Diseases Commons^™

Liposomal Eribulin (E7389-Lf) Plus Nivolumab: A Potential Treatment Option For Patients With Advanced Gastric Cancer?, Ali Raza Shaikh, Daniel Lin

Jefferson Hospital Staff Papers and Presentations

No abstract provided.

Association Between Mri Findings Of Facet Arthropathy And Synovitis With Health-Related Outcome And Pain Scores Following Therapeutic Lumbar Facet Injections., Michael S Green, Michele Van Hal, Matthew Onimus, Christopher R Hoffman, Dhruv K C Goyal, Valeria Potigailo, Khuram S Kazmi

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Low back pain is a common complaint among adults. The facet joint is a major source of lumbar pain, and therapeutic facet injections have gained popularity as a minimally invasive treatment option. In addition, magnetic resonance imaging (MRI) utilization for diagnosing low back pain has increased significantly over the past few decades. Facet synovitis is an entity characterized by edema and inflammatory changes affecting the facet joints, adjacent bone marrow, and surrounding soft tissues. Although its underlying etiology remains poorly understood, recent reports suggest a high incidence in patients with arthropathy and arthritis. It is essential to explore potential correlations …

Pathological Fractures And The Perils Of Purchasing Steroids Online, Danielle C Thor, Valerie Rome

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Exogenous steroids are a staple of modern medicine, with utility in a variety of direct and supplemental treatment modalities. However, all pharmaceuticals are undoubtedly coupled with unique side effect profiles, and steroids are no exception. In the case presented, the assessment and management of a 36-year-old male who inappropriately self-administered high-dose steroids for prolonged periods of time is reviewed. In doing so, attention is drawn to both the impact of glucocorticoid-induced osteoporosis and the greater risk of online availability of these powerful medications.

Physician Perspectives About The Diagnosis And Management Of Acute Chest Syndrome, Neha Bhasin, Dana Marie Leblanc, Sean Yates, Quentin Eichbaum, An Pham, Deva Sharma, Li Zhang, Elliott P. Vichinsky, Ravi Sarode

School of Medicine Faculty Publications

Background: Acute chest syndrome (ACS) is the leading cause of mortality, accounting for 25% of all deaths among individuals with sickle cell disease (SCD). There is a lack of evidence-based laboratory and clinical risk stratification guidelines for the diagnosis and management of ACS. Study Design and Methods: To better understand physician practices for the management of ACS in the United States, we created an ACS Working Group including hematology and transfusion medicine physicians from four different SCD treatment centers in the United States. The working group created a physician survey that included physician demographics and ACS diagnostic criteria that they …

Molecular Architecture Of Chitin And Chitosan-Dominated Cell Walls In Zygomycetous Fungal Pathogens By Solid-State Nmr, Qinghui Cheng, Malitha C. Dickwella Widanage, Jayasubba Reddy Yarava, Ankur Ankur, Jean Paul Latgé, Ping Wang, Tuo Wang

School of Medicine Faculty Publications

Zygomycetous fungal infections pose an emerging medical threat among individuals with compromised immunity and metabolic abnormalities. Our pathophysiological understanding of these infections, particularly the role of fungal cell walls in growth and immune response, remains limited. Here we conducted multidimensional solid-state NMR analysis to examine cell walls in five Mucorales species, including key mucormycosis causative agents like Rhizopus and Mucor species. We show that the rigid core of the cell wall primarily comprises highly polymorphic chitin and chitosan, with minimal quantities of β-glucans linked to a specific chitin subtype. Chitosan emerges as a pivotal molecule preserving hydration and dynamics. Some …

Acne And The Cutaneous Microbiome: A Systematic Review Of Mechanisms And Implications For Treatments, Alicia Podwojniak, Isabella J Tan, John Sauer, Zachary Neubauer, Hanna Rothenberg, Hira Ghani, Aarushi K Parikh, Bernard Cohen

