Use of provider education, intra-operative decision support, and an email-feedback system in improving compliance with sugammadex dosage guideline and reducing drug expenditures

2022 ◽  
Vol 77 ◽  
pp. 110627
Author(s):  
Andrew M. Pregnall ◽  
Rajnish K. Gupta ◽  
Jacob C. Clifton ◽  
Jonathan P. Wanderer
2020 ◽  
Vol 23 (6) ◽  
pp. 148-160
Author(s):  
E. A. Averchenkova

Purpose of research. This paper is a description of the methodology for regional socio-economic system management based on the principles and concepts of management theory. Methods. A methodology for regional socio-economic system managing has been developed, taking into account the impact of National projects and the influence of the external environment. The methodology consists of six stages and fourteen techniques that allow describing the regional socio-economic system management in terms and tools of the management theory: the region itself is considered as an object of management experiencing a controlling action formed under some affecting influence. The methodology also assumes the formalization of a negative feedback system and a control system in the developed model of regional socio-economic system management. Results. The methodology of managing the regional socio-economic system can be used in the management process. Those who make management decisions at the regional level usually rely on their own professional skills, past experience, and intuition. However, the heuristic approach to regional management can be extended by the capabilities of the developed methodology, the practical implementation of which can be presented as a decision support system. This will allow regional governments to improve the effectiveness of management decisions based on monitoring the state of socio-economic systems. Conclusion. The methodology for managing the regional socio-economic system provides a complete management cycle: from the formalization of basic concepts to the description of the control and feedback system. The information implementation of the methodology is presented in the form of an automated product – a decision support system - that can be used in the formation of an automated workplace for civil servants. 


Author(s):  
Svetlana Melamed ◽  
Bryanna Buchman ◽  
Kyle Pronko ◽  
Sarah C. Yale ◽  
Fatima Anibaba

2022 ◽  
Vol 13 (01) ◽  
pp. 030-036
Author(s):  
Carrie T. Chan ◽  
Megen Vo ◽  
Jennifer Carlson ◽  
Tzielan Lee ◽  
Marcello Chang ◽  
...  

Abstract Objectives An electronic clinical decision support (CDS) alert can provide real-time provider support to offer pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV). The purpose of this study was to evaluate provider utilization of a PrEP CDS alert in a large academic-community pediatric network and assess the association of the alert with PrEP prescribing rates. Methods HIV test orders were altered for patients 13 years and older to include a hard-stop prompt asking if the patient would benefit from PrEP. If providers answered “Yes” or “Not Sure,” the CDS alert launched with options to open a standardized order set, refer to an internal PrEP specialist, and/or receive an education module. We analyzed provider utilization using a frequency analysis. The rate of new PrEP prescriptions for 1 year after CDS alert implementation was compared with the year prior using Fisher's exact test. Results Of the 56 providers exposed to the CDS alert, 70% (n = 39) responded “Not sure” to the alert prompt asking if their patient would benefit from PrEP, and 54% (n = 30) chose at least one clinical support tool. The PrEP prescribing rate increased from 2.3 prescriptions per 10,000 patients to 6.6 prescriptions per 10,000 patients in the year post-intervention (p = 0.02). Conclusion Our findings suggest a knowledge gap among pediatric providers in identifying patients who would benefit from PrEP. A hard-stop prompt within an HIV test order that offers CDS and provider education might be an effective tool to increase PrEP prescribing among pediatric providers.


2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 300-300
Author(s):  
Julia Cooper Hall ◽  
Joanna M. Hamilton ◽  
David Michael Jackman ◽  
Carole Kathleen Tremonti ◽  
Teresa L. Greenberg ◽  
...  

300 Background: A clinical pathways program requires regular updates to pathways content, real-time decision support, and data collection and analysis of decisions made. A goal of Dana-Farber Pathways (DFP) is to analyze data to reduce unwarranted variation and inform granular, warranted variation. Methods: Each of our 31 medical oncology pathways is created and updated by DF experts (clinicians and scientists). DFP is implemented through a web-based portal that provides real-time decision support. DFP captures on- and off- pathway treatment decisions and reasons for off-pathway decisions; this is shared with each disease group monthly. For each interval review meeting we assess on-pathway rates and decisions for each node in the pathway. Low on-pathway rates prompt discussion about possible action, including provider education or pathway modification. Results: In 2017, 7,460 total treatment decisions were collected through DFP; 78% were on-pathway. We have clinical reasoning for 90% of the off-pathway decisions. Off-pathway analysis has been used in several important ways: 1. Catalyzing change: we detected early adoption of immunotherapy in small cell lung cancer and discussed the relevant data. The pathway was updated to adopt this class of treatment. 2. Understanding unexpected events: we identified a recent etoposide shortage and discussed alternate recommendations. They were added to the pathway in case of future shortages. 3. Provider education: we detected a consistently low on-pathway rate in one location, mostly driven by a specific provider. This provided a mechanism to discuss practice patterns and provide targeted education. Conclusions: Off-pathway analysis provides insight into user variation, fosters and supports peer coaching, and supports the creation of dynamic, up-to-date pathways.[Table: see text]


Author(s):  
Oliver C. Wells ◽  
Mark E. Welland

Scanning tunneling microscopes (STM) exist in two versions. In both of these, a pointed metal tip is scanned in close proximity to the specimen surface by means of three piezos. The distance of the tip from the sample is controlled by a feedback system to give a constant tunneling current between the tip and the sample. In the low-end STM, the system has a mechanical stability and a noise level to give a vertical resolution of between 0.1 nm and 1.0 nm. The atomic resolution STM can show individual atoms on the surface of the specimen.A low-end STM has been put into the specimen chamber of a scanning electron microscope (SEM). The first objective was to investigate technological problems such as surface profiling. The second objective was for exploratory studies. This second objective has already been achieved by showing that the STM can be used to study trapping sites in SiO2.


2013 ◽  
Vol 46 (2) ◽  
pp. 52
Author(s):  
CHRISTOPHER NOTTE ◽  
NEIL SKOLNIK

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