Day 1 :
Keynote Forum
Robert N Jamison
Harvard Medical School, USA
Keynote: Using mobile health (mHealth) technology to improve acute and chronic pain: where are we now and where are we going?
Biography:
Robert Jamison is a Professor at Harvard Medical School with appointments in the Departments of Anesthesiology, Perioperative and Pain Medicine, Psychiatry, and Physical Medicine and Rehabilitation. His professional time is spent teaching and actively engaging in research. His recent research has focused on the examination of predictors of opioid abuse in chronic pain patients, patient engagement using telemedicine, and numerous clinical trials funded by the NIH and industry. He has been Research Mentor to several attending physicians and graduate students at Harvard and other Institutions. He also has assisted the coordination of clinical research within the Pain Trials Center at Brigham and Women’s Hospital. He has been Principal Investigator on several NIH-funded projects. He is currently a Member of five scientific journal Editorial Boards. He has authored two books, and over 300 peer-reviewed articles, chapters, and abstracts in the areas of Innovative Technology, Behavioral Medicine and Chronic Pain. He has been active and held board positions in many regional, national, and international organizations such as the American Pain Society and the International Association for the Study of Pain. He has been the Past President of the New England Pain Association and has served on the Executive Committee and Board of Directors of the American Pain Society. He is committed to the Clinician Teacher/Trainer Model and is a very important Figure in Clinical Research.
Abstract:
There has been a rise in interest in remote monitoring of pain and use of mobile health (mHealth) technology designed to support individuals in making lifestyle changes needed to improve pain management. Consumer demand for remote assessment programs, health ‘apps’ and sensors has far outpaced the science needed to understand their benefits and impact. For persons with chronic pain and providers who treatment them, mobile apps and activity monitors can help encourage behavioral changes including symptom monitoring, education, reinforcement of positive behaviors, and as tools to enhance patient-provider communication. Dr. Jamison will review the literature on the use of web-based electronic pain assessment programs, smartphone pain apps, activity monitors, and telemedicine to help manage pain patients’ conditions remotely and that have the potential to decrease healthcare utilization. He will detail the content, face validity, reliability, usability, expense, and technical issues associated with the use of mHealth technology. He will also present recently completed studies that highlight the role of pain apps and artificial intelligence in clinical pain centers and describe findings from studies on the effects of a remote electronic pain assessment program and use of teletherapy in pain medicine. He will illustrate how automated engagement incorporated into clinical care holds significant promise to solving problems of tracking patients remotely without disrupting clinical care. He will present how the future of healthcare and managing costs will require new approaches to engage the patient. This session will help to demonstrate how leveraging existing technologies holds significant promise to maintain effective communication with patients between visits while tracking and educated patients with real world decision-making that positively impacts healthcare.
Keynote Forum
Kagalwala Fatima
The Lister Hospital-East and North Hertfordshire NHS Trust, UK
Keynote: Quality improvement project on optimizing hydroxycarbamide prescriptions in paediatric sickle cell disease
Biography:
Dr Kagalwala is Consultant Paediatrician specialising in haematology, based in the Lister Hospital. She is the paediatric haematology lead in the East and North Hertfordshire Trust, overseeing patients with benign and malignant haematology conditions.
