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.
- 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.