Gasping for air: measuring patient education and activation skillsets in two clinical assessment contexts

2020 ◽  
pp. bmjstel-2020-000759
Author(s):  
Jeffrey A Wilhite ◽  
Harriet Fisher ◽  
Lisa Altshuler ◽  
Elisabeth Cannell ◽  
Khemraj Hardowar ◽  
...  
Keyword(s):  
Real World ◽  
Safety Net ◽  
Simulated Patient ◽  
Simulated Patients ◽  
Future Research ◽  
Patient Case ◽  
Objective Structured Clinical Examinations ◽  
Safety Net Clinic ◽  
Understanding Of Illness ◽  
Competency Assessments

Objective structured clinical examinations (OSCEs) provide a controlled, simulated setting for competency assessments, while unannounced simulated patients (USPs) measure competency in situ or real-world settings. This exploratory study describes differences in primary care residents’ skills when caring for the same simulated patient case in OSCEs versus in a USP encounter. Data reported describe a group of residents (n=20) who were assessed following interaction with the same simulated patient case in two distinct settings: an OSCE and a USP visit at our safety-net clinic from 2009 to 2010. In both scenarios, the simulated patient presented as an asthmatic woman with limited understanding of illness management. Residents were rated through a behaviourally anchored checklist on visit completion. Summary scores (mean % well done) were calculated by domain and compared using paired sample t-tests. Residents performed significantly better with USPs on 7 of 10 items and in two of three aggregate assessment domains (p<0.05). OSCE structure may impede assessment of activation and treatment planning skills, which are better assessed in real-world settings. This exploration of outcomes from our two assessments using the same clinical case lays a foundation for future research on variation in situated performance. Using both assessments during residency will provide a more thorough understanding of learner competency.

scholarly journals Transition of a Text-Based Insulin Titration Program From a Randomized Controlled Trial Into Real-World Settings: Implementation Study (Preprint)

2017 ◽  
Author(s):  
Natalie Koch Levy ◽  
Natasha A Orzeck-Byrnes ◽  
Sneha R Aidasani ◽  
Dana N Moloney ◽  
Lisa H Nguyen ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Real World ◽  
Controlled Trial ◽  
Insulin Dose ◽  
Safety Net ◽  
Text Messages ◽  
Implementation Study ◽  
Randomized Controlled ◽  
Process Outcomes ◽  
Safety Net Clinic

BACKGROUND The Mobile Insulin Titration Intervention (MITI) program helps patients with type 2 diabetes find their correct basal insulin dose without in-person care. Requiring only basic cell phone technology (text messages and phone calls), MITI is highly accessible to patients receiving care in safety-net settings. MITI was shown in a randomized controlled trial (RCT) to be efficacious at a New York City (NYC) safety-net clinic where patients often have challenges coming for in-person care. In 2016, MITI was implemented as usual care at Bellevue Hospital (the site of the original RCT) and at Gouverneur Health (a second NYC safety-net clinic) under 2 different staffing models. OBJECTIVE This implementation study examined MITI’s transition into real-world settings. To understand MITI’s flexibility, generalizability, and acceptability among patients and providers, we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations, outside of an RCT setting. METHODS Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose (FBG) values and a weekly titration call. The goal was for patients to reach their optimal insulin dose (OID), defined either as the dose of once-daily basal insulin required to achieve either an FBG of 80-130 mg/dL (4.4-7.2 mmol/L) or as the reaching of the maximum dose of 50 units. After 12 weeks, if OID was not reached, the patients were asked to return to the clinic for in-person care and titration. MITI program outcomes, clinical outcomes, process outcomes, and patient satisfaction were assessed. RESULTS MITI was successful at both sites, each with a different staffing model. Providers referred 170 patients to the program—129 of whom (75.9%, 129/170) were eligible. Of these, 113 (87.6%, 113/129) enrolled. Moreover, 84.1% (95/113) of patients reached their OID, and they did so in an average of 24 days. Clinical outcomes show that mean FBG levels fell from 209 mg/dL (11.6 mmol/L) to 141 mg/dL (7.8 mmol/L), P<.001. HbA1c levels fell from 11.4% (101 mmol/mol) to 10.0% (86 mmol/mol), P<.001. Process outcomes show that 90.1% of MITI’s text message prompts received a response, nurses connected with patients 81.9% of weeks to provide titration instructions, and 85% of attending physicians made at least one referral to the MITI program. Satisfaction surveys showed that most patients felt comfortable sharing information over text and felt the texts reminded them to take their insulin, check their sugar, and make healthy food choices. CONCLUSIONS This implementation study showed MITI to have continued success after transitioning from an RCT program into real-world settings. MITI showed itself to be flexible and generalizable as it easily fits into a second site staffed by general medical clinic–registered nurses and remained acceptable to patients and staff who had high levels of engagement with the program.

Does the Presence of On-Site Medical Services at Outdoor Music Festivals Affect Attendees’ Planned Alcohol and Recreational Drug Use?

