Publications by authors named "Harjit Singh"

78 Publications

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.

Transplantation 2021 Dec;105(12):2507-2512

National Transplant Resource Centre, Ministry of Health, Kuala Lumpur, Malaysia.

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http://dx.doi.org/10.1097/TP.0000000000003591DOI Listing
December 2021

Trends, Predictors and In-Hospital Outcomes of the Next Day Discharge Approach After Transcatheter Mitral Valve Repair.

Am J Cardiol 2021 10 29;156:93-100. Epub 2021 Jul 29.

Department of Medicine, Cardiovascular Division, University of Miami Miller School of Medicine.

Early discharge strategies are associated with lower cost and resource utilization during hospitalization, as such we sought to evaluate trends, predictors and outcomes of the next day discharge (NDD) approach after transcatheter mitral valve repair (TMVR) procedures with the MitraClip device. The National Inpatient Sample (NIS) was queried between 2013 and 2018 for patients undergoing TMVR using the International Classification of Diseases (ICD) 9 procedure code '3597' and ICD-10 procedure code '02UG3JZ'. Patients undergoing TMVR were stratified into two groups, determined by hospital length of stay (LOS) [≤1 day, NDD versus >1-day, non-NDD]. Overall, 22,035 patients underwent TMVR with 35.7% (n  = 7,870) belonging to the NDD group (mean age 78.1 ± 9.7 years, women 45%). From 2013 to 2018, the proportion of patients being discharged using the NDD approach trended upward from 18.3% to 46.0%. Amongst demographic and social factors, female sex, black race, and low median household income were predictive of non-NDD (p <0.05 for all). Amongst clinical factors, anemia, iron deficiency anemia, major depressive disorder, thrombocytopenia, obesity and end stage renal disease were some predictors of non-NDD (p <0.05 for all). In the non-NDD group there was a downward trend of pooled post-procedure complications, post procedure cardiogenic shock, vascular complications, acute kidney injury, mechanical circulatory support use, acute respiratory distress and postoperative ischemic stroke and (p for trend <0.001 for all). Despite the overall downward trend, complications began increasing in 2017-18. In conclusion, these trends may reflect improving operator experience, advancement in vascular access device closures and techniques, and prioritization of decreasing length of stay. Ideally, the feasibility and safety of this approach should be confirmed in larger-sized multicenter, randomized trials.
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http://dx.doi.org/10.1016/j.amjcard.2021.06.038DOI Listing
October 2021

The health coaching competency gap - Analysis of pharmacist competency frameworks from Australia, Canada, New Zealand the United Kingdom and the United States of America.

Health Soc Care Community 2021 Jul 10. Epub 2021 Jul 10.

The School of Health and Biomedical Sciences, RMIT University VIC, Bundoora, Vic., Australia.

The traditional competency frameworks for coaches, the International Coaching Federation (ICF) and the European Mentoring and Coaching Council (EMCC) disregard the differences in expertise required among the diverse professions that may provide coaching. A recent systematic review has identified competencies specific to health professionals who health coach. There are increasing workload pressures in primary care; pharmacists can potentially shift to the greater provision of health promotion services, such as health coaching. The provision of such services needs to be underpinned by competency frameworks, which support the role of pharmacists as health coaches. This analysis identifies the competency gaps for pharmacists if they are to take on the role of health coaching. The enabling competencies of health coaches were compared to the competency frameworks of pharmacists from Australia (AUS), Canada (CAN), New Zealand (NZ), the United Kingdom (UK) and the United States of America (USA). Correlations between the international pharmacist competency frameworks and the competencies enabling health coaching showed that entry to practice pharmacists from AUS, CAN and NZ all require training enabling the health coaching competency 'demonstrates confidence', whereas competency frameworks for pharmacists from both the UK and the USA included all competencies required to health coach. Although pharmacists from the countries examined had most of the competencies required to health coach, gaps within the international pharmacist competency frameworks were apparent, university curricula addressing these gaps would equip entry to practice pharmacists with the knowledge and understanding to confidently provide emerging professional pharmacy services such as health coaching.
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http://dx.doi.org/10.1111/hsc.13494DOI Listing
July 2021

Spoken buddy for individuals with autism spectrum disorder.

Asian J Psychiatr 2021 08 3;62:102712. Epub 2021 Jun 3.

Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, India. Electronic address:

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http://dx.doi.org/10.1016/j.ajp.2021.102712DOI Listing
August 2021

Does the national competency standards framework for pharmacists in Australia support the provision of behaviour change interventions?

Health Promot J Austr 2021 May 15. Epub 2021 May 15.

School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.

Issue Addressed: Australian pharmacists are increasingly moving towards the provision of patient-centred professional pharmacy services for chronic disease management. Some of these services are targeted towards improving patients' health and wellbeing through the facilitation of patient-driven health behaviour change. This paper investigates whether the provision of behaviour change interventions by Australian pharmacists is adequately underpinned by the current competency framework.

Methods: The foundation and behaviour change competences within each of the domains in the generic health behaviour change competency framework (GHBC-CF), was mapped to the Australian pharmacist competency framework.

Results: Although the Australian competency framework underpins most of the foundation and behaviour change competences of the GHB-CF required to undertake low-intensity interventions, for medium to high-intensity interventions four specific task-related competences need to be addressed. These are F12 'Ability to recognise barriers to and facilitators of implementing interventions', BC4 'ability to agree on goals for the intervention', BC5 'capacity to implement behaviour change models in a flexible but coherent manner' and BC6 'capacity to select and skilfully apply most appropriate intervention method'.

Conclusion: Additional training is necessary if pharmacists aspire to provide behaviour change interventions for chronic disease management, in particular those that are complex as they involve changes to multiple health behaviours. SO WHAT?: The identification of these gaps is critical and can potentially be addressed in postgraduate training programs and as pharmacy curricula are updated.
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http://dx.doi.org/10.1002/hpja.503DOI Listing
May 2021

In-Hospital Utilization and Outcomes of Palliative Care Consultation in Patients With Advanced Heart Failure Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support.

Am J Cardiol 2021 06 6;148:94-101. Epub 2021 Mar 6.

Cardiovascular Division, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami/Florida/United States Of America.

Prior studies have shown that the early inclusion of palliative care (PC) specialist is associated with better end-of-life experiences. The National Inpatient Sample Database was queried from 2012 to 2017 for relevant of ICD)-9 and -10 procedural and diagnostic codes to identify patients above 18 years with advanced heart failure (HF) admitted with cardiogenic shock (CS) requiring mechanical circulatory support (MCS). Baseline characteristics, utilization trends and invasive procedures and complications were compared among patients evaluated by PC and those who were not. There were 65,230 patients hospitalized for advanced HF complicated by CS requiring MCS, of these a PC consult was placed in in 9,200 patients (14.1%) and trended upward from 9.4 to 16.8%, between 2012 to 2017. The majority of patients, (37.3%) from the total population died in hospital. In reference to patients who were discharged alive, PC consultation was associated with a lower incidence of invasive procedures such as mechanical ventilation, pacemaker implantation, defibrillator implantation, insertion of percutaneous feeding tubes and tracheostomies performed (p <0.05 for all) whereas complications such as major bleeding, septic shock, transfusion of any blood product were comparable between both cohorts (nonsignificant p value for all). On the other hand, in those patients who died in hospital PC was associated with a lower incidence of pacemaker implantation, defibrillator implantation and insertion of percutaneous feeding tubes (p <0.05 for all). Despite the high morbidity and mortality associated with advanced HF patients with CS requiring MCS, the overall prevalence of PC consultation is exceedingly low. When utilized, the incidence of invasive procedures was lower. This study highlights the underutilization of PC services in this patient population, precluding any perceived benefit in end-of-life experiences.
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http://dx.doi.org/10.1016/j.amjcard.2021.02.024DOI Listing
June 2021

Deep Neural Network-based Handheld Diagnosis System for Autism Spectrum Disorder.

Neurol India 2021 Jan-Feb;69(1):66-74

I.K.G. Punjab Technical University, Kapurthala; Khalsa College of Engineering and Technology, Amritsar, Punjab, India.

Objective: The aim of the present work was to propose and implement deep neural network (DNN)-based handheld diagnosis system for more accurate diagnosis and severity assessment of individuals with autism spectrum disorder (ASD).

