Browsing by Author "Mirro, Michael"
Now showing 1 - 9 of 9
Results Per Page
Sort Options
Item The association of COMT genotype with buproprion treatment response in the treatment of major depressive disorder(Wiley, 2020-05-27) Fawver, Jay; Flanagan, Mindy; Smith, Thomas; Drouin, Michelle; Mirro, Michael; BioHealth Informatics, School of Informatics and ComputingBackground Pharmacodynamics and pharmacogenetics are being explored in pharmacological treatment response for major depressive disorder (MDD). Interactions between genotype and treatment response may be dose dependent. In this study, we examined whether MDD patients with Met/Met, Met/Val, and Val/Val COMT genotypes differed in their response to bupropion in terms of depression scores. Methods This study utilized a convenience sample of 241 adult outpatients (≥18 years) who met DSM‐5 criteria for MDD and had visits at a Midwest psychopharmacology clinic between February 2016 and January 2017. Exclusion criteria included various comorbid medical, neurological, and psychiatric conditions and current use of benzodiazepines or narcotics. Participants completed genetic testing and the 9 question patient‐rated Patient Health Questionnaire (PHQ‐9) at each clinic visit (M = 3.8 visits, SD = 1.5) and were prescribed bupropion or another antidepressant drug. All participants were adherent to pharmacotherapy treatment recommendations for >2 months following genetic testing. Results Participants were mostly Caucasian (85.9%) outpatients (154 female and 87 male) who were 44.5 years old, on average (SD = 17.9). For Val carriers, high bupropion doses resulted in significantly lower PHQ‐9 scores than no bupropion (t(868) = 5.04, p < .001) or low dose bupropion (t(868) = 3.29, p = .001). Val carriers differed significantly from Met/Met patients in response to high dose bupropion (t(868) = −2.03, p = .04), but not to low dose bupropion. Conclusion High‐dose bupropion is beneficial for MDD patients with Met/Val or Val/Val COMT genotypes, but not for patients with Met/Met genotype. Prospective studies are necessary to replicate this pharmacodynamic relationship between bupropion and COMT genotypes and explore economic and clinical outcomes.Item Clinician use of data elements from cardiovascular implantable electronic devices in clinical practice(Elsevier, 2023-01-20) Daley, Carly; Coupe, Amanda; Allmandinger, Tina; Shirazi, Jonathan; Wagner, Shauna; Drouin, Michelle; Ahmed, Ryan; Toscos, Tammy; Mirro, Michael; BioHealth Informatics, School of Informatics and ComputingBackground: Cardiovascular implantable electronic devices (CIEDs) capture an abundance of data for clinicians to review and integrate into the clinical decision-making process. The multitude of data from different device types and vendors presents challenges for viewing and using the data in clinical practice. Efforts are needed to improve CIED reports by focusing on key data elements used by clinicians. Objective: The purpose of this study was to uncover the extent to which clinicians use the specific types of data elements from CIED reports in clinical practice and explore clinicians' perceptions of CIED reports. Methods: A brief, web-based, cross-sectional survey study was deployed using snowball sampling from March 2020 through September 2020 to clinicians who are involved in the care of patients with CIEDs. Results: Among 317 clinicians, the majority specialized in electrophysiology (EP) (80.1%), were from North America (88.6%), and were white (82.2%). Over half (55.3%) were physicians. Arrhythmia episodes and ventricular therapies rated the highest among 15 categories of data presented, and nocturnal or resting heart rate and heart rate variability were rated the lowest. As anticipated, clinicians specializing in EP reported using the data significantly more than other specialties across nearly all categories. A subset of respondents offered general comments describing preferences and challenges related to reviewing reports. Conclusion: CIED reports contain an abundance of information that is important to clinicians; however, some data are used more frequently than others, and reports could be streamlined for users to improve access to key information and facilitate more efficient clinical decision making.Item Data Integration and Interoperability for Patient-Centered Remote Monitoring of Cardiovascular Implantable Electronic Devices(MDPI, 2019-03-17) Daley, Carly; Toscos, Tammy; Mirro, Michael; BioHealth Informatics, School of Informatics and ComputingThe prevalence of cardiovascular implantable electronic devices with remote monitoring capabilities continues to grow, resulting in increased volume and complexity of biomedical data. These data can provide diagnostic information for timely intervention and maintenance of implanted devices, improving quality of care. Current remote monitoring procedures do not utilize device diagnostics to their potential, due to the lack of interoperability and data integration among proprietary systems and electronic medical record platforms. However, the development of a technical framework that standardizes the data and improves interoperability shows promise for improving remote monitoring. Along with encouraging the implementation of this framework, we challenge the current paradigm and propose leveraging the framework to provide patients with their remote monitoring data. Patient-centered remote monitoring may empower patients and improve collaboration and care with health care providers. In this paper, we describe the implementation of technology to deliver remote