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Wilkins T, Shiver S, Butler C, Corcoran L, Marshall R, Brody C, Cliett K, Nolan MA, Sowinski T, Schreiber M. Development of an Emergency Department Surge Plan Based on the NEDOCS score. Ann Fam Med 2024; 21:4789. [PMID: 38271089 PMCID: PMC10983305 DOI: 10.1370/afm.22.s1.4789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Context: Emergency Department (ED) overcrowding is a significant problem worldwide. Many factors contribute to ED overcrowding, including staffing shortages, diagnostic testing delays, and inadequate inpatient beds to meet the demand. ED overcrowding results in patient safety issues like higher inpatient mortality and other negative impacts, such as an increased length of stay (LOS) and an increased trend of leaving the ED before undergoing an evaluation and treatment. The National emergency department overcrowding study (NEDOCS) is a scoring system to detect ED overcrowding objectively. Objective: To determine the impact of implementing an ED adult surge plan on ED throughput. Study Design: Prospective single-site study of adults presenting to the ED from January to April 2023. Setting or Dataset: Academic medical center. Population studied: Adult ED patients. Outcome Measures: Mean adult ED hold times, mean ED LOS, left without seen rate, mean door-to-doctor exam time, mean NEDOCS scores. Results: This analysis included 16,701 ED visits and 12,269 patients. During this time, 3,751 (22.5%) patients were admitted to inpatient status, and 1,413 (8.5%) were admitted to observation status. Pre-implementation, the mean ED hold time was 9.9 hours which decreased to 5.7 hours post-implementation (p=0.03). Pre-implementation, the mean ED LOS was 15.4 hours which decreased to 14.1 hours post-implementation (p=ns). Pre-implementation, the left without being seen rate was 4.8%, which decreased to 4.0% post-implementation (p=ns). Pre-implementation, the mean door-to-doctor exam time was 57.6 minutes which decreased to 54.0 minutes postimplementation (p=ns). Pre-implementation, the mean NEDOCS score was 186.2, which decreased to 131.2 post-implementation (p<0.0001). Conclusions: Our study suggests that implementing an ED adult surge plan can significantly improve ED hold hours and NEDOCS scores. However, it is important to note that other important ED throughput metrics (mean ED LOS, left without seen rate, mean door-to-doctor exam time) did not significantly improve. Further research may be necessary to understand the factors contributing to these outcomes and identify additional interventions that may improve ED throughput.
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Bryant AD, Robinson TJ, Gutierrez-Perez JT, Manning BL, Glenn K, Imborek KL, Kuperman EF. Outcomes of a home telemonitoring program for SARS-CoV-2 viral infection at a large academic medical center. J Telemed Telecare 2024; 30:675-680. [PMID: 35275502 PMCID: PMC8919094 DOI: 10.1177/1357633x221086067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telemedicine serves as a viable option during the COVID-19 pandemic to provide in-home care, maintain home isolation precautions, reduce unnecessary healthcare exposures, and de-burden hospitals. METHODS We created a novel telemedicine program to closely monitor patients infected with SARS-CoV-2 (COVID-19) at home. Adult patients with COVID-19 were enrolled in the program at the time of documented infection. Patients were followed by a team of providers via telephone or video visits at frequent intervals until resolution of their acute illness. Additionally, patients were stratified into high-risk and low-risk categories based on demographics and underlying comorbidities. The primary outcome was hospitalization after enrollment in the home monitoring program, including 30 days after discharge from the program. RESULTS Over a 3.5-month period, 1128 patients met criteria for enrollment in the home monitoring program. 30.7% were risk stratified as high risk for poor outcomes based on their comorbidities and age. Of the 1128 patients, 6.2% required hospitalization and 1.2% required ICU admission during the outcome period. Hospitalization was more frequent in patients identified as high risk (14.2% vs 2.7%, P < 0.001). DISCUSSION Enrollment in a home monitoring program appears to be an effective and sustainable modality for the ambulatory management of COVID-19.
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Affiliation(s)
- Andrew D Bryant
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Tommy J Robinson
- Internal Medicine Residency, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Bradley L Manning
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Glenn
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Katherine L Imborek
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ethan F Kuperman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Arrona KL. Implementation of a technician success and onboarding coordinator to reduce technician turnover. Am J Health Syst Pharm 2024; 81:e249-e255. [PMID: 38141655 DOI: 10.1093/ajhp/zxad323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/25/2023] Open
Abstract
PURPOSE This article provides an overview of changes implemented at an academic medical center to reduce pharmacy technician turnover. SUMMARY Pharmacy technician turnover has been a problem for years. Technicians come and go; they move on to other positions, and continuous turnover is an avoidable expense. With greater focus on creating a successful onboarding experience for newly hired technicians, turnover should decrease and satisfaction and engagement should increase. When a newly hired technician leaves a department within the first year, it can have a negative impact on the engagement of the remaining technicians who spent time training new hires in how to complete tasks, mentoring them, and incorporating them into the team. Creating a positive onboarding experience will decrease expenses accrued and minimize wasted resources and staff time dedicated to a technician who will not be around in 6 months to 1 year. At M Health Fairview, a Minneapolis, MN-based health system, technician retention has been improved through a standardized approach to onboarding and orientation, including creation of the new staff role of technician success and onboarding coordinator (TSOC). CONCLUSION A standard approach to onboarding pharmacy technicians and integrating them into the pharmacy department has proven to be essential to technician retention at M Health Fairview. To get started, it is important to find the right person for the TSOC role to coordinate successful onboarding of newly hired pharmacy technicians. That person should be an individual with passion to engage and inspire newly hired technicians, with several years of experience, and with the ability to cascade knowledge.
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Ke Y, Yang R, Liu N. Comparing Open-Access Database and Traditional Intensive Care Studies Using Machine Learning: Bibliometric Analysis Study. J Med Internet Res 2024; 26:e48330. [PMID: 38630522 DOI: 10.2196/48330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/01/2023] [Accepted: 01/14/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Intensive care research has predominantly relied on conventional methods like randomized controlled trials. However, the increasing popularity of open-access, free databases in the past decade has opened new avenues for research, offering fresh insights. Leveraging machine learning (ML) techniques enables the analysis of trends in a vast number of studies. OBJECTIVE This study aims to conduct a comprehensive bibliometric analysis using ML to compare trends and research topics in traditional intensive care unit (ICU) studies and those done with open-access databases (OADs). METHODS We used ML for the analysis of publications in the Web of Science database in this study. Articles were categorized into "OAD" and "traditional intensive care" (TIC) studies. OAD studies were included in the Medical Information Mart for Intensive Care (MIMIC), eICU Collaborative Research Database (eICU-CRD), Amsterdam University Medical Centers Database (AmsterdamUMCdb), High Time Resolution ICU Dataset (HiRID), and Pediatric Intensive Care database. TIC studies included all other intensive care studies. Uniform manifold approximation and projection was used to visualize the corpus distribution. The BERTopic technique was used to generate 30 topic-unique identification numbers and to categorize topics into 22 topic families. RESULTS A total of 227,893 records were extracted. After exclusions, 145,426 articles were identified as TIC and 1301 articles as OAD studies. TIC studies experienced exponential growth over the last 2 decades, culminating in a peak of 16,378 articles in 2021, while OAD studies demonstrated a consistent upsurge since 2018. Sepsis, ventilation-related research, and pediatric intensive care were the most frequently discussed topics. TIC studies exhibited broader coverage than OAD studies, suggesting a more extensive research scope. CONCLUSIONS This study analyzed ICU research, providing valuable insights from a large number of publications. OAD studies complement TIC studies, focusing on predictive modeling, while TIC studies capture essential qualitative information. Integrating both approaches in a complementary manner is the future direction for ICU research. Additionally, natural language processing techniques offer a transformative alternative for literature review and bibliometric analysis.
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Affiliation(s)
- Yuhe Ke
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Rui Yang
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Bailey R, Segon A, Garcia S, Kottewar S, Lu T, Tuazon N, Sanchez L, Gelfond JA, Bowling G. Increasing and sustaining discharges by noon - a multi-year process improvement project. BMC Health Serv Res 2024; 24:478. [PMID: 38632568 PMCID: PMC11025149 DOI: 10.1186/s12913-024-10960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024] Open
Abstract
High hospital occupancy degrades emergency department performance by increasing wait times, decreasing patient satisfaction, and increasing patient morbidity and mortality. Late discharges contribute to high hospital occupancy by increasing emergency department (ED) patient length of stay (LOS). We share our experience with increasing and sustaining early discharges at a 650-bed academic medical center in the United States. Our process improvement project followed the Institute of Medicine Model for Improvement of successive Plan‒Do‒Study‒Act cycles. We implemented multiple iterative interventions over 41 months. As a result, the proportion of discharge orders before 10 am increased from 8.7% at baseline to 22.2% (p < 0.001), and the proportion of discharges by noon (DBN) increased from 9.5% to 26.8% (p < 0.001). There was no increase in balancing metrics because of our interventions. RA-LOS (Risk Adjusted Length Of Stay) decreased from 1.16 to 1.09 (p = 0.01), RA-Mortality decreased from 0.65 to 0.61 (p = 0.62) and RA-Readmissions decreased from 0.92 to 0.74 (p < 0.001). Our study provides a roadmap to large academic facilities to increase and sustain the proportion of patients discharged by noon without negatively impacting LOS, 30-day readmissions, and mortality. Continuous performance evaluation, adaptability to changing resources, multidisciplinary engagement, and institutional buy-in were crucial drivers of our success.
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Affiliation(s)
- Ryan Bailey
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Ankur Segon
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Sean Garcia
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Saket Kottewar
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Ting Lu
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Nelson Tuazon
- University Health, 4502 Medical Drive, San Antonio, TX, 78229, USA
| | - Lisa Sanchez
- University Health, 4502 Medical Drive, San Antonio, TX, 78229, USA
| | | | - Gregory Bowling
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
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Schmalstieg-Bahr K, MacDonald S, Pohontsch N, Debus S, Scherer M. Asking the generalist - evaluation of a General Practice rounding and consult service. BMC Prim Care 2024; 25:113. [PMID: 38627632 PMCID: PMC11020190 DOI: 10.1186/s12875-024-02353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Vascular surgery patients admitted to the hospital are often multimorbid. In case of questions regarding chronic medical problems different specialties are consulted, which leads to a high number of treating physicians and possibly contradicting recommendations. The General Practitioner´s (GP) view could minimize this problem. However, it is unknown for which medical problems a GP would be consulted and if regular GP-involvement during rounds would be considered helpful by the specialists. The aim of this study was to establish and describe a General Practice rounding service (GP-RS), to evaluate if the GP-RS is doable in a tertiary care hospital and beneficial to the specialists and to explore GP-consult indications. METHODS The GP-RS was established as a pilot project. Between June-December 2020, a board-certified GP from the Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE) joined the vascular surgery team (UKE) once-weekly on rounds. The project was evaluated using a multi-methods approach: semi-structured qualitative interviews were conducted with vascular surgery physicians that had either participated in the GP-RS (G1), had not participated (G2), other specialists usually conducting consults on the vascular surgery floor (G3) and with the involved GP (G4). Interviews were analyzed using Kuckartz' qualitative content analysis. In addition, two sets of quantitative data were descriptively analyzed focusing on the reasons for a GP-consult: one set from the GP-RS and one from an established, conventional "as needed" GP-consult service. RESULTS 15 interviews were conducted. Physicians perceived the GP-RS as beneficial, especially for surgical patients (G1-3). Optimizing medication, avoiding unnecessary consults and a learning effect for physicians in training (G1-4) were named as other benefits. Critical voices saw an increased workload through the GP-RS (G1, G3) and some consult requests as too specific for a GP (G1-3). Based on data from 367 vascular surgery patients and 80 conventional GP-consults, the most common reasons for a GP-consult were cardiovascular diseases including hypertension and diabetes. CONCLUSIONS A GP-RS is doable in a tertiary care hospital. Studies of GP co-management model with closer follow ups would be needed to objectively improve patient care and reduce the overall number of consults. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Katharina Schmalstieg-Bahr
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Building W37, 20246, Hamburg, Germany.
| | - Sophia MacDonald
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Building W37, 20246, Hamburg, Germany
| | - Nadine Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Building W37, 20246, Hamburg, Germany
| | - Sebastian Debus
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Building W37, 20246, Hamburg, Germany
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Ruetzler K, Bustamante S, Schmidt MT, Almonacid-Cardenas F, Duncan A, Bauer A, Turan A, Skubas NJ, Sessler DI. Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial. JAMA 2024; 331:1279-1286. [PMID: 38497992 PMCID: PMC10949146 DOI: 10.1001/jama.2024.0762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/18/2024] [Indexed: 03/19/2024]
Abstract
Importance Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear. Objective To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy. Design, Setting, and Participants Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat. Interventions Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt. Main Outcomes and Measures The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries. Results Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]). Conclusion and Relevance In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures. Trial Registration ClinicalTrials.gov Identifier: NCT04701762.
