile physiologically. In treating older persons, these principles are relevant to the use of psychotropic medications. In such older patients, pharmacokinetic inefficiency and a more porous blood–brain barrier lead to increased sensitivity to central nervous system (CNS) effects of drugs. Fewer agents at lower doses are indicated. Vascular depression and dementia are major risks, but monoamine agonists have notable medical risks in most cases in older persons. Other agents may have symptomatic benefits, which need to be weighed against a range of increased risks.
Conference papers on the topic "Patient Centric Agent"
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Wadud, Md Anwar Hussen, T. M. Amir-Ul-Haque Bhuiyan, Md Ashraf Uddin, and Md Motiur Rahman. "A Patient Centric Agent Assisted Private Blockchain on Hyperledger Fabric for Managing Remote Patient Monitoring." In 2020 11th International Conference on Electrical and Computer Engineering (ICECE). IEEE, 2020. http://dx.doi.org/10.1109/icece51571.2020.9393124.
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Cleto, Isabela Virgílio, Guilherme Silva Guimarães, Leticia Poloni dos Santos, Carolina Miguel Nôga, and Leticia Moraes Aquino. "Health education in physiotherapy for spinocerebelar ataxia." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.546.
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Introduction: Ataxia is a symptom of several degenerative medical conditions; the most common in Brazil being Spinocerebelar ataxia (SCA). These patients have difficulty performing fine coordination motors activities, altered body balance and gait. The treatment is based on multidisciplinar rehabilitation, to improve quality of life and mantain general health. Health education (HE) can benefit these patients, but there are few reports about it, especially in SCA patients. Objectives: To search the literature for evidence of the use of HE in phyisiotherapy for SCA patients in Brazil. Design and settings: Study carried out at Centro Universitario São Camilo. Methodology: Literature review in the databases: Scielo, UNIFESP and LILACS, Key words: “SCA”, ”rehabilitation”, “HE” and “physiotherapy”, in Portuguese, English or Spanish . Results: 27 articles were found, of which 16 were eligible. Studies demonstrates the need for more evidence for HE to be part of the physiotherapist’s routine, encouraging the participation and autonomy of the patient and family in the rehabilitation process. It is possible to develop educational materials that complement the health guidelines for these patients. Conclusion: There is a literary gap about the direct role of the physiotherapist as a HE agent, with responsibilities beyond rehabilitation; within the scope of prevention, health promotion and self-management of the patient and family.
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"PATIENT-CENTRED LABORATORY VALIDATION USING SOFTWARE AGENTS." In International Conference on Health Informatics. SciTePress - Science and and Technology Publications, 2008. http://dx.doi.org/10.5220/0001036302740279.
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Miyahira, Clara Kimie, and Vania Maria Sabadoto Brienze. "Comparative analysis between the profile of cerebrospinal liquid (CSF) and clinical evolution in patients with bacterial meningitis." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.023.
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Background: Bacterial meningitis is a serious infection that occurs in the Central Nervous System, which presents important morbidity and mortality, mainly in children. The main bacterial agents causing meningitis in the community are Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae. Specific signs and symptoms suggest meningitis and cerebrospinal fluid analysis is the main exam leading to diagnosis. Objectives: To analyze the behavior of cerebrospinal fluid during the evolution of the patient with bacterial meningitis. Methods: A retrospective study revised the medical records of patients with bacterial meningitis confirmed by cerebrospinal fluid examination in the Base Hospital of São José do Rio Preto from January 1996 to December 2002. Results: in the 63 Patients, there were 18 cases (28.6%) of S. pneumoniae, 20 cases (31.7%) of H. influenzae, 12 cases (19%) of N.meningitides B and 13 (20.6%) cases of N. meningitidis C. In the 18 patients with pneumococcus, 10 (55.6%) were discharged and 8 (44.4%) died. In the 20 patients with HIB, only 3 (15%) died, there was no death patients with meningococcus B and C. Conclusion: There was no difference statistics in the cerebrospinal fluid of the patients who were discharged and those who died.
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Rauthan, Amit, Poonam Patil, Rajashree Aswath, Nitin Yashas, and Gaurav Ningade. "Immunotherapy in Patients with Lung Cancer with Driver Mutations: A Single-Centre Experience." In Annual Conference of Indian Society of Medical and Paediatric Oncology (ISMPO). Thieme Medical and Scientific Publishers Pvt. Ltd., 2021. http://dx.doi.org/10.1055/s-0041-1735365.
