The PICASO cloud platform for improved holistic care in rheumatoid arthritis treatment-experiences of patients and clinicians

Background

Multimorbidity raises the number of essential information needed for delivery of high-quality care in patients with chronic diseases like rheumatoid arthritis (RA). We evaluated an innovative ICT platform for integrated care which orchestrates data from various health care providers to optimize care management processes.

Methods

The Horizon2020-funded research project PICASO (picaso-project.eu) established an ICT platform that offers integration of care services across providers and supports patients’ management along the continuum of care, leaving the data with the owner. Strict conformity with ethical and legal legislations was augmented with a usability-driven engineering process, user requirements gathering from relevant stakeholders, and expert walkthroughs guided developments. Developments based on the HL7/FHIR standard granting interoperability. Platform’s applicability in clinical routine was an essential aim. Thus, we evaluated the platform according to an evaluation framework in an observational 6-month proof-of-concept study with RA patients affected by cardiovascular comorbidities using questionnaires, interviews, and platform data.

Results

Thirty RA patients (80% female) participated, mean age 59 years, disease duration 13 years, average number of comorbidities 2.9. Home monitoring data demonstrated high platform adherence. Evaluations yielded predominantly positive feedback: The innovative dashboard-like design offering time-efficient data visualization, comprehension, and personalization was well accepted, i.e., patients rated the platform “overall” as 2.3 (1.1) (mean (SD), Likert scales 1–6) and clinicians recommended further platform use for 93% of their patients. They managed 86% of patients’ visits using the clinician dashboard. Dashboards were valued for a broader view of health status and patient-physician interactions. Platform use contributed to improved disease and comorbidity management (i.e., in 70% physicians reported usefulness to assess patients’ diseases and in 33% potential influence on treatment decisions; risk manager was used in 59%) and empowered patients (i.e., 48% set themselves new health-related goals, 92% stated easier patient-physician communications).

Conclusion

Comprehensive aggregation of clinical data from distributed sources in a modern, GDPR-compliant cloud platform can improve physicians’ and patients’ knowledge of the disease status and comorbidities as well as patients’ management. It empowers patients to monitor and positively contribute to their disease management. Effects on patients’ outcome, behavior, and changes in the health care systems should be explored by implementing ICT-based platforms enriched by upcoming Artificial Intelligence features where possible.

Trial registration

DRKS—German Clinical Trials Register, DRKS00013637, prospectively registered. 17 January 2018.

AB1189 PICASO - THE PLATFORM FOR IMPROVED PERSONAL AND COORDINATED CARE OF CHRONICALLY ILL – SIX MONTHS RESULTS FROM A PROOF-OF-CONCEPT STUDY

Background:

Cross-sectoral coordination of treatment plans and efficient management of patients with chronic diseases and co-morbidities are of great importance. In rheumatoid arthritis (RA) it is essential to orchestrate information available for a patient at various locations, to allow (cost) efficient data use, to optimize management processes and to avoid redundant diagnostics. The information and communication platform developed in the Horizon2020 funded PICASO project (www.picaso-project.eu) supports the management of patients and their data along the continuum of care, consisting of hospitals, outpatient departments, practices, other health service providers via remote health monitoring. The platform might empower patients to improve their self-management of their illnesses.

Objectives:

What technological expertise and resources do RA patients and physicians have, who are willing to participate in a proof-of-concept study using a modern ICT platform? What is the user satisfaction? What are platform`s clinical implications?

Methods:

PICASO pursued a user-centered design approach. Platform`s user requirements were determined through workshops and interviews with physicians from various disciplines, patients and other stakeholders in the health care system (e.g. data protection officers). The development was accompanied by so-called “expert walkthroughs” to ensure a user-friendly design. An evaluation concept assessing the usability of the applications, user satisfaction and clinical relevance of the platform was part of the 6-month proof-of-concept study with RA patients and their physicians (rheumatologists and family doctors). A positive ethics vote was obtained.

Results:

111 user requirements were identified and used to develop the platform. Conformity with the GDPR as well as national regulations were precisely adhered to. All developments are based on the new ‘Fast Healthcare Interoperability Resources’ standard enabling data exchange with other software systems in the healthcare sector. This offers many advantages, e.g. a semantic model for describing the smallest units in the health care system (e.g. medication intake times, diagnostic procedures). Thus information can be linked and made available across sectors. Data can remain with the data owner and role-specific data access is ensured.

30 RA patients (80% female) participated, mean age was 58.6±10.8 years, disease duration 12.6±8.5 years, DAS28 2.6±0.9, average number of comorbidities 3.0±1.6. Patients’ IT-experience was heterogeneous. After 6 months evaluations showed a good platform acceptance with an overall rating of 2.3±1.1 (n=27, Likert scale (LS) 1-6) and evaluation of ‘ease of use’ at 2.3±1.2 (n=27, LS 1-6). Usability tests showed that for patients the presentation of (1) tasks to be performed for the management of their disease, (2) results from their remote health monitoring, and (3) patient-reported outcome instruments in a dashboard was clear and easy to understand. Time required for documentation and daily tasks was rated as appropriate by 75.9% of the patients. No major technical problems or impairments due to RA where experienced when using the dashboard. 8 physicians (37.5 % female) participated in the evaluation; overall the platform was rated at 2.2±0.5 (LS 1-6).