Methods: Initially, the learning of the proposed system for ASD diagnosis was performed by implementing DNN algorithms such as a convolutional neural network (CNN) and long short-term memory (LSTM), and multilayer perceptron (MLP) with DSM-V based acquired dataset. The performance of the DNN algorithms was analyzed based on parameters viz. accuracy, loss, mean squared error (MSE), precision, recall, and area under the curve (AUC) during the training and validation process. Later, the optimum DNN algorithm, among the tested algorithms, was implemented on handheld diagnosis system (HDS) and the performance of HDS was analyzed. The stability of proposed DNN-based HDS was validated with the dataset group of 20 ASD and 20 typically developed (TD) individuals.

Results: It was observed during comparative analysis that LSTM resulted better in ASD diagnosis as compared to other artificial intelligence (AI) algorithms such as CNN and MLP since LSTM showed stabilized results achieving maximum accuracy in less consumption of epochs with minimum MSE and loss. Further, the LSTM based proposed HDS for ASD achieved optimum results with 100% accuracy in reference to DSM-V, which was validated statistically using a group of ASD and TD individuals.

Conclusion: The use of advanced AI algorithms could play an important role in the diagnosis of ASD in today's era. Since the proposed LSTM based HDS for ASD and determination of its severity provided accurate results with maximum accuracy with reference to DSM-V criteria, the proposed HDS could be the best alternative to the manual diagnosis system for diagnosis of ASD.
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http://dx.doi.org/10.4103/0028-3886.310069DOI Listing
June 2021

A pharmacist health coaching trial evaluating behavioural changes in participants with poorly controlled hypertension.

BMC Fam Pract 2021 02 14;22(1):35. Epub 2021 Feb 14.

Discipline of Pharmacy, The School of Health and Biomedical Sciences, RMIT University VIC, Bundoora, VIC, 3083, Australia.

Background: To investigate whether pharmacist health coaching improves progression through the stages of change (SOC) for three modifiable health behaviours; diet, exercise, and medication management in participants with poorly controlled hypertension.

Methods: In this four-month controlled group study two community-based pharmacists provided three health coaching sessions to 20 participants with poorly controlled hypertension at monthly intervals. Changes in participants' stages of change with respect to the modifiable health behaviours; diet, exercise, and medication management were assessed. To confirm the behaviour change outcomes, SOC were also assessed in a control group over the same period.

Results: Statistically significant changes in the modifiable health behaviours- medication management (d = 0.19; p = 0.03) and exercise (d = 0.85; p = 0.01) were apparent in participants who received health coaching and were evident through positive changes in the SOC charts. The participants in the control group did not experience significant changes with respect to the SOC. This was parallel to a decrease in mean systolic blood pressure from session one to session four by 7.53 mmHg (p < 0.05, d = - 0.42) in participants who received health coaching. Improvements to medication adherence was also apparent in these participants, evident from the mean scores for the Adherence to Refills and Medications Scale (ARMS), which decreased significantly from a mean of 15.60 to 13.05 (p < 0.05) from session one to four.

Conclusions: Pharmacist health coaching produced promising health outcomes in participants with poorly controlled hypertension. Pharmacists were able to facilitate a positive behaviour change in participants. However, larger participant cohorts are needed to explore these findings further.

Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618001839291 . Date of registration 12/11/2018.
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http://dx.doi.org/10.1186/s12875-021-01385-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883432PMC
February 2021

Thinking ahead: gallbladder intussusception following transperitoneal percutaneous cholecystostomy tube placement.

BMJ Case Rep 2021 Feb 9;14(2). Epub 2021 Feb 9.

The Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, USA.

Percutaneous cholecystostomy (PC) is a common minimally invasive, image-guided procedure performed primarily on high-risk patients with acute cholecystitis for gallbladder decompression. Herein, we present a case of a patient undergoing PC placement using a transperitoneal approach. On subsequent upsizing attempts, the gallbladder fundus was found to invaginate during advancement of replacement drains, causing gallbladder intussusception. The use of a balloon and locked pigtail catheter were required to reposition the gallbladder to proper position. The patient's planned percutaneous cholecystoscopy was delayed by 4 weeks until intended upsizing could be performed. This case demonstrates the advantage of achieving transhepatic gallbladder access to support tract formation and limit procedural complications.
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http://dx.doi.org/10.1136/bcr-2020-238885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875293PMC
February 2021

A Pilot Australian Pharmacist Health Coaching Trial of Participants with Poorly Controlled Hypertension: A Qualitative Study of Participants' and Coaches' Experiences.