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Affiliation(s)
- Kurt Ruetzler
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
- Division of Multi-Specialty Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Sergio Bustamante
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Marc T. Schmidt
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | | | - Andra Duncan
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Bauer
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Alparslan Turan
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
- Division of Multi-Specialty Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Nikolaos J. Skubas
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Daniel I. Sessler
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
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Cornelius AP, Rodrigues-Rosa A. A faculty-led resident strike team as a force expander during disaster. Am J Disaster Med 2024; 19:5-13. [PMID: 38597642 DOI: 10.5055/ajdm.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
The emergence of the coronavirus disease 2019 (COVID-19) pandemic produced an unprecedented strain on the United States medical system. Prior to the pandemic, there was an estimated 20,000 physician shortage. This has been further stressed by physicians falling ill and the increased acuity of the COVID-19 patients. Federal medical team availability was stretched to its capabilities with the large numbers of deployments. With such severe staffing shortages, creative ways of force expansion were undertaken. New Orleans, Louisiana, was one of the hardest hit areas early in the pandemic. As the case counts built, a call was put out for help. The Louisiana State University (LSU) system responded with a faculty-led resident strike team out of the LSU Health Shreveport Academic Medical Center. Residents and faculty alike volunteered, forming a multispecialty, attending-led medical strike team of approximately 10 physicians. Administrative aspects such as institution-specific credentialing, malpractice coverage, resident distribution, attending physician oversight, among other aspects were addressed, managed, and agreed upon between the LSU Health Shreveport and the New Orleans hospital institutions and leadership prior to deployment in April 2020. In New Orleans, the residents managed patients within the departments of emergency medicine, medical floor, and intensive care unit (ICU). The residents assigned to the medical floor became a new hospitalist service team. The diversity of specialties allowed the team to address patient care in a multidisciplinary manner, leading to comprehensive patient care plans and unhindered team dynamic and workflow. During the first week alone, the team admitted and cared for over 100 patients combined from the medical floor and ICU. In a disaster situation compounded by staff shortages, a resident strike team is a beneficial solution for force expansion. This article qualitatively reviews the first published incidence of a faculty-led multispecialty resident strike team being used as a force expander in a disaster.
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Affiliation(s)
- Angela P Cornelius
- John Peter Smith Hospital, Fort Worth Emergency Medicine Residency; Associate Professor, Clinical Emergency Medicine TCU/UNT, Fort Worth, Texas; Associate Professor, Louisiana State University-Shreveport Academic Medical Center, Shreveport, Louisiana. ORCID: https://orcid.org/0000-0002-0405-1433
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Goldhaber NH, Mehta S, Longhurst CA, Malachowski E, Jones M, Clary BM, Schaefer RL, McHale M, Rhodes LP, Mekeel KL, Reeves JJ. Call me Ishmael: addressing the white whale of team communication in the operating room with labelled surgical caps at an academic medical centre. BMJ Open Qual 2024; 13:e002453. [PMID: 38589054 PMCID: PMC11015231 DOI: 10.1136/bmjoq-2023-002453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/12/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre. MATERIALS AND METHODS This was a quasi-experimental, uncontrolled, before-and-after quality improvement study. A survey regarding perceptions of team communication, knowledge of names and roles, communication barriers, and culture was administered before and after cap delivery. Survey results were measured on a 5-point Likert Scale; descriptive statistics and mean scores were compared. All cause National Surgical Quality Improvement Project (NSQIP) morbidity and mortality outcomes for surgical specialties were examined. RESULTS 1420 caps were delivered across the institution. Mean survey scores increased for knowing the names and roles of providers around the OR, feeling that people know my name and feeling comfortable communicating without barriers across disciplines. The mean score for team communication around the OR is excellent was unchanged. The highest score both before and after was knowing the name of an interdisciplinary team member is important for patient care. A total of 383 and 212 providers participated in the study before and after cap delivery, respectively. Participants agreed or strongly agreed that labelled surgical caps made it easier to talk to colleagues (64.9%) while improving communication (66.0%), team culture (60.5%) and patient care (56.8%). No significant differences were noted in NSQIP outcomes. CONCLUSIONS Personalised labelled surgical caps are a simple, inexpensive tool that demonstrates promise in improving perioperative team communication. Creating highly reliable surgical teams with optimal communication channels requires a multifaceted approach with engaged leadership, empowered front-line providers and an institutional commitment to continuous process improvement.
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Affiliation(s)
| | - Shivani Mehta
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Christopher A Longhurst
- Department of Pediatrics, Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Elizabeth Malachowski
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Melissa Jones
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Bryan M Clary
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Robin L Schaefer
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Michael McHale
- Department of OBGYN, University of California San Diego, La Jolla, California, USA
| | - Lisa P Rhodes
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Kristin L Mekeel
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - J Jeffery Reeves
- Department of Surgery, University of California San Diego, La Jolla, California, USA
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Jorissen A, van de Kant K, Ikiz H, van den Eertwegh V, van Mook W, de Rijk A. The importance of creating the right conditions for group intervision sessions among medical residents- a qualitative study. BMC Med Educ 2024; 24:375. [PMID: 38580954 PMCID: PMC10996180 DOI: 10.1186/s12909-024-05342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The burnout rates among residents urge for adequate interventions to improve resilience and prevent burnout. Peer reflection, also called group intervision sessions, is a potentially successful intervention to increase the resilience of young doctors. We aimed to gain insight into the perceived added value of intervision sessions and the prerequisite conditions to achieve this, according to residents and intervisors. Our insights might be of help to those who think of implementing intervision sessions in their institution. METHODS An explorative, qualitative study was performed using focus groups and semi-structured interviews with both residents (n = 8) and intervisors (n = 6) who participated in intervision sessions in a university medical center in the Netherlands. The topic list included the perceived added value of intervision sessions and factors contributing to that. The interviews were transcribed verbatim and coded using NVivo. Thematic analysis was subsequently performed. RESULTS According to residents and intervisors, intervision sessions contributed to personal and professional identity development; improving collegiality; and preventing burn-out. Whether these added values were experienced, depended on: (1) choices made during preparation (intervisor choice, organizational prerequisites, group composition, workload); (2) conditions of the intervision sessions (safety, depth, role of intervisor, group dynamics, pre-existent development); and (3) the hospital climate. CONCLUSIONS Intervision sessions are perceived to be of added value to the identity development of medical residents and to prevent becoming burned out. This article gives insight in conditions necessary to reach the added value of intervision sessions. Optimizing preparation, meeting prerequisite conditions, and establishing a stimulating hospital climate are regarded as key to achieve this.
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Affiliation(s)
- Anouk Jorissen
- Department of Social Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Kim van de Kant
- Academy for Postgraduate Medical Training, Maastricht University Medical Center, PO Box 5800, Maastricht, 6202 AZ, the Netherlands.
- Department of Family Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, PO Box 5800, Maastricht, 6202 AZ, the Netherlands.
| | - Habibe Ikiz
- Department of Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Valerie van den Eertwegh
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Walther van Mook
- Academy for Postgraduate Medical Training, Maastricht University Medical Center, PO Box 5800, Maastricht, 6202 AZ, the Netherlands
- Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Brown TR, Amir H, Hirsch D, Jansen MO. Designing a Novel Digitally Delivered Antiracism Intervention for Mental Health Clinicians: Exploratory Analysis of Acceptability. JMIR Hum Factors 2024; 11:e52561. [PMID: 38568730 PMCID: PMC11024743 DOI: 10.2196/52561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND There is a great need for evidence-based antiracism interventions targeting mental health clinicians to help mitigate mental health disparities in racially and ethnically minoritized groups. OBJECTIVE This study provides an exploratory analysis of mental health clinicians' perspectives on the acceptability of a web-based antiracism intervention. METHODS Mental health clinicians were recruited from a single academic medical center through outreach emails. Data were collected through individual 30-minute semistructured remote video interviews with participants, then recorded, transcribed, and analyzed using content analysis. RESULTS A total of 12 mental health clinicians completed the study; 10 out of 12 (83%) were female candidates. Over half (7/12, 58%) of the respondents desired more robust antiracism training in mental health care. Regarding the web-based antiracism intervention, (8/12, 67%) enjoyed the digitally delivered demo module, (7/12, 58%) of respondents suggested web-based content would be further enhanced with the addition of in-person or online group components. CONCLUSIONS Our results suggest a strong need for additional antiracist training for mental health clinicians. Overall, participants responded favorably to novel web-based delivery methods for an antiracism intervention. These findings provide important support for future development and pilot testing of a large-scale digitally enhanced antiracist curriculum targeting mental health clinicians.
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Affiliation(s)
- Tashalee Rushell Brown
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Habiba Amir
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Drew Hirsch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Madeline Owens Jansen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Liu S, McCoy AB, Peterson JF, Lasko TA, Sittig DF, Nelson SD, Andrews J, Patterson L, Cobb CM, Mulherin D, Morton CT, Wright A. Leveraging explainable artificial intelligence to optimize clinical decision support. J Am Med Inform Assoc 2024; 31:968-974. [PMID: 38383050 PMCID: PMC10990514 DOI: 10.1093/jamia/ocae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To develop and evaluate a data-driven process to generate suggestions for improving alert criteria using explainable artificial intelligence (XAI) approaches. METHODS We extracted data on alerts generated from January 1, 2019 to December 31, 2020, at Vanderbilt University Medical Center. We developed machine learning models to predict user responses to alerts. We applied XAI techniques to generate global explanations and local explanations. We evaluated the generated suggestions by comparing with alert's historical change logs and stakeholder interviews. Suggestions that either matched (or partially matched) changes already made to the alert or were considered clinically correct were classified as helpful. RESULTS The final dataset included 2 991 823 firings with 2689 features. Among the 5 machine learning models, the LightGBM model achieved the highest Area under the ROC Curve: 0.919 [0.918, 0.920]. We identified 96 helpful suggestions. A total of 278 807 firings (9.3%) could have been eliminated. Some of the suggestions also revealed workflow and education issues. CONCLUSION We developed a data-driven process to generate suggestions for improving alert criteria using XAI techniques. Our approach could identify improvements regarding clinical decision support (CDS) that might be overlooked or delayed in manual reviews. It also unveils a secondary purpose for the XAI: to improve quality by discovering scenarios where CDS alerts are not accepted due to workflow, education, or staffing issues.
