A novel approach to determine a tactical and operational decision for dynamic appointment scheduling at nuclear medical center

e14047 Background: There is currently a lack of easily-accessible data regarding the volume and type of cancer patients seen at VUMC, despite extensive use of an electronic medical record (EMR) with a dedicated tumor registry. This leads to errors in estimating metrics that depend on subject accrual to clinical trials. We aimed to develop a tool to determine the number of head and neck squamous cell carcinoma (HNSCC) patients, stratified by desired subsets, seen yearly at the VUMC in order to achieve a more accurate and efficacious approach to estimating future patient accrual to clinical trials. Methods: Working with Nashville Biosciences, we identified patients with HNSCC using ICD codes in combination with VUMC’s Tumor Registry data (collected for patients diagnosed and treated at VUMC). We estimated the rate of accrual of HNSCC patient blood samples (a proxy for ICD code) based on the number of specimens acquired over the past 3 years. Each patient was counted only once based on their first blood sample acquired during this period, based on a comprehensive list of laboratories and clinical procedures that require a specimen to be drawn. We then evaluated the distribution of patients by primary site, standardized to SEER registry terminology. We also investigated what fraction of patients received treatment with surgery, radiation, and/or chemotherapy (we expect that this includes treatment with biologics) using a combination of ICD9/10 and CPT coding. Results: We identified a total of 1,131 HNSCC patients. SEER summary staging information was available for 603 patients - 432 (72%) had Stage 1-3 disease and 171 (28%) had Stage 4 disease. Primary site data was available for 717 patients - 648 (90%) HNSCC of the oral cavity, 20 (3%) had HNSCC of the oropharynx, 29 (4%) HNSCC of the larynx, 20 (3%) HNSCC of the hypopharynx. Of all patients, we found that 598 had at least 1 code for chemotherapy, 540 for radiotherapy, and 825 for surgery such that the majority (96%) received cancer treatment. We have not evaluated the timing of the treatment relative to diagnosis. Conclusions: By using ICD codes and tumor registry data extracted from VUMC’s EMR, we determined the site distribution and type of treatment for HNSCC over a 3-year period. The disease site distribution did not match prior experience Refinements are ongoing. However, once improved, these methods may be used to estimate future clinical trial accrual, thus reducing start-up time, cost and poor trial site performance, while increasing accrual.

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The "State of Implementation" Progress Report (SIPREP): A Pilot Demonstration of a Navigation System for Implementation

10.21203/rs.3.rs-35436/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Edward J Miech ◽

Angela Larkin ◽

Julie C Lowery ◽

Andrew J Butler ◽

Kristin M Pettey ◽

...

Keyword(s):

Navigation System ◽

Organizational Context ◽

Medical Center ◽

Veterans Health ◽

Health Administration ◽

Novel Approach ◽

Wide Range ◽

The Individual ◽

Implementation Progress ◽

Specific Implementation

Abstract Background: Implementation of new clinical programs across diverse facilities in national healthcare systems like the Veterans Health Administration (VHA) can be extraordinarily complex. Implementation is a dynamic process, influenced heavily by local organizational context and the individual staff at each medical center. It is not always clear in the midst of implementation what issues are most important to whom or how to address them. In recognition of these challenges, implementation researchers within VHA developed a new systemic approach to map the implementation work required at different stages and provide ongoing, detailed and nuanced feedback about implementation progress.Methods: This observational pilot demonstration project details how a novel approach to monitoring implementation progress was applied across two different national VHA initiatives. Stage-specific grids organized the implementation work into columns, rows and cells, identifying specific implementation activities at the site level to be completed along with who was responsible for completing each implementation activity. As implementation advanced, item-level checkboxes were crossed off and cells changed colors, offering a visual representation of implementation progress within and across sites across the various stages of implementation. Results: Applied across two different national initiatives, the SIPREP provided a novel navigation system to guide and inform ongoing implementation within and across facilities. The SIPREP addressed different needs of different audiences, both described and explained how to implement the program, made ample use of visualizations, and revealed both what was happening and not happening within and across sites. The final SIPREP product spanned distinct stages of implementation. Conclusions: The SIPREP made the work of implementation explicit at the facility level (i.e., who does what, and when) and provided a new common way for all stakeholders to monitor implementation progress and to help keep implementation moving forward. This approach could be adapted to a wide range of settings and interventions, and is planned to be integrated into the national deployment of two additional VHA initiatives within the next 12 months.

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The “State of Implementation” Progress Report (SIPREP):A Pilot Demonstration of a Navigation System for Implementation

10.21203/rs.3.rs-35436/v2 ◽

2020 ◽

Author(s):

Edward J Miech ◽

Angela Larkin ◽

Julie C Lowery ◽

Andrew J Butler ◽

Kristin M Pettey ◽

...