Patient Prefer Adherence 2021 28;15:127-140. Epub 2021 Jan 28.

The School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.

Objective: An exploratory qualitative study was conducted to explore how stakeholders - participants and coaches experienced, and made sense of, being involved in coaching for people with poorly controlled hypertension.

Methods: Two pharmacists provided monthly health coaching sessions to twenty participants for three-months. Qualitative semi-structured interviews of participants were carried out by pharmacist coaches at baseline, one month, and at three months post-study completion. The pharmacist health coaches were also interviewed. Participant and pharmacist audio-recorded interviews were transcribed verbatim and analyzed thematically.

Results: Twenty participants with poorly controlled hypertension received health coaching. Analysis of the transcripts from participant interviews indicated the emergence of three main themes "beliefs about and management of hypertension", "reflection on health goals" and "understanding of and experiences from health coaching". Only one theme emerged from the pharmacist interviews: "logistics of health coaching in pharmacy".

Conclusion: Analysis of interviews showed that participants experienced a variety of positive health changes. Changes included a better understanding of health coaching, more realistic beliefs about hypertension, and improved management of hypertension and health goals. Participants were also positive about their experiences of coaching. Interviews with the pharmacists revealed factors such as planning, teamwork, and time management which are related to the implementation and provision of health coaching in community pharmacy practice which could be overcome through consideration and planning.
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http://dx.doi.org/10.2147/PPA.S290403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850563PMC
January 2021

Withdrawal Notice: Recent Advancements in Lung Cancer Treatment us-ing Receptor Targeting

Curr Mol Pharmacol 2021 01 11. Epub 2021 Jan 11.

Pharmaceutics,ISF College of Pharmacy, Moga,ISF COLLEGE OF PHARMACY, MOGA, PUNJAB. India.

The article for the journal Current Molecular Pharmacology has been removed by the Publisher due to acute language inconsistencies and grammatical errors.

The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policiesmain.php

Bentham Science Disclaimer: It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submit-ting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript, the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.
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http://dx.doi.org/10.2174/1874467214666210112105531DOI Listing
January 2021

Dieulafoy's lesion: an unexpected and rare cause of upper gastrointestinal bleeding.

BMJ Case Rep 2020 Dec 23;13(12). Epub 2020 Dec 23.

Department of Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia

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http://dx.doi.org/10.1136/bcr-2020-240905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759959PMC
December 2020

The utility of CardioMEMS in left ventricular assist device patients with gastrointestinal bleeding.

J Cardiol Cases 2020 Dec 19;22(6):276-279. Epub 2020 Jul 19.

Advanced Heart Failure Program, Baptist Health South Florida, Miami, FL, USA.

We report a correlation between trends of hemodynamic parameters including pulmonary artery pressures (PAP) and heart rate recorded by CardioMEMS device (St. Jude Medical, St. Paul, MN, USA) and presentation of gastrointestinal (GI) bleeding in two patients with left ventricular assist devices. We observed a decline in PAP levels prior to symptom onset and reduction in hemoglobin level in both patients. Early recognition of hemodynamic changes by CardioMEMS device might help clinicians to detect the preclinical phase of GI bleeding and intervene before patients develop severe symptoms and associated morbidity. < Early recognition of changes in pulmonary artery pressures and heart rate by CardioMEMS device might help clinicians to detect the preclinical phase of gastrointestinal bleeding that is a common complication in left ventricular assist device patients and to intervene before patients develop severe symptoms and associated morbidity.>.
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http://dx.doi.org/10.1016/j.jccase.2020.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718533PMC
December 2020

In-Hospital Outcomes in Patients With a History of Malignancy Undergoing Transcatheter Aortic Valve Implantation.

Am J Cardiol 2021 03 4;142:109-115. Epub 2020 Dec 4.

Jackson Memorial Hospital, Miami, Florida; Cardiovascular Division, Department of Internal Medicine, University of Miami Miller School of MedicineMiami, Florida.

