Clinical Testing in Diabetic Peripheral Neuropathy

Abstract:Diabetic polyneuropathy is a complex disease of progressive nerve fiber loss. Initial screening and diagnosis in clinical practice usually depend on assessment of subjective complaints. A need exists for objective, simple, and reproducible assessment tools that can be readily used in clinical practice. The importance of early diagnosis is highlighted by the recent North American Diabetes Control and Complications Trial where intensive insulin therapy reduced the risk of developing diabetic neuropathy by 61%. At the University of Michigan, we have developed an outpatient neuropathy program. Patients are given a questionnaire and a brief screening examination, designated the Neuropathy Screening Instrument. Diabetic neuropathy is confirmed and staged in patients with a positive Neuropathy Screening Instrument, by a quantitative neurologic examination and nerve conduction studies, designated the Diabetic Neuropathy Score. The Michigan program has been compared with well-established instruments and has been found to be sensitive and reproducible for screening and diagnosis. We believe the program provides a valuable tool for the clinician in the practice setting and should allow diagnosis and intervention earlier in the course of diabetic neuropathy.

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Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study (Preprint)

10.2196/preprints.22536 ◽

2020 ◽

Author(s):

Donald Likosky ◽

Steven J Yule ◽

Michael R Mathis ◽

Roger D Dias ◽

Jason J Corso ◽

...

Keyword(s):

Adverse Events ◽

Technical Skills ◽

Assessment Tools ◽

Complication Rates ◽

University Of Michigan ◽

Electronic Health Record Data ◽

Institutional Review ◽

Computer Based ◽

The University ◽

The Relationship

BACKGROUND Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. OBJECTIVE The objectives of this study are to (1) investigate the relationship between peer assessments of intraoperative technical skills and nontechnical practices with risk-adjusted complication rates and (2) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and nontechnical practices. METHODS This multicenter study will use video recording, established peer assessment tools, electronic health record data, registry data, and a high-dimensional computer vision approach to (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based nontechnical practices and variability in risk-adjusted patient adverse events; and (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven, computer-based assessments to automate the measurement of important intraoperative determinants of risk-adjusted patient adverse events. RESULTS The project has been funded by the National Heart, Lung and Blood Institute in 2019 (R01HL146619). Preliminary Institutional Review Board review has been completed at the University of Michigan by the Institutional Review Boards of the University of Michigan Medical School. CONCLUSIONS We anticipate that this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon’s technical skills and operating room team member nontechnical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/22536

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Comparison of venous thromboembolism risk stratification models in a high risk otolaryngology patient cohort

Journal of Perioperative Practice ◽

10.1177/1750458919826794 ◽

2019 ◽

Vol 29 (5) ◽

pp. 129-134

Author(s):

Tristan Tham ◽

Peter Costantino

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

High Risk ◽

Scoring Systems ◽

Neck Surgery ◽

Assessment Tools ◽

University Of Michigan ◽

Data Collection Process ◽

The Mean ◽

The University

Our objective was to compare the venous thromboembolism outcomes in two of the most commonly utilised venous thromboembolism assessment tools, the Caprini system and the University of Michigan system, in a high risk head and neck surgery population. Currently, there is a lack of data reporting the validation of well known scoring systems in this patient population. Established risk factors for venous thromboembolism were included in the data collection process. We retrospectively evaluated all patients with the Caprini Risk Assessment and the University of Michigan Health System (UMHS) Scores. Out of all the risk factors, only length of surgery was found to be associated with venous thromboembolism. The mean Caprini scores in those with and without venous thromboembolism were 8.00 ± 3.00 and 6.86 ± 1.45, respectively. The mean UMHS scores in those with and without venous thromboembolism were 6.85 ± 1.28 and 6.54 ± 1.20, respectively. Both scoring systems were not found to be associated with venous thromboembolism.

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Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study

JMIR Research Protocols ◽

10.2196/22536 ◽

2021 ◽

Vol 10 (1) ◽

pp. e22536

Author(s):

Donald Likosky ◽

Steven J Yule ◽

Michael R Mathis ◽

Roger D Dias ◽

Jason J Corso ◽

...