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Acne vulgaris is a pervasive skin disease characterized by inflammation of sebaceous units surrounding hair follicles. It results from the complex interplay between skin physiology and the intricate cutaneous microbiome. Current acne treatments, while effective, have major limitations, prompting a shift towards microbiome-based therapeutic approaches. This study aims to determine the relationship between acne and the cutaneous microbiome, assess the effects of current treatments on the cutaneous microbiome and explore the implications for developing new therapies. A systematic review was performed using PubMed and SCOPUS databases within the last 10 years. Methodological quality was assessed independently by two authors. The …

Factors Associated With Recanalization And Reintervention Following Below Knee Polidocanol Endovenous Microfoam Ablation For Great Saphenous And Small Saphenous Veins, John Fang, Christian Fang, Andy Moyal, Enrico Ascher, Anil Hingorani, Natalie Marks

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Polidocanol endovenous microfoam (PEM) has been used to treat lower extremity venous reflux for almost one decade with specific advantages for below knee (BK) truncal veins where thermal ablation poses a risk of injury to adjacent nerves. The current literature of the BK segment often examines short-term outcomes with modest sample sizes. We aim to identify factors associated with recanalization and reintervention in this subset of patients.

METHODS: We performed a retrospective study of a prospectively maintained database of patients from a single institution who underwent 1% PEM ablation for BK great saphenous vein (GSV) and small saphenous vein …

Bilio-Cecal Stent Migration Presenting As Massive Rectal Bleeding., Lefika Bathobakae, Shady Geris, Mohita Jariwala, Mansi Patel, Jessica Escobar, Ruhin Yuridullah, Kamal Amer, Yana Cavanagh

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Endoscopic biliary stenting is a well-established intervention for the treatment of biliary, hepatic, and pancreatic disorders. The common indications include strictures, neoplasms, stones, infections, and bile leaks. Stents can be occluded, predisposing patients to ascending cholangitis and biliary sepsis. Distal stent migration is another known complication of endoscopic stenting and is usually spontaneous. Bowel perforation, abscesses, bleeding, and pancreatitis are rare complications of distal stent migration and are usually limited to the duodenum. Herein, we describe an extremely rare case of bilio-cecal stent migration presenting as rectal bleeding.

Simple And Epididymal-Sparing Orchiectomy For Surgical Castration In Stage Iv Prostate Cancer, Harrison Travis, Michael Dubic, Joseph Bardot, Blane Edwards, Jessie R. Gills, Scott E. Delacroix, Stephen Lacour, Matthew Mutter, Donald Bell, Mary E. Westerman

School of Medicine Faculty Publications

Background: Androgen deprivation therapy, the mainstay of treatment for patients with advanced prostate cancer, can be either medical or surgical. Surgery has cost benefits compared to medical treatment. In this study, we evaluated the use of simple and epididymal-sparing orchiectomy in 2 different practice settings for the treatment of metastatic prostate cancer. Methods: We reviewed patients who underwent surgical castration for metastatic prostate cancer between 2011 and 2022. The primary outcome was achieving castration-level total testosterone of /dL. We also compared the characteristics of patients who were seen at a public academic teaching hospital vs those who were seen at …

A Review Of The Literature On The Utilization Of Stem Cells In Knee Osteoarthritis, Katrina Krist

Theses and Graduate Projects

Background: This literature review evaluates the utilization of various types of stem cells in the treatment of osteoarthritis.

Purpose: To assess the different types of stem cell therapy available in an attempt to determine its effectiveness and viability as a long term therapy option.

Methods: Articles were found by searching Augsburg Library Services, Google Scholar, and PubMed for recent, original studies using both allogeneic or autologous stem cells from a variety of cell lines including bone marrow and adipose tissue.