A history of malignancy is incorporated in the Society of Thoracic Surgeons score to assess presurgical risk in patients undergoing surgical aortic valve replacement, however data on the prognostic importance in those undergoing transcatheter aortic valve implantation (TAVI) remains limited. We sought to investigate the utilization and in-hospital outcomes of TAVI in patients with a history of malignancy. The National Inpatient Sample Database was queried from 2012 to 2017 to identify patients who underwent TAVI using International Classification of Diseases (ICD) 9 and ICD-10 procedure codes. Between 2012 and 2017, there were 123,070 patients who underwent TAVI, of these 23,670 patients (19.2%) had a previous history of malignancy. The proportion of patients undergoing TAVI with a history of malignancy trended upward between 2012 and 2017. Patients with a history of malignancy were similar in age to those without (81.1 ± 7.9 vs 80.1 ± 6.7 years old, p <0.001), with a higher prevalence of tobacco use and major depressive disorder (p <0.001 for both). Patients with a history of malignancy had higher rates of post-TAVI pacemaker implantation (p <0.001), otherwise periprocedural complication rates were similar to those without. Using a multivariate logistic regression model to adjust for confounding factors, a history of malignancy was predictive of decreased odds of death in patients underwent TAVI (OR: 0.67, 95% CI, 0.60 to 0.76, p <0.001) and higher odds of pacemaker implantation (OR: 1.14, 95% CI, 1.09 to 1.19, p <0.001). In conclusion, with time the proportion of TAVI patients with a history of malignancy trended upward. Despite a greater prevalence of previous tobacco use and major depressive disorder, patients with a history of malignancy had TAVI safely with a low in-hospital all-cause mortality, yet greater cost of hospitalization and more frequent implantation of pacemaker devices.
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http://dx.doi.org/10.1016/j.amjcard.2020.11.029DOI Listing
March 2021

The Cholangioscopy Expander: A Handmade Device to Improve Visualization and Minimize Mucosal Injury during Percutaneous Cholangioscopy.

J Vasc Interv Radiol 2020 11 22;31(11):1956-1958. Epub 2020 Sep 22.

Department of Vascular and Interventional Radiology, The Johns Hopkins School of Medicine, 601 N. Caroline St., Baltimore, MD 21205.

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http://dx.doi.org/10.1016/j.jvir.2020.04.024DOI Listing
November 2020

Does the Modality Used in Health Coaching Matter? A Systematic Review of Health Coaching Outcomes.

Patient Prefer Adherence 2020 24;14:1477-1492. Epub 2020 Aug 24.

The School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.

Objective: The purpose of this review was to evaluate the modalities (e.g., face-to-face, telephone or electronic) of pharmacist health coaching providing the greatest improvement in patient outcomes, to enable a more comprehensive evaluation to be done and quality decision-making around health coaching modalities to be undertaken by pharmacists.

Methods: This systematic review followed the PRISMA guidelines. CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS were searched (2000-2019). Included articles were reviewed for the modality used to health coach, the training provided, and the outcomes.

Results: Twelve papers met the eligibility criteria. A majority of studies included involved a combination of modalities of pharmacist health coaching. Four papers referred to face-to-face sessions, and one study used telephone coaching. In each paper, coaching led to an improvement in clinical and non-clinical health outcomes.

Conclusion: The training provided to health coaches varied and in some cases was not reported. Inconsistencies in reports led to difficulties when comparing study outcomes. Therefore, conclusions about the modality providing the greatest improvement in patient outcomes and the most pragmatic health coaching modality are not possible. Studies that document the training, the modality, the outcomes and the cost benefits of coaching by pharmacists are warranted to enable a more comprehensive evaluation to be done and quality decision-making around health coaching modalities to be undertaken by pharmacists.
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http://dx.doi.org/10.2147/PPA.S265958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457552PMC
August 2020

Formulation, Optimization and In vitro / In vivo Characterization of Spray Dried Doxorubicin Loaded Folic Acid Conjugated Gelatin Nanoparticles.

Curr Mol Pharmacol 2021 ;14(3):367-380

Department of Pharmaceutics, ISF College of Pharmacy, Moga-144002 (Punjab), India.

Aim: Formulation, optimization and anticancer activity of spray-dried Doxorubicin loaded folic acid conjugated Gelatin nanoparticles (DOX-FA-GN).

Methods: Doxorubicin loaded gelatin nanoparticles (DOX-GN) were prepared by the Coacervation phase separation method, optimized using DoE and then conjugated with folic acid by covalent coupling to formulate Doxorubicin loaded folic acid conjugated nanoparticles (DOX-FA-GN). The formulated nanoparticles were characterized to evaluate its physicochemical properties. Cellular uptake and cell viability studies were carried out using MTT assay and biodistribution studies were carried out in Wistar rats.