monitoring data to patients in two recent studies. Our body of work explains the potential for developing a patent-facing information display that affords the meaningful use of implantable device data and enhances interactions with providers. This paradigm shift in remote monitoring-empowering the patient with data-is critical to using the vast amount of complex and clinically relevant biomedical data captured and transmitted by implantable devices to full potential.Item Diaphragmatic Function in Cardiovascular Disease: JACC Review Topic of the Week(Elsevier, 2022-10-25) Salah, Husam M.; Goldberg, Lee R.; Molinger, Jeroen; Felker, G. Michael; Applefeld, Willard; Rassaf, Tienush; Tedford, Ryan J.; Mirro, Michael; Cleland, John G. F.; Fudim, Marat; Biomedical Engineering and Informatics, Luddy School of Informatics, Computing, and EngineeringIn addition to the diaphragm's role as the primary respiratory muscle, it also plays an under-recognized role in cardiac function. It serves as a pump facilitating venous and lymph return, modulating left ventricular afterload hemodynamics and pericardial pressures, as well as regulating autonomic tone. Heart failure (HF) is associated with diaphragmatic changes (ie, muscle fiber atrophy and weakness, increased ratio of type I to type II muscle fibers, and altered muscle metaboreflex) that lead to diaphragmatic dysfunction with subsequent symptomatic manifestations of HF. Herein, it is proposed that targeting the diaphragm in patients with HF via inspiratory muscle training or device-based stimulation can provide a novel treatment pathway for HF. Reviewed are several potential mechanisms through which therapies targeting the diaphragm can be beneficial in HF (ie, improving preload reserve, atrial and ventricular synchrony, and metaboreflex activity; reducing pericardial restraint; and restoring diaphragm strength).Item Involving patients as key stakeholders in the design of cardiovascular implantable electronic device data dashboards: Implications for patient care(Elsevier, 2020-05-11) Daley, Carly; Ghahari, Romisa Rohani; Drouin, Michelle; Ahmed, Ryan; Wagner, Shauna; Reining, Lauren; Coupe, Amanda; Toscos, Tammy; Mirro, Michael; BioHealth Informatics, School of Informatics and ComputingBackground: Data from remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) currently are not accessible to patients despite demand. The typical RM report contains multiple pages of data for trained technicians to read and interpret and requires a patient-centered approach to be curated to meet individual user needs. Objective: The purpose of this study was to understand which RM data elements are important to patients and to gain design insights for displaying meaningful data in a digital dashboard. Methods: Adults with implantable cardioverter-defibrillators (ICDs) and pacemakers (PMs) participated in this 2-phase, user-centered design study. Phase 1 included a card-sorting activity to prioritize device data elements. Phase 2 included one-on-one design sessions to gather insights and feedback about a visual display (labels and icons). Results: Twenty-nine adults (mean age 71.8 ± 11.6 years; 51.7% female; 89.7% white) participated. Priority data elements for both ICD and PM groups in phase 1 (n = 19) were related to cardiac episodes, device activity, and impedance values. Recommended replacement time for battery was high priority for the PM group but not the ICD group. Phase 2 (n = 10) revealed that patients would like descriptive, nontechnical terms to depict the data and icons that are intuitive and informative. Conclusion: This user-centered design study demonstrated that patients with ICDs and PMs were able to prioritize specific data from a comprehensive list of data elements that they had never seen before. This work contributes to the goal of sharing RM data with patients in a way that optimizes the RM feature of CIEDs for improving patient outcomes and clinical care.Item Patient responses to daily cardiac resynchronization therapy device data: A pilot trial assessing a novel patient-centered digital dashboard in everyday life(Elsevier, 2020-09) Toscos, Tammy; Daley, Carly; Wagner, Shauna; Coupe, Amanda; Ahmed, Ryan; Holden, Richard J.; Flanagan, Mindy E.; Pfafman, Rachel; Ghahari, Romisa Rohani; Mirro, Michael; Medicine, School of MedicineBackground Heart failure (HF) is a growing public health problem in the United States. Implantable cardiac resynchronization therapy (CRT) devices reduce mortality and morbidity, and remote monitoring (RM) of these devices improves outcomes. However, patient RM adherence is low, due in part to lack of access to their RM data. Providing these data to patients may increase engagement, but they must be appropriately tailored to ensure understanding. Objective The purpose of this study was to examine patients’ experiences interacting with their RM data through a novel digital dashboard as part of daily life. Methods In this mixed-methods pilot study, 10 patients with implantable CRT defibrillators were given access to a patient-centered RM data dashboard, updated daily for 6–12 months. Pre- and post-health literacy, engagement, electronic portal (MyChart, Epic Systems Corporation) logins, and RM adherence were measured; system usability scores were collected at exit; and dashboard views were tracked. Exit interviews were conducted to elucidate patients’ experiences. Results Participants (100% white; 60% male; age 34–80 years [mean ± SD: 62.0 ± 13.4]) had adequate health literacy, increased MyChart logins (P = .0463), and nonsignificant increase in RM