2021 ◽  
pp. 1-5
Author(s):  
Alison Hutton ◽  
Matthew Brendan Munn ◽  
Sydney White ◽  
Peter Kara ◽  
Jamie Ranse
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Great Majority ◽  
Safety Net ◽  
Medical Services ◽  
Future Research ◽  
Recreational Drug ◽  
Recreational Drugs ◽  
Mandatory Requirement ◽  
Recreational Drug Use

Abstract Background: Dedicated on-site medical services have long been recommended to improve health outcomes at mass-gathering events (MGEs). In many countries, they are being reviewed as a mandatory requirement. While it is known that perceptions of risk shape substance use plans amongst outdoor music festival (OMF) attendees, it is unclear if attendees perceive the presence of on-site medical services as a part of the safety net. The aim of this paper is to better understand whether attendees’ perceptions of on-site medical services influence high-risk behaviors like alcohol and recreational drug use at OMFs. Method: A questionnaire was distributed to a random sample of attendees entering and attending two separate 20,000-person OMFs; one in Canada (Festival A) and one in New Zealand (Festival B). Responses focused on demographics, planned alcohol and recreational drug use, perceptions of medical services, and whether the absence of medical services would impact attendees’ planned substance use. Results: A total of 851 (587 and 264 attendees for Festival A and Festival B, respectively) attendees consented and participated. Gender distribution was equal and average ages were 23 to 25. At Festival A, 48% and 89% planned to use alcohol and recreational drugs, respectively, whereas at Festival B, it was 92% and 44%. A great majority were aware and supportive of the presence of medical services at both festivals, and a moderate number considered them a factor in attendance and something they would not attend without. There was significant (>10%) agreement (range 11%-46%; or 2,200-9,200 attendees for a 20,000-person festival) at both festivals that the absence of medical services would affect attendees’ planned use of alcohol and recreational drugs. Conclusions: This study found that attendees surveyed at two geographically and musically distinct OMFs had high but differing rates of planned alcohol and recreational drug use, and that the presence of on-site medical services may impact attendees’ perceptions of substance use risk. Future research will aim to address the limitations of this study to clarify these findings and their implications.

scholarly journals Revisiting the CompCars Dataset for Hierarchical Car Classification: New Annotations, Experiments, and Results

Sensors ◽  
2021 ◽  
Vol 21 (2) ◽  
pp. 596
Author(s):  
Marco Buzzelli ◽  
Luca Segantin
Keyword(s):  
Real World ◽  
High Performance ◽  
Ad Hoc ◽  
Future Research ◽  
Levels Of Detail ◽  
Excellent Starting Point ◽  
Starting Point ◽  
Hierarchical Nature ◽  
Multiple Levels ◽  
Entire Dataset

We address the task of classifying car images at multiple levels of detail, ranging from the top-level car type, down to the specific car make, model, and year. We analyze existing datasets for car classification, and identify the CompCars as an excellent starting point for our task. We show that convolutional neural networks achieve an accuracy above 90% on the finest-level classification task. This high performance, however, is scarcely representative of real-world situations, as it is evaluated on a biased training/test split. In this work, we revisit the CompCars dataset by first defining a new training/test split, which better represents real-world scenarios by setting a more realistic baseline at 61% accuracy on the new test set. We also propagate the existing (but limited) type-level annotation to the entire dataset, and we finally provide a car-tight bounding box for each image, automatically defined through an ad hoc car detector. To evaluate this revisited dataset, we design and implement three different approaches to car classification, two of which exploit the hierarchical nature of car annotations. Our experiments show that higher-level classification in terms of car type positively impacts classification at a finer grain, now reaching 70% accuracy. The achieved performance constitutes a baseline benchmark for future research, and our enriched set of annotations is made available for public download.

scholarly journals Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

2010 ◽  
Vol 1 (1) ◽  
pp. 11
Author(s):  
Sarah M. Westberg ◽  
Kathrine Beeksma
Keyword(s):  
Internal Medicine ◽  
Nursing Staff ◽  
Medication Reconciliation ◽  
Future Research ◽  
Original Research ◽  
Educational Initiative ◽  
Medicine Clinic ◽  
Internal Medicine Clinic ◽  
The Impact ◽  
Competency Assessments

Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic. Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation. Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting. Type: Original Research

Genomic landscape of advanced prostate cancer in racial minority populations: Real-world experience in a safety-net hospital oncology clinic.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 14-14
Author(s):  
Tamer Khashab ◽  
Alexander D Le ◽  
Samantha Cohen ◽  
Salma Kaochar ◽  
Heidi Dowst ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Real World ◽  
Safety Net ◽  
Access To Healthcare ◽  
Minority Populations ◽  
Precision Oncology ◽  
Genomic Landscape ◽  
Safety Net Hospital ◽  
Ngs Data ◽  
Racial Ethnic

