Condet

Paul B. Yu, MD, PhD

• Assistant Professor of Medicine
• Harvard Medical School
• Assistant Physician, Massachusetts General Hospital
• Cardiology Division and Cardiovascular
• Research Center
• Boston, Massachusetts

Assessing the capacity of social determinants of health data to augment predictive models identifying patients in need of wraparound social services women's health issues in sudan buy serophene 50 mg with mastercard. Decision support from local data: Creating adaptive order menus from past clinician behavior womens health keene nh purchase 50mg serophene fast delivery. A roadmap to integrated digital public health surveillance: the vision and the challenges breast cancer quotes of hope discount 25 mg serophene amex. Use of deep learning to examine the association of the built environment with prevalence of neighborhood adult obesity women's health boutique in escondido discount 100mg serophene otc. Unsupervised reverse domain adaptation for synthetic medical images via adversarial training. Machine-learning system determines the fewest, smallest doses that could still shrink brain tumors. Clinical decision support alert appropriateness: A review and proposal for improvement. Deep patient: An unsupervised representation to predict the future of patients from the electronic health records. Use of a robotic seal as a therapeutic tool to improve dementia symptoms: A cluster-randomized controlled trial. Building health behavior models to guide the development of just-in-time adaptive interventions: A pragmatic framework. Reading the (functional) writing on the (structural) wall: Multimodal fusion of brain structure and function via a deep neural network based translation approach reveals novel impairments in schizophrenia. Recent developments in human gait research: Parameters, approaches, applications, machine learning techniques, datasets and challenges. Integrating socially assistive robotics into mental healthcare interventions: Applications and recommendations for expanded use. Design and implementation of a standardized framework to generate and evaluate patient-level prediction models using observational healthcare data. Implementing and scaling artificial intelligence solutions: Considerations for policy makers and decision makers. Machine learning analysis of left ventricular function to characterize heart failure with preserved ejection fraction. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. International Journal of Medical Robotics and Computer Assisted Surgery 14(6):e1943. Sociomarkers and biomarkers: Predictive modeling in identifying pediatric asthma patients at risk of hospital revisits. Deep learning localizes and identifies polyps in real time with 96% accuracy in screening colonoscopy. Perceived benefits of sharing health data between people with epilepsy on an online platform. An automated technique for identifying associations between medications, laboratory results and problems. Opportunities and challenges in developing deep learning models using electronic health records data: A systematic review. Toward high-throughput phenotyping: Unbiased automated feature extraction and selection from knowledge sources. A new non-invasive diagnostic tool in coronary artery disease: Artificial intelligence as an essential element of predictive, preventive, and personalized medicine. SimNest: Social media nested epidemic simulation via online semi-supervised learning. Robotic gastrotomy with intracorporeal suture for patients with gastric gastrointestinal stromal tumors located at cardia and subcardiac region. There have been legitimate discontinuous leaps in computational capacity, electronic data availability. Just as algorithms can now automatically name the breed of a dog in a photo and generate a caption of a "dog catching a frisbee" (Vinyals et al. Such functionality is incredible but can easily lead one to mistakenly assume that the computer "knows" what skin cancer is and that a surgical excision is being considered. Instead, these algorithms are each designed to complete specific tasks, such as answering well-formed multiple-choice questions. This comparison may not even make sense with the fundamentally different architectures of computer processors and biological brains, because computers already can exceed human brains by measures of pure storage and speed (Fischetti, 2011).