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Abstract Introduction Immunotherapy has revolutionized treatment in metastatic nonsmall cell lung cancer (NSCLC) without driver mutations. Trial data shows that programmed death-1/PDL1 blockade in epidermal growth factor receptor (EGFR) and other driver mutation positive lung cancers is not beneficial; and instead maybe detrimental. Here, we evaluated the efficacy of immune check point inhibitors in a series of patients with EGFR and other driver mutation–positive advanced NSCLC. Objectives This study was aimed to evaluate the efficacy of immune check point inhibitors in a series of patients with EGFR and other driver mutation–positive advanced NSCLC. Materials and Methods We retrospectively analyzed 75 patients which received PD1/PDL1 inhibitors for advanced NSCL between January 2017 and January 2020. Ten patients were detected to have driver mutations on either tumor tissue or blood by next-generation sequencing (NGS). PDL1 status was assessed on SP263 ventana platform. Results Out of 10 patients, 7 were male and 3 were female. EGFR was detected in six patients (three on tumor and three in blood NGS), MET exon 14 skipping mutation in two patients, and RAS mutation in two patients on NGS in blood. Immunotherapy combined with chemotherapy was given in 5 (50%) patients, immunotherapy + bevacizumab + chemotherapy in two (20%) and immunotherapy alone in three patients (30%). Immunotherapy was started as first line in four patients as tumor tissue was negative for EGFR, ALK, and ROS1 by single gene testing. The remaining six patients received immunotherapy on progression in the second or subsequent lines. On NGS testing at progression, EGFR mutation was detected in one patient, MET exon 14 skip mutation was detected in two patients, and RAS mutation was detected in two patients. Immunotherapy alone was used in three patients in view of advanced age and multiple comorbidities. The median progression-free survival (PFS) was 5 months (range: 2–11 months). Two patients who received chemotherapy + bevacizumab + immunotherapy continue to do well without progression at 9 months. Conclusion PD1/PDL1 checkpoint inhibitors seem to have a limited impact in treatment in patients with driver mutations. Molecular testing by NGS is recommended either on tumor tissue or on blood by NGS if single gene testing for EGFR/ALK/ROS1 alterations is negative. We recommend not using single agent checkpoint inhibitors in molecular driven advanced NSCLC even with high PDL1 expression. We do see benefit in patients who received PD1/PDL1 inhibitors in combination with chemotherapy with bevacizumab. In conclusion, in patients with molecular-driven NSCLC who progress after standard therapy can be treated with PD1/PDL1 inhibitors, but this should always be given in combination with chemotherapy and bevacizumab.
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Gopan, Gayatri, Geetha Narayanan, Sreejith G. Nair, Prakash Purushothaman, Rona Joseph, Rekha A. Nair, and Jagathnath Krishna. "Outcome of Treatment in Elderly Myeloma—A Single-Centre Experience." In Annual Conference of Indian Society of Medical and Paediatric Oncology (ISMPO). Thieme Medical and Scientific Publishers Pvt. Ltd., 2021. http://dx.doi.org/10.1055/s-0041-1735368.
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Abstract Introduction Multiple myeloma (MM) accounts for approximately 1% of all cancers and 10% of all hematologic malignancies. In our institution, we see around 200 patients with myeloma every year. We present our experience with multiple myeloma in the patients aged more than 60 years. Objectives This is a retrospective study of 300 newly diagnosed multiple myeloma patients above 60 years of age treated in the Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India, during the period between 2014 and 2017. The medical records of the patients were studied and following data were collected: demographic and clinical details, diagnostic and staging workup, primary treatment, response assessment, relapse, and survival. Survival was estimated using the Kaplan–Meier method. Results A total of 300 patients were included in the study. The median age was 66 years with a male-to-female ratio of 1.4:1. The common clinical presentations were backache (134), fatigue (49), lower respiratory infection (20), and paraparesis (14). Monoclonal protein was immunoglobulin (Ig)-G in 199 patients (66.6%), IgA in 52 patients (17.4%), IgM in 2 patients, and IgD in 1 patient. Light-chain disease was seen in 42 patients (14%). One hundred and sixty patients (53.5%) had ISS stage III. Only 285 patients received treatment, of which 203 (67.8%) received bortezomib-based regimen, - bortezomib and dexamethasone (BD; 33.4%); bortezomib, lenalidomide, and dexamethasone (BLD; 19.7%); bortezomib, cyclophosphamide, and dexamethasone (VCD; 8.7%); bortezomib, thalidomide, and dexamethasone (BTD; 2.3%); and bortezomib, melphalan, and prednisolone (3.7%). Nonbortezomib-based regimens used were melphalan and prednisolone (MP) alone or with thalidomide or lenalidomide (15%), lenalidomide and dexamethasone (LD; 10.4%), and thalidomide and dexamethasone (TD; 2%). Response assessment was done as per IMWG guidelines. Fifty-seven (26.3%) patients achieved complete response (CR), 94 (43.3%) achieved very good partial response (VGPR), 19 (8.8%) attained partial response (PR), 15 (5.6%) had stable disease, and 46 (15.4%) developed progressive disease. With bortezomib-based regimens, 119 patients (58.3%) achieved CR/VGPR, and with non-bortezomib based regimens, 42 patients (51.2%) achieved CR/VGPR. One hundred and forty-three patients (47.8%) received maintenance therapy of which 79 received maintenance with bortezomib, 49 with lenalidomide, and 15 with thalidomide. The average duration of maintenance was 24 months. Second-line chemotherapy regimens were used in 37 patients. Agents used were MP, LD, TD, and VCD. With second-line treatment, 15 patients achieved VGPR, 10 patients achieved partial response, and 25 patients developed progressive disease. Third-line chemotherapy regimens were used in 22 patients and the regimens used were pomalidomide and dexamethasone, MP, TD, LD, vincristine, doxorubicin, and dexamethasone and carfilzomib and dexamethasone. At a median follow-up of 34 months, the 2-year overall survival (OS) was 68%. The median progression-free survival was 21 months. The 2-year OS for patients receiving initial bortezomib-based regimen was 67.8% and non-bortezomib based regimen was 68% which was similar. Conclusion In this study, CR/VGPR rates and 2-year OS in patients treated with bortezomib and non-bortezomib based regimens were not statistically significant.