14 Background: The largest US cancer health disparity exists in prostate cancer (PC), with African American (AA) men having: ~1.6-1.8-fold higher risk of developing PC; younger age and more advanced stage at diagnosis; increased risk of recurrence after radical prostatectomy; and up to 2.5-fold higher mortality rate relative to men of other ancestries. Access to healthcare and other socioeconomic and environmental factors contribute to the disparity in clinical outcomes. However, genetic factors may also be involved, and their role and prevalence need to be better defined, especially in real-world clinical settings, as the high cost of next-generation sequencing (NGS) may have resulted in underrepresentation of uninsured and minority patients in prior studies. Methods: We retrospectively analyzed NGS data obtained via Tempus|xT tissue assay (DNA sequencing of 648 genes in tumor and matched normal samples at 500x depth) and/or Tempus|xF liquid biopsy assay (ctDNA sequencing of 105 genes in peripheral blood samples at 5,000x depth) for germline and/or somatic mutations detected in 100 patients (53 AA) receiving androgen deprivation therapy for locally advanced, biochemically recurrent or metastatic PC at Ben Taub Hospital (BTH), a safety net hospital in Harris County/Houston serving a patient population of which 91% are racial/ethnic minorities. For confirmation, we analyzed de-identified NGS data from a nationwide cohort of 1,211 metastatic PC patients (213 AA) previously sequenced with xT and/or xF by Tempus Labs (Chicago, IL). Results: We found higher frequencies of AR (18.9%), TP53 (41.5%), SPOP (20.7%) and homologous recombination repair (HRR) pathway gene mutations, in particular BRCA2 (17%), in our AA BTH cohort, as compared to PC patients of other races/ethnicities. The latter finding was confirmed in the nationwide Tempus Labs cohort, with 91/213 (42.7%) AA patients exhibiting mutation in at least one of 14 HRR pathway genes associated with PC sensitivity to PARP inhibitors, compared to 347/998 (34.7%) non-AA patients (P < 0.05). This difference was mainly driven by higher frequency of BRCA2 (16.9%), CDK12 (8%) and PALB2 (5.2%) mutations in AA patients. In both cohorts, TMPRSS2 fusions were much less common in AA PC patients. Conclusions: The observed high frequency of mutations in key PC drivers in AA patients may reflect differences in disease biology between racial/ethnic groups or the more advanced disease presentation of AA patients due to socioeconomic factors delaying access to healthcare. Our study provides a real-world snapshot of the genomic landscape of advanced PC in a safety net hospital serving large racial/ethnic minority populations and highlights the role that NGS testing can play to improve their access to treatment with novel targeted therapies and to biomarker-based Precision Oncology clinical trials.

Challenges in Sharing Computer and Network Logs

2010 ◽  
pp. 2310-2325
Author(s):  
Adam Slagell ◽  
Kiran Lakkaraju
Keyword(s):  
Real World ◽  
Future Research ◽  
The Past ◽  
Trade Offs ◽  
Reduce Risk ◽  
Share Information ◽  
Made In

It is desirable for many reasons to share information, particularly computer and network logs. Researchers need it for experiments, incident responders need it for collaborative security, and educators need this data for real world examples. However, the sensitive nature of this information often prevents its sharing. Anonymization techniques have been developed in recent years that help reduce risk and navigate the trade-offs between privacy, security and the need to openly share information. This chapter looks at the progress made in this area of research over the past several years, identifies the major problems left to solve and sets a roadmap for future research.

Gamification Research

2020 ◽  
pp. 397-412
Author(s):  
Kingsley Ofosu-Ampong ◽  
Thomas Anning-Dorson
Keyword(s):  
Systematic Review ◽  
Information Technology ◽  
Developing Countries ◽  
Real World ◽  
Game Design ◽  
Future Research ◽  
Agriculture Education ◽  
Design Elements ◽  
Scopus Database ◽  
Education Business

Despite advances in information technology, studies suggest that there is little knowledge of how developing countries are applying gamification in agriculture, education, business, health, and other domains. Thus, from a systematic review, this chapter examines the extent of gamification research in the developing country context. In this chapter, 56 articles were reviewed, and the search was done in the Scopus database. This chapter explains the idea of game design elements in information systems and provides real-world examples of gamified systems outcomes from developing countries. The authors conclude with directions for future research to extend our knowledge of gamification and advance the existing methodologies, domains, and theories.

Thesaurus-Based Automatic Indexing

2011 ◽  
pp. 331-345
Author(s):  
Luis M. de Campos
Keyword(s):  
Text Mining ◽  
Real World ◽  
Future Research ◽  
Automatic Indexing ◽  
Distinguishing Features

In this chapter, we present a thesaurus application in the field of text mining and more specifically automatic indexing on the set of descriptors defined by a thesaurus. We begin by presenting various definitions and a mathematical thesaurus model, and also describe various examples of real world thesauri which are used in official institutions. We then explore the problem of thesaurus-based automatic indexing by describing its difficulties and distinguishing features and reviewing previous work in this area. Finally, we propose various lines of future research.

Sign in / Sign up

Export Citation Format

Share Document