Joseph Azuri

Home detection of freezing of gait using support vector machines through a single waist-worn triaxial accelerometer

Among Parkinson’s disease (PD) symptoms, freezing of gait (FoG) is one of the most debilitating. To assess FoG, current clinical practice mostly employs repeated evaluations over weeks and months based on questionnaires, which may not accurately map the severity of this symptom. The use of a non-invasive system to monitor the activities of daily living (ADL) and the PD symptoms experienced by patients throughout the day could provide a more accurate and objective evaluation of FoG in order to better understand the evolution of the disease and allow for a more informed decision-making process in making adjustments to the patient’s treatment plan. This paper presents a new algorithm to detect FoG with a machine learning approach based on Support Vector Machines (SVM) and a single tri-axial accelerometer worn at the waist. The method is evaluated through the acceleration signals in an outpatient setting gathered from 21 PD patients at their home and evaluated under two different conditions: first, a generic model is tested by using a leave-one-out approach and, second, a personalised model that also uses part of the dataset from each patient. Results show a significant improvement in the accuracy of the personalised model compared to the generic model, showing enhancement in the specificity and sensitivity geometric mean (GM) of 7.2%. Furthermore, the SVM approach adopted has been compared to the most comprehensive FoG detection method currently in use (referred to as MBFA in this paper). Results of our novel generic method provide an enhancement of 11.2% in the GM compared to the MBFA generic model and, in the case of the personalised model, a 10% of improvement with respect to the MBFA personalised model. Thus, our results show that a machine learning approach can be used to monitor FoG during the daily life of PD patients and, furthermore, personalised models for FoG detection can be used to improve monitoring accuracy.

The impact of residents' training in Electronic Medical Record (EMR) use on their competence: report of a pragmatic trial.

OBJECTIVES Even though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor-patient-computer communication (DPCC). METHODS 36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training. RESULTS Performance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction. CONCLUSION We assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills. PRACTICE IMPLICATION Simulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.

Reassuring the medical students' disease - Health related anxiety among medical students

Background: Studying a specific illness could lead medical students to an incorrect interpretation of certain physical symptoms, so that symptoms which were previously considered normal are now regarded as a true sign of an illness. Aim: To examine the appraisal of self-health state, the existing fear of morbidity and the level of health-related anxiety among medical students throughout medical school. Methods: Anonymous questionnaires were distributed to first through sixth year medical students at the Tel-Aviv University Medical School. The questionnaires were distributed to all the students who were present on the study days. Results: We observed a significant rise in the emotional–distress process with entering the clinical years followed by a significant decrease later on. Similar pattern was seen in health anxiety and in preoccupation with and fear of illness and death. While the perceptual–cognitive process increased gradually, there was no change in interference with life scores. Conclusion: “Medical students disease” should be regarded as a phenomenon depending on the years of learning. By breaking it down into its components, one can better characterize it and predict its onset. By defining it as a normal process, one can assist in guiding medical students to reduce their level of anxiety and distress.

Can we predict the need for pharmacological treatment according to demographic and clinical characteristics in gestational diabetes

Abstract Objective: To determine the ability to predict the need for pharmacological treatment in gestational diabetes mellitus (GDM). Method: A retrospective cohort study. Data were collected from medical records of 1324 GDM patients including demographic data, family history of diabetes, obstetrical history, laboratory results, treatment modality and level of glycemic control. Patients who were identified as pre-gestational diabetes were excluded. Results: Overall, 143 (10.8%) GDM patients required pharmacological therapy. Of women who had GDM in their previous pregnancy; only 11.65% achieved desired glycemic control solely by diet treatment. Moreover, 62.5% of patients requiring pharmacological therapy in their previous pregnancy achieved desired level of glycemic control only by diet. Of patients who achieved desired level of glycemic control on diet until the second antenatal visit, 95% continued to maintain desired level glycemic control throughout pregnancy. Pre-pregnancy BMI >30, fasting plasma glucose >95 mg/dL and maternal age above 30 were associated with increase need for pharmacological treatment. One abnormal value in the OGTT and GCT result >2 mg/dL did not predict the need for pharmacological therapy. Primigravida and family history of GDM were not found to be predictors for treatment modality. Conclusion: Using clinical and demographical data can predict the need for pharmacological treatment for GDM.

Outcomes of different protocols of pelvic floor physical therapy and anti-cholinergics in women with wet over-active bladder: A 4-year follow-up.

We investigated the 4‐year outcomes of three protocols of pelvic floor physical therapy and anticholinergic drug in women with wet over‐active bladder (OAB).

Smoking prevention and primary physician's and patient's characteristics.

OBJECTIVE To describe relationships between primary physician and patient characteristics and the approach to prevention and quitting of smoking. METHODS A questionnaire composed of descriptions of cases and clinic activities was given to primary physicians. RESULTS Fewer smoking physicians use written materials, yet former smokers more often recommend smoking cessation groups. Greatest efforts are invested in high-risk patients. However, former smokers invest greater efforts among youth and pregnant women. Workload and patients main complaint exert great influence on raising the subject. CONCLUSIONS The various attitudes of physicians emphasize the importance of physician education that should be according to their smoking habits.