Keyword(s):

Adverse Events ◽

Technical Skills ◽

Assessment Tools ◽

Complication Rates ◽

University Of Michigan ◽

Electronic Health Record Data ◽

Institutional Review ◽

Computer Based ◽

The University ◽

The Relationship

Background Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. Objective The objectives of this study are to (1) investigate the relationship between peer assessments of intraoperative technical skills and nontechnical practices with risk-adjusted complication rates and (2) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and nontechnical practices. Methods This multicenter study will use video recording, established peer assessment tools, electronic health record data, registry data, and a high-dimensional computer vision approach to (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based nontechnical practices and variability in risk-adjusted patient adverse events; and (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven, computer-based assessments to automate the measurement of important intraoperative determinants of risk-adjusted patient adverse events. Results The project has been funded by the National Heart, Lung and Blood Institute in 2019 (R01HL146619). Preliminary Institutional Review Board review has been completed at the University of Michigan by the Institutional Review Boards of the University of Michigan Medical School. Conclusions We anticipate that this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon’s technical skills and operating room team member nontechnical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. International Registered Report Identifier (IRRID) PRR1-10.2196/22536

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GME Innovations Grant Program at the University of Michigan Health System—Fostering Changes in Education and Clinical Care

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00317.1 ◽

2013 ◽

Vol 5 (4) ◽

pp. 665-667 ◽

Cited By ~ 2

Author(s):

Lisa M. Colletti ◽

Joseph C. Kolars ◽

James O. Woolliscroft

Keyword(s):

Health System ◽

Educational Research ◽

Clinical Care ◽

Assessment Methods ◽

Assessment Tools ◽

University Of Michigan ◽

Educational Grant ◽

Grant Program ◽

Simulation Center ◽

The University

Abstract Background Changes in graduate medical education (GME) have resulted in curricula, goals and objectives, and assessment methods becoming more formal, yet there is little financial support for the educational research required to develop better teaching approaches and assessment tools. Objective We sought to encourage the development of new educational tools and assessment methods to improve the overall conduct of GME at the University of Michigan. Intervention The University of Michigan Health System has recently established a new educational grant that is designed to foster innovative educational research in GME. We describe the experience with a new and robust internal educational grant, including the source of funding, mechanisms for reviewing and assessing the proposals, the types of proposals that have currently been funded, and the effect and results of these studies on GME at the University of Michigan Health System. Outcomes Projects funded by the grant have changed the curriculum in the involved programs, and many have resulted in sustained changes, including new methodologies in the simulation center, the development of an “academy” of faculty physicians with significant teaching expertise, and the creation of web-based teaching and assessment tools for “just in time” learning, and have been disseminated at national meetings and in peer-reviewed journals. Conclusions The GME Innovations Grant Program at the University of Michigan Health System has been successful to date, funding 11 proposals during the course of 6 years. Some of these proposals have resulted in permanent changes and additions to residency training programs.

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Novae in the Magellanic Clouds

International Astronomical Union Colloquium ◽

10.1017/s0252921100073334 ◽

1979 ◽

Vol 46 ◽

pp. 96-101

Author(s):

J.A. Graham

Keyword(s):

Large Magellanic Cloud ◽

Magellanic Cloud ◽

Magellanic Clouds ◽

University Of Michigan ◽

The Past ◽

Spectroscopic Information ◽

Objective Prism ◽

The University ◽

Small Cloud ◽

Low Dispersion

During the past several years, a systematic search for novae in the Magellanic Clouds has been carried out at Cerro Tololo Inter-American Observatory. The Curtis Schmidt telescope, on loan to CTIO from the University of Michigan is used to obtain plates every two weeks during the observing season. An objective prism is used on the telescope. This provides additional low-dispersion spectroscopic information when a nova is discovered. The plates cover an area of 5°x5°. One plate is sufficient to cover the Small Magellanic Cloud and four are taken of the Large Magellanic Cloud with an overlap so that the central bar is included on each plate. The methods used in the search have been described by Graham and Araya (1971). In the CTIO survey, 8 novae have been discovered in the Large Cloud but none in the Small Cloud. The survey was not carried out in 1974 or 1976. During 1974, one nova was discovered in the Small Cloud by MacConnell and Sanduleak (1974).

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