Results: Particle size, PDI and entrapment efficiency for optimized DOX-GN were found to be 152.3 ± 9.3 nm 0.294 ± 0.1 and 86.9± 3.4% while for DOX-FA-GN, 193.9 ± 12.3 nm 0.247 ± 0.2 and 84 ± 3.6%. The cytotoxic studies showed a cell viability of 75.1% for DOX-GN and 29.5% DOX-FA-GN. Biodistribution studies were found to be statistically insignificant for conjugated nanoparticles with excellent flow properties. Significantly higher DOX distribution in the lungs was observed in the case of DOX-FA-GN.

Conclusion: There was a higher uptake of DOX on HeLa cells with DOX-FA-GN compared to DOX-GN. Also, the biodistribution of Dox in the lungs of Wistar rats was higher in conjugated nanoparticles as compared to unconjugated nanoparticles.
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http://dx.doi.org/10.2174/1874467213666200505095143DOI Listing
January 2021

Pharmacist health coaching in Australian community pharmacies: What do pharmacy professionals think?

Health Soc Care Community 2020 07 5;28(4):1190-1198. Epub 2020 Feb 5.

The School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.

Health coaching is a service provided to patients by healthcare professionals for the purposes of disease management and health risk prevention. Internationally, pharmacist health coaching services provided to patients with chronic health conditions have produced beneficial health outcomes. Despite this, the service is not currently provided within Australian community pharmacies. This study evaluates the knowledge, opinions and attitudes of leaders within the pharmacy profession about the concept of health coaching as a service in community pharmacy. Semi-structured interviews with leaders in the pharmacy profession were carried out. Pharmacy leaders were interviewed until data saturation was reached; 10 pharmacists were interviewed. The interviews were transcribed verbatim and analysed thematically; extracts from the transcripts were compared and categorised to establish themes and subcategories. Analysis of the transcripts indicated the emergence of two main themes and 10 subcategories. The main themes were as follows: 'positive view of health coaching in Australian community pharmacy' and 'barriers to integrating health coaching into Australian community pharmacy'. There was an overall perception that health coaching within community pharmacies would be valued by the Australian community. Interviewees held differing perceptions of pharmacists' capability to effectively coach pharmacy clients and suggested that the main impediments to its introduction related to remuneration for the service. The findings indicated that there is a potential for pharmacists to provide a health coaching service in community pharmacies, but that remuneration is a fundamental barrier. The research also indicated the need to clearly identify the knowledge, skills and attitudes needed to health coach and to identify whether potential gaps in the competencies of Australian community pharmacists exist.
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http://dx.doi.org/10.1111/hsc.12952DOI Listing
July 2020

Competencies and training of health professionals engaged in health coaching: A systematic review.

Chronic Illn 2020 Jan 16:1742395319899466. Epub 2020 Jan 16.

The School of Health and Biomedical Sciences, RMIT University, VIC, Australia.

Objective: A systematic review was undertaken in order to evaluate the competencies of primary healthcare professionals who are engaged with health coaching patients with chronic health conditions.

Methods: The databases CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS were searched to identify peer reviewed papers referring to competencies of health professionals engaged in health coaching.

Results: Nine key competencies that health professionals met and which resulted in successful patient outcomes from health coaching were identified. Comparisons of the core health coaching competencies to the competencies for coaches established by the International Coaching Federation and European Mentoring and Coaching Council showed considerable overlap. However, the comparison also reiterated the need for competencies specific to health coaches to be made explicit.

Discussion: Health coaching has been shown to improve the health outcomes in patients with chronic health conditions. As such, there is a need to build an evidenced-based competency framework specific to health coaches. At present, the lack of a competency framework on which to base health coach training could significantly impact the outcomes of patients receiving health coaching. Practical implications include improving regulation and quality of health coaching, and more importantly, the health outcomes of patients receiving the service.
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http://dx.doi.org/10.1177/1742395319899466DOI Listing
January 2020

Preventing strokes in people with atrial fibrillation by improving ABC.

BMJ Open Qual 2019 27;8(4):e000783. Epub 2019 Nov 27.

Clinical Effectiveness Group, Queen Mary University of London, London, UK.