Conclusions: The utilization of stem cells as a viable treatment option for osteoarthritis shows improvement in pain management and return …

Renal Mass Imaging Modalities: Does Body Mass Index (Bmi) Matter?, Young Son, Mark E Quiring, Raeann M Dalton, Brian Thomas, Noah Davidson, Dayna Devincentz, Collin Payne, Sahil H Parikh, Benjamin A Fink, Thomas Mueller, Gordon Brown

Rowan-Virtua School of Osteopathic Medicine Departmental Research

PURPOSE: Accurate measurement of renal mass size is crucial in the management of renal cancer. With the burdensome cost of imaging yet its need for management, a better understanding of the variability among patients when determining mass size remains of urgent importance. Current guidelines on optimal imaging are limited, especially with respect to body mass index (BMI). The aim of this study is to discern which modalities accurately measure renal mass size and whether BMI influences such accuracy.

METHODS: A multi-institutional chart review was performed for adult patients undergoing partial or radical nephrectomy between 2018 and 2021, with 236 patients …

Effect Of Cvd Education On The Perception And Modifiable Health Behaviors Of College Students, Sanitha Douglas

Doctor of Nursing Practice Projects

Background

Research reports that cardiovascular disease (CVD) has been a national and global health problem for many years, and that knowledge has increased regarding its prevention (Hennekens, 2020). However, according to Hennekens (2020), CVD remains the number one cause of death in America and most developed countries worldwide. The lack of perception and knowledge of actual CVD risk in the young adult population may be contributing to this deadly disease. This project evaluated the effectiveness of education on CVD risk perception and modifiable health behaviors of college students.

Purpose

This project’s purpose was to assess college students' perception of their …

An Uncommon Cause Of Dyspnea: Unilateral Diaphragmatic Paralysis, Devin Chen

SIU Journal of Medical Science Scholarly Works

Purpose: The purpose of this case report is to review an uncommon cause of dyspnea: unilateral diaphragmatic paralysis.

Method: A 57-year-old male presented to the clinic with exertional dyspnea. Thorough history and physical exam were performed to evaluate the patient, leading to referrals to different specialists for further evaluation. Evaluations from gastroenterology, cardiology, pulmonology, and cardiothoracic surgery specialists allowed for accurate diagnosis and treatment. Emphasis was placed on the causes, symptoms, and treatment of unilateral diaphragmatic paralysis.

Results: The unilateral diaphragmatic paralysis was treated with left thoracotomy and hemi-diaphragm plication, resulting in resolution of symptoms.

Conclusion: …

Csf1r Inhibition Depletes Brain Macrophages And Reduces Brain Virus Burden In Siv-Infected Macaques, Diana G. Bohannon, Laurent D. Zablocki-Thomas, Evan S. Leung, Jinbum K. Dupont, Julian B. Hattler, Jolanta Kowalewska, Miaoyun Zhao, Jiangtao Luo, Marco Salemi, Angela M. Amedee, Qingsheng Li, Marcelo J. Kuroda, Woong-Ki Kim

School of Graduate Studies Faculty Publications

Perivascular macrophages (PVMs) and, to a lesser degree, microglia are targets and reservoirs of HIV and simian immunodeficiency virus (SIV) in the brain. Previously, we demonstrated that colony-stimulating factor 1 receptor (CSF1R) in PVMs was upregulated and activated in chronically SIV-infected rhesus macaques with encephalitis, correlating with SIV infection of PVMs. Herein, we investigated the role of CSF1R in the brain during acute SIV infection using BLZ945, a brain-penetrant CSF1R kinase inhibitor. Apart from three uninfected historic controls, nine Indian rhesus macaques were infected acutely with SIVmac251 and divided into three groups (n = 3 each): an untreated control and …

Sump Syndrome: The Forgotten Cause Of Painless Jaundice In The Elderly, Mark Ayoub, Amna Anees

Journal of Community Hospital Internal Medicine Perspectives

Painless jaundice is a common presentation of abdominal malignancy seen in elderly patients. While malignancy may be a common cause of obstructive jaundice in that population group, anchor bias should always be avoided. We present a case of an elderly woman who presented with painless jaundice and weight loss. She had a very remote history of cholecystitis. She was found to have Sump syndrome due to a stricture at the Choledochoduodenostomy (CDD) site. She underwent endoscopic retrograde cholangiopancreatography (ERCP) with stent placement which shortly led to resolution of her jaundice. Biopsy from the stricture site came back negative for malignancy.

