What are we doing these days...
Crotty Bradley H, Somai Melek
In this narrative case, we identify issues related to patients’ use of technology, make comparisons between telehealth adoption and the deployment of electronic health records, and propose that building intuitive and supported digital care experiences for patients is required to make virtual care sustainable.
Crotty Bradley H., Hyun Noorie, Polovneff Alexandra, Dong Yilu, Decker Michael C., Mortensen Natalie, Holt Jeana M., Winn Aaron N., Laud Purushottam W., Somai Melek M.
This quality improvement study of 137 846 video visits showed an overall 90% success rate. Patient rather than clinician factors were more systematically associated with successful completion of video visits, and clinician comfort with technology was associated with successful video visits or conversion to telephone visits. The findings suggest that, as policy makers consider expanding telehealth coverage and hospital systems focus on investments, consideration of patient support, equity, and friction should be kept in the forefront.
Charpignon Marie-Laure, Vakulenko-Lagun Bella, Zheng Bang, Magdamo Colin, Su Bowen, Evans Kyle, Rodriguez Steve, Sokolov Artem, Boswell Sarah, Sheu Yi-Han, Somai Melek, Middleton Lefkos, Hyman Bradley T., Betensky Rebecca A., Finkelstein Stan N., Welsch Roy E., Tzoulaki Ioanna, Blacker Deborah, Das Sudeshna, Albers Mark W.
Metformin, an antidiabetic drug, triggers anti-aging cellular responses. Aging is the principal risk factor for dementia, but previous observational studies of the diabetes drugs metformin vs. sulfonylureas have been mixed. We tested the hypotheses that metformin improves survival and reduces the risk of dementia, relative to the sulfonylureas, by emulating target trials in electronic health records of diabetic patients at an academic-centered healthcare system in the US and a wide-ranging group of primary care practices in the UK. To address metformin’s potentially dual influences on dementia risk—that it might reduce the hazard of death and put more people at risk of developing dementia while reducing the hazard of dementia by slowing biological aging, we used a competing risks approach and carefully grounded that within a causal inference emulated trial framework. To identify candidate biomarkers of metformin’s actions in the brain that might mediate reduced dementia risk, we conducted an in-vitro systems pharmacology evaluation of metformin and glyburide on differentiated human neural cells through differential gene expression. We named our multi-dimensional approach DRIAD-EHR (Drug Repurposing in Alzheimer’s Disease-Electronic Health Records). In intention-to-treat analyses, metformin was associated with a lower hazard of all-cause mortality than sulfonylureas in both cohorts. In competing risks analyses, there was also a lower cause-specific hazard of dementia onset among metformin initiators. In in-vitro studies, metformin reduced human neural cell expression of SPP1 and APOE, two secreted proteins that have been implicated in Alzheimer’s disease pathogenesis and whose levels can be quantified in the CSF. Together, our findings suggest that metformin might prevent dementia in patients without type II diabetes. In addition, our results inform the design of clinical trials of metformin in non-diabetics and suggest a pharmacodynamic CSF biomarker, SPP1, for metformin’s action in the brain.
Luo Jake, Tong Ling, Crotty Bradley H., Somai Melek, Taylor Bradley, Osinski Kristen, George Ben
The outbreak of coronavirus disease 2019 (COVID-19) further accelerated the deployment and utilization of telemedicine services. An analysis of the socioeconomic characteristics of telemedicine users to understand potential socioeconomic gaps and disparities is critical for improving the adoption of telemedicine services among patients.. This study aims to measure the correlation of socioeconomic determinants with the use of telemedicine services in Milwaukee metropolitan area.
Winn Aaron N., Somai Melek, Fergestrom Nicole, Crotty Bradley H.
Online triage tools are increasingly being adopted in health care to aid patients in identifying the appropriate care level. However, there is a lack of empirical evidence on how patients use virtual triage and whether these tools influence care-seeking behavior. Using data from a free online triage tool, we describe the common symptoms queried by users and analyze whether the tool was associated with the level of care that patients intended to seek.
The ever-increasing pace of technological advancements, rising costs, and new entrants into the health care marketplace are part of the challenge health care incumbents face today. With no alternative but to adapt, health care organizations must find effective methods to embrace innovation, which we define as the delivery of new patient and clinician value. Embedding and accelerating innovation in health care, however, has proven to be difficult. In health care, most current processes of governance, business planning, and information technology implementation are designed to minimize risk to organizations and are often inflexible to adapt quickly to new technological changes, netting incremental changes that fail to deliver much needed transformation.
Saber Hamidreza, Somai Melek, Rajah Gary B., Scalzo Fabien, Liebeskind David S.
Advances in predictive analytics and machine learning supported by an ever-increasing wealth of data and processing power are transforming almost every industry. Accuracy and precision of predictive analytics have significantly increased over the past few years and are evolving at an exponential pace. There have been significant breakthroughs in using Predictive Analytics in healthcare where it is held as the foundation of precision medicine. Yet, although the research in the field is expanding with the profuse volume of papers applying machine learning algorithms to medical data, very few have contributed meaningfully to clinical care. This lack of impact stands in stark contrast to the enormous relevance of machine learning to many other industries. Regardless of the status of its current contribution, the field of predictive analytics is expected to fundamentally change the way we diagnose and treat diseases, as well as the conduct of biomedical science research. In this review, we describe the main tools and techniques in predictive analytics and will analyze the trends in application of these techniques over the recent years. We will also provide examples of its application in medicine and more specifically in stroke and neurovascular research and outline current limitations.
Stavropoulou Charitini, Somai Melek, Ioannidis John P. A.
The UK is one of the largest funders of health research in the world, but little is known about how health funding is spent. Our study explores whether major UK public and charitable health research funders support the research of UK-based scientists producing the most highly-cited research.