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Esposito, Cara, Maureen E. McDonald, Priscilla Machado, Michael Savage, David Fischman, Praveen Mehrotra, Ira Cohen, et al. "Estimating Central Cardiac Pressures Noninvasively in Patients Using Ultrasound Contrast Agents." In 2020 IEEE International Ultrasonics Symposium (IUS). IEEE, 2020. http://dx.doi.org/10.1109/ius46767.2020.9251608.
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Tabe, J. "4CPS-288 Clinical pharmacist’s impact in improving the safety of therapies for patients using oral anticancer agents: a prospective single centre study." In 25th Anniversary EAHP Congress, Hospital Pharmacy 5.0 – the future of patient care, 23–28 March 2021. British Medical Journal Publishing Group, 2021. http://dx.doi.org/10.1136/ejhpharm-2021-eahpconf.120.
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Vasconcelos, Matheus Felipe de Souza, Francisco Tomaz Meneses de Oliveira, Rafael Zini Moreira da Silva, and Alex Michel Daoud. "Neurological and adrenal insufficiency symptons in adult x-linked adrenoleukodystrophy: case report." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.347.
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Context: X-linked adrenoleukodystrophy (X-ALD) is a rare genetic demyelinating disease caused by mutations in ABC1 gen associated with an impairment of beta- oxidation of very long chain fatty acids (VLCFA) in peroxisomes. It causes accumulation of VCLFA in tissues affecting majoritary the central nervous system, testicles and the adrenal córtex resulting in symptoms which provides restricted neurological prognosis and sequels. Methods: Specific data related of a clinical case through prontuary and complementary exams in a patient attended at Santa Casa de Misericórdia de São Paulo hospital. Case report: Male patient, 39 years old, complaning about vomiting, hyperpigmented skin associated with abolish, psicoses, urinary incontinence, temporal and spacial confusion as well as were found: hyperkalaemia, hyponatremia, hypoglycemia, elevated ACTH levels, basal cortisol decresead, antibody anti-21-hidroxilase non reagente, screening for infectious agents were carried out and infection subsequently ruled out. Were observed in MRI Brain: hypersignal in cerebral white matter on T2-FLAIR sequence bilaterally in which the occipitoparietal region, frontal lobe and basal ganglia were more affected. After metabolic and hydroelectric disorders estabilization using Prednisone, Fludrocortisone per day for 5 days, he evolved with worsening of cognitive and behavioral status until nowdays. Actually, he is totally dependent on his basic activities. Conclusions: It is a rare disease, but it must be recognized by every neurologist, since it is can affect other systems and can leave serious sequelae.
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Teixeira, Rebecca Vieira, André Luiz Guimarães de Queiroz, Louis Fernando Marques de Almeida, Érico Induzzi Borges, Herval Ribeiro Soares Neto, and Sônia Maria Cesar de Azevedo Silva. "Adalimumab treatment in a patient with severe presentation of VogtKoyanagi-Harada." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.491.
Full textAbstract:
Context: Vogt-Koyanagi-Harada syndrome (VKH) is a rare, multisystemic, autoimmune disease mediated by a Th1 response against melanocytes in the eye, inner ear, central nervous system, skin and hair. In this article, we report a case of VKH with severe visual impairment and discuss the therapeutic response to corticotherapy followed by the use of Adalimumab, a tumor necrosis factor (TNFα) inhibitor. Case report: A 61-year-old black woman started bilateral frontal headache of severe intensity, associated with bilateral eye pain, hyperemia and watery eyes, progressing with visual turbidity with gradual worsening, seeing only figures after eight days. After ten days bilateral hypoacusis started, also progressive. She denied eye movement pain, diplopy, dizziness, fever, joint pain or skin injuries. On examination, visual acuity (VA) in RE: hand movement for 30 cm, LE: light perception, fundus of the eye with serous bilateral retinal detachment. CSF with 155 lymphomonocyte predominance cells, proteins: 73, negative bacterioscopy and cultures. Pulsotherapy was performed for 7 days followed by 1g of cyclophosphamide and maintenance therapy with fortnightly Adalimumab. Two months after discharge, she presented VA in RE: 20/200 and LE: counting fingers at 1 meter. Conclusions: Aggressive and early treatment with immunosuppression is key to the effective treatment of VKH. Immunotherapy can be used in patients who are unresponsive to corticosteroid doses. Biological agents that target TNFα have effective results in non-infectious uveitis. Adalimumab is a safe and effective option, which also reduces the need for chronic corticosteroid therapy. The prognosis depends on the early diagnosis and treatment.