Conclusion:

The platform offers cross-sectoral orchestration of patient data and thus innovative capabilities for modern management processes (e.g. treat-to-target, tele-monitoring). The PICASO platform is available for RA patients as well as for other chronic diseases.

Acknowledgments:

This project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 689209.

Disclosure of Interests:

None declared

Survivin and XIAP expression in distinct tumor compartments of surgically resected gastric cancer: XIAP as a prognostic marker in diffuse and mixed type adenocarcinomas

There is considerable evidence that the inhibitor of apoptosis protein (IAP) family serves a role in tumorigenesis. The most studied IAP family members, survivin and X-linked inhibitor of apoptosis (XIAP), have been demonstrated to serve as biomarkers in distinct tumor entities. Thus, the present study aimed to investigate the expression levels of both IAPs in the tumor center, invasion front and lymph node metastases of surgically resected gastric cancer (GC) specimens. Tissue microarrays containing samples from 201 primary GCs were analyzed. IAP expression was detected using immunohistochemistry in different tumor compartments, normal mucosa and lymph node metastases. In addition, the association between the expression levels of these proteins, and clinicopathological parameters and overall survival was investigated. High levels of survivin and XIAP were evident in GC, when compared with normal mucosa, and were correlated with intestinal-type and well-differentiated GC, as well as low International Union Against Cancer stages. Increased XIAP expression was detected in lymph node metastases as compared with corresponding primary tumors. XIAP overexpression was identified to be an independent negative prognostic marker in diffuse and mixed type GC. These results suggest a potential role of survivin and XIAP in the early phase of gastric carcinogenesis. In addition, increased XIAP expression in lymph node metastases supports the observation that IAPs serve an essential role in metastatic tumor disease. Since XIAP expression was identified to be associated with poor survival in diffuse and mixed type GC, XIAP may serve as a novel therapeutic target in these types of GC.

Einzelfallstudie über die Effekte von Spiegeltherapie auf die motorische Funktionsfähigkeit bei einem Kind mit Hemiparese

Hintergrund: Die Spiegeltherapie stellt bei der Behandlung von Hemiparesen nach Schlaganfall bei Erwachsenen eine effektive Therapieform zur Verbesserung motorischer Funktionen dar. Aufgrund der vorliegenden Evidenz bei Erwachsenen und den Wirkmechanismen dieser Therapieform kann vermutet werden, dass sie auch bei der Behandlung eines Kindes mit Hemiparese positive Effekte hervorrufen kann.

Ziel: Die Studie diente der Evaluation möglicher Effekte von Spiegeltherapie auf die motorische Funktionsfähigkeit des betroffenen Arms bei einem Kind mit Hemiparese. Zusätzlich wurde auch die praktische Umsetzung betrachtet.

Methode: Die Probandin (weiblich, 7 Jahre) der kontrollierten Einzelfallstudie im A-B-Design führte die Spiegeltherapie über einen Zeitraum von 4 Wochen lang 3-mal täglich für 10 Minuten aus. Es wurden sowohl uni- als auch bilaterale Bewegungen integriert. Die primäre Fragestellung betraf das Assisting Hand Assessment (AHA). Zur Verlaufskontrolle erfolgte 2-mal wöchentlich der Box-and-Block-Test. Daneben kamen Skalen zur Erfassung der Motivations- und Konzentrationsfähigkeit während der Spiegeltherapie zum Einsatz.

Ergebnisse: Die Probandin zeigte bei allen eingesetzten Assessments positive Veränderungen. Der Posttest des AHA wies eine deutliche Verbesserung auf.

Schlussfolgerung: Es besteht Grund zur Annahme, dass Spiegeltherapie bei Kindern mit Hemiparese eine effektive Behandlungsmaßnahme darstellt. Für evidenzbasierte Aussagen bedarf es weiterer und umfangreicherer Studien.

Role of high endothelial postcapillary venules and selected adhesion molecules in periodontal diseases: a review