Efficiency Of 7-Dehydrocholesterol Vitamin-D3 Complex Cream For Xerosis And Pruritus In Elderly Women, Yulia Farida Yahya, Meirina Rahmadini, Pandu Haryo Jatmiko, M. Afif Baskara Emirzon, Dewa Ayu Bulan Nabila, Yuli Kurniawati, Theresia Lumban Toruan, Nur Riviati

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Xerosis and pruritus (XP) are the most common skin conditions in the elderly, manifesting clinically as roughness, scales, fissures, and mild-to-severe itching. Vitamin D improves skin hydration, transepidermal water loss (TEWL), and regulates the immune system. We aimed to determine the efficiency of topical 7-dehydrocholesterol (DHC)-vitamin D3 complex cream in elderly patients with XP.

Methods: An experimental phase III study was performed on elderly women with XP from December 2021 to March 2022 at the Geriatric Dermatology Clinic of Dr. Mohammad Hoesin General Hospital, Palembang. Inclusion criteria were age older than 55 years, healthy or with comorbidity. The exclusion …

Chronic Cutaneous Chromoblastomycosis: A Rare Case, Nanda Earlia, Mimi Maulida, Risna Handriani, Reno Keumalazia Kamarlis, Aldilla Pradistha

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Chromoblastomycosis (CBM) is a rare, chronic granulomatous and suppurative skin infection classified as a subcutaneous mycosis. CBM has a poor prognosis with a low cure rate and a high recurrence rate. The lack of scientific data regarding the diagnosis and treatment of CBM also presents a challenge for clinicians in treating this disease. Appropriate therapy can increase the cure rate and prevent disease recurrence.

Case Illustration: A 66-year-old woman presented with swelling in her left arm since the last 18 years due to wood-related injuries. There were multiple well-defined hyperkeratotic verrucous plaques, papules, and nodules, measuring 6-10 …

Agapanthus Allergic Contact Dermatitis: A Case Report, Yasuhiro Horiuchi

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Agapanthus (Lily of the Nile) is a genus in the flowering plant family Amaryllidaceae. Contact dermatitis caused by flowering plants is common, but there are no reports of contact dermatitis caused by this plant, Agapanthus.

Case Illustration: An 82-year-old Japanese man had cultivated Agapanthus in his home garden. After breaking the stem of the leaf while wearing shorts, he noticed erythematous rashes on the thighs. The patch test of the leaf stem sap “as is” showed mildly positive, with erythematous papules.

Discussion: The patch test confirmed the allergic contact dermatitis of Agapanthus with leaf stem sap. There are many …

Facial Skin Rejuvenation With Poly-L-Lactic Acid (Plla): Four Case Studies, Stanley Setiawan, Theressia Handayani, Stefani Luziani

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Facial aging is characterized by the decline and loss of skin structure. Poly-l-lactic acid (PLLA) is a biopolymer and biodegradable injection material that functions as a collagen stimulator. This active ingredient works by stimulating the formation of skin collagen after interacting with the PLLA crystal component. The expected final result is an increase in the skin volume with the thickening and increased density of the skin layers due to collagen remodeling. At present, data on the application of PLLA for facial photorejuvenation remains limited.

Case Illustration: Four patients aged 22-49 years old, with different severity of aging, underwent PLLA …

Dermoscopic And Histopathologic Findings In Diagnosing Postpartum Pemphigoid Gestationis, Rudi Chandra, Irma Damayanti Roesyanto-Mahadi

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Pemphigoid gestationis (PG) is an uncommon autoimmune vesiculobullous skin disorder associated with pregnancy, that occurs during mid-to-late pregnancy and immediate postpartum period. The diagnosis of PG is based on histopathology and direct immunofluorescence. Dermoscopy is a non-invasive diagnostic tool that provides a connection between macroscopic clinical dermatology and microscopic dermatopathology.

