Texas Medical Center

About: Texas Medical Center is a healthcare organization based out in Houston, Texas, United States. It is known for research contribution in the topics: Population & Cancer. The organization has 2845 authors who have published 2394 publications receiving 79426 citations.

Less invasive off-pump implantation of axial flow pumps in chronic ischemic heart failure: Survival effects

Abstract: Background Off-pump implantation of left ventricular assist device (LVAD) axial or centrifugal flow pumps in patients with low ejection fraction (EF) is of major clinical relevance. In addition, all pre-clinical, long-term implantations performed so far have been carried out in healthy animals, but this does not reflect the eventual clinical setting. In this study we established a new technique using a miniaturized axial flow pump in sheep with chronically ischemic myocardium. Methods Sheep (n = 15) underwent intracoronary sphere injection to create chronic ischemic heart failure. Reduced EF was assessed using transesophageal echocardiography. All animals underwent implantation of a new miniaturized axial flow pump via an extraperitoneal, subcostal surgical approach. Results Our technique allows easy exposure of the diaphragmatic surface of the heart and the descending aorta. Ten animals (range 65 to 78 kg) underwent off-pump implantation 30 (range 25 to 33) days after intracoronary sphere injection. All animals had significantly reduced EF (25 ± 4.8%) and were receiving high doses of inotropic agents to maintain cardiac function. Nine animals survived the surgical procedure. The average 12-hour blood loss was 435 ml. Cardiac index improved significantly in all animals. The procedure time was not extended by any adverse events (60 to 145 minutes). Conclusions The extraperitoneal, subcostal surgical approach is less invasive than a median sternotomy and allows centrifugal or axial to be implanted quickly and without cardiopulmonary bypass (CPB). Avoiding CPB and an extensive mediastinal dissection can help to decrease significantly the number of complications in patients with end-stage organ failure.

Comparison of smartphone application-based vital sign monitors without external hardware versus those used in clinical practice: a prospective trial

Abstract: Use of healthcare-related smartphone applications is common. However, there is concern that inaccurate information from these applications may lead patients to make erroneous healthcare decisions. The objective of this study is to study smartphone applications purporting to measure vital sign data using only onboard technology compared with monitors used routinely in clinical practice. This is a prospective trial comparing correlation between a clinically utilized vital sign monitor (Propaq CS, WelchAllyn, Skaneateles Falls, NY, USA) and four smartphone application-based monitors Instant Blood Pressure, Instant Blood Pressure Pro, Pulse Oximeter, and Pulse Oximeter Pro. We performed measurements of heart rate (HR), systolic blood pressures (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO2) using standard monitor and four smartphone applications. Analysis of variance was used to compare measurements from the applications to the routine monitor. The study was completed on 100 healthy volunteers. Comparison of routine monitor with the smartphone applications shows significant differences in terms of HR, SpO2 and DBP. The SBP values from the applications were not significantly different from those from the routine monitor, but had wide limits of agreement signifying a large degree of variation in the compared values. The degree of correlation between monitors routinely used in clinical practice and the smartphone-based applications studied is insufficient to recommend clinical utilization. This lack of correlation suggests that the applications evaluated do not provide clinically meaningful data. The inaccurate data provided by these applications can potentially contribute to patient harm.

A Theoretical Framework to Understand and Engineer Persuasive Interruptions

Abstract: A Theoretical Framework to Understand and Engineer Persuasive Interruptions Muhammad Walji (Muhammad.F.Walji@uth.tmc.edu) University of Texas Health Science Center at Houston, School of Health Information Sciences, 7000 Fannin, Houston, TX 77030 USA Juliana Brixey (Juliana.J.Brixey@uth.tmc.edu) University of Texas Health Science Center at Houston, School of Health Information Sciences, 7000 Fannin, Houston, TX 77030 USA Kathy Johnson-Throop (Kathy.A.Johnson@jsc.nasa.gov) NASA Johnson Space Center, Houston, TX 77058 USA Jiajie Zhang (Jiajie.Zhang@uth.tmc.edu) University of Texas Health Science Center at Houston, School of Health Information Sciences, 7000 Fannin, Houston, TX 77030 USA positive outcomes, while at the same time minimizing some of their most disruptive properties. After all, interruptions are constantly used to help manage and complete important everyday tasks. Such interruptions also have the ability to influence and change behavior. In order to better understand and explain how interruptions can be engineered to be positive and persuasive we propose a theoretical framework and conceptualization. The theoretical framework may also guide designers on discovering factors to help develop appropriate interruptions. Abstract Interruptions are often seen as distracting or sometimes devastating elements that need to be minimized or eliminated. However, interruptions are also used to increase efficiency, productivity, prevent errors, and even influence behavior. Existing theories and taxonomies of interruptions fail to account for the helpful aspects of interruptions. Therefore we propose a theoretical framework to help explain the positive aspects of interruptions. Warnings & alerts, reminders, suggestions and notifications are examples of interruptions that have beneficial outcomes by changing and influencing behavior. We propose a cognitive theory of interruptions based on the properties of the users, their tasks, and best presentations depending on the desired effectiveness of the interruption. Norman’s 7-stage action model serves to explain how and why an interruption is accepted, and potential mismatches between the goal of the interruption and the user. Potential applications of this model include better understanding the effects of interruptions, and guidance to design effective and persuasive warnings and alerts, reminders, suggestions and notifications. Effects of Interruptions Detrimental Effects of Interruptions Introduction Interruption has been an active area in human-computer interaction research for some time. A comprehensive review was provided by McFarlane and Latorella (2002). Interruptions are typically defined as a change or disturbance in a process or in people’s activities.(Cooper & Franks, 1993; McFarlane & Latorella, 2002) Interruptions are categorized along different dimensions by different researchers, such as source, effect, content, applicability, and duration by Cooper & Franks (1993) and individual properties, methods, meaning, source, channel, change, and effect by McFarlane and Latorella (2002). Significant research has been expelled in determining how to classify, prevent, minimize, and provide tools to help users deal with interruptions. However, there is little understanding how interruptions can be exploited for The effects of interruptions are generally described as negative Users perceive an interrupted task as being more difficult to complete than an uninterrupted task (Bailey, Konstan, & Carlis, 2000). An interruption is also thought to take longer to process and return back to task when it is unrelated to the task at hand (Cutrell, Czerwinski, & Horvitz, 2001). The added memory load seems to make it difficult for a task to be resumed. It also becomes difficult to remember what task was being processed before the interruption. (Burmistrov & Leonova, 1996; Dix, Ramduny, & Wilkinson, 1995). Further, the complexity of the task being interrupted effects the disruptiveness of an interruption. Interrupting complex tasks inhibits performance, and has no effect on simpler tasks (Burmistrov & Leonova, 1996). Interestingly, people can recall details about interrupted tasks better than uninterrupted tasks.(McFarlane & Latorella, 2002) People also have individual differences in their ability to respond and manage interruptions (McFarlane & Latorella, 2002). Interruptions also affect performance. Users are thought in general to perform slower on interrupted tasks (Bailey et al., 2000), although some evidence exist that an interruption may actually speed up task completion (Zijlstra,