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Affiliation(s)
- Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Computer Science, Vanderbilt University, Nashville, TN 37212, United States
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Josh F Peterson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Thomas A Lasko
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Computer Science, Vanderbilt University, Nashville, TN 37212, United States
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX 77030, United States
| | - Scott D Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Jennifer Andrews
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Lorraine Patterson
- HeathIT, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Cheryl M Cobb
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - David Mulherin
- HeathIT, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Colleen T Morton
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, United States
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13
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Bordieri MJ, Waddill PJ, Zhang Q, McCarthy ML, Fuller C, Balthrop D. Exploring the stability of the gender gap in faculty perceptions of gender climate at a rural regional university. PLoS One 2024; 19:e0301285. [PMID: 38564594 PMCID: PMC10986963 DOI: 10.1371/journal.pone.0301285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Increasing awareness of gender barriers and biases in academic institutions is an essential component of institutional change strategies to promote equity and inclusion. There is an established perception gap in recognizing gender inequities in the workplace, whereby men faculty under acknowledge the stressors, barriers, and biases faced by their women faculty colleagues. This study explored the gender gap in faculty perceptions of institutional diversity climate at a rural comprehensive regional university in the United States. In addition to gender, differences across academic discipline and time were explored using 2 (men and women) x 2 (STEM and other) x 2 (2017 and 2022) between-groups ANOVAs. Results revealed a gender gap that persisted across time and perceptions of stressors, diversity climate, student behavior, leadership, and fairness in promotion/tenure procedures, with marginalized (women) faculty consistently reporting greater barriers/concern for women faculty relative to the perceptions of their men faculty colleagues. These findings are largely consistent with the extant literature and are discussed both with regard to future research directions and recommendations for reducing the perception gap and addressing institutional barriers to gender equity.
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Affiliation(s)
- Michael J. Bordieri
- Department of Psychology, Murray State University, Murray, KY, United States of America
| | - Paula J. Waddill
- Department of Psychology, Murray State University, Murray, KY, United States of America
| | - Qiaofeng Zhang
- Department of Earth and Environmental Sciences, Murray State University, Murray, KY, United States of America
| | - Maeve L. McCarthy
- Department of Mathematics and Statistics, Murray State University, Murray, KY, United States of America
| | - Claire Fuller
- Department of Biological Sciences, Murray State University, Murray, KY, United States of America
| | - David Balthrop
- Department of Global Languages and Theatre Arts, Murray State University, Murray, KY, United States of America
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14
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Liebzeit D, Geiger O, Jaboob S, Bjornson S, Strayer A, Buck H, Werner NE. Older Adults' Process of Collaborating With a Support Team During Transitions From Hospital to Home: A Grounded Theory Study. Gerontologist 2024; 64:gnad096. [PMID: 37436125 DOI: 10.1093/geront/gnad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about how older adults engage with multiple sources of support and resources during transitions from hospital to home, a period of high vulnerability. This study aims to describe how older adults identify and collaborate with a support team, including unpaid/family caregivers, health care providers, and professional and social networks, during the transition. RESEARCH DESIGN AND METHODS This study utilized grounded theory methodology. One-on-one interviews were conducted with adults aged 60 and older following their discharge from a medical/surgical inpatient unit in a large midwestern teaching hospital. Data were analyzed using open, axial, and selective coding. RESULTS Participants (N = 25) ranged from 60 to 82 years of age, 11 were female, and all participants were White, non-Hispanic. They described a process of identifying a support team and collaborating with that team to manage at home and progress their health, mobility, and engagement. Support teams varied, but included collaborations between the older person, unpaid/family caregiver(s), and their health care providers. Their collaboration was impacted by the participant's professional and social networks. DISCUSSION AND IMPLICATIONS Older adults collaborate with multiple sources of support and this collaboration is a dynamic process that varies across phases of their transition from hospital to home. Findings reveal opportunities for assessing individual's support and social networks, in addition to health and functional status, to determine needs and leverage resources during transitions in care.
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Affiliation(s)
- Daniel Liebzeit
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Olivia Geiger
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Saida Jaboob
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | | | - Andrea Strayer
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Harleah Buck
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Nicole E Werner
- School of Public Health, Indiana University-Bloomington, Bloomington, Indiana, USA
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15
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Cherestal S, Salajegheh A, Waltman B, Kanellopoulos D. Two Models for Developing Diversity, Equity, and Inclusion Programs in Psychiatric Academic Medical Centers. Acad Psychiatry 2024; 48:215-216. [PMID: 37415065 DOI: 10.1007/s40596-023-01816-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
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16
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Stratchko LM, Rossebo AE, Kisting MA, Hinshaw JL, Mao L, Meyer CA, Robbins JB, Tuite MJ, Grist TM, Lee FT. Unreimbursed Costs of Multidisciplinary Conferences to a Radiology Department: A Prospective Analysis at an Academic Medical Center. J Am Coll Radiol 2024; 21:668-675. [PMID: 37922969 DOI: 10.1016/j.jacr.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Multidisciplinary conferences (MDCs) are important for clinical care but are unreimbursed and can be time-consuming for radiologists to prepare for and present. The purpose of this single-center, prospective, survey-based study is to measure the per-conference time and total time radiologists devote to MDCs at a single academic medical center. Secondary objectives are to determine the source of radiologist preparation time, and calculate the per conference and overall radiology departmental costs of MDC participation. METHODS A prospective survey was performed to capture all radiology preparation and presentation time for MDCs in a 3-month period, which was then annualized. Total cost was calculated on the basis of Association of Administrators in Academic Radiology survey data for nonchair academic radiologist compensation plus a 30% fringe-benefit rate. RESULTS The survey response rate was 86.9%. A total of 3,358 hours were devoted annually to MDCs, which represents time equivalent to 1.9 full-time equivalents or $1,155,152 in unreimbursed radiology departmental costs. Per-MDC total preparation and presentation time was 2.7 hours, at an annual cost of $46,440 for each weekly MDC. Radiologists used a combination of personal time (49.7%), academic time (42%), and/or clinical time (35.4%) to prepare for MDCs. Radiologists devoted a mean of 47.9 hours (1.2 weeks) of time per annum to MDCs. CONCLUSIONS Radiologist time devoted to MDCs at the survey institution was substantial, and preparation time was drawn disproportionately from personal and academic time, which may have negative implications for burnout, recruitment and retention, and academic productivity unless it is effectively mitigated.
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Affiliation(s)
- Lindsay M Stratchko
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Cristopher A Meyer
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael J Tuite
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
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17
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Parks MA, Gaskins JT, Jin A, Galandiuk S, Kavalukas SL. You Want to be a Surgical Leader? Consider Training Elsewhere - An Observation of How Training Background May Impact Leadership Selection. J Surg Educ 2024; 81:564-569. [PMID: 38388306 DOI: 10.1016/j.jsurg.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/15/2023] [Accepted: 12/22/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE The significance of thought differences has always held importance in medicine, but it could be considered as increasingly acknowledged and valued to a greater extent in recent times as more emphasis is placed on diversity, equity, and inclusion. These unique perspectives have been examined according to race, gender, and ethnicity, but there is limited published data examining the prevalence of leadership roles within surgical departments in terms of training background. Our main objective is to identify trends in surgical leaders' education, and emphasize training diversity in surgical leadership. DESIGN A descriptive study of the training background of all surgical academic leaders. SETTING This internet search was performed at a tertiary care, academic medical center. PARTICIPANTS Academic chairpersons, division directors, and program directors. RESULTS 124 programs had pertinent information available. There was a mean of 7.6 leaders per institute examined: total 939 positions (119 chairs, 704 division directors, 116 program directors). 90/119 (76%) of the Chairs led at institutions outside of the places they completed their training. 4/119 (3%) did all their training at the same institution they chaired. 25/119 (21%) completed at least some but not all their training there, and later rose to the role of Chair. Among division directors, 217/704 (31%) did some training at that institution, and program directors were significantly more likely to have completed some training at their current institute (53/116, 46%; p = 0.001). There were no statistically significant differences when examined geographically. Women made up 18% of the leaders and were significantly more likely to lead as program director rather than a chair or division director (p < 0.001). CONCLUSION A majority of surgery chairs hold positions at institutions where they did not complete their medical training. This suggests that outside perspective could be a contributing factor when searching for this position.
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Affiliation(s)
- Mary Alex Parks
- University of Louisville, Department of Surgery, Louisville, Kentucky
| | - Jeremy T Gaskins
- University of Louisville, Department of Bioinformatics & Biostatistics, Louisville, Kentucky
| | - Allie Jin
- University of Louisville, Department of Surgery, Louisville, Kentucky
| | - Susan Galandiuk
- University of Louisville, Department of Surgery, Louisville, Kentucky
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18
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Peng T, Green A, Mourad M. Assessing the contribution of hospital medicine patients to the tertiary quaternary care mission of an academic medical center. J Hosp Med 2024; 19:287-290. [PMID: 38093510 DOI: 10.1002/jhm.13260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 04/04/2024]
Abstract
Academic medical centers must balance caring for patients in their community with their role as referral centers for more profitable tertiary quaternary (T/Q) care. Hospital medicine services, which admit patients largely from the emergency department, often have the lowest proportion of T/Q care and may thus be under pressure to demonstrate their value to the health system. Looking at the 5771 patients that were discharged from our hospital medicine service between 2021 and 2022, we found that three quarters (74.6%) of patients had at least one prior outpatient encounter at our institution, and that more than a third (36.1%) were established patients in departments of strategic importance to our institution. Our study provides a framework for academic hospital medicine services looking to assess their patient population's connection with the broader health system and suggests that our hospital medicine service provides inpatient care to a population critical to the role of the institution in our community both locally and regionally.
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Affiliation(s)
- Theodore Peng
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Adrienne Green
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michelle Mourad
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
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19
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Balasubramanian C, Leemaster J, Basar P, Pawlik TM. Building a national brand: The experience of The Ohio State University Wexner Medical Center Department of Surgery. Surgery 2024; 175:1224-1228. [PMID: 37926580 DOI: 10.1016/j.surg.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
People have an abundance of choices relative to health care choices. Patients can easily access personal reviews, third-party rankings, and other information from a computer or mobile phone. In turn, health care organizations can have difficulty setting themselves apart from others. A brand can refer to an organization's image and design elements; the messaging and values it conveys to consumers, staff, and the public; and its reputation in the community. A strong brand evokes trust, reliability, and value among other competitors. The foundation of any health care organization's brand is built on these key elements: mission, vision, and values; logo, colors, typography, and imagery; brand voice; brand consistency; brand experience. The Ohio State University Wexner Medical Center has positioned itself nationally as a leading academic health center. The Department of Surgery has built upon this strong brand to create an equally strong reputation among other departments nationwide. Marketing efforts for the department have focused on promoting its nationally ranked general surgery residency program, world-renowned clinical programs and faculty, and robust research portfolio. We herein highlight some of the tactics that go into building a strong, vibrant brand for a department of surgery.
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Affiliation(s)
- Cassandra Balasubramanian
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, OH; Marketing and Communication, The Ohio State Wexner Medical Center, Columbus, OH
| | - Joy Leemaster
- Marketing and Communication, The Ohio State Wexner Medical Center, Columbus, OH
| | - Paola Basar
- Marketing and Communication, The Ohio State Wexner Medical Center, Columbus, OH
| | - Timothy M Pawlik
- Marketing and Communication, The Ohio State Wexner Medical Center, Columbus, OH.