Abstract:
Hydroxycarbamide is a cytotoxic agent that blocks the ribonucleotide reductase system resulting in inhibition of DNA synthesis. By stimulating fetal haemoglobin (HbF) synthesis, hydroxycarbamide leads to reduction of HbS concentration which in turn reduces HbS polymerization. Hydroxycarbamide is recommended for prevention of vaso-occlusive disease. Its use in children with sickle cell anaemia is on the increase. However, given its narrow therapeutic index and increased patient variability in dose responsiveness, close monitoring and careful dose titration is required, as overdosing can lead to myelosuppression. Conversely, underdosing would lead to missed opportunity to optimize medication efficacy in reducing further sickling. The main focus of our quality improvement project was to introduce a reliable, sustainable method of monitoring blood results to facilitate decision-making by the paediatric consultant with haematology expertise with regards to hydroxycarbamide dose adjustment. Our study includes the following findings: Out of the 33 HbSS patients on our register, 15 were on hydroxycarbamide. Eight out of 15 patients were male (53.3%), 7 (46.7%) were female. Mean age of sickle cell patients on hydroxycarbamide at 1st March 2019 was 10.9 years. Mean age of patients when hydroxycarbamide was commenced was 7.4 years. In terms of formulation of hydroxycarbamide, 10 (67%) patients received capsules while 5 (33%) received liquid formulation. The average duration of each dispensed formulation was 9.7 weeks. The average dose of hydroxycarbamide as of 1st March 2019 was 21 mg/kg/d (median 17 mg/kg/d). As a result of this QI project, there was an observable 75% increase in frequency of testing post-introduction of this new monitoring system from four times to seven times per year. This is suggestive of better compliance to monitoring, allowing better dose optimization. Prior to the new hydroxycarbamide prescribing chart, the frequency of outpatient monitoring had been less, possibly due to more difficulty keeping track of patients, previous test results and dose adjustments. Analysis of emergency department (ED) attendance data had shown a decline in presentation of acute sickle crisis in the last six months. Through peer communication, an increased uptake of this medication was observed in this cohort. Consequently, our district general hospital paediatric department has seen a substantial rise in the number of children on hydroxycarbamide managed within the region. There have been no reported prescription errors since introduction of the new charts. In conclusion, this new prescribing chart had improved patient safety via a well-regulated, double-gated surveillance system (pharmacist-clinician). Improved patient monitoring had maximized the drug efficacy and enhanced quality of life of these children with reduced hospital presentation from painful crisis.
- Blood Transfusion
Session Introduction
Gihan Nabil Mahmoud
Prince Sultan Oncology Center, Saudi Arabia
Title: An audit of compliance with the British Society for Haematology (BSH) guideline on red cell transfusion in sickle cell disease (SCD)-Part II: indications for transfusion
Biography:
Gihan Nabil Mahmoud has completed her PhD in Benign and Malignant Haematology from Alexandria University in Egypt. Currently, she is the Director of Paediatric Haematology/Oncology section in Prince Sultan Oncology Center in Tabuk, KSA.
Abstract:
Introduction: Sickle cell disease (SCD) is a recessively inherited hemolytic anemia with a wide spectrum of complications. Red cell transfusion in SCD has certain indications aiming to increase tissue delivery of oxygen since HbS is known to be a low affinity Hb and so delivers oxygen at a lower partial pressure of oxygen compared to HbA. Red cell transfusion can be a lifesaving treatment for patients with SCD so compliance with its indications is the responsibility of the medical team as well as the caregivers to ensure the best quality of care is given to this entity of patients. The British Society of Hematology (BSH) has published guidance on the indications for red cell transfusion in SCD. This audit will review compliance with some of the level 1 recommendations made.
Methods: This is a retrospective review of patients with sickle cell disease who are following in King Salman Armed Forces Hospital. The target population was children with SCD had age range of one to 15 years. Indications of red cell transfusion were tracked in the patients who attended for follow up during January and February 2019, in order to audit a compliance with the recommended guidelines on red cell transfusion in patients with SCD as advised by the BSH. Results and percentages of the descriptive analysis of the data are presented in tabulated and graphical form.
Results: The data of 50 consecutive patients (30 males and 20 females) with SCD who have attended the hospital in January and February 2019 were collected. Sixty percent and 44% compliance were met in patients who need primary and secondary prevention of stroke, respectively, and who are in need to achieve a HBS level of less<30% using transfusion/exchange program. Other identified patients with acute complications and pre-operative requirements met the BSH guidance with 100% compliance rate. A re-audit was performed in July 2019, after setting a bundle of recommendations. There was full compliance in all chosen standards following the required modification.
Conclusion: Regular auditing is beneficial in detecting the reasons behind incompliance to the standards, finding ways to solve them and overcome the obstacles that could jeopardize the patient care.
Andriy Hospodarskyy
Ternopil Medical University, Ukraine
Title: Artificial intelligence and telerehabilitation of patients with injuries of the lower extremities
Biography:
Andriy Hospodarskyy has completed his PhD from Ternopil Medical University and Postdoctoral studies from Lviv Medical University. He is the Associate Professor of General Surgery Department, and has published more than 90 papers in reputed journals. He is a Co-author of two books on Surgery for Medical Student, and he was invited as a speaker of several International Congresses of American Telemedicine Association.