Nationally, anticoagulation for atrial fibrillation (AF) is improving but remains characterised by marked provider variation. Uncontrolled blood pressure and coronary artery disease further increase cardiovascular risk. Redbridge Clinical Commissioning Group (CCG) and local National Health Service (NHS) hospital trusts supported a programme to improve anticoagulation, blood pressure and cholesterol management; the ABC of AF improvement. The programme was delivered by a clinical pharmacist in 43 general practices, who used Active Patient Link (APL-AF) software to identify and electronically review the records of AF patients potentially suitable for anticoagulation. These patients were invited for a general practitioner (GP)-pharmacist consultation with initiation of anticoagulation where appropriate. Blood pressure and lipid treatment were also optimised. The university-based Clinical Effectiveness Group (CEG) provided software support using standard data entry templates from which the APL-AF software was enabled. This identified suitable patients (eg, on aspirin monotherapy, no treatment or inappropriate dual treatments) for clinical and treatment review. It also reported real-time overall practice performance. Additionally, GP education on direct oral anticoagulant initiation in general practices, use of software and performance reviews, took place for all practices in Redbridge. A weekly multidisciplinary team (MDT) video conference discussed complex patients with a cardiologist, haematologist, GP with specialist interest in cardiology, GP coordinator and clinical pharmacist. This enabled sharing of patient records between GPs and hospital specialists with improved communication and learning. Over 1 year 2016-2017, anticoagulation in eligible AF patients (CHADS-VASc≥2) increased significantly by 6.3% from 77.0% to 83.3% (p<0.0001), in comparison to 2.8% average improvement in England. Exception reporting was also significantly reduced from 10.0% to 5.8%; a reduction of 4.2% in comparison to a reduction in England of 1.5%. Use of antiplatelet monotherapy was approximately halved, from 12.3% to 6.4%. These methods are being scaled locally in other London CCGs and are potentially scalable nationally, specifically targeting the poorer performing CCGs.
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http://dx.doi.org/10.1136/bmjoq-2019-000783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887489PMC
July 2020

IoT based assistive companion for hypersensitive individuals (ACHI) with autism spectrum disorder.

Asian J Psychiatr 2019 Dec 27;46:92-102. Epub 2019 Sep 27.

Khalsa College of Engineering and Technology, Amritsar, India; IKG Punjab Technical University, Kapurthala, India. Electronic address:

Objective: Today, most of the individuals with Autism Spectrum Disorders (ASD) have atypical sensory behaviors. The main aim of this study is to propose an assistive intervention for supporting the overloaded sensory responses in hypersensitive individuals with ASD.

Methods: The vision, auditory, smell, and physical balance related multi-sensors based hardware prototype, namely Assistive Companion for Hypersensitive Individuals (ACHI) has been designed for individuals with ASD. The proposed ACHI prototype is an assistive-technology based companion for hypersensitive individuals with ASD which is able to 'fetch/detect the sensory information using electronic sensors', 'making the decision using fuzzy logic on the basis of fetched sensory information' and then, 'transmit the generated information over the internet through the Internet of Things (IoT)', and also able for 'generating alerts to caregivers'. The proposed design is also capable of providing audio & video feedback to calm down individuals with ASD.

Results: After testing, it is observed that 93% percent of the caregivers rated the proposed ACHI intervention on the scale of above average. The remarkable reduction in hyperactive states related triggering incidents in ASD has been found with the use of ACHI.

Conclusion: The present work and the proposed prototype can identify and control the sensory overload triggers in ASD and it can guide the caregiver or clinicians to optimize the responsible surrounding causes of explosive behavior in ASD and would help the individuals with ASD to become calm.
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http://dx.doi.org/10.1016/j.ajp.2019.09.030DOI Listing
December 2019

Six Months Later: Final Helistroke Pilot Time Analysis.

J Vasc Interv Radiol 2019 10;30(10):1714-1716

Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.

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http://dx.doi.org/10.1016/j.jvir.2019.05.007DOI Listing
October 2019

Evaluation of treatment satisfaction, efficacy and safety of dipeptidyl peptidase-4 inhibitors in geriatric patients with type 2 diabetes mellitus: A cross-sectionalcomparative study.

J Family Med Prim Care 2018 Jan-Feb;7(1):70-76

Department of Pharmacology, All Institute of Medical Sciences, New Delhi, India.