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20
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Moore SL, Grim S, Kessler R, Luna MLD, Miller DE, Thomas JF. Reduction of Environmental Pollutants and Travel Burden Through an Academic Medical Center-based Electronic Consultation Program. Telemed J E Health 2024; 30:1020-1025. [PMID: 38064483 PMCID: PMC11035922 DOI: 10.1089/tmj.2023.0435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
Background: We evaluated the impact of electronic consultation (eConsult) in reducing the environmental pollutants associated with health care delivery. Methods: A retrospective analysis of the eConsult data between July 2018 and December 2022 was extracted from the electronic health record (Epic). Travel time and mileage from the patient home to the academic medical center (AMC) were calculated along with fuel expenditure and greenhouses gas savings. Projected savings through the end of the decade were forecast using a random walk model. Results: A total of 15,499 eConsults were submitted to AMC specialist providers from community primary care providers. Completed eConsults (n = 11,590) eliminated the need for a face-to-face visit with a specialist provider, eliminating mileage, fuel, time, and pollutants associated with face to face visits. In-state travel distance saved was 310,858 miles, travel time saved was 5,491 h, with an associated fuel reduction of 13,575 gallons and $56,893 savings. This reduced greenhouse gas emissions by 128 metric tons of carbon dioxide, 0.022 tons of nitrogen oxide, 0.005 tons of methane, and 0.001 tons of nitrous oxide. Out of state travel distance saved was 188,346 miles with 2,842 h reduced travel time, and associated fuel reduction of 8,225 gallons and of $34,118. Reduced greenhouse gas emissions were equivalent to 77 metric tons of carbon dioxide, 0.0132 tons of nitrogen oxide, 0.0033 tons of methane, and 0.0007 tons of nitrous oxide. Conclusion: This study indicates that medical care provided through telehealth modalities reduces the environmental impact of pollutants associated with face to face visits.
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Affiliation(s)
- Susan L. Moore
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado, USA
| | - Stephanie Grim
- Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rodger Kessler
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mayra Loera De Luna
- Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Devin E. Miller
- Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John F. Thomas
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado, USA
- Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
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21
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Hawn MT. Philanthropic support of academic programs. Surgery 2024; 175:1250-1251. [PMID: 38281853 DOI: 10.1016/j.surg.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
Academic surgical departments must subsidize the research mission, as most funded research does not fully support the faculty effort and true costs of the investigation. Most departments support their research program with the margin from clinical revenue; however, increased pressure on clinical income poses a challenge to this strategy. Philanthropy is an increasingly important revenue source to fund academic missions. The opportunities and challenges of this funding source are discussed in this article.
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Affiliation(s)
- Mary T Hawn
- Stanford University School of Medicine, Stanford, CA.
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22
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Scheetz S, Prochaska M, Roy R, Nguyen KT. Improving Direct Admissions to Internal Medicine Services. J Patient Saf 2024; 20:222-226. [PMID: 38345393 DOI: 10.1097/pts.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Direct admissions from clinic or home to the hospital may improve efficiency and reduce emergency room utilization, but nonoptimized processes may increase the risk of harm during the transition of care. Our multidisciplinary team aimed to understand and improve the process of directly admitting patients to inpatient medicine services at a large academic medical center. METHODS In this single-institution quality improvement initiative, we identified key communication gaps within the direct admission process and implemented a handoff tool in the form of a templated note and order set to bridge those communication gaps. The primary outcome measure was the monthly utilization rate of the handoff note as a surrogate for handoffs and uptake of the intervention. RESULTS We launched our intervention in April 2022. We achieved sustained use of the SmartText and a peak of 24% of direct admissions utilizing the SmartText in January 2023. Based on feedback during Plan-Do-Study-Act cycles, we added direct admission instructions for outpatient teams to follow in the order set and reduced text in the handoff note. CONCLUSIONS This study demonstrates the design and implementation of a quality improvement initiative to identify and address communication gaps for direct admissions of adult medicine patients.
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Affiliation(s)
- Seth Scheetz
- From the University of Chicago Medicine, Chicago, Illinois
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23
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Tran BW, May KA, Pal N. Academic Anesthesiology: What Does It Mean for Most of Us? Anesth Analg 2024; 138:e15-e16. [PMID: 38489800 DOI: 10.1213/ane.0000000000006898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Affiliation(s)
- Bryant W Tran
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia,
| | - Keith A May
- Department of Anesthesiology, University of Tennessee, Knoxville, Tennessee
| | - Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
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24
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Bloomhardt H, Rubin M, Xue Y, Jin Z, Masino L, Seidel D, Hijiya N, Beauchemin M. Pediatric oncology provider perspectives and patient/family perceptions of chemotherapy-induced nausea and vomiting management: Experiences at an academic medical center. Pediatr Blood Cancer 2024; 71:e30883. [PMID: 38279826 DOI: 10.1002/pbc.30883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Chemotherapy-induced nausea and vomiting (CINV) is common in children undergoing cancer treatment, and significantly impacts quality of life. Clinical practice guidelines (CPGs) have been developed to guide CINV management, though many patients do not receive guideline-concordant care. Few studies have examined provider perspectives on CINV management or preferred improvement approaches, or pediatric patient perception of CINV control. METHODS A cross-sectional study of pediatric oncology providers was conducted at a large freestanding children's hospital. Providers completed an anonymous online survey about CINV control in patients admitted for scheduled chemotherapy, and their knowledge and utilization of CINV CPGs. A survey of English and Spanish-speaking pediatric oncology patients admitted for scheduled chemotherapy was conducted to assess CINV management, with key demographics used to understand association with perceptions and adherence to antiemetic guidelines. RESULTS For providers, 75% of respondents felt CINV management could be moderately or extremely improved, significantly more so by chemotherapy prescribers and pediatric medical residents than nurses. Over half of respondents did not have awareness of CINV CPGs, particularly pediatric medical residents. For patients, nausea was reported to be extremely well controlled in 44% of cases, and vomiting extremely well controlled in 50% of cases. There were no significant differences in patient-reported CINV across demographics, when considering emetogenicity of chemotherapy received, or concordance to guidelines. CONCLUSIONS Implementing education in this area may help to improve provider comfort, and ultimately, the patient experience. Future studies will expand upon this novel patient perception, and develop and evaluate CINV management interventions.
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Affiliation(s)
- Hadley Bloomhardt
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Pediatric Advanced Care Team, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Melissa Rubin
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- NewYork-Presbyterian Morgan Stanley Children's Hospital, NewYork, New York, USA
| | - Yanling Xue
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Laura Masino
- NewYork-Presbyterian Morgan Stanley Children's Hospital, NewYork, New York, USA
| | - Drew Seidel
- NewYork-Presbyterian Morgan Stanley Children's Hospital, NewYork, New York, USA
| | - Nobuko Hijiya
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Melissa Beauchemin
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
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Czerminski J, Pahade JK, Davis MA, Mezrich JL. The disproportionate impact of peer learning on emergency radiology. Emerg Radiol 2024; 31:133-139. [PMID: 38261134 DOI: 10.1007/s10140-024-02207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE The use of peer learning methods in radiology continues to grow as a means to constructively learn from past mistakes. This study examined whether emergency radiologists receive a disproportionate amount of peer learning feedback entered as potential learning opportunities (PLO), which could play a significant role in stress and career satisfaction. Our institution offers 24/7 attending coverage, with emergency radiologists interpreting a wide range of X-ray, ultrasound and CT exams on both adults and pediatric patients. MATERIALS AND METHODS Peer learning submissions entered as PLO at a single large academic medical center over a span of 3 years were assessed by subspecialty distribution and correlated with the number of attending radiologists in each section. Total number of studies performed on emergency department patients and throughout the hospital system were obtained for comparison purposes. Data was assessed using analysis of variance and post hoc analysis. RESULTS Emergency radiologists received significantly more (2.5 times) PLO submissions than the next closest subspeciality division and received more yearly PLO submissions per attending compared to other subspeciality divisions. This was found to still be true when normalizing for increased case volumes; Emergency radiologists received more PLO submissions per 1000 studies compared to other divisions in our department (1.59 vs. 0.85, p = 0.04). CONCLUSION Emergency radiologists were found to receive significantly more PLO submissions than their non-emergency colleagues. Presumed causes for this discrepancy may include a higher error rate secondary to wider range of studies interpreted, demand for shorter turn-around times, higher volumes of exams read per shift, and hindsight bias in the setting of follow-up review.
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Affiliation(s)
- Jan Czerminski
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA
| | - Jay K Pahade
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA
| | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA
| | - Jonathan L Mezrich
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA.
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Antonic M, Djordjevic A. 25th anniversary of the Department of Cardiac Surgery at the University Medical Center Maribor: advancing hearts, changing lives : A quarter century of commitment. Wien Klin Wochenschr 2024; 136:220-223. [PMID: 38285180 PMCID: PMC11006772 DOI: 10.1007/s00508-024-02323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
In 1996, Slovenia witnessed a profound transformation in its cardiac care landscape with the establishment of the Department of Cardiac Surgery at the University Medical Centre Maribor. This momentous milestone heralded the birth of the nation's second heart surgery center revolutionizing cardiovascular care accessibility. Today, the Department of Cardiac Surgery stands as a regional hub, delivering specialized cardiac surgical services to Slovenia's northeastern region and beyond. Its unwavering commitment to excellence, patient-centered care, and adherence to international guidelines reflects its dedication to providing top-tier cardiac care. As the department commemorates its 25th anniversary, this article offers a reflective overview of its establishment, development, growth and future trajectory for further development in an ever-changing era of cardiovascular medicine. The article also highlights the department's active involvement in international collaborations, scientific research, medical education, and innovations in minimally invasive cardiac surgery.