Abstract:
The continuous development of technology that paves the way towards the expansion of connections through the internet and the growth of the capacity to process data have created greater possibilities of the development of telemedicine. The increase of telemedicine has shown the rise of possible artificial intelligence (AI) application. The overarching theme of this paper is to discuss implementation of the telemedicine technology with machine learning algorithm for rehabilitation of patients with injuries of the lower extremities. A total of 148 subjects with lower extremity injuries were enrolled in the study. Fifty two patients from the control group underwent traditional rehabilitation procedures. A total of 96 subjects were enrolled in the telerehabilitation group. Home remote monitoring for the 96 test subjects included use of a prototype device with axis-sensor, temperature and volume sensor, which were fixed to the injured limb. Software with machine learning was developed in the Ternopil Medical University and permits the monitoring of exercise time, local temperature, the frequency of active movements of the injured limb with algorithm of machine learning. Based on the patient’s individual condition and machine learning algorithm, the rehabilitation doctor created an individualized rehabilitation plan for each subject, containing an activity plan. Patient satisfaction was higher for the telerehabilitation with machine learning algorithm (78.3%, SD: 12.6) than for the traditional rehabilitation (36.7%, SD:7.3). The telerehabilitation system with machine learning algorithm can be used in complex rehabilitation of patients with injuries of the lower extremities.
Mizanur Rahman
Karolinska Institute, Sweden
Title: Malondialdehyde modified human serum albumin and induced pro-inflammatory T-cell activation in atheroscleortic palques
Biography:
Mizanur Rahman has completed MSc in Biotechnology from The Royal Institue of Technology, Stockholm, Sweden and MSc in Molecular life science from Stockholm University, Stockholm, Sweden. At present he is a PhD student at Karolinska Institutet, Sweden. Since several years he is working on cardiovascular diseases and he has important findings on this area.
Abstract:
In atherosclerotic plaques, immune cells especially dendritic cells (DCs), T-cells and M1 macrophages are abundant. These cells when activated could play an important role in plaque rupture and thus, cardiovascular disease (CVD). T-cells in atherosclerotic plaques can be activated in response to oxidized low density lipoprotein (OxLDL) but role of different components including malondialdehyde (MDA) in OxLDL is not clear, though MDA, which forms adduct with proteins, is implicated. Here, we study MDA conjugated with human serum albumin (MDA-HSA). DCs, differentiated from human monocytes were stimulated with MDA-HSA and co-cultured with autologous T-cells from human blood or atherosclerotic plaques or T cells were stimulated directly with MDA-HSA. In addition, monocytes or macrophages were also stimulated with MDA-HSA. MDA-HSA-stimulated-DC induced activation of pro-inflammatory T-cell as determined by FAC Scan, intracellular or extracellular cytokine as well as transcription factors. Direct effect of MDA-HSA on T cells was pronounced. The DCs mediated but not the direct activation was T-cell receptor dependent. MDA-HSA induced expression of TLR2 & TLR4, and induced activation of inflammatory pathway mitogen-activated protein kinase. Either anti-MDA antibodies or an inhibitor of mitochondrial reactive oxygen species (ROS) affected MDA-HSA induced activation of T-cells. MDA modified peptide sequences of HSA in vitro were similar to MDA modified peptide sequences was observed in atherosclerotic patients’ plasma. Monocyte or macrophages differentiated into pathogenic macrophages in response to MDAHSA. MDA-HSA could play a role in promoting plaque rupture. Anti-MDA antibodies or ROS inhibitor could be potential candidate to reduce plaques inflammation and thus, instability.
Uthenas Larseang
Khon Kaen University, Thailand
Title: Report of wasted blood products at blood transfusion centre, Faculty of Medicine, Khon Kaen University, Thailand
Biography:
Uthenas Larsaeng has completed his Certificate of Medical Science from Khon Kaen University, Thailand. He is a specialist in Blood Transfusion Sciences at Blood Transfusion Centre, Faculty of Medicine, Khon Kaen University, Thailand.
