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Feasibility of a clearing house for improved cooperation between telemedicine networks delivering humanitarian services: acceptability to network coordinators
Richard Wootton,Laurent Bonnardot,Antoine Geissbuhler,Kamal Jethwani
Global Health Action , 2012, DOI: 10.3402/gha.v5i0.18713

Abstract: Background: Telemedicine networks, which deliver humanitarian services, sometimes need to share expertise to find particular experts in other networks. It has been suggested that a mechanism for sharing expertise between networks (a ‘clearing house’) might be useful. Objective: To propose a mechanism for implementing the clearing house concept for sharing expertise, and to confirm its feasibility in terms of acceptability to the relevant networks. Design: We conducted a needs analysis among eight telemedicine networks delivering humanitarian services. A small proportion of consultations (5–10%) suggested that networks may experience difficulties in finding the right specialists from within their own resources. With the assistance of key stakeholders, many of whom were network coordinators, various methods of implementing a clearing house were considered. One simple solution is to establish a central database holding information about consultants who have agreed to provide help to other networks; this database could be made available to network coordinators who need a specialist when none was available in their own network. Results: The proposed solution was examined in a desktop simulation exercise, which confirmed its feasibility and probable value. Conclusions: This analysis informs full-scale implementation of a clearing house, and an associated examination of its costs and benefits.

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Assessing Hospital Readmission Risk Factors in Heart Failure Patients Enrolled in a Telemonitoring Program
Adrian H. Zai,Jeremiah G. Ronquillo,Regina Nieves,Henry C. Chueh,Joseph C. Kvedar,Kamal Jethwani
International Journal of Telemedicine and Applications , 2013, DOI: 10.1155/2013/305819

Abstract: The purpose of this study was to validate a previously developed heart failure readmission predictive algorithm based on psychosocial factors, develop a new model based on patient-reported symptoms from a telemonitoring program, and assess the impact of weight fluctuations and other factors on hospital readmission. Clinical, demographic, and telemonitoring data was collected from 100 patients enrolled in the Partners Connected Cardiac Care Program between July 2008 and November 2011. 38% of study participants were readmitted to the hospital within 30 days. Ten different heart-failure-related symptoms were reported 17,389 times, with the top three contributing approximately 50% of the volume. The psychosocial readmission model yielded an AUC of 0.67, along with sensitivity 0.87, specificity 0.32, positive predictive value 0.44, and negative predictive value 0.8 at a cutoff value of 0.30. In summary, hospital readmission models based on psychosocial characteristics, standardized changes in weight, or patient-reported symptoms can be developed and validated in heart failure patients participating in an institutional telemonitoring program. However, more robust models will need to be developed that use a comprehensive set of factors in order to have a significant impact on population health. 1. Introduction Several predictive models can identify the risk status of patients with heart failure [1]. However, predictors used in those models are often not actionable, as they are typically based on demographic (e.g., age, race/ethnicity) or clinical data (e.g., medical history, billing or laboratory data). In our previous work, we aimed to identify a subset of high-risk patients with reversible risk factors, as our goal was to prevent their readmission by connecting those patients to appropriate interventions. Since psychosocial factors might be a root cause for cardiac decompensation, we set ourselves to develop a multivariable logistic regression model based on psychosocial predictors [2]. In that work, we identified 5 psychosocial predictors “dementia,” “depression,” “adherence,” “declining/refusal of services,” and “missed clinical appointments” as significant predictors of readmission [2]. Similarly, patient-reported symptoms and other factors collected by a telemonitoring system could potentially serve as reversible predictors to eventually strengthen our original model. In fact, body weight gain among heart failure patients is already a known factor linked to early readmissions [3]. Telemonitoring is a promising innovation that allows clinicians to monitor

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Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output
Wootton,Richard; Geissbuhler,Antoine; Jethwani,Kamal; Kovarik,Carrie; Person,Donald A; Vladzymyrskyy,Anton; Zanaboni,Paolo; Zolfo,Maria;
Bulletin of the World Health Organization , 2012, DOI: 10.2471/BLT.11.099143

Abstract: objective: to summarize the experience, performance and scientific output of long-running telemedicine networks delivering humanitarian services. methods: nine long-running networks -those operating for five years or more -were identified and seven provided detailed information about their activities, including performance and scientific output. information was extracted from peer-reviewed papers describing the networks' study design, effectiveness, quality, economics, provision of access to care and sustainability. the strength of the evidence was scored as none, poor, average or good. findings: the seven networks had been operating for a median of 11 years (range: 5-15). all networks provided clinical tele-consultations for humanitarian purposes using store-and-forward methods and five were also involved in some form of education. the smallest network had 15 experts and the largest had more than 500. the clinical caseload was 50 to 500 cases a year. a total of 59 papers had been published by the networks, and 44 were listed in medline. based on study design, the strength of the evidence was generally poor by conventional standards (e.g. 29 papers described non-controlled clinical series). over half of the papers provided evidence of sustainability and improved access to care. uncertain funding was a common risk factor. conclusion: improved collaboration between networks could help attenuate the lack of resources reported by some networks and improve sustainability. although the evidence base is weak, the networks appear to offer sustainable and clinically useful services. these findings may interest decision-makers in developing countries considering starting, supporting or joining similar telemedicine networks.