Periodontitis is accompanied by the proliferation of small blood vessels in the gingival lamina propria. Specialized postcapillary venules, termed periodontal high endothelial-like venules, are also present, and demonstrate morphological and functional traits similar to those of high endothelial venules (HEVs) in lymphatic organs. The suggested role of HEVs in the pathogenesis of chronic periodontitis involves participation in leukocyte transendothelial migration and therefore proinflammatory effects appear. Recent observations suggest that chronic periodontitis is an independent risk factor for systemic vascular disease and may result in stimulation of the synthesis of acute phase protein by cytokines released by periodontal high endothelial cells (HECs). However, tissue expression of HEV-linked adhesion molecules has not been evaluated in the gingiva of patients with chronic periodontitis. This is significant in relation to potential therapy targeting expression of the adhesion molecules. In this review, current knowledge of HEV structure and the related expression of four surface adhesion molecules of HECs [CD34, platelet endothelial cell adhesion molecule 1, endoglin and intercellular adhesion molecule 1 (ICAM-1)], involved in the key steps of the adhesion cascade in periodontal diseases, are discussed. Most studies on the expression of adhesion molecules in the development and progression of periodontal diseases pertain to ICAM-1 (CD54). Studies by the authors demonstrated quantitatively similar expression of three of four selected surface markers in gingival HEVs of patients with chronic periodontitis and in HEVs of reactive lymph nodes, confirming morphological and functional similarity of HEVs in pathologically altered tissues with those in lymphoid tissues.

The effect of liposomes on thermotropic membrane phase transitions of bovine spermatozoa and oocytes: implications for reducing chilling sensitivity

We have examined the effects of combinations between egg-phosphatidylcholine (EPC) or dipalmitoylphosphatidylcholine (DPPC) liposomes with either bovine spermatozoa or oocytes on cellular chilling sensitivity, lipid phase transition temperature (T(m)), and the ability of the oocytes to develop to the blastocyst stage. Spermatozoa and oocytes were exposed to EPC and DPPC liposomes at various temperatures (spermatozoa: 4, 12, 16, and 25 degrees C; oocytes: 4, 16, and 32 degrees C). The membrane integrity of the spermatozoa-control group decreased significantly following exposure to 16 or 12 degrees C, compared to ambient temperature (25 degrees C). In contrast, the EPC-sperm group had a greater resistance to chilling at each temperature and showed a decline in membrane integrity only at the lowest temperatures investigated. However, the DPPC-sperm group was injured significantly at all temperatures tested. Similar to the sperm, oocytes from the control group that were exposed to 16 degrees C were injured more severely than oocytes that were electrofused with EPC or DPPC liposomes. The membrane integrity of the oocytes at 16 degrees C that were electrofused with either EPC or DPPC liposomes was approximately the same as the control group held at 32 degrees C (normalized to 100%), compared to 46% in the control group at 16 degrees C (P<0.01). The transition temperatures of the sperm and oocyte membranes revealed different T(m) for the different liposome treatments. All groups had a significantly higher cleavage rate, as well as increased blastocyst formation when oocytes were exposed to temperatures above or below their T(m). We suggest that the T(m) of spermatozoa or oocytes can be changed by spontaneous association or electrofusion of liposomes with cellular membranes and, consequently, the chilling sensitivity can be altered. The resulting possibility is that embryo development after cryopreservation could be improved with such a method.

The influence of caesium-137 distribution in Poland's north-eastern ecosystem on effective dose 10 years after the Chernobyl disaster

A comparison is presented of particular methods of exposure in the first year after the Chernobyl disaster and ten years later. This comparison shows that the population exposure due to the presence of radiocaesium in the environment results from the presence of caesium contained in the soil, which provides 68% of the dose (as compared to 32% in 1987) while the influence of diet has been reduced to 32% (from 68%). The exposure from caesium-137 contained in the air has dropped from 14% to 0. The effective dose from caesium has been 50 times smaller than that from environmental sources of the natural radiation estimated for the region under study to be 1.61 mSv x y(-1).

Detection of T-2 toxin in different cereals by flow-through enzyme immunoassay with a simultaneous internal reference

In most previously described membrane-based immunoassays a separate negative control assay is always carried out to evaluate the performance of the assay. To overcome this problem, a membrane-based flow-through enzyme immunoassay with an internal control has been developed for the detection of T-2 toxin in cereals (patent pending). An Immunodyne ABC membrane was coated with 2 microL of goat anti-horseradish peroxidase (HRP) (internal control spot) (1:1000) and 2 microL of rabbit anti-mouse (test spot) (undiluted) immunoglobulins, and the free binding sites were blocked. In addition to the antibody-coated Immunodyne ABC membrane, the assay also comprises a plastic snap-fit device, absorbent cotton wool, mouse anti-T-2 monoclonal antibodies (Mab), and T-2-HRP conjugate. The color intensity (Delta) of the internal control and that of the negative sample showed no difference (P > 0.05), whereas there was a significant difference between the internal control and positive samples (P < 0.05). The minimum detectable limit that could be visually detected with confidence was 50 ng of T-2 per gram of cereal sample.

Natural radioactivity of building components and materials used in Białystok province

The paper presents the results of the measurements of natural radioactivity of building components and materials used in the North-East part of Poland performed by the Department of Biophysics, Medical Academy of Białystok. The natural radioactivity (40K, 224Ra and 232Th) of 133 samples was measured and the qualifying coefficients f1 and f2 were calculated. All measured samples of different materials had radioactivity level below legally accepted value. The lowest values of f1 and f2 were observed in prefabricated building materials; and they were lower then in traditional red brick. Only one sample of furnace slag had increased value of natural radioactivity, which was higher than legally permitted level.