Keyword(s):

Navigation System ◽

Organizational Context ◽

Medical Center ◽

Veterans Health ◽

Health Administration ◽

Novel Approach ◽

Wide Range ◽

The Individual ◽

Implementation Progress ◽

Specific Implementation

Abstract Background: Implementation of new clinical programs across diverse facilities in national healthcare systems like the Veterans Health Administration (VHA) can be extraordinarily complex. Implementation is a dynamic process, influenced heavily by local organizational context and the individual staff at each medical center. It is not always clear in the midst of implementation what issues are most important to whom or how to address them. In recognition of these challenges, implementation researchers within VHA developed a new systemic approach to map the implementation work required at different stages and provide ongoing, detailed and nuanced feedback about implementation progress.Methods: This observational pilot demonstration project details how a novel approach to monitoring implementation progress was applied across two different national VHA initiatives. Stage-specific grids organized the implementation work into columns, rows and cells, identifying specific implementation activities at the site level to be completed along with who was responsible for completing each implementation activity. As implementation advanced, item-level checkboxes were crossed off and cells changed colors, offering a visual representation of implementation progress within and across sites across the various stages of implementation. Results: Applied across two different national initiatives, the SIPREP provided a novel navigation system to guide and inform ongoing implementation within and across facilities. The SIPREP addressed different needs of different audiences, both described and explained how to implement the program, made ample use of visualizations, and revealed both what was happening and not happening within and across sites. The final SIPREP product spanned distinct stages of implementation. Conclusions: The SIPREP made the work of implementation explicit at the facility level (i.e., who does what, and when) and provided a new common way for all stakeholders to monitor implementation progress and to help keep implementation moving forward. This approach could be adapted to a wide range of settings and interventions, and is planned to be integrated into the national deployment of two additional VHA initiatives within the next 12 months.

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Efficient Pneumonia Detection in Chest Xray Images Using Deep Transfer Learning

Diagnostics ◽

10.3390/diagnostics10060417 ◽

2020 ◽

Vol 10 (6) ◽

pp. 417 ◽

Cited By ~ 5

Author(s):

Mohammad Farukh Hashmi ◽

Satyarth Katiyar ◽

Avinash G Keskar ◽

Neeraj Dhanraj Bokde ◽

Zong Woo Geem

Keyword(s):

Deep Learning ◽

Transfer Learning ◽

Data Augmentation ◽

Medical Center ◽

Training Dataset ◽

Test Accuracy ◽

X Rays ◽

Learning Models ◽

Novel Approach ◽

Unseen Data

Pneumonia causes the death of around 700,000 children every year and affects 7% of the global population. Chest X-rays are primarily used for the diagnosis of this disease. However, even for a trained radiologist, it is a challenging task to examine chest X-rays. There is a need to improve the diagnosis accuracy. In this work, an efficient model for the detection of pneumonia trained on digital chest X-ray images is proposed, which could aid the radiologists in their decision making process. A novel approach based on a weighted classifier is introduced, which combines the weighted predictions from the state-of-the-art deep learning models such as ResNet18, Xception, InceptionV3, DenseNet121, and MobileNetV3 in an optimal way. This approach is a supervised learning approach in which the network predicts the result based on the quality of the dataset used. Transfer learning is used to fine-tune the deep learning models to obtain higher training and validation accuracy. Partial data augmentation techniques are employed to increase the training dataset in a balanced way. The proposed weighted classifier is able to outperform all the individual models. Finally, the model is evaluated, not only in terms of test accuracy, but also in the AUC score. The final proposed weighted classifier model is able to achieve a test accuracy of 98.43% and an AUC score of 99.76 on the unseen data from the Guangzhou Women and Children’s Medical Center pneumonia dataset. Hence, the proposed model can be used for a quick diagnosis of pneumonia and can aid the radiologists in the diagnosis process.

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Global Health Leadership Pathway: A Novel Approach to Global Radiology Curriculum Integration for Residents

Journal of Global Radiology ◽

10.7191/jgr.2021.1111 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Katrina McGinty ◽

Robert G. Dixon ◽

Melissa P. Culp

Keyword(s):