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KEM Hospital′s response to serial bomb blasts in the Mumbai suburban trains on 11th July 2006: Students′ perspective
Goenka A,Jethwani K
Journal of Postgraduate Medicine , 2006,

Abstract:

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A beginner′s guide to research-part I
Jethwani K,Kanodra N
Journal of Postgraduate Medicine , 2005,

Abstract:

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The internet: Revolutionizing medical research for novices and virtuosos alike
Jethwani K,Chandwani H
Journal of Postgraduate Medicine , 2008,

Abstract:

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The Feasibility and Impact of Delivering a Mind-Body Intervention in a Virtual World
Daniel B. Hoch, Alice J. Watson, Deborah A. Linton, Heather E. Bello, Marco Senelly, Mariola T. Milik, Margaret A. Baim, Kamal Jethwani, Gregory L. Fricchione, Herbert Benson, Joseph C. Kvedar
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033843

Abstract: Introduction Mind-body medical approaches may ameliorate chronic disease. Stress reduction is particularly helpful, but face-to-face delivery systems cannot reach all those who might benefit. An online, 3-dimensional virtual world may be able to support the rich interpersonal interactions required of this approach. In this pilot study, we explore the feasibility of translating a face-to-face stress reduction program into an online virtual setting and estimate the effect size of the intervention. Methods and Findings Domain experts in virtual world technology joined with mind body practitioners to translate an existing 8 week relaxation response-based resiliency program into an 8-week virtual world-based program in Second Life？ (SL). Twenty-four healthy volunteers with at least one month's experience in SL completed the program. Each subject filled out the Perceived Stress Scale (PSS) and the Symptom Checklist 90- Revised (SCL-90-R) before and after taking part. Participants took part in one of 3 groups of about 10 subjects. The participants found the program to be helpful and enjoyable. Many reported that the virtual environment was an excellent substitute for the preferred face-to-face approach. On quantitative measures, there was a general trend toward decreased perceived stress, (15.7 to 15.0), symptoms of depression, (57.6 to 57.0) and anxiety (56.8 to 54.8). There was a significant decrease of 2.8 points on the SCL-90-R Global Severity Index (p<0.05). Conclusions This pilot project showed that it is feasible to deliver a typical mind-body medical intervention through a virtual environment and that it is well received. Moreover, the small reduction in psychological distress suggests further research is warranted. Based on the data collected for this project, a randomized trial with less than 50 subjects would be appropriately powered if perceived stress is the primary outcome.

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Dressing after Dressing: Sadra’s Interpretation of Change [PDF]
Muhammad Kamal
Open Journal of Philosophy (OJPP) , 2013, DOI: 10.4236/ojpp.2013.31009

Abstract:

This paper deals with the doctrine of transubstantial change advocated by Mulla Sadra in which substances as well as accidents are thought to be in constant and gradual change. Against Aristotle’s doctrine of accidental change, Mulla Sadra argues that no stable ground can bring about change and since substance is renewable it cannot carry identity of a changing existent. Here we investigate whether identity is possible or not. If it is possible then what becomes a ground for establishing identity of changing substances.

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Aliskiren Augments the Activities of Anti-Oxidant Enzymes in Liver Homogenates of DOCA Salt-Induced Hypertensive Rats [PDF]
Sahar Kamal
Advances in Enzyme Research (AER) , 2014, DOI: 10.4236/aer.2014.22010

Abstract: Hypertension is a serious problem that is recently thought to be associated with damaging effects on target organs partially via oxidative stress. On the other hand, there is accumulating literature describing some sort of therapeutic interaction between antioxidant enzymes in vital organs and hypertension. Therefore, the aim of this study is to investigate the possible effect of a direct renin inhibitor, aliskiren, used in treatment of hypertension via renin-angiotensin-aldosterone system (RAAS), on selected anti-oxidant enzymes in hepatic homogenates in DOCA salt-induced hypertesnive albino rats. Thirty male wister albino rats were assigned randomly into 3 groups (n = 10/ group). Group 1 received no treatement and serves as control. Group 2 received 0.5% carboxymethylcellulose sodium ip as a solvent of aliskiren, as a direct renin inhibitor (DRI). Group 3 received aliskiren 100 mg/kg/day ip for 4 weeks through gastric tube. Systolic blood pressure (SBP) was measured every week and its mean was recorded at the end of the study. Superoxide dismutase (SOD) enzyme in RBCs lysates, activities of catalase (CAT) and glutathione peroxidase enzymes and thiobarbituric acid reactive substance (TBARS), as a marker of lipid peroxidation, in hepatic homogenates were measured at the end of the study. DRI produced a marked reduction in mean SBP of hypertensive rats. It also significantly (p < 0.05) increased the activities of measured anti-oxidant enzymes while it significantly (p < 0.05) reduced TBARS in liver homogenates. These results indicated that renin possesses an oxidative effect in the liver in hypertensive rats. Aliskiren, in addition to its powerful anti-hypertensive effect, it could induce a great anti-oxidant effect in liver homogenates of DOCA salt-hypertensive rats.

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