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Affiliation(s)
- Miha Antonic
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Anze Djordjevic
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
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Randhawa MK, Takigami AK, Thondapu V, Ranganath PG, Zhang E, Parakh A, Goiffon RJ, Baliyan V, Foldyna B, Lu MT, Tower-Rader A, Meyersohn NM, Hedgire S, Ghoshhajra BB. Selective Use of CT Fractional Flow at a Large Academic Medical Center: Insights from Clinical Implementation after 1 Year of Practice. Radiol Cardiothorac Imaging 2024; 6:e230073. [PMID: 38573127 DOI: 10.1148/ryct.230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Purpose This special report outlines a retrospective observational study of CT fractional flow reserve (CT-FFR) analysis using dual-source coronary CT angiography (CTA) scans performed without heart rate control and its impact on clinical outcomes. Materials and Methods All patients who underwent clinically indicated coronary CTA between August 2020 and August 2021 were included in this retrospective observational study. Scans were performed in the late systolic to early diastolic period without heart rate control and analyzed at the interpreting physician's discretion. Demographics, coronary CTA features, and rates of invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), myocardial infarction, and all-cause death at 3 months were assessed by chart review. Results During the study period, 3098 patients underwent coronary CTA, of whom 113 with coronary bypass grafting were excluded. Of the remaining 2985 patients, 292 (9.7%) were referred for CT-FFR analysis. Two studies (0.7%) were rejected from CT-FFR analysis, and six (2.1%) analyses did not evaluate the lesion of concern. A total of 160 patients (56.3%) had CT-FFR greater than 0.80. Among patients with significant stenosis at coronary CTA, patients who underwent CT-FFR analysis presented with lower rates of ICA (74.5% vs 25.5%, P = .04) and PCI (78.9% vs 21.1%, P = .05). Conclusion CT-FFR was implemented in patients not requiring heart rate control by using dual-source coronary CTA acquisition and showed the potential to decrease rates of ICA and PCI without compromising safety in patients with significant stenosis and an average heart rate of 65 beats per minute. Keywords: Angiography, CT, CT-Angiography, Fractional Flow Reserve, Cardiac, Heart, Arteriosclerosis Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Mangun K Randhawa
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Angelo K Takigami
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Vikas Thondapu
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Praveen G Ranganath
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Eric Zhang
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Anushri Parakh
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Reece J Goiffon
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Vinit Baliyan
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Borek Foldyna
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Michael T Lu
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Albree Tower-Rader
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Nandini M Meyersohn
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Sandeep Hedgire
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
| | - Brian B Ghoshhajra
- From the Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295, Boston, MA 02114
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Pawlik MT, Dendl LM, Achajew LA, Zeman F, Blecha S, Jung M, Schleder S, Schreyer AG. Clinical Value and Operational Risks of MRI in ICU patients - A Retrospective Analysis Performed at a University Medical Center. ROFO-FORTSCHR RONTG 2024; 196:371-380. [PMID: 37967821 DOI: 10.1055/a-2193-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
PURPOSE Intensive care unit (ICU) patients have a high risk of developing complications when leaving the ICU for diagnostic procedures or therapeutic interventions. Our study examined the frequency of adverse events associated with magnetic resonance imaging (MRI) of intensive care patients and the extent of changes in therapy due to the MRI scan to weigh the risks associated with the scan against the potential benefits of an MR scan, using a change in therapy as an indicator of benefit. MATERIALS AND METHODS 4434 ICU patients (January to December 2015) were identified by Hospital Information System (SAP-R/3 IS-H, Walldorf, Germany), ICU patient data management system Metavision (iMDsoft, Israel), and Radiology Information System (Nexus.medRIS, Version 8.42, Nexus, Germany). All intensive care and medical records (HIS) and MRI reports (RIS) were matched and further evaluated in a retrospective case-to-case analysis for biometric data, mechanical ventilation, ICU requirements, planned postoperative vs. emergency diagnostic requirements, complications and impact on further diagnosis or therapy. RESULTS Out of 4434 ICU patients, 322 ICU patients (7.3 %) underwent a total of 385 MRI examinations. 167 patients needed a total of 215 emergency scans, while 155 patients underwent 170 planned postoperative MRI exams. 158 (94.6 %) out of 167 emergency scan patients were ventilated under continuous intravenous medication and monitoring. In the planned postoperative group, only 6 (3.9 %) out of 155 were ventilated, but a total of 38 (24.5 %) were under continuous medication. 111 patients were accompanied by nurses only during MRI. Only one severe adverse event (0.3 %) was noted and was attributed to study preparation (n = 385). In 8 MRI examinations (2.1 %), the examination was interrupted or cancelled due to the patients' condition. While all MRI examinations in the planned group were completed (n = 170, 100 %) (e. g., postoperative controls), only 207 out of 215 (96.3 %) could be performed for emergency diagnostic reasons. MRI influenced the clinical course with a change in diagnosis or therapy in 74 (19.2 %) of all 385 MRI examinations performed, and in the emergency diagnostic group it was 31.2 % (n = 67/215). CONCLUSION Nearly 20 % of MRI examinations of ICU patients resulted in a change of therapy. With only one potentially life-threatening adverse event (0.3 %) during transport and the MRI examination, the risk seems to be outweighed by the diagnostic benefit. KEY POINTS · The risk of adverse events associated with MRI scans in ICU patients is low.. · The rate of premature termination of ICU patients' MRI scans is low.. · Almost 20 % of ICU patients' MRI scans lead to a change of therapy..
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Affiliation(s)
- Michael T Pawlik
- Anaesthesiology and Intensive Care Medicine, Caritas-Krankenhaus Sankt Josef Regensburg, Germany
| | - Lena M Dendl
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
| | - Lom-Ali Achajew
- Anaesthesiology and Intensive Care Medicine, Caritas-Krankenhaus Sankt Josef Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University of Regensburg, Germany
| | | | - Michael Jung
- Radiology, University Hospital Regensburg, Germany
| | - Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Barmherzige Brüder Klinikum Sankt Elisabeth Straubing GmbH, Straubing, Germany
| | - Andreas G Schreyer
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
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Pien J, Ali TK, Schlozman S, Jamal A, Bucknor MD, Srinivasan M. Participation in a Physician Creative Writing Community: 15-Year Program Survey Outcomes at an Academic Medical Center. J Gen Intern Med 2024; 39:815-817. [PMID: 38196073 DOI: 10.1007/s11606-023-08595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Jennifer Pien
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Palo Alto, CA, USA.
| | - Tayyeba K Ali
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- Palo Alto Medical Foundation, Sutter Health, Sunnyvale, CA, USA
| | - Sofia Schlozman
- Narrative Medicine Program, Columbia University, New York City, NY, USA
| | - Armaan Jamal
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew D Bucknor
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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George JF, Chen H. Developing research programs that align with the clinical mission. Surgery 2024; 175:1244-1246. [PMID: 38123371 DOI: 10.1016/j.surg.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
Building a competitive research program within a department of surgery requires a significant commitment by the department and the institution to provide the necessary resources for faculty recruitment, retention of current faculty, and physical space/infrastructure to support research activities. We expanded the academic footprint of our department as demonstrated by the expansion of the department of surgery research funding by 13-fold over a period of 7 years, resulting in an increase in national ranking from 55th place to 10th place in the National Institutes of Health extramural funding. This required attention to multiple factors that affect the ability of faculty to establish and maintain competitive research programs. We executed a plan that established a leadership structure that coordinates resources and provides mentorship to faculty. The department invested heavily in the recruitment of new faculty, especially junior faculty, but also some mid-career and senior investigators to develop a critical mass in specific areas for competitive large grant and program project applications. The pipeline of new trainees interested in research was augmented by successful training grant applications that created a mechanism by which residents and fellows can pursue research for periods ranging from a few weeks to 2 years. Administrative infrastructure was created to assist faculty in grant submissions as well as post-award management. Finally, in partnership with institutional leadership, the department acquired the physical space necessary to support both dry-lab and wet-lab research activities. To achieve true excellence, an academic surgery department must maintain excellence in both the clinical and research areas, which, in the context of an academic medical center, are not separate goals.
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Affiliation(s)
- James F George
- Department of Surgery, University of Alabama at Birmingham, AL
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, AL.
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Maggio LA, Costello JA, Kolars JC, Cervero RM, Jackson KM, Durning SJ, Ma T. In Search of a "Metric System" for Measuring Faculty Effort: A Qualitative Study on Educational Value Units at U.S. Medical Schools. Acad Med 2024; 99:445-451. [PMID: 38266197 DOI: 10.1097/acm.0000000000005635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE Faculty at academic health centers (AHCs) are charged with engaging in educational activities. Some faculty have developed educational value units (EVUs) to track the time and effort dedicated to these activities. Although several AHCs have adopted EVUs, there is limited description of how AHCs engage with EVU development and implementation. This study aimed to understand the collective experiences of AHCs with EVUs to illuminate benefits and barriers to their development, use, and sustainability. METHOD Eleven faculty members based at 10 AHCs were interviewed between July and November 2022 to understand their experiences developing and implementing EVUs. Participants were asked to describe their experiences with EVUs and to reflect on benefits and barriers to their development, use, and sustainability. Transcripts were analyzed using thematic analysis. RESULTS EVU initiatives have been designed and implemented in a variety of ways, with no AHCs engaging alike. Despite differences, the authors identified shared themes that highlighted benefits and barriers to EVU development and implementation. Within and between these themes, a series of tensions were identified in conjunction with the ways in which AHCs attempted to mitigate them. Related to barriers, the majority of participants abandoned or paused their EVU initiatives; however, no differences were identified between those AHCs that retained EVUs and those that did not. CONCLUSIONS The collective themes identified suggest that AHCs implementing or sustaining an EVU initiative would need to balance benefits and barriers in light of their unique context. Study findings align with reviews on EVUs and provide additional nuance related to faculty motivation to engage in education and the difficulties of defining EVUs. The lack of differences observed between those AHCs that retained EVUs and those that did not suggests that EVUs may be challenging to implement because of the complexity of AHCs and their faculty.
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Guedes NLKO, Dwan AJ, Gerlero P, Nico MMS. Delusional infestation treated with risperidone: a series of 27 patients. Clin Exp Dermatol 2024; 49:364-367. [PMID: 38001055 DOI: 10.1093/ced/llad411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Patients with delusional infestation (DI) frequently refuse to be treated with psychoactive drugs. In the past, pimozide was commonly used as a first-line agent but is now prescribed more rarely. Risperidone was first used to treat DI in 1995. A recent review identified 12 studies that evaluated the use of risperidone in 43 patients with DI. OBJECTIVES To study the characteristics of and therapeutic results in patients with DI treated with risperidone at a university medical centre in São Paulo, Brazil. METHODS We performed a retrospective study of patients with DI treated with risperidone at a dermatological university clinic since 2016. Records were reviewed for personal data and findings related to treatment. RESULTS Twenty-seven patients were studied (20 women and 7 men). The maintenance dose of risperidone varied from 1 mg three times weekly to 8 mg daily. Control of symptoms was achieved in the majority of patients. A reduction in dosage due to side-effects was seen in four patients; risperidone had to be switched to another antipsychotic in three cases, despite a good response. Only one patient did not respond to risperidone. CONCLUSIONS Risperidone is an effective, well-tolerated and safe treatment for delusional parasitosis. Adequate follow-up is mandatory in order to obtain long-term control of symptoms.
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Affiliation(s)
| | - Alexandre J Dwan
- Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
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Scheibler F, Geiger F, Wehkamp K, Danner M, Debrouwere M, Stolz-Klingenberg C, Schuldt-Joswig A, Sommer CG, Kopeleva O, Bünzen C, Wagner-Ullrich C, Koch G, Coors M, Wehking F, Clayman M, Weymayr C, Sundmacher L, Rüffer JU. Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre-post trial. BMJ Evid Based Med 2024; 29:87-95. [PMID: 37890982 PMCID: PMC10982630 DOI: 10.1136/bmjebm-2023-112462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM). DESIGN Pre-post study. SETTING University Hospital Schleswig-Holstein (UKSH), Kiel Campus. PARTICIPANTS Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH. INTERVENTIONS The S2C programme is a comprehensive implementation strategy including four core modules: (1) physician training, (2) SDM support training for and support by nurses as decision coaches, (3) patient activation and (4) evidence-based patient decision aid development and integration into patient pathways. After full implementation, departments received the S2C certificate. MAIN OUTCOME MEASURES In this paper, we report on the feasibility and effectiveness outcomes of the implementation. Feasibility was judged by the degree of implementation of the four modules of the programme. Outcome measures for effectiveness are patient-reported experience measures (PREMs). The primary outcome measure for effectiveness is the Patient Decision Making subscale of the Perceived Involvement in Care Scale (PICSPDM). Pre-post comparisons were done using t-tests. RESULTS The implementation of the four components of the S2C programme was able to be completed in 18 of the 22 included departments within the time frame of the study. After completion of implementation, PICSPDM showed a statistically significant difference (p<0.01) between the means compared with baseline. This difference corresponds to a small to medium yet clinically meaningful positive effect (Hedges' g=0.2). Consistent with this, the secondary PREMs (Preparation for Decision Making and collaboRATE) also showed statistically significant, clinically meaningful positive effects. CONCLUSIONS The hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care.