In adults menstruation hunger generic serophene 50 mg on line, it is more commonly associated with other medical disorders breast cancer yoga best serophene 25mg, medication use womens health institute peoria il purchase serophene 50mg with amex, or anxiety or depressive disorders whole woman's health generic serophene 100mg free shipping. Clinically, the person may simply sit up with their eyes open, appearing to be awake, or they may engage in a complex task. Contrary to popular belief, it is safe to wake a sleepwalker, but they may be confused and disoriented on waking. There is no particular treatment except to avoid triggers if known, or treat anxiety or depression. We often advise families to make sure the windows are closed and that there is no possibility of sleepwalking leading to danger for the patient. Sleep Disorders in Medical Illnesses Various medical illnesses are related to disturbances of sleep. Patients with chronic lung disease may experience low oxygen levels at night that disturb sleep. Patients with asthma may develop wheezing or shortness of breath at night, usually in the early 216 the Effortless Sleep Method: Cure for Insomnia. Patients with heart failure may develop abnormal breathing at night, which disturbs sleep much in the way that sleep apnea does. Sleep Disorders in Mental Illnesses So many people with mental illnesses, notably depression, anxiety, post-traumatic stress syndrome, and panic attacks, develop profound sleep disturbances. Evaluation and treatment by a health care provider skilled in these disorders, usually in conjunction with evaluation by a sleep specialist, often brings about great improvement. Sleep Medicine: Scope, Classification and Treatment 217 10 Sleep Medicine: Scope, Classification and Treatment Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many questions about sleepwake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people. The first sleep clinics in the United States were established in the 1970s by interested physicians and technicians; the study, diagnosisand treatment of obstructive sleep apnea were their first tasks. As late as 1999, virtually any American physician, with no specific training in sleep medicine, could open a sleep laboratory. Disorders and disturbances of sleep are widespread and can have significant consequences for affected individuals as well as economic and other consequences for society. Charles Czeisler, member of the Institute of Medicine and Director of the Harvard University 218 the Effortless Sleep Method: Cure for Insomnia. Sleep deprivation has also been a significant factor in dramatic accidents, such as the Exxon Valdez oil spill, the nuclear incidents at Chernobyl and Three Mile Island and the explosion of the space shuttle Challenger. Anthropologists find that isolated societies without electric light sleep in a variety of patterns; seldom do they resemble our modern habit of sleeping in one single eight-hour bout. Much has been written about dream interpretation, from biblical times to Freud, but sleep itself was historically seen as a passive state of not-awake. Most sleep doctors were primarily concerned with apnea; some were experts in narcolepsy. There was as yet nothing to restrict the use of the title "sleep doctor," and a need for standards arose. The review of more than 50 studies indicates that both doctors and patientsappear reluctant to discuss sleep complaints, in part because of perceptions that treatments for insomnia are ineffective or associated with risks, and: "Physicians may avoid exploring problems such as sleep difficulties in order to avoid having to deal with issues that could take up more than the normal allotted time for a patient. This certification presumably makes those individuals more qualified to run a sleep laboratory; however, the certification is not required to run a laboratory or to read sleep studies. Another common complaint is insomnia, a set of symptoms that can have many causes, physical and mental.

Head lice cannot survive away from the scalp for more than 2 days at room temperature menstruation calculator menstrual cycle generic 50mg serophene with mastercard. Nits found more than a quarter of an inch away from the scalp have already hatched or will never hatch women's health center victoria bc generic serophene 50mg amex. Students with live head lice can remain in class and go home at the end of the school day women's health a-z cheap serophene 100 mg with amex, be treated breast cancer month 2014 cheap serophene 25 mg with visa, and return to school after the appropriate treatment has begun. Nits may persist after initial treatment, therefore, students with nits should be allowed back in school the next day. Suggest resources for parents on how to treat head lice, such as those available through the Washington State Department of Health Lice Web page. Refer to a licensed health care provider for evaluation of secondary infection (such as skin infections from scratching), if suspected. All family members should be examined and treated simultaneously to avoid reinfestation. Discreetly manage lice infestations so that the student is not ostracized, isolated, humiliated, or psychologically traumatized. Routine or periodic classroom and schoolwide screenings are no longer recommended. Follow-up with the student and family to ensure that the infestation is being addressed appropriately until the infestation has ended. Have pro-active policies and procedures in place for dealing with head lice in schools. Educate school personnel and the parent/guardian in recognizing and managing a head lice infestation. This could include periodically providing information to families of all students on the diagnosis, treatment, and prevention of head lice. Assure students, parents/guardians, and staff that anyone can get head lice, and it is not an indication of lack of cleanliness. Educate school personnel and parents about the revised guidelines regarding "No Nit" school policies. The use of chemical sprays or "bug bombs" to treat the environment within the school setting is not recommended due to potential toxicity, harm to humans, and their lack of efficacy. Launder floor pillows, mats, and other shared fabric items regularly and dry in a hot dryer. Resources American Academy of Pediatrics: Head Lice Policy (2002) Statement of reaffirmation (2009) Policy revision (2010) aappolicy. Centers for Disease Control and Prevention, Head Lice Information for Schools. National Association of School Nurses, Position statement: Pediculosis Management in the School Setting. These complications include ear infections, diarrhea, pneumonia, encephalitis, and even death. Before the introduction of a measles vaccine in 1963, there were more than 500,000 measles cases a year and 500 deaths a year in the United States. Mode of Transmission Measles is spread from person-to-person by airborne droplets or by the nasal and throat secretions of an infected person. Infectious Period Measles is infectious from one day before the beginning of the respiratory symptoms (usually about 4 days before the rash onset) to 4 days after the appearance of the rash. Any student with a rash illness, especially if fever and/or other symptoms are present, should be referred to a health care provider for diagnosis. Report to your local health jurisdiction of suspected cases by telephone is mandatory and must be immediate.

