Transforming the Primary Care Journey with Generative AI: A Foundation Model to Boost Efficiency, Quality, and Engagement.

Primary care is the cornerstone of every patient's health journey. Given its central role in the delivery of medical care, primary care is crucial in the integration of artificial intelligence (AI) into healthcare. Generative AI has the potential to augment primary care workflows to achieve the quintuple aim.

Data Transformation to Advance AI/ML Research and Implementation in Primary Care.

Artificial intelligence and machine learning (AI/ML) in health care is accelerating at a breathtaking pace. As the largest health care delivery platform, primary care is where the power, opportunity, and future of AI/ML are most likely to be realized in the broadest and most ambitious scale. However, there is a relative lack of organized, open, large-scale primary care datasets to attract industry and academia in primary care-focused research and development.

Evaluation of SNOMED CT Grouper Accuracy and Coverage in Organizing the Electronic Health Record Problem List by Clinical System: Observational Study.

Background: The problem list (PL) is a repository of diagnoses for patients' medical conditions and health-related issues. Unfortunately, over time, our PLs have become overloaded with duplications, conflicting entries, and no-longer-valid diagnoses. The lack of a standardized structure for review adds to the challenges of clinical use.

Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19.

On January 30, 2023, the Biden Administration announced its intention to end the existing COVID-19 public health emergency declaration. The transition to a "postpandemic" landscape presents a unique opportunity to sustain and strengthen pandemic-era changes in care delivery. With this in mind, we present 3 critical lessons learned from a primary care perspective during the COVID-19 pandemic.

Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents.

Background: Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study.

Methods: This was a non-randomized trial (pilot study) including NH staff and residents from five facilities.

Accumulation in Visceral Adipose Tissue Over 6 Years Is Associated With Lower Paraspinal Muscle Density.

Context: Visceral adipose tissue (VAT) has been recognized to be a metabolically active fat depot that may have paracrine effects on surrounding tissues, including muscle. Since many adults accumulate VAT as they age, the effect of changes in VAT on muscle is of interest.

Objective: We determined the association between 6-year changes in VAT and paraspinal muscle density, an indicator of fatty infiltration.

Increased Clinician Time Using Electronic Health Records During COVID-19 Pandemic.

The COVID-19 pandemic challenged how healthcare systems provided care in socially distanced formats. We hypothesized that the COVID-19 era changes in clinical care delivery models contributed to increased Electronic Health Record (EHR) related work. To evaluate the changes in time and volume metrics of EHR usage, we segregated EHR audit log metric data into PreCOVID2019 March/April/May, initial COVID2020 March/April/May, and late COVID2021 March/April/May for 1262 physician providers.

The Trial to Reduce Antimicrobial Use in Nursing Home Residents With Alzheimer Disease and Other Dementias (TRAIN-AD): A Cluster Randomized Clinical Trial.

Importance: Antimicrobials are extensively prescribed to nursing home residents with advanced dementia, often without evidence of infection or consideration of the goals of care.

Objective: To test the effectiveness of a multicomponent intervention to improve the management of suspected urinary tract infections (UTIs) and lower respiratory infections (LRIs) for nursing home residents with advanced dementia.

Design, Setting, And Participants: A cluster randomized clinical trial of 28 Boston-area nursing homes (14 per arm) and 426 residents with advanced dementia (intervention arm, 199 residents; control arm, 227 residents) was conducted from August 1, 2017, to April 30, 2020.

The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing.

Background/objectives: This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services.

Design: Cluster randomized controlled trial with randomization at the housing site level.

The trial to reduce antimicrobial use in nursing home residents with Alzheimer's disease and other dementias: study protocol for a cluster randomized controlled trial.

Background: Infections are common in nursing home (NH) residents with advanced dementia but are often managed inappropriately. Antimicrobials are extensively prescribed, but frequently with insufficient evidence to support a bacterial infection, promoting the emergence of multidrug-resistant organisms. Moreover, the benefits of antimicrobials remain unclear in these seriously ill residents for whom comfort is often the goal of care.

A Cluster Randomized Trial of Tai Chi vs Health Education in Subsidized Housing: The MI-WiSH Study.

Objectives: Tai Chi (TC) may benefit older adults with a variety of diseases and disabilities. We tested the hypothesis that TC improves physical function in older adults living in low-income housing facilities.

Design: Cluster randomized controlled trial.

Contrasting lengths of Pelargonium floral nectar tubes result from late differences in rate and duration of growth.

Background And Aims: Much of morphological evolution in flowers has arisen from pollinator-mediated selection, often manifest as a match between the length of the pollinator's proboscis and the depth of tubular corollas or spurs. We investigate development, growth and homology of the unique nectar tube of Pelargonium, frequently described as 'a spur adnate to the pedicel'.

Methods: We focused on two species.

Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

Background: There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure.

Frailty, Physical Activity, and Mobility in Patients With Cardiac Implantable Electrical Devices.

Background: This study aimed to demonstrate the feasibility of measuring frailty in patients with cardiac implantable electrical devices while validating the physiologic significance of device-detected physical activity by evaluating its association with frailty and mobility.

Methods And Results: Outpatients with cardiac implantable electrical devices compatible with physical activity analysis with at least 7 days of data were eligible. Office testing included frailty status (Study of Osteoporotic Fractures instrument), gait speed (m/s), mobility according to the Timed Up and Go (TUG) test (seconds), and daily physical activity (h/d) as measured by cardiac implantable electrical device.

Modelling amorphous computations with transcription networks.

The power of electronic computation is due in part to the development of modular gate structures that can be coupled to carry out sophisticated logical operations and whose performance can be readily modelled. However, the equivalences between electronic and biochemical operations are far from obvious. In order to help cross between these disciplines, we develop an analogy between complementary metal oxide semiconductor and transcriptional logic gates.