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Affiliation(s)
- Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Köln, Germany
| | - Friedemann Geiger
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Marion Danner
- DARUM Marion Danner und Anne Rummer GbR, Cologne, Germany
| | - Marie Debrouwere
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Constanze Stolz-Klingenberg
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Anja Schuldt-Joswig
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christina Gesine Sommer
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Olga Kopeleva
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
- Department of General Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Claudia Bünzen
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christine Wagner-Ullrich
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Gerhard Koch
- Department for Orthodontics, University Hospital Schleswig Holstein, Kiel, Germany
| | - Marie Coors
- Department of Health Economics, Technical University of Munich, München, Germany
| | - Felix Wehking
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - Marla Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christian Weymayr
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, München, Germany
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Umer EK, Abebe AT, Kebede YT, Bekele NT. Burden and risk profile of acute kidney injury in severe COVID-19 pneumonia admissions: a Finding from Jimma University medical center, Ethiopia. BMC Nephrol 2024; 25:109. [PMID: 38504176 PMCID: PMC10953204 DOI: 10.1186/s12882-024-03522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/25/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious complication of the Corona Virus Disease of 2019 (COVID-19). However, data on its magnitude and risk factors among hospitalized patients in Ethiopia is limited. This study aimed to determine the magnitude of AKI and associated factors among patients admitted for severe COVID-19 pneumonia. METHODS An institution-based retrospective cross-sectional study was conducted among 224 patients admitted to Jimma University Medical Center in Ethiopia for severe COVID-19 pneumonia from May 2020 to December 2021. Systematic random sampling was used to select study participants. Medical records were reviewed to extract sociodemographic, clinical, laboratory, therapeutic, and comorbidity data. Bivariable and multivariable logistic regressions were performed to examine factors associated with AKI. The magnitude of the association between the explanatory variables and AKI was estimated using an adjusted odds ratio (AOR) with a 95% confidence interval (CI), and significance was declared at a p-value of 0.05. RESULTS The magnitude of AKI was 42% (95% CI: 35.3-48.2%) in the study area. Mechanical ventilation, vasopressors, and antibiotics were required in 32.6, 3.7, and 97.7% of the patients, respectively. After adjusting for possible confounders, male sex (AOR 2.79, 95% CI: 1.3-6.5), fever (AOR 6.5, 95% CI: 2.7-15.6), hypoxemia (AOR 5.1, 95% CI: 1.4-18.9), comorbidities (AOR 2.8, 95% CI: 1.1-7.0), and severe anemia (AOR 10, 95% CI: 1.7-65.7) remained significantly associated with higher odds of AKI. CONCLUSION The burden of AKI among patients with severe COVID-19 pneumonia is high in our setting. Male sex, abnormal vital signs, chronic conditions, and anemia can identify individuals at increased risk and require close monitoring and prevention efforts.
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Affiliation(s)
- Ebrahim Kelil Umer
- Department of Internal Medicine, Adama Hospital Medical College, Adama, Ethiopia
| | - Abel Tezera Abebe
- School of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Yabets Tesfaye Kebede
- School of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Ganeshan S, Liu AW, Kroeger A, Anand P, Seefeldt R, Regner A, Vaughn D, Odisho AY, Mourad M. An Electronic Health Record-Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study. J Med Internet Res 2024; 26:e52071. [PMID: 38502159 PMCID: PMC10988365 DOI: 10.2196/52071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/23/2023] [Accepted: 01/22/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician's schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. OBJECTIVE We evaluated an electronic health record (EHR)-based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. METHODS In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. RESULTS From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11%) were accepted across all departments, and 5399 (8.9%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US $3 million. CONCLUSIONS Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access.
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Affiliation(s)
- Smitha Ganeshan
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Andrew W Liu
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - Anne Kroeger
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Prerna Anand
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Richard Seefeldt
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Alexis Regner
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Diana Vaughn
- UCSF Health Faculty Practices, University of California San Francisco, San Francisco, CA, United States
| | - Anobel Y Odisho
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - Michelle Mourad
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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Cardinaal EMM, Truijens J, Jeurissen PPT, Berden H. Use of business model potential in Dutch academic medical centres-A case study. PLoS One 2024; 19:e0297966. [PMID: 38489295 PMCID: PMC10942033 DOI: 10.1371/journal.pone.0297966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024] Open
Abstract
Academic Medical Centres (AMCs) are large organisations with a complex structure due to various intertwined missions and (public) roles that can be conflicting. This complexity makes it difficult to adapt to changing circumstances. The literature points to the use of business models to address such challenges. A business model describes the resources, processes, and cost assumptions that an organisation makes in order to the delivery of a unique value proposition to a customer/patient. Do AMC business operations managers actually use business models to address challenges and operate in a way that enables AMCs to adapt to changing circumstances? This study explored whether the use of a business model is a starting point for bringing about change in AMC operations. A case study design was considered appropriate to explore the knowledge and experience of business models among business operations managers of Dutch AMCs. Through purposive sampling, participants were invited to participate in a questionnaire to provide in-depth and detailed information about the use of business models in AMCs. Our research showed that a business model can support the complex organisation of an AMC, but the design and use of business models varies. In general, respondents attribute more potential to the use of a business model than they experience in daily practice. The majority consider a business model to be suitable for bringing about change, but see it only sparingly used in their own AMC. This is the first study to provide some initial insights into the use of business models in Dutch AMCs. We can assume that improvements are possible in order to optimise the change potential of business models in AMCs worldwide. In order to successfully implement an innovative business model, the interpretation of the concept of a business model and the creation of a framework of preconditions should be taken into account. Healthcare providers, policy makers or researchers should explicitly identify the environment in which the model will operate. In particular, by identifying the level of readiness for change readiness at all levels of the organisation.
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Affiliation(s)
- Ester M. M. Cardinaal
- Operating Rooms, Anesthesiology, Pain and Palliative Medicine, Radboud Universitair Medisch Centrum, Nijmegen, The Netherlands
| | - Joey Truijens
- Radboud Universitair Medisch Centrum, Nijmegen, The Netherlands
| | | | - Hubert Berden
- Radboud Institute of Health Sciences (RIHS), Nijmegen, The Netherlands
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Lim L, Gim U, Cho K, Yoo D, Ryu HG, Lee HC. Real-time machine learning model to predict short-term mortality in critically ill patients: development and international validation. Crit Care 2024; 28:76. [PMID: 38486247 PMCID: PMC10938661 DOI: 10.1186/s13054-024-04866-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/09/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND A real-time model for predicting short-term mortality in critically ill patients is needed to identify patients at imminent risk. However, the performance of the model needs to be validated in various clinical settings and ethnicities before its clinical application. In this study, we aim to develop an ensemble machine learning model using routinely measured clinical variables at a single academic institution in South Korea. METHODS We developed an ensemble model using deep learning and light gradient boosting machine models. Internal validation was performed using the last two years of the internal cohort dataset, collected from a single academic hospital in South Korea between 2007 and 2021. External validation was performed using the full Medical Information Mart for Intensive Care (MIMIC), eICU-Collaborative Research Database (eICU-CRD), and Amsterdam University Medical Center database (AmsterdamUMCdb) data. The area under the receiver operating characteristic curve (AUROC) was calculated and compared to that for the National Early Warning Score (NEWS). RESULTS The developed model (iMORS) demonstrated high predictive performance with an internal AUROC of 0.964 (95% confidence interval [CI] 0.963-0.965) and external AUROCs of 0.890 (95% CI 0.889-0.891) for MIMIC, 0.886 (95% CI 0.885-0.887) for eICU-CRD, and 0.870 (95% CI 0.868-0.873) for AmsterdamUMCdb. The model outperformed the NEWS with higher AUROCs in the internal and external validation (0.866 for the internal, 0.746 for MIMIC, 0.798 for eICU-CRD, and 0.819 for AmsterdamUMCdb; p < 0.001). CONCLUSIONS Our real-time machine learning model to predict short-term mortality in critically ill patients showed excellent performance in both internal and external validations. This model could be a useful decision-support tool in the intensive care units to assist clinicians.
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Affiliation(s)
- Leerang Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ukdong Gim
- VUNO, 479 Gangnam-Daero, Seocho-gu, Seoul, 06541, Republic of Korea
| | - Kyungjae Cho
- VUNO, 479 Gangnam-Daero, Seocho-gu, Seoul, 06541, Republic of Korea
| | - Dongjoon Yoo
- VUNO, 479 Gangnam-Daero, Seocho-gu, Seoul, 06541, Republic of Korea
- Department of Critical Care Medicine and Emergency Medicine, Inha University College of Medicine, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Critical Care Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Bowman LA, Berger O, Nesbit S, Stoller KB, Buresh M, Stewart R. Operationalizing the new DEA exception: A novel process for dispensing of methadone for opioid use disorder at discharge from acute care settings. Am J Health Syst Pharm 2024; 81:204-218. [PMID: 38091380 DOI: 10.1093/ajhp/zxad288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
PURPOSE To describe one strategy for dispensing of methadone at emergency department (ED) and hospital discharge implemented within 2 urban academic medical centers. SUMMARY Expanding access to medications for opioid use disorder (OUD) is a national priority. ED visits and hospitalizations offer an opportunity to initiate or continue these lifesaving medications, including methadone and buprenorphine. However, federal regulations governing methadone treatment and significant gaps in treatment availability have made continuing methadone upon ED or hospital discharge challenging. To address this issue, the Drug Enforcement Administration (DEA) granted an exception allowing hospitals, clinics, and EDs to dispense a 72-hour supply of methadone while continued treatment is arranged. Though this exception addresses a critical unmet need, guidance for operationalizing this service is limited. To facilitate expanded patient access to methadone on ED or hospital discharge at 2 Baltimore hospitals, key stakeholders within the parent health system were identified, and a workgroup was formed. Processes were established for requesting, approving, preparing, and dispensing the methadone supply using an electronic health record order set. Multidisciplinary educational materials were created to support end users of the workflow. In the first 3 months of implementation, 42 requests were entered, of which 36 were approved, resulting in 79 dispensed methadone doses. CONCLUSION This project demonstrates feasibility of methadone dispensing at hospital and ED discharge. Further work is needed to evaluate impact on patient outcomes, such as hospital and ED utilization, length of stay, linkage to treatment, and retention in treatment.
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Affiliation(s)
- Lindsay A Bowman
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Olivia Berger
- Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Suzanne Nesbit
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kenneth B Stoller
- Johns Hopkins Broadway Center for Addiction, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan Buresh
- Bayview Medical Center Addiction Consult Service, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosalyn Stewart
- Johns Hopkins Hospital Addiction Consult Service, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Leung CW, Patel MR, Miller M, Spring E, Wang Z, Wolfson JA, Cohen AJ, Heisler M, Hao W. Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan. JAMA Netw Open 2024; 7:e243723. [PMID: 38530312 DOI: 10.1001/jamanetworkopen.2024.3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Importance Health care systems are increasingly adopting methods to screen for and integrate food insecurity and other social risk factors into electronic health records. However, there remain knowledge gaps regarding the cumulative burden of food insecurity in large clinical settings, which patients are most at risk, and the extent to which patients are interested in social assistance through their health care system. Objective To evaluate the 5-year prevalence and associated risk factors of food insecurity among adult primary care patients, and to examine factors associated with patients' interest in social assistance among those with food insecurity. Design, Setting, and Participants This cross-sectional analysis of a retrospective cohort study took place at a tertiary care academic medical center (encompassing 20 primary care clinics) in Michigan. Participants included adult patients who completed screening for social risk factors between August 1, 2017, and August 1, 2022. Data analysis was performed from November 2022 to June 2023. Exposure Food insecurity was assessed using the Hunger Vital Sign. Main Outcomes and Measures The primary outcome was patients' interest in social assistance, and associated factors were examined using multivariate logistic regression models, adjusting for patients' demographic and health characteristics. Results Over the 5-year period, 106 087 adult primary care patients (mean [SD] age, 52.9 [17.9] years; 61 343 women [57.8%]) completed the standardized social risk factors questionnaire and were included in the analysis. The overall prevalence of food insecurity was 4.2% (4498 patients), with monthly trends ranging from 1.5% (70 positive screens) in August 2018 to 5.0% (193 positive screens) in June 2022. Food insecurity was significantly higher among patients who were younger, female, non-Hispanic Black or Hispanic, unmarried or unpartnered, and with public health insurance. Food insecurity was significantly associated with a higher cumulative burden of social needs, including social isolation, medical care insecurity, medication nonadherence, housing instability, and lack of transportation. Only 20.6% of patients with food insecurity (927 patients) expressed interest in social assistance. Factors associated with interest in social assistance including being non-Hispanic Black, unmarried or unpartnered, a current smoker, and having a higher burden of other social needs. Conclusions and Relevance In this retrospective cohort study, the overall prevalence of food insecurity was 4.2%, of whom approximately 1 in 5 patients with food insecurity expressed interest in assistance. This study highlights ongoing challenges in ensuring all patients complete routine social determinants of health screening and gaps in patients' interest in assistance for food insecurity and other social needs through their health care system.