adherence. Participants viewed their dashboards 0–42 times (mean 14.9 ± 12.5). Interviews revealed participants generally appreciated access to their data, understood it, and responded to changes; however, questions and concerns remained regarding data interpretation and visualization. Conclusion Preliminary findings support potential future integration of a CRT RM data dashboard in the daily care of HF patients. With appropriate informational support and personalization, sharing RM data with patients in a tailored dashboard may improve health engagement.Item Sustained Stimulus Paradigms and Sexual Dimorphism of the Aortic Baroreflex in Rat(2019-05) Mintch, Landan M.; Schild, John; Yoshida, Ken; Mirro, MichaelThe neurophysiological pathways associated with beat-to-beat regulation of mean arterial pressure are well known. Less known are the control dynamics associated with short term maintained of arterial blood pressure about a homeostatic set point. The barorefex (BRx), the most rapid and robust of neural refexes within the autonomic nervous system, is a negative feedback controller that monitors and regulates heart rate and blood pressure. By leveraging the parasympathetic and sympathetic divisions of the autonomic nervous system, the BRx can change blood pressure within a single heart beat. To better understand these controller dynamics, a classic BRx refexogenic experimental preparation was carried out. This thesis recon rmed previous observations of an electrically-evoked sexually-dimorphic peak depressor response in the BRx of Sprague-Dawley rats and veri ed that these functional refexogenic differences carry over to sustained electrical paradigms. Further, it uncovered interesting recovery dynamics in both blood pressure and heart rate. The rat aortic depressor nerve was used as an experimental target for electrical activation of the parasympathetic-mediated reduction in mean arterial pressure. The duration, frequency, and patterning of stimulation were explored, with emphasis on differences between sexes. By measuring the normalized percent decrease in mean arterial pressure as well as the differences in beats per minute during rest and during stimulation, the null hypothesis was rejected.Item Uncertainty Management Among Older Adults with Heart Failure: Responses to Receiving Implanted Device Data using a Fictitious Scenario Interview Method(Sage, 2019) Daley, Carly; Cornet, Victor; Patekar, Gauri; Kosarabe, Swapnil; Bolchini, Davide; Toscos, Tammy; Mirro, Michael; Wagner, Shauna; Martin, Elizabeth; Ghahari, Romisa Rohani; Ahmed, Ryan; Miller, Amy; Holden, Richard J.; Medicine, School of MedicineHeart failure (HF) is a complex chronic illness that affects the older adult population, requiring medical therapy and day-to-day management to prevent worsening and exacerbation. Patients with HF are often treated with cardiac implanted electronic devices (CIEDs) which capture diagnostic and predictive parameters for HF. In this work we explore how patients would respond to receiving data from an implanted device, using a fictitious scenario interview method with 24 older adults with HF. We applied an uncertainty management lens to better understand how patients face uncertain outcomes and integrate novel data into their decision making. The findings provide insight into how patients would engage and respond to a technology which provides an indicator of their HF status from an implanted device.Item Visualization of Cardiac Implantable Electronic Device Data for Older Adults Using Participatory Design(Thieme, 2019-09-18) Ahmed, Ryan; Toscos, Tammy; Ghahari, Romisa Rohani; Holden, Richard J.; Martin, Elizabeth; Wagner, Shauna; Daley, Carly; Coupe, Amanda; Mirro, Michael; BioHealth Informatics, School of Informatics and ComputingPatients with heart failure (HF) are commonly implanted with cardiac resynchronization therapy (CRT) devices as part of their treatment. Presently, they cannot directly access the remote monitoring (RM) data generated from these devices, representing a missed opportunity for increased knowledge and engagement in care. However, electronic health data sharing can create information overload issues for both clinicians and patients, and some older patients may not be comfortable using the technology (i.e., computers and smartphones) necessary to access this data. To mitigate these problems, patients can be directly involved in the creation of data visualization tailored to their preferences and needs, allowing them to successfully interpret and act upon their health data. We held a participatory design (PD) session with seven adult patients with HF and CRT device implants, who were presently undergoing RM, along with two informal caregivers. Working in three teams, participants used drawing supplies and design cards to design a prototype for a patient-facing dashboard with which they could engage with their device data. Information that patients rated as a high priority for the “Main Dashboard” screen included average percent pacing with alerts for abnormal pacing, other device information such as battery life and recorded events, and information about who to contact with for data-related questions. Preferences for inclusion in an “Additional Information” display included a daily pacing chart, health tips, aborted shocks, a symptom list, and a journal. These results informed the creation of an actual dashboard prototype which was later evaluated by both patients and clinicians. Additionally, important insights were gleaned regarding the involvement of older patients in PD for health technology.