Global Health ◽

Clinical Education ◽

Medical Center ◽

Academic Medical Center ◽

Opportunity To Learn ◽

Structured Education ◽

Academic Field ◽

Health Leadership ◽

Radiology Training ◽

Novel Approach

Purpose: Our radiology residency programs are at an academic medical center in the southeastern United States and are accredited by the Accreditation Council for Graduate Medical Education (ACGME). During the initial eight years of our department’s global health program, 22 residents participated in our global health collaborations with a related $31,000 in extradepartmental travel awards. Increasingly, residents applying to our program convey interest in the integration of global health into their careers as radiologists. To that end, our administration, global health faculty, and residency program directors created and approved a Global Health Leadership Pathway (GHLP). The Pathway spans all years of radiology training to provide curriculum support with the aim of ensuring that our residents have the knowledge and skills necessary to become future leaders in global health. Description: The GHLP is a residency track that residents apply to join with a related radiology clinical education, global health specific curriculum throughout all training years, integration of the RAD-AID Certificate of Proficiency in Global Health Radiology, individual mentorship, and participation with an international elective. Structured education on global radiology, epidemiology, access implications, and related methodologies give our residents the opportunity to learn best practices for sustainability in global health. Conclusion: Because of increasing interest and due to the past successful involvement of our radiology residents in global health, our department created this Global Health Leadership Pathway to give our trainees the educational resources to support their future leadership and involvement in the academic field of global health.

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Virtual Reality Smoking Cessation–Designed for Teens, by Teens

The Open Family Studies Journal ◽

10.2174/1874922401709010021 ◽

2017 ◽

Vol 09 (1) ◽

pp. 21-30

Author(s):

Brenda K. Wiederhold ◽

Ian Miller ◽

Mark D. Wiederhold

Keyword(s):

Smoking Cessation ◽

Virtual Reality ◽

Virtual Worlds ◽

Clinical Success ◽

Medical Center ◽

Peer Pressure ◽

The United States ◽

Addictive Behaviors ◽

Novel Approach ◽

Smoking Behaviors

Introduction: Today, about 90% of adult smokers started smoking before the age of 18. As the largest preventable cause of disease and death in the United States, tobacco use accounts for nearly 500,000 deaths and hundreds of billions of dollars to care for smoking-related illnesses every year. While most smoking cessation programs are geared toward adults, there is a void in attempts to curb teen smoking. Objective: With funding from the National Institute on Drug Abuse, the Virtual Reality Medical Center (VRMC) sought to create a more effective way to help teens quit smoking. Utilizing cue exposure therapy to eliminate the association of smoking with objects and activities, the program uses virtual environments containing smoking cues to elicit the addictive behaviors and teach the users how to recognize and resist these triggers. Method: In a novel approach, VRMC recruited students from a local high school to aid in the design and development of virtual worlds in order to create an entertaining and effective program for teens. Researchers and the participants of this TeenSmoking program created a variety of anti-smoking environments ranging from scenarios at home, to peer pressure situations at school, all intended to elicit and educate users on addictive smoking behaviors. Conclusion: With past clinical success, researchers at VRMC hope to continue to implement widely available teen smoking cessation programs with enhanced usability, graphics, and multiplayer functionality. Overall, researchers hope to advance more comprehensive use of virtual reality to curb teen smoking addictions.

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Introduction

The Trusted Doctor ◽

10.1093/med/9780190859909.003.0001 ◽

2020 ◽

pp. 1-8

Author(s):

Rosamond Rhodes

Keyword(s):

Medical Ethics ◽

Medical Center ◽

Academic Medical Center ◽

Codes Of Ethics ◽

Common Morality ◽

Medical Professionalism ◽

Good Position ◽

Novel Approach ◽

Academic Medical ◽

The World

This book begins by rejecting the reigning view of medical ethics as the application of common morality, that is, the ethics of everyday life, to dilemmas that arise in today’s medical practice. Instead, it argues for a new theory of medical ethics that is actually in line with the codes of ethics and professional oaths proclaimed by physicians around the world. This introduction explains how a philosopher who has spent 30 years as a bioethicist at an academic medical center and medical school is in a good position to propose a novel approach to the ethics of medicine. The proposed theory of medical ethics makes sense of the concept of medical professionalism and serves as a useful guide for doctors who confront ethically challenging situations in their clinical practice.

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Believe the H.I.P.E.: Hematology-Oncology Inter Professional Education to improve provider collaboration at an inpatient tertiary medical center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.10538 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 10538-10538

Author(s):

Richard Lewis Martin ◽

Anna Hux ◽

Ryan Miller ◽

Mario Davidson ◽

Leora Horn ◽

...

Keyword(s):