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Affiliation(s)
- Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | | | | | - Zixi Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alicia J Cohen
- Center for Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, Rhode Island
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health Providence, Rhode Island
| | - Michele Heisler
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Wei Hao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
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Futterman J, Bi C, Crow B, Kureshi S, Okah E. Medical educators' perception of race in clinical practice. BMC Med Educ 2024; 24:230. [PMID: 38439004 PMCID: PMC10913645 DOI: 10.1186/s12909-024-05232-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND While several medical societies endorse race as a social construct, it is still often used as a biological trait in medical education. How medical educators employ race while teaching is likely impacted by their beliefs as to what race represents and its relevance in clinical care. Understanding these beliefs is necessary to guide medical education curriculum reform. METHODS This was a qualitative survey study, conducted in June 2020, of Georgetown University Medical Center faculty. As part of the survey, faculty were asked to rate, on a 5-point Likert scale, the extent to which they perceived race as a biological trait and its importance in clinical care. Self-identified clinical or preclinical faculty (N = 147) who believed that race had any importance were asked to provide an example illustrating its significance. Free-text responses were coded using content analysis with an inductive approach and contextualized by faculty's perspectives on the biological significance of race. RESULTS There were 130 (88%) responses categorized into two major themes: race is important for [1] screening, diagnosing, and treating diseases and [2] contextualizing patients' experiences and health behaviors. Compared to faculty who perceived race as biological, those who viewed race as strictly social were more likely to report using race to understand or acknowledge patients' exposure to racism. However, even among these faculty, explanations that suggested biological differences between racial groups were prevalent. CONCLUSIONS Medical educators use race primarily to understand diseases and frequently described biological differences between racial groups. Efforts to reframe race as sociopolitical may require education that examines race through a global lens, accounting for the genetic and cultural variability that occurs within racial groups; greater awareness of the association between structural racism and health inequities; movement away from identity-based risk stratification; and incorporation of tools that appraise race-based medical literature.
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Affiliation(s)
| | | | - Brendan Crow
- Mountain Area Health Education Center, Asheville, NC, USA
| | - Sarah Kureshi
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ebiere Okah
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
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Garcia P, Ma SP, Shah S, Smith M, Jeong Y, Devon-Sand A, Tai-Seale M, Takazawa K, Clutter D, Vogt K, Lugtu C, Rojo M, Lin S, Shanafelt T, Pfeffer MA, Sharp C. Artificial Intelligence-Generated Draft Replies to Patient Inbox Messages. JAMA Netw Open 2024; 7:e243201. [PMID: 38506805 PMCID: PMC10955355 DOI: 10.1001/jamanetworkopen.2024.3201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Importance The emergence and promise of generative artificial intelligence (AI) represent a turning point for health care. Rigorous evaluation of generative AI deployment in clinical practice is needed to inform strategic decision-making. Objective To evaluate the implementation of a large language model used to draft responses to patient messages in the electronic inbox. Design, Setting, and Participants A 5-week, prospective, single-group quality improvement study was conducted from July 10 through August 13, 2023, at a single academic medical center (Stanford Health Care). All attending physicians, advanced practice practitioners, clinic nurses, and clinical pharmacists from the Divisions of Primary Care and Gastroenterology and Hepatology were enrolled in the pilot. Intervention Draft replies to patient portal messages generated by a Health Insurance Portability and Accountability Act-compliant electronic health record-integrated large language model. Main Outcomes and Measures The primary outcome was AI-generated draft reply utilization as a percentage of total patient message replies. Secondary outcomes included changes in time measures and clinician experience as assessed by survey. Results A total of 197 clinicians were enrolled in the pilot; 35 clinicians who were prepilot beta users, out of office, or not tied to a specific ambulatory clinic were excluded, leaving 162 clinicians included in the analysis. The survey analysis cohort consisted of 73 participants (45.1%) who completed both the presurvey and postsurvey. In gastroenterology and hepatology, there were 58 physicians and APPs and 10 nurses. In primary care, there were 83 physicians and APPs, 4 nurses, and 8 clinical pharmacists. The mean AI-generated draft response utilization rate across clinicians was 20%. There was no change in reply action time, write time, or read time between the prepilot and pilot periods. There were statistically significant reductions in the 4-item physician task load score derivative (mean [SD], 61.31 [17.23] presurvey vs 47.26 [17.11] postsurvey; paired difference, -13.87; 95% CI, -17.38 to -9.50; P < .001) and work exhaustion scores (mean [SD], 1.95 [0.79] presurvey vs 1.62 [0.68] postsurvey; paired difference, -0.33; 95% CI, -0.50 to -0.17; P < .001). Conclusions and Relevance In this quality improvement study of an early implementation of generative AI, there was notable adoption, usability, and improvement in assessments of burden and burnout. There was no improvement in time. Further code-to-bedside testing is needed to guide future development and organizational strategy.
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Affiliation(s)
- Patricia Garcia
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stephen P Ma
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Shreya Shah
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Margaret Smith
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Yejin Jeong
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Anna Devon-Sand
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Ming Tai-Seale
- Department of Family Medicine, University of California San Diego School of Medicine, La Jolla
| | - Kevin Takazawa
- Technology and Digital Solutions, Stanford Medicine, Stanford, California
| | - Danyelle Clutter
- Technology and Digital Solutions, Stanford Medicine, Stanford, California
| | - Kyle Vogt
- Technology and Digital Solutions, Stanford Medicine, Stanford, California
| | - Carlene Lugtu
- Nursing Informatics & Innovation, Stanford Healthcare, Stanford, California
| | - Matthew Rojo
- Technology and Digital Solutions, Stanford Medicine, Stanford, California
| | - Steven Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Tait Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Michael A Pfeffer
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Technology and Digital Solutions, Stanford Medicine, Stanford, California
| | - Christopher Sharp
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Thombley RL, Rogers SE, Adler-Milstein J. Developing electronic health record-based measures of the 4Ms to support implementation and evidence generation for Age-Friendly Health Systems. J Am Geriatr Soc 2024; 72:882-891. [PMID: 38126964 DOI: 10.1111/jgs.18722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/03/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND To support implementation of the 4Ms framework and more rigorous evidence of 4Ms impact, we translated Institute for Healthcare Improvement's (IHI's) recommended 4Ms routine care practices into electronic health record-based, encounter-level adherence measures and then implemented measures at a large academic medical center. METHODS We started with the 19 care practices in IHI's 4Ms implementation guide and developed encounter-level adherence measures using structured EHR data. We also developed overall 4Ms-level and M-level composite measures. Next, we operationalized measures at UCSF Health-an academic medical center that has implemented the 4Ms using the IHI guide. We identified UCSF Health patients who should have received 4Ms care during their inpatient admission (19,335 individuals 65 years and older with an admission between January 1, 2019 and December 31, 2021), then implemented the individual measures and composite measures (all at the encounter level) using Epic EHR data. We focused on 4Ms inpatient care processes, but similar approaches can be followed for ambulatory, post-acute, and other settings. RESULTS We developed 18 EHR-based measures that captured all IHI care practices, 16 of which could be implemented using UCSF Health EHR data. For example, the EHR-based measure for the Medication care practice "deprescribe high risk medications" was measured using EHR data as "Patient had no previously existing prescriptions for high-risk medications OR patient had ≥1 previously existing prescriptions for high-risk medications deprescribed during the encounter," and 29.5% of UCSF Health encounters met this measure. For composite measures, on average, UCSF Health encounters had 61.1% adherence to the 4Ms (SD = 14.4%), with the lowest average adherence to What Matters (50.9%; SD = 44.3%) and the highest for Mentation (68.4%; SD = 13.4%). CONCLUSIONS It is feasible to construct encounter-level measures of 4Ms adherence using EHR data and derive insights to guide ongoing implementation efforts. Future efforts should refine measures based on assessments of reliability and validity.
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Affiliation(s)
- Robert L Thombley
- Department of Medicine, Division of Clinical Informatics and Digital Transformation, University of California, San Francisco, California, USA
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco, California, USA
| | - Stephanie E Rogers
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, California, USA
| | - Julia Adler-Milstein
- Department of Medicine, Division of Clinical Informatics and Digital Transformation, University of California, San Francisco, California, USA
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco, California, USA
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Strickland CD, Korf JA, Jesse MK, Dodd GD. Strategies for successful integration of work from home faculty in an academic radiology department. Curr Probl Diagn Radiol 2024; 53:185-187. [PMID: 38151438 DOI: 10.1067/j.cpradiol.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023]
Abstract
Academic radiology departments have added increasing numbers of entirely remote "work-from-home" or hybrid faculty. This change has presented both an opportunity to recruit and retain faculty as well as a set of challenges to maintaining the full academic mission and educational environment. In this article we describe our experience with creating a remote faculty position and the key elements that we believe made it successful. Guiding principles for the department and faculty member accepting such a position are proposed and discussed.
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Affiliation(s)
- Colin D Strickland
- Section Head, Musculoskeletal Imaging and Intervention, Department of Radiology, University of Colorado, CU Anschutz Leprino Building, 12401 East 17th Avenue, Aurora, CO 80045, United States.
| | - James A Korf
- Department of Radiology, University of Colorado, Aurora, CO 80045, United States
| | - Mary K Jesse
- Department of Radiology, University of Colorado, Aurora, CO 80045, United States
| | - Gerald D Dodd
- Department of Radiology Chairman, Department of Radiology, University of Colorado, Aurora, CO 80045, United States
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Aggarwal M, Hutchison B, Wong ST, Katz A, Slade S, Snelgrove D. What factors are associated with the research productivity of primary care researchers in Canada? A qualitative study. BMC Health Serv Res 2024; 24:263. [PMID: 38429708 PMCID: PMC10908166 DOI: 10.1186/s12913-024-10644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Research evidence to inform primary care policy and practice is essential for building high-performing primary care systems. Nevertheless, research output relating to primary care remains low worldwide. This study describes the factors associated with the research productivity of primary care researchers. METHODS A qualitative, descriptive key informant study approach was used to conduct semi-structured interviews with twenty-three primary care researchers across Canada. Qualitative data were analyzed using reflexive thematic analysis. RESULTS Twenty-three primary care researchers participated in the study. An interplay of personal (psychological characteristics, gender, race, parenthood, education, spousal occupation, and support), professional (mentorship before appointment, national collaborations, type of research, career length), institutional (leadership, culture, resources, protected time, mentorship, type), and system (funding, systematic bias, environment, international collaborations, research data infrastructure) factors were perceived to be associated with research productivity. Research institutes and mentors facilitated collaborations, and mentors and type of research enabled funding success. Jurisdictions with fewer primary care researchers had more national collaborations but fewer funding opportunities. The combination of institutional, professional, and system factors were barriers to the research productivity of female and/or racialized researchers. CONCLUSIONS This study illuminates the intersecting and multifaceted influences on the research productivity of primary care researchers. By exploring individual, professional, institutional, and systemic factors, we underscore the pivotal role of diverse elements in shaping RP. Understanding these intricate influencers is imperative for tailored, evidence-based interventions and policies at the level of academic institutions and funding agencies to optimize resources, promote fair evaluation metrics, and cultivate inclusive environments conducive to diverse research pursuits within the PC discipline in Canada.