Case Illustration: We reported a case of a 22-year-old primigravida woman with postpartum PG. This PG case was diagnosed clinically, dermoscopically, and histopathologically.

Discussion: Since PG is thought to be a variation of the bullous pemphigoid (BP), the two resemble each other clinically and immunologically. The well-defined structures with …

Immunomodulators In Leprosy: A Narrative Review, Kesya Kimberly, Siti Aisha Nabila Ferina, Prima Kartika Esti

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Current therapeutic regimen, like the multidrug therapy (MDT), are effective in treating most cases, but new cases continue to emerge in Indonesia every year. While multidrug therapy alone is adequate for treating leprosy, there is a need for adjuvant treatment options to boost the host’s immune system to prevent the worsening of leprosy and reduce the activation of M. leprae, such as immunomodulators.

Discussion: Immunomodulators are drugs that can stimulate the body’s natural and adaptive defense mechanisms, acting as either immunosuppressants or immunostimulants. To understand …

The Effects Of Vitamin D On Chronic Wounds, Mufqi Handaru Priyanto, Eliza Miranda, Shannaz Nadia Yusharyahya, Lili Legiawati, Endi Novianto, Kusmarinah Bramono, Roro Inge Ade Krisanti

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Wounds that fail to proceed through the normal healing process are referred to as chronic wounds, also known as ulcers. Chronic wounds have immeasurable biological, psychological, social, and economic effects, bringing tremendous challenges for patients, doctors, healthcare providers, and healthcare systems.

Discussion: This condition is associated with a variety of comorbidities and complex etiologies. The global incidence of chronic wounds is expected to increase with longer life expectancy. Thus, a holistic approach is necessary, such as proper wound management, proper control of comorbidities, and provision of adequate nutrition, including vitamin D supplementation. Vitamin D is an essential pro-hormone for …

Low Plasma Melatonin Levels Negatively Correlate With Melasma Severity, I Gusti Ayu Agung Praharsini, Corry Khathreen, Nyoman Suryawati, I Gusti Ayu Agung Elis Indira, I Gusti Ayu Sattwika Pramita

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Chronic exposure to ultraviolet light plays a role in the pathogenesis of melasma. Exposure to excessive sunlight leads to the formation of free radicals. As a result, the body responds by forming antioxidants such as melatonin, which is activated through the melatoninergic antioxidative system to fight oxidative stress. The relationship between melatonin and melasma is yet to be elucidated. This study aims to determine the correlation between melatonin and the severity of melasma.

Methods: This analytical cross-sectional study involved 50 melasma subjects and 10 non-melasma subjects who met the inclusion criteria and were aged between 21-50 years at Prof. …

Administration Of Vitamin D3 Topical In Increasing Serum Vitamin D Level: A Literature Review, He Yeon Asva Nafaisa, Fajar Waskito, Ronny Martien, Retno Danarti

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Vitamin D is an essential fat-soluble vitamin that is required daily by the body. Deficiency in vitamin D is experienced by most of the world's population. Vitamin D plays a role in maintaining the skin barrier by regulating keratinocyte proliferation and differentiation, promoting filaggrin formation, and intraepidermal lipids.

Discussion: The vital role of vitamin D, non-compliance with supplement consumption, and poor nutritional status of adult patients and the elderly with deficiency and insufficiency of vitamin D encourage studies regarding vitamin D delivery via the transdermal route. The lipophilicity of vitamin D allows it to penetrate through the skin barrier. …

Loss Of Hormone Receptor Expression After Exposure To Fluid Shear Stress In Breast Cancer Cell Lines, Jonathan Cuccia, Braulio Andres Ortega Quesada, Ethan P. Littlefield, Alejandra M. Ham, Matthew E. Burow, Adam T. Melvin, Elizabeth C. Martin