In 1968 womens health hershey medical center purchase 25mg serophene with visa, Allan Rechtschaffen and Anthony Kales created ``A Manual of Standardised Terminology breast cancer fundraiser ideas serophene 25mg low cost, Techniques and Scoring System for Sleep Stages of Human Subjects menstrual irregularity icd 9 serophene 100 mg discount,'4 and in 1978 breast cancer 1 serophene 50 mg otc, Mary Carskadon and colleagues5 developed the first test to assess for sleepiness, known as the multiple sleep latency test. The first study in resident physicians, conducted by Friedman and colleagues6 in 1971, showed that postcall residents made more errors in reading a standardized electrocardiogram than their rested colleagues. All subjects reported a decline in performance after 24 to 30 hours without sleep, and several highlighted chronic partial sleep loss, defined as sleep duration of fewer than 5 hours for several consecutive nights, as a significant cause of reduced performance. Chronic partial sleep loss is common in residents, and residents who reported sleeping 5 or fewer hours per night were more likely to report having worked in an ``impaired condition' and having made medical errors. Research on type of performance found that vigilance appears to be affected first by sleep loss and to a higher degree than memory and cognitive function, with gross motor performance being quite resilient. The first is that many residents experience chronic partial sleep loss owing to their working schedules; the second relates to differences in how studies were conducted. This approach results in studies with less rigid control on the number of sleep hours for the sleep-deprived group, which attenuates the effect size of sleep loss in these field studies. Its authors35 and an unpublished meta-analysis of articles on the effect of work and sleep hours on clinical performance and medical errors hypothesized that by eliminating some of the chronic sleep debt, the duty hour limits may have reduced the negative effect of acute sleep loss in postcall individuals (Ingrid Philibert, unpublished metaanalysis, December 2010). Fitness for Duty Standards and regulations to promote patient safety and resident alertness for the learning process traditionally have focused on the number of hours worked. However, focusing predominantly on duty hours neglects much of the science about sleep and performance that may influence multiple human factors. Sleep experts who have advocated for further restrictions in resident hours acknowledge that a host of factors, both genetic and adaptive, contributes to different individual responses to the amount and quality of sleep obtained. The ideal would be a quick, reliable, easy to administer, and inexpensive assessment tool that could accurately predict the ability to safely provide care, effectively participate in the learning process, and ensure the safety of the resident on activities such as driving home. To date, no reliable mechanism exists that would be Enhancing Quality of Care, Supervision, and Resident Professional Development feasible and practical for application in residency programs. Research in this area has been conducted for the past 2 decades and continues to focus on the development of a model of alertness and performance by using 3 relatively simple inputs: the time of day, the time since awakening, and the duration of prior sleep. There also is an emerging science of how to maintain and manage alertness by identifying and addressing various factors that assist in maintaining wakefulness and alertness. Alertness management strategies can minimize the adverse effects of sleep loss and circadian disruption and promote optimal alertness and performance in operational settings. Sleep and circadian physiology are complex, individuals are different, the task demands of settings are different, and schedules are extremely diverse; therefore, no single strategy will fully address the fatigue, sleepiness and performance vulnerabilities engendered by 24-hour operational demands. Rather than attempt to eliminate fatigue, it may be more useful to consider the critical factors that can promote and optimize alertness management. In addition, they include new standards for education in alertness management and fatigue mitigation, and for programs to adopt fatigue mitigation strategies such as naps or backup schedules. The standards call for each program to do the following: & Educate all faculty members and residents to recognize the signs of fatigue and sleep deprivation; Educate all faculty members and residents in alertness management and fatigue mitigation processes; and, Adopt fatigue mitigation processes, such as naps or backup call schedules, to manage the potential negative effects of fatigue on patient care and learning. Preventive strategies (coming to work rested and ready for duty), in addition to operational strategies (napping, use of caffeine) have been assessed and have proved effective. Residents and faculty members must demonstrate an understanding and acceptance of their personal role in the following: assurance of the safety and welfare of patients entrusted to their care; provision of patient- and family-centered care; assurance of their fitness for duty; management of their time before, during, and after clinical assignments; recognition of impairment, including illness and fatigue, in themselves and in their peers. This is based on research showing that obtaining appropriate rest between duty periods greatly improves operational effectiveness in several occupational sectors. Strategic napping, use of selected stimulants,62 physical activity,63 and eating properly have been shown to be of benefit. The use of stimulants has been studied in shift workers; of these stimulants, caffeine is the safest and easiest to use (T A B L E). Naps in the workplace have been tested in some occupations, with beneficial effects on alertness.

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References

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