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Affiliation(s)
- Monica Aggarwal
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada.
| | - Brian Hutchison
- McMaster University, Departments of Family Medicine and Health Research Methods, Evidence and Impact and the Centre for Health Economics and Policy Analysis, Hamilton, Ontario, Canada
| | - Sabrina T Wong
- University of British Columbia, School of Nursing, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada
| | - Alan Katz
- University of Manitoba, Departments of Community Health Sciences and Family Medicine Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Steve Slade
- The College of Family Physicians of Canada, Mississauga, Canada
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Bienvenu OJ, Nestadt PS, Witmer A, Prince EJ, Gerstenblith TA, Carroll CP, Triplett PT. Proactive versus traditional psychiatric consults in a large urban academic medical center. Gen Hosp Psychiatry 2024; 87:155-156. [PMID: 37957095 DOI: 10.1016/j.genhosppsych.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Affiliation(s)
- O Joseph Bienvenu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St. Baltimore, MD 21205, USA.
| | - Paul S Nestadt
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St. Baltimore, MD 21205, USA
| | - Ashley Witmer
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Hampton House 624 N. Broadway - 8th Floor Baltimore, MD 21205, USA
| | - Elizabeth J Prince
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St. Baltimore, MD 21205, USA
| | - Ted-Avi Gerstenblith
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St. Baltimore, MD 21205, USA
| | - C Patrick Carroll
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St. Baltimore, MD 21205, USA
| | - Patrick T Triplett
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St. Baltimore, MD 21205, USA
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King A, Tanumihardjo J, Ahn D, Zasadzinski L, Robinson E, Quinn M, Peek M, Saunders M. Assessing knowledge of end-stage kidney disease and treatment options in hospitalized African American patients undergoing hemodialysis. Chronic Illn 2024; 20:145-158. [PMID: 37106575 DOI: 10.1177/17423953231168803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE African Americans are more likely to develop end-stage kidney disease (ESKD) than whites and face multiple inequities regarding ESKD treatment, renal replacement therapy (RRT), and overall care. This study focused on determining gaps in participants' knowledge of their chronic kidney disease and barriers to RRT selection in an effort to identify how we can improve health care interventions and health outcomes among this population. METHODS African American participants undergoing hemodialysis were recruited from an ongoing research study of hospitalized patients at an urban Midwest academic medical center. Thirty-three patients were interviewed, and the transcribed interviews were entered into a software program. The qualitative data were coded using template analysis to analyze text and determine key themes. Medical records were used to obtain demographic and additional medical information. RESULTS Three major themes emerged from the analysis: patients have limited information on ESKD causes and treatments, patients did not feel they played an active role in selecting their initial dialysis unit, and interpersonal interactions with the dialysis staff play a large role in overall unit satisfaction. DISCUSSION Although more research is needed, this study provides information and suggestions to improve future interventions and care quality, specifically for this population.
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Affiliation(s)
- Akilah King
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Jacob Tanumihardjo
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Daniel Ahn
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Eric Robinson
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Michael Quinn
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Monica Peek
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Milda Saunders
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
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Staal J, Katarya K, Speelman M, Brand R, Alsma J, Sloane J, Van den Broek WW, Zwaan L. Impact of performance and information feedback on medical interns' confidence-accuracy calibration. Adv Health Sci Educ Theory Pract 2024; 29:129-145. [PMID: 37329493 DOI: 10.1007/s10459-023-10252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/04/2023] [Indexed: 06/19/2023]
Abstract
Diagnostic errors are a major, largely preventable, patient safety concern. Error interventions cannot feasibly be implemented for every patient that is seen. To identify cases at high risk of error, clinicians should have a good calibration between their perceived and actual accuracy. This experiment studied the impact of feedback on medical interns' calibration and diagnostic process. In a two-phase experiment, 125 medical interns from Dutch University Medical Centers were randomized to receive no feedback (control), feedback on their accuracy (performance feedback), or feedback with additional information on why a certain diagnosis was correct (information feedback) on 20 chest X-rays they diagnosed in a feedback phase. A test phase immediately followed this phase and had all interns diagnose an additional 10 X-rays without feedback. Outcome measures were confidence-accuracy calibration, diagnostic accuracy, confidence, and time to diagnose. Both feedback types improved overall confidence-accuracy calibration (R2No Feedback = 0.05, R2Performance Feedback = 0.12, R2Information Feedback = 0.19), in line with the individual improvements in diagnostic accuracy and confidence. We also report secondary analyses to examine how case difficulty affected calibration. Time to diagnose did not differ between conditions. Feedback improved interns' calibration. However, it is unclear whether this improvement reflects better confidence estimates or an improvement in accuracy. Future research should examine more experienced participants and non-visual specialties. Our results suggest that feedback is an effective intervention that could be beneficial as a tool to improve calibration, especially in cases that are not too difficult for learners.
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Affiliation(s)
- J Staal
- Institute of Medical Education Research, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - K Katarya
- Institute of Medical Education Research, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Faculty of Medical Sciences, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Speelman
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - R Brand
- Intensive Care Unit, Haaglanden Medical Center Den Haag, The Hague, The Netherlands
| | - J Alsma
- Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J Sloane
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - W W Van den Broek
- Institute of Medical Education Research, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Zwaan
- Institute of Medical Education Research, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Howe C, Smith ID, Coles TM, Overton R, Economou-Zavlanos N, Solomon MJ, Doss J, Henao R, Clowse MEB, Leverenz DL. Evaluating Provider Perceptions of Telehealth Utility in Outpatient Rheumatology Telehealth Encounters. J Clin Rheumatol 2024; 30:46-51. [PMID: 38169348 DOI: 10.1097/rhu.0000000000002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE This study aims to explore the factors associated with rheumatology providers' perceptions of telehealth utility in real-world telehealth encounters. METHODS From September 14, 2020 to January 31, 2021, 6 providers at an academic medical center rated their telehealth visits according to perceived utility in making treatment decisions using the following Telehealth Utility Score (TUS) (1 = very low utility to 5 = very high utility). Modified Poisson regression models were used to assess the association between TUS scores and encounter diagnoses, disease activity measures, and immunomodulatory therapy changes during the encounter. RESULTS A total of 481 telehealth encounters were examined, of which 191 (39.7%) were rated as "low telehealth utility" (TUS 1-3) and 290 (60.3%) were rated as "high telehealth utility" (TUS 4-5). Encounters with a diagnosis of inflammatory arthritis were significantly less likely to be rated as high telehealth utility (adjusted relative risk [aRR], 0.8061; p = 0.004), especially in those with a concurrent noninflammatory musculoskeletal diagnosis (aRR, 0.54; p = 0.006). Other factors significantly associated with low telehealth utility included higher disease activity according to current and prior RAPID3 scores (aRR, 0.87 and aRR, 0.89, respectively; p < 0.001) and provider global scores (aRR, 0.83; p < 0.001), as well as an increase in immunomodulatory therapy (aRR, 0.70; p = 0.015). CONCLUSIONS Provider perceptions of telehealth utility in real-world encounters are significantly associated with patient diagnoses, current and prior disease activity, and the need for changes in immunomodulatory therapy. These findings inform efforts to optimize the appropriate utilization of telehealth in rheumatology.
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Affiliation(s)
| | | | - Theresa M Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | | | | | | | - Jayanth Doss
- Division of Rheumatology and Immunology, Department of Medicine
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Ayvaci ER, Minhajuddin A, Elmore JS, Yagnik K, Jha MK, Emslie GJ, Mayes TL, Trivedi MH. Treatment of Adolescent Depression: Comparison of Psychiatric and Pediatric Settings at an Academic Medical Center Using the VitalSign 6 Application. J Child Adolesc Psychopharmacol 2024; 34:80-88. [PMID: 38252552 DOI: 10.1089/cap.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background: Similar outcomes and remission rates have been found for the treatment of depression in adults in primary and psychiatric care settings. However, comparatively little is known about how pediatric depression is managed across different settings. This study aims to address this gap by comparing depression treatment in pediatric and psychiatric settings. We hypothesized that pediatric care settings would be more likely to treat individuals with lower depression severity and would select pharmacotherapy less frequently as a treatment option. Methods: Patients (n = 3498) were screened for depression at a children's hospital from May 2017 to May 2022 as part of the VitalSign6 project, a web-based application for depression management. The two-item patient health questionnaire (PHQ) was used for screening, and the data set contains patient-reported measures and provider-reported diagnoses and treatment selections at each clinic visit. Patients with nine-item PHQ (PHQ-9) scores ≥10 at baseline were included in the analysis to compare diagnosis and treatment recommendations between pediatric and psychiatric settings. Results: Among the 1323 patients who screened positive for depression, those in psychiatric settings had higher PHQ-9 scores (15.9 ± 5.0 vs. 12.1 ± 5.5; p < 0.0001). Patients with PHQ-9 ≥ 10 in psychiatric settings were more likely to be diagnosed with major depressive disorder (60.6% vs. 24.7%, p < 0.0001) and receive pharmacotherapy (54.8% vs. 6.6%) than those in pediatric settings. Pediatric setting patients were more likely to receive nonpharmacological treatment alone (36.3% vs. 4.3%) or an outside referral (27.7% vs. 5.7%). Remission rates did not significantly differ between the two settings. Conclusions: Youth in psychiatric settings are more likely to screen positive for depression and to have greater depression severity than those in pediatric settings. Both settings provide treatment recommendations for moderate-to-severe depression, but treatment types vary substantially. Yet, remission rates remain similar. Further research is needed to understand the nuances of treatment differences and their implications.
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Affiliation(s)
- Emine Rabia Ayvaci
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center, Dallas, Texas, USA
| | - Abu Minhajuddin
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joshua S Elmore
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kush Yagnik
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Manish K Jha
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Graham J Emslie
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center, Dallas, Texas, USA
| | - Taryn L Mayes
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
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Muenyi CS, Bowers AF, Aregbe A, Smith J, Maina RM, Zalamea NN, Foretia DA. Interests and Barriers to Medical Students Participation in a Dedicated Global Surgery Curriculum. J Surg Res 2024; 295:603-610. [PMID: 38096774 DOI: 10.1016/j.jss.2023.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Despite many institutions establishing global surgery (GS) programs to support clinical care and education in resource-limited settings, few have established a specific curriculum in GS. This study's objective was to assess medical student interest in such a curriculum and prospects for future careers in GS/global health (GH), and to define the barriers to pursuing an international rotation. METHODS We conducted an anonymous online survey of all 495 medical students at a major academic medical center in the mid-South that collected demographic data, country of origin, interest in a GS/GH elective, and barriers to pursuing a GS/GH rotation abroad. The data were analyzed using SPSS software. RESULTS Prior international experience increased the likelihood of a student's involvement in GS/GH and more preclinical (years 1 & 2) students (90%) than clinical students. (years 3 & 4) (70%) felt strongly about the value of a GS/GH experience. Of the 163 students who completed the survey, 80% expressed interest in a GS/GH elective, with preclinical students expressing more interest (90%) than clinical students (71%). This interest strongly correlated with an interest in pursuing a career in GH (94%) and/or GS (100%). Identified barriers to engagement in a GS/GH experience abroad included financing (74%), scheduling (58%), family obligations (23%), and personal safety (19%). CONCLUSIONS The students we surveyed were very interested in a GS/GH curriculum that included a rotation abroad, especially if they were to receive financial support. Preclinical students expressed more willingness to self-fund such experiences. The findings of this survey further strengthen the need to incorporate GS/GH in medical school curricula.
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Affiliation(s)
- Clarisse S Muenyi
- University of North Carolina Health Nash, Rocky Mount, North Carolina.
| | - Alexander F Bowers
- College Of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Adegbemisola Aregbe
- College Of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jessica Smith
- College Of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Renee M Maina
- Department Of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nia N Zalamea
- Department Of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center For Multicultural And Global Health, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Denis A Foretia
- Department Of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center For Multicultural And Global Health, University of Tennessee Health Science Center, Memphis, Tennessee
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