Professional Education ◽

Professional Training ◽

Medical Center ◽

Advanced Practice ◽

Qualitative And Quantitative Analysis ◽

Learning Satisfaction ◽

Content Development ◽

Novel Approach ◽

Preparation Phase ◽

Provider Shortages

10538 Background: With projected provider shortages and increasing pharmaceutical complexity, Advanced Practice Providers (APPs) and Pharmacists are becoming increasingly utilized members of hematology/oncology teams. Despite significant interdependence in practice, inter-professional training remains rare. Medical IPE has been shown to improve learning satisfaction and attitudes, however, IPE has seldom incorporated inter-professionalism into content development nor has it been evaluated in terms of sustainability. Methods: We developed a pilot IPE curriculum consisting of six, 1-hour long, case-based sessions. A preparation phase required a lead APP, Fellow, and Pharmacist to collectively build a case around three teaching points; 1) diagnosis, 2) treatment, and 3) coordination of care. The APP and Pharmacist presented the case while the Fellow moderated to ensure active participation among all groups. Surveys on collaboration, interaction, interest, and connection, as well as open-ended comments on strengths and areas for improvement were collected after each session ( > 80% completion rate). Results: With 3 of 6 sessions completed (02/19), attendance was stable, averaging 10 of 18 (Fellow), 5 of 8 (APP), and 3 of 6 (Pharmacist). Sessions were rated an average of 4.6/5 on collaboration, 4.5/5 interactive, 4.7/5 application, 4.3/5 communication, and 4.2/5 professionalism. 69% of attendees reported being more likely to attend future conferences. 65% reported feeling more connected to the care team. The most common suggestion for improvement was giving more teaching opportunities to the APPs. Session leaders were initially recruited but quickly transitioned to eager volunteers. Conclusions: Our IPE curriculum shows promising initial sustainability with perceived high marks in collaboration and applicability. Incorporating inter-professionalism into content development and longitudinal delivery to providers in practice provides a novel approach to educating IP teams. Future steps include ensuring continued sustainability, conducting qualitative and quantitative analysis, and dissemination to other units.

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Advancing team cohesion: Using an escape room as a novel approach

Journal of Patient Safety and Risk Management ◽

10.1177/25160435211005934 ◽

2021 ◽

pp. 251604352110059

Author(s):

Tara N Cohen ◽

Andrew C Griggs ◽

Falisha F Kanji ◽

Kate A Cohen ◽

Elizabeth H Lazzara ◽

...

Keyword(s):

Care Delivery ◽

Medical Center ◽

Team Building ◽

Group Cohesion ◽

Healthcare Teams ◽

Novel Approach ◽

Significant Difference ◽

Interprofessional Healthcare ◽

The One ◽

Patient Care Delivery

Objective An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p < .001; Wilks’ Λ = .725; partial η2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.

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Sodium bicarbonate catheter lock solution reduces hemodialysis catheter loss due to catheter-related thrombosis and blood stream infection: an open-label clinical trial

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy388 ◽

2019 ◽

Vol 34 (10) ◽

pp. 1739-1745 ◽

Cited By ~ 5

Author(s):

Adel S El-Hennawy ◽

Elena Frolova ◽

Wesley A Romney

Keyword(s):

Sodium Bicarbonate ◽

Blood Stream Infection ◽

Medical Center ◽

Blood Stream ◽

Open Label ◽

Hemodialysis Catheter ◽

Novel Approach ◽

Lock Solution ◽

Catheter Lock ◽

Catheter Related Thrombosis

AbstractBackgroundThere is no ideal lock solution that prevents hemodialysis (HD) catheter loss due to catheter-related thrombosis (CRT) and catheter-related bloodstream infection (CRBSI). Catheter loss is associated with increased hospitalization and high inpatient costs. Sodium bicarbonate (NaHCO3) demonstrates anti-infective and anticoagulation properties with a good safety profile, making it an ideal lock solution development target.The objective of this study was to determine the safety and efficacy of using sodium bicarbonate catheter lock solution (SBCLS) as a means of preventing HD catheter loss due to CRT and CRBSI.MethodsThe study took place in a community hospital in Brooklyn, NY, USA. All admitted patients ≥18 years of age who needed HD treatment through CVC were included in the study. 451 patients included in the study were provided SBCLS or NSCLS post-dialysis. Catheter loss due to CRT or CRBSI was evaluated over a period of 546 days.ResultsA total of 452 patients met the criteria; 1 outlier was excluded, 226 were in the NSCLS group and 225 were in the SBCLS group. There were no significant differences between groups in comorbidities at the outset. The NSCLS group had CRT and CRBSI rates of 4.1 and 2.6/1000 catheter days (CD), respectively, compared with 0.17/1000 CD for both outcomes in the SBCLS group. SBCLS patients had a significantly reduced catheter loss rate due to CRT (P < 0.0001) and CRBSI (P = 0.0004). NSCLS patients had higher odds of losing their catheter due to CRT {odds ratio [OR] 26.6 [95% confidence interval (CI) 3.57–198.52]} and CRBSI [OR 15.9 (95% CI 2.09–121.61)] during the study period.ConclusionThe novel approach of using SBCLS was found to be safe and was statistically superior to normal saline in preventing HD catheter loss due to CRT and CRBSI. NaHCO3 solution is inexpensive, readily available in various settings and holds the potential to decrease hospitalization, length of stay and dialysis-related costs.Trial registrationMaimonides Medical Center Investigational Review Board, Study IRB 2015-06-25-CIH. ClinicalTrials.gov identifier: NCT03627884.

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