Abstract:
Introduction: Cost-effective transfusion services have to be considered seriously. One of these services is expired blood product waste or the discard rate from abnormal appearance such as breakage of blood components bag which is under or lower whole blood volume collection. Wasted blood components result in significant losing of the budget. The problems should be analyzed and warned.
Objective: To determine the factors involved in blood product waste at Srinagarind Hospital (tertiary care institute), Faculty of Medicine, Khon Kaen University, Thailand.
Method: Discard blood components were strictly reported in 2017 and the frequency was analyzed for in each cause.
Result: Red cells concentrates expired rate in 2015 - 2017 were 4.8%, 4.3% and 5.6%, respectively. Total of whole blood (WB) collection in 2017 was 30,010 units while WB collection out of standard volume was 486 units (1.6%), the breakage blood bag between blood components preparation was 169 units (0.6%) and buffy coat discard from platelet preparation recorded as 1,133 units (3.8%).
Conclusion: Red cells concentrate expired rate was close to maximum limit (5.0%), normally blood components discard WB collection to standard volume, the procedure in blood components breakage has to re-consider because all discards are leading to cost effective.
Donovan Casas Patino
Autonomous University of the State of Mexico
Title: Pepitometro: virtual page to combat childhood obesity and overweight
Biography:
Donovan Casas Patiño is a Doctor, Family Medicine Specialist. He has completed his Master’s degree in Population and Health, Doctor in Collective Health, has completed his Postdoctoral in Social Anthropology, Medical Anthropology and Politics and Health. He is a Professor at the Autonomous University of the State of Mexico and the Intercultural University of the State of Mexico. Lines of academic activity: Collective Health.
Abstract:
Mexico occupies the first place worldwide in childhood overweight and obesity (OySP), in this context there have been multiple proposals to combat OySP, from invasive clinical models to food policies such as food labeling and calorie reduction in food, and even thus, the problem of OySP is increasing, so we devised a virtual page proposal which, through translation of the knowledge of experts in the area under study, we propose the creation of the pepitometer, which functions as the diffuser instrument of the knowledge of styles of healthy life in this age group, through two parameters scientific awareness of knowledge translation and availability of information, this makes in children behavioral appropriation towards healthy lifestyles through the promotion of these contents in the family nucleus. It is worth mentioning that this page was piloted in a group of 300 children between eight and 12 years old, of which 69% on admission to the page presented OySP, 7% malnutrition and 24% normal weight, in a period of two months 6,000 visits were registered by registered users, the most visited portals, menu of the week (30%), pepitometer function (30%), physical activity (20%) and games (20%), at the end of the cross section after two months, we found 77% of OySP, 6% malnutrition and 17% normal weight this in registered users, this shows that the trend remains static, in two dichotomous slopes of the country, OySP and malnutrition, this page pepitometer, It is a tool that can be very useful for monitoring and combating these global pandemics, which depend on social nutrition.
Andriy Tsvyakh
Ternopil Medical University, Ukraine
Title: Rehabilitation of patients with injuries of the elbow joint of the upper extremities by telemedicine and artificial intelligence technology
Biography:
Andriy Tsvyakh has completed his PhD from the Ternopil Medical University and Doctor of Science degree from Ternopil Medical University. He is the Chief of Traumatology and Orthopaedic Department. He has published more than 45 papers in reputed journals, is a Co-author of one book on Traumatology for Medical Student. He was invited as a speaker of several International Congresses of American Telemedicine Association.
Abstract:
The international orthopedic community aims to achieve the best possible outcome for patient care by modifying rehabilitation methods and using telemedicine technology. The use of artificial intelligence (AI) has a major role in the implementation of telemedicine technology. The aim of this article is to discuss the integration of telemedicine technology with machine learning algorithm in the rehabilitation of patients with injuries of the upper extremities. A total of 84 subjects with upper extremity elbow joint injuries were enrolled in the study. Forty eight patients from the control group underwent traditional rehabilitation procedures. A total of 36 subjects were enrolled in the telerehabilitation group. Home remote monitoring for the 36 test subjects included use of a prototype device with axis-sensor, temperature and volume sensors, which were fixed to the injured limb. Software with machine learning permits the monitoring of exercise time, local temperature, the frequency of active movements of the injured limb with algorithm of machine learning. Based on the patient’s individual condition and machine learning algorithm, the rehabilitation doctor created an individualized rehabilitation plan for each subject. During telerehabilitation doctor use significantly less time to consult patients (2.3 min–0.4) than the traditional rehabilitation (12.6 min–2.9). Patient satisfaction was higher for the telerehabilitation (83.1%–14.2) than for traditional rehabilitation (33.1%–8.9). Subjects reported a higher satisfaction with telerehabilitation with machine learning algorithm. The telerehabilitation systems with machine learning algorithm improve the quality of life in this group of patients and significantly reduce the cost of the rehabilitation period.