Introduction: Dipeptidyl peptidase 4 (DPP4) inhibitors are attractive agents to be used in the elderly patients with Type 2 diabetes mellitus (T2DM) because of their beneficial effects.

Methods: In this cross-sectional, observational study, we evaluated and compared the treatment satisfaction using Diabetes Treatment Satisfaction Questionnaire (DTSQ) in two groups (i.e., regimens containing DPP4 inhibitors vs. other regimens). Efficacy was evaluated by assessing and comparing the glycosylated hemoglobin (HbA1c) values and the percentage of patients who achieved the glycemic control (HbA1c <7%). The adverse drug reactions (ADRs) were also recorded and compared among two groups.

Results: A total of 115 patients participated in the study (42 in Group 1 and 73 in Group 2). Significantly better DTSQ scores were observed among Group 1 patients in terms of DTSQ score total ( = 0.01) and DTSQ score for perception of hyperglycemia ( = 0.008) as compared to Group 2 patients. Significant difference was observed in HbA1c values among two groups ( = 0.02, 95% confidence interval [CI], 0.06-1.14). Also, significantly higher proportion of patients had achieved glycemic control, i.e., HbA1c <7% in Group 1 as compared to Group 2 ( = 0.002, 95% CI, 11.8%-48.1%). Significantly higher number of ADRs were observed among Group 1 patients as compared to Group 2 ( = 0.003).

Conclusion: DPP4 inhibitors seem to offer better treatment satisfaction and efficacy in geriatric T2DM patients but at the expense of increased frequency of ADRs; however, further research is warranted.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_89_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958596PMC
June 2018

A systematic review of pharmacy health coaching and an evaluation of patient outcomes.

Res Social Adm Pharm 2019 03 21;15(3):244-251. Epub 2018 Apr 21.

The School of Health and Biomedical Sciences, RMIT University, VIC, Australia.

Background: Pharmacy health coaching is a nascent topic offering promise on several fronts. There is considerable benefit to discerning the contributions thus far and future directions of pharmacy health coaching and research of the topic.

Objective: The objective of this review was to synthesize the available empirical evidence regarding pharmacy health coaching and to define it.

Methods: This systematic review followed the PRISMA guidelines. CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS) were searched (2000-2017) to identify sources related to pharmacy health coaching. Included articles were reviewed for their definition and outcomes of health coaching as well as recurring terms/themes pertaining to health coaching.

Results: Ten papers met the eligibility criteria. The results of each empirical study as well as the definitions were used to identify the key outcomes associated with pharmacy health coaching and were then cross tabulated. The most commonly occurring outcome of health coaching was an improvement in a health outcome of a target population. An improvement in medication management/adherence and the relationship between health professionals was equally evident. Lastly, an improved attitude towards drug therapy was referred to more often than the cost-effectiveness of health coaching.

Conclusions: The evaluations enabled the formulation of a grounded definition of health coaching.
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http://dx.doi.org/10.1016/j.sapharm.2018.04.012DOI Listing
March 2019

Impact of Coronary Computed Tomography Angiography Findings on Initiation of Cardioprotective Medications.

Circulation 2017 11;136(22):2195-2197

Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (A.M.C., J.EH.).

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http://dx.doi.org/10.1161/CIRCULATIONAHA.117.029994DOI Listing
November 2017

Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis.

J Hepatobiliary Pancreat Sci 2018 Jan 16;25(1):96-100. Epub 2017 Dec 16.

Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India.

Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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http://dx.doi.org/10.1002/jhbp.519DOI Listing
January 2018

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).

J Hepatobiliary Pancreat Sci 2018 Jan 9;25(1):41-54. Epub 2018 Jan 9.

Mt Elizabeth Novena Hospital, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1 edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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http://dx.doi.org/10.1002/jhbp.515DOI Listing
January 2018

Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis.

J Hepatobiliary Pancreat Sci 2018 Jan 8;25(1):31-40. Epub 2018 Jan 8.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.

The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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http://dx.doi.org/10.1002/jhbp.509DOI Listing
January 2018

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos).

J Hepatobiliary Pancreat Sci 2018 Jan 21;25(1):87-95. Epub 2017 Nov 21.

Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.

Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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http://dx.doi.org/10.1002/jhbp.504DOI Listing
January 2018
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