Achievement of low-density lipoprotein cholesterol goals in 18 countries outside Western Europe: The International ChoLesterol management Practice Study (ICLPS):

Background Little is known about the achievement of low density lipoprotein cholesterol (LDL-C) targets in patients at cardiovascular risk receiving stable lipid-lowering therapy (LLT) in countries outside Western Europe. Methods This cross-sectional observational study was conducted in 452 centres (August 2015−August 2016) in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America. Patients (n = 9049) treated for ≥3 months with any LLT and in whom an LDL-C measurement on stable LLT was available within the previous 12 months were included. Results The mean±SD age was 60.2 ± 11.7 years, 55.0% of patients were men and the mean ± SD LDL-C value on LLT was 2.6 ± 1.3 mmol/L (101.0 ± 49.2 mg/dL). At enrolment, 97.9% of patients were receiving a statin (25.3% on high intensity treatment). Only 32.1% of the very high risk patients versus 51.9% of the high risk and 55.7% of the moderate risk patients achieved their LDL-C goals. On multivariable analysis, factors independently associated with not achieving LDL-C goals were no (versus lower dose) statin therapy, a higher (versus lower) dose of statin, statin intolerance, overweight and obesity, female sex, neurocognitive disorders, level of cardiovascular risk, LDL-C value unknown at diagnosis, high blood pressure and current smoking. Diabetes was associated with a lower risk of not achieving LDL-C goals. Conclusions These observational data suggest that the achievement of LDL-C goals is suboptimal in selected countries outside Western Europe. Efforts are needed to improve the management of patients using combination therapy and/or more intensive LLTs.

Primary Care Physicians' Characteristics and Attitudes on Smoking Cessation.

OBJECTIVES Primary care physicians are uniquely positioned to initiate and promote smoking cessation. However, their attitude towards smoking cessation is influenced by many factors, including their own smoking habits and knowledge. The aim of the study was to assess the impact of smoking habits, knowledge, and personal characteristics of primary care physicians on their attitude towards smoking cessation in comparison to a previous study conducted a decade ago. METHODS Overall, 302 primary care physicians filled out a questionnaire designed specifically to evaluate knowledge, smoking habits, and smoking cessation interventions they use. RESULTS More never-smoking physicians initiate conversations about smoking cessation, recommend smoking cessation groups, and set quit date to their smoking patients. They also invest greater efforts in patients with smoking complications. More current-smoking physicians advise Nicotine Replacement Therapy and joining Internet forums and telephone consultations. Keeping good relations with the patients plays an important role in the willingness of physicians to initiate a talk. A large proportion of physicians state they would prescribe smoking cessation medications to patients even when contraindicated. CONCLUSION The various approaches of primary care physicians emphasize the importance of physician education according to their own smoking habits.

How reliable are self-assessments using mobile technology in healthcare? The effects of technology identity and self-efficacy

Abstract Traditionally in clinics or hospitals, it is the staff (physician, nurses, and so forth) who would check the patients health status (e.g., blood pressure, height, weight, body temperature, and so forth). However, when mobile apps are used as the point of contact between patients and healthcare providers, the self-monitoring of health status will be exposed to biases due to being done by common people. Therefore ‘self-report reliability’ becomes an essential factor in the mobile healthcare context. Drawing on ‘technology identity’ and ‘technology self-efficacy’ literature, we theorized that perceived mobile technology identity directly affects self-report reliability, and perceived self-efficacy moderates the relationship between the two. A sample of patients from a clinic who completed a survey and self-reported their health status using a mobile health app was collected. The results of the analyses suggest that academic education affects the reliability of self-reports. In addition, patients aged 61 and above were more accurate in reporting their health status. Moreover, we found that self-efficacy improves the accuracy of self-reports and moderates the effect of mobile technology identity on self-report reliability. The findings of this paper contribute to the ongoing research around mobile healthcare application use and issues surrounding this phenomenon.

Contributors to Women's Perceived Stress at the Start of Assisted Reproductive Technology

Abstract Clinicians are often called upon to treat the stress that accompanies Assisted Reproductive Technology (ART). In this study, we sought to examine the contribution of the internal resources of meaning in life and attachment style and the interpersonal resource of self-disclosure to her mother to a womans level of perceived stress upon commencement of ART. In addition, we examined the association between age and perceived stress. The sample consisted of 180 Israeli women (106 aged 20–34; 74 aged 35–44) who completed a series of self-report questionnaires after their initial meeting with a fertility specialist. Regression analysis indicated that older age, lower attachment anxiety, higher perception of meaning in life, and greater self-disclosure to the mother were related to lower levels of perceived stress. Self-disclosure was also found to mediate the association between avoidant attachment and stress. The study highlights the importance of a woman’s personal and interpersonal resources for reducing the experience of stress in the early stages of ART. The results have practical implications for the development of professional interventions seeking to enhance these resources among women embarking on fertility treatment.