- Poster Sessions
Session Introduction
Saad Bin Zafar Mahmood
Aga Khan University Hospital, Pakistan
Title: An unusual case of non-resolving cellulits with underlying deep venous thrombosis
Biography:
Saad Bin Zafar Mahmood has completed his MBBS (Bachelor of Medicine and Bachelor of Surgery) from Ziauddin University, Pakistan. He is currently pursuing his Post-grauate Resident in the Department of Internal Medicine at Aga Khan University Hospital, Pakistan. He has interest in acute medicine, hematology, infectious disease and endocrinology. He is involved in various research and academic projects at the University.
Abstract:
A 50 year-old lady presented to emergency room with worsening right upper arm swelling, pain and intermittant fever for one month, examination and workup revealing cellulitis along with deep venous thrombosis (DVT) of right brachial vein, hence started on enoxaparin and antibotics. With no resolution of symptoms even after escalation of antibiotics magnetic resonance imaging of right shoulder and arm was done showing swelling and subcutaneous inflammatory changes in deltoid, biceps and triceps and an abnormal signal area with negative contrast enhancement in deltoid prompting a trucut biopsy along with Positron emission tomography scan which showed massive hypermetabolic soft tissue lesion involving the right shoulder, scapula and proximal two third of arm with additonal deposits in spleen, left kidney, pancreas and marrow deposits in axial and appendicular skeleton. Histopathology confirmed diagnosis of Primary skeletal muscle Diffuse large B-cell lymphoma (DLBCL) and aggressive treatment was initiated wih R-EPOCH regimen however she expired within a week of the first cycle of chemotherapy. Primary skeletal muscle lymphomas are exceptionally rare accounting for only 0.5% of extranodal lymphomas which themselves constitute only around 20-30% of all Non-Hodgkin lymphomas. The most commonly involved sites are lower extremities, pelvis and gluteal muscles, with only seven reported cases in the upper extremity and only one with an initial finding of DVT. This case shows that although primary skeletal muscle lymphomas are rare, they should be kept in consideration where symptoms are non-resolving as delay can result in poor outcomes.
Nima Latifsoltojar
Amirkabir University of Technology, Iran
Title: Artificial intelligence clustering for finding indirect drug competitions based on RxNorm Terminology
Biography:
N Latifsoltojar has graduated from Amirkabir University of Technology in the field of Biomedical Engineering. He is the Senior Business Analyst and Healthcare Terminologist of EMR Project and Clinical trials in CinnaGen Company. He is the Director of three books in Business Domain, has more than five patents in Iran, honored as a Selective Inventor by 17th Khwarizmi Festival and has been serving as a Mentor in two innovation events.
Abstract:
Artificial intelligence clustering for finding indirect drug competitions based on RxNorm terminology: market analysis seeks to understand the dynamics of markets, with the goal of informing business strategies and drug pipeline. Analysis of the current and potential future markets for drugs to treat particular diseases is used by pharmaceutical companies in decisions about where to invest in drug research and development. The first step to realizing the market is finding the drug rivals. We define two kind of rivalry between drugs, direct and indirect. The indirect drug rivals does not have a same generic but in a prescription they can be written instead of each other by physician, for a same disease and same level of care. In our analysis we selected a group of oncology drugs from RxNorm (version: 05-Aug-2019) and used the neural network clustering method and indication, Anatomical Therapeutic Chemical (ATC) levels and physiologic effects as features for finding the rivals. All iterations of results shared with five oncologists. We found the groups of drugs with different generic name, but same role in drug market competition. However, cause of missing data in RxTerm this method cannot be executed for all drugs.