School of Medicine Faculty Publications

Following metastatic spread, many hormone receptor positive (HR(+)) patients develop a more aggressive phenotype with an observed loss of the HRs estrogen receptor (ER) and progesterone receptor (PR). During metastasis, breast cancer cells are exposed to high magnitudes of fluid shear stress (FSS). Unfortunately, the role for FSS on the regulation of HR expression and function during metastasis is not fully understood. This study was designed to elucidate the impact of FSS on HR(+) breast cancer. Utilizing a microfluidic platform capable of exposing breast cancer cells to FSS that mimics in situ conditions, we demonstrate the impact of FSS exposure …

Deciphering The Contribution Of Microglia To Neurodegeneration In Friedreich's Ataxia, Sydney N. Gillette

Master's Theses

Friedreich's ataxia (FRDA) is the most prevalent inherited ataxia, affecting one in every 50,000 individuals in the United States. This hereditary condition is caused by an abnormal GAA trinucleotide repeat expansion within the first intron of the frataxin gene resulting in decreased levels of the frataxin protein (FXN). Insufficient cellular frataxin levels results in iron accumulation, increased reactive oxygen species production and mitochondrial dysfunction. Tissues most heavily impacted are those most dependent on oxidative phosphorylation as an energy source and include the nervous system and muscle tissue. This is evident in the clinical phenotype which includes muscle weakness, ataxia, neurodegeneration …

Using Rapid Protein Degradation To Determine The Effect Of Runx1 Loss-Of- Function On Dna Damage Accumulation And Repair., Jackriel Pina Morales

Theses and Dissertations

Germline mutations in RUNX1 are associated with familial platelet disorder with a predisposition to myeloid malignancy (RUNX1-FPDMM), in which patients present with low platelet counts,excessive bleeding and bruising, and an increased risk of Acute Myeloid Leukemia (AML)/Myelodysplastic Syndrome (MDS) development throughout their lifetime. To understand how these loss-of-function mutations in RUNX1 drive predispose to malignancy, it is important to develop a detailed understanding of the molecular basis of RUNX1 function. While RUNX1 is a transcription factor, preliminary data from our group and work from others suggests that RUNX1 also interacts with proteins that are critical for DNA damage …

Comparing Bilateral And Unilateral Metal Stabilizers: Incision Complications In Pectus Repair, Seth Saylors, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph, Nelimar Cruz-Centeno, Nitin Nadella

Research Days

Introduction: The use of metal stabilizers in minimally invasive pectus excavatum repair (MIPER) has been previously associated with multiple postoperative complications. We aimed to identify if bilateral metal stabilizers increase the risk of incision complications when compared to unilateral stabilizers.

Methods: Institutional Review Board approval was obtained. Patients that underwent MIPER with metal stabilizers from 2019 to 2022 and currently had the bar in place, at a single tertiary care pediatric center, were included. A telephone survey evaluated if they had incision-associated symptoms, and if the location was congruent with the stabilizer site. A retrospective chart review was performed to …

Pro-Resolving Lipid Mediator Reduces Amyloid-Β42-Induced Gene Expression In Human Monocyte-Derived Microglia, Ying Wang, Xiang Zhang, Henrik Biverstål, Nicolas G. Bazan, Shuai Tan, Nailin Li, Makiko Ohshima, Marianne Schultzberg, Xiaofei Li

School of Medicine Faculty Publications

JOURNAL/nrgr/04.03/01300535-202503000-00031/figure1/v/2024-06-17T092413Z/r/image-tiff Specialized pro-resolving lipid mediators including maresin 1 mediate resolution but the levels of these are reduced in Alzheimer's disease brain, suggesting that they constitute a novel target for the treatment of Alzheimer's disease to prevent/stop inflammation and combat disease pathology. Therefore, it is important to clarify whether they counteract the expression of genes and proteins induced by amyloid-β. With this objective, we analyzed the relevance of human monocyte-derived microglia for in vitro modeling of neuroinflammation and its resolution in the context of Alzheimer's disease and investigated the pro-resolving bioactivity of maresin 1 on amyloid-β42-induced Alzheimer's disease-like inflammation. Analysis of …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …