scholarly journals An Educational Forum to Engage Infectious Diseases and Microbiology Residents in Resource Stewardship Modelled after the Choosing Wisely Campaign

2015 ◽  
Vol 26 (5) ◽  
pp. 231-233 ◽  
Author(s):  
Derek R MacFadden ◽  
Wayne L Gold ◽  
Ibrahim Al-Busaidi ◽  
Jeffrey D Craig ◽  
Dan Petrescu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Care Delivery ◽  
Daily Practice ◽  
Choosing Wisely ◽  
Delphi Panel ◽  
Potential Harm ◽  
Modified Delphi ◽  
Five Practices

BACKGROUND: Rising costs present a major threat to the sustainability of health care delivery. Resource stewardship is increasingly becoming an expected competency of physicians. The Choosing Wisely framework was used to introduce resource stewardship at a national educational retreat for infectious disease and microbiology residents.METHODS: During the 2014 Annual Canadian Infectious Disease and Microbiology Resident Retreat in Toronto, Ontario, infectious disease (n=50) and microbiology (n=17) residents representing 11 Canadian universities from six provinces, were invited to participate in a modified Delphi panel. Participants were asked, in advance of the retreat, to submit up to five practices that infectious disease and microbiology specialists should not routinely perform due to lack of proven benefit(s) and/or potential harm to patients. Submissions were discussed in small and large group forums using an iterative approach involving electronic polling until consensus was reached for five practices. A finalized list was created for both educational purposes and for residents to consider enacting; however, it was not intended to replace formal society-endorsed statements. A follow-up survey at two-months was conducted.RESULTS: Consensus was reached by the residents regarding five low-value practices within the purview of infectious diseases and microbiology physicians. After the retreat, 20 participants (32%) completed the follow-up survey. The majority of respondents (75%) believed that the session was at least as relevant as other sessions they attended at the retreat, including 95% indicating that at least some of the material discussed was new to them. Since returning to their home institutions, nine (45%) respondents have incorporated what they learned into their daily practice; four (20%) reported that they have considered initiating a project related to the session; and one (5%) reported having initiated a project.CONCLUSIONS: The present educational forum demonstrated that trainees can become actively engaged in the identification and discussion of low-value practices. Embedding residence training programs with resource stewardship education will be necessary to improve the value of care offered by the future members of our profession.

eHealth in cardiac rehabilitation

2020 ◽  
pp. 171-176
Author(s):  
Ines Frederix ◽  
Paul Dendale
Keyword(s):  
Cardiac Rehabilitation ◽  
Progress Monitoring ◽  
Care Delivery ◽  
Cost Effective ◽  
Daily Practice ◽  
Point Of View ◽  
Successful Implementation ◽  
Sustained Delivery ◽  
Definition Of

TeleCR is an innovative and (cost-)effective preventive care delivery strategy that can overcome the challenges associated with traditional centre-based cardiac rehabilitation (CR). This chapter describes how it can be implemented in daily practice. From an organizational point of view, it implies a shift in traditional and operational workflows and reorganization of the (non-)human resources for care delivery. The establishment of a well-coordinated tele-team, the definition of clear goals, profound progress monitoring and follow-up, and the creation of an environment that promotes sustained delivery of teleCR are paramount. Tackling the current legal and technological challenges is another prerequisite for successful implementation.

scholarly journals 1134. Substance Use Disorder Patients’ Perspectives of a Multidisciplinary Antimicrobial Infusion Service

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S596-S596
Author(s):  
Joy J Juskowich ◽  
Clinton G Cooper ◽  
Ruchi Bhandari ◽  
Stephanie S Boyd ◽  
Neil Reece ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Substance Use ◽  
Infectious Diseases ◽  
Substance Use Disorder ◽  
Antimicrobial Therapy ◽  
Addiction Treatment ◽  
Healthcare Providers ◽  
Injection Drugs ◽  
Addiction Therapy

Abstract Background Injection drug use is associated with infectious diseases such as endocarditis and osteomyelitis requiring prolonged intravenous (IV) antimicrobial therapy. Few programs offer simultaneous inpatient infectious disease and addiction treatment. WVU Medicine implemented a multidisciplinary Infusion Service (IS) to provide IV antimicrobial therapy while treating substance use disorder. From 2017 through 2019, IS cared for over 840 patients. The aim of this study was to evaluate IS by assessing patients’ perspectives of overall experience, interactions with healthcare providers, and preparation for continued recovery from substance use. Methods Adults ≥ 18 and < 90 years-old with substance use disorder on IS between November 2019 and May 2020 were eligible. Demographic, substance use, and infectious diseases data were obtained by chart review. Confidential surveys with questions about overall experience, interactions with healthcare providers, and preparation for continued recovery were administered during the first week after transfer to IS and again the week of discharge. Results Forty-two patients completed 39 initial and 12 follow up surveys. All used injection drugs, 85.7% (36/42) used opioids and 66.7% (28/42) used methamphetamine. Endocarditis was most common infection (61.9% (26/42)), with Staphylococcus aureus most often isolated (59.5% (25/42)). IS experience and care for infection were excellent or good in 97.4% (38/39) initial and 100% (12/12) follow up surveys. During IS, patients did not perceive being treated differently due to substance use in 94.9% (37/39) initial and 83.3% (10/12) follow up surveys. Before IS, patients perceived being treated differently in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Patients felt IS would help with continued recovery in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Conclusion According to patients’ perspectives, IS is effective in creating a positive overall healthcare experience, reducing stigma associated with substance use, and preparing patients for continued recovery after discharge. This study supports combining inpatient infectious disease and addiction therapy. Infectious diseases providers should be educated about this multidisciplinary approach. Disclosures All Authors: No reported disclosures

scholarly journals 483. OPAT Delivery during COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S308-S308
Author(s):  
Michael J Swartwood ◽  
Renae A Boerneke ◽  
Alan C Kinlaw ◽  
Nikolaos Mavrogiorgos ◽  
Ashley Marx ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Care Delivery ◽  
Clinical Care ◽  
Monitoring Program ◽  
Baseline Data ◽  
Readmission Rates ◽  
Team Members ◽  
Comparison Time ◽  
Clinic Visits

Abstract Background In 2020, COVID-19 spurred unprecedented change in the delivery of routine clinical care. The UNC OPAT program staff, previously accustomed to in-person collaboration in the hospital, became geographically distant amid North Carolina’s partial shutdown starting in March 2020. Team members relied on teleworking and many OPAT clinic visits shifted to phone and video telehealth. We assessed how COVID-19 impacted our care of OPAT patients including follow-up visits and readmissions. Methods UNC’s OPAT database contains clinical and demographic information on all patients on OPAT for at least 14 days who received specialized monitoring program led by an infectious diseases (ID) pharmacist, after evaluation by an ID physician. For all OPAT courses that ended between 3/1/20 and 5/20/20 (last available data cut), we assessed the length of OPAT treatment course, readmissions, adverse events, follow-up ID clinic visits, and the method of follow up visit utilized. We compared these measurements to historical baseline data from 3/1/19 to 5/20/19. Results During the 2020 period, 73 patients completed OPAT, with median OPAT enrollment lasting 36 days, which was similar to 2019 data (70 patients; median OPAT enrollment of 35 days). During the 2019 period, 93% of patients attended a follow up visit with an infectious diseases clinician, all of which took place in person. During the 2020 (COVID-19) period, 85% of patients attended an ID follow up visit; contrary to 2019, 42% of these visits took place in person, 45% were by phone and 13% were via a telemedicine video service. Readmission rates were similar across the two time periods (16% during COVID-19 vs 14% during 2019 comparison time period, P=0.72). Conclusion UNC OPAT continued through the emergence of COVID-19 as an essential service for a high patient volume by adapting its care delivery and follow-up visit protocols to include virtual care options. Readmission rates for OPAT patients during COVID-19 were comparable to historical baseline data. Disclosures All Authors: No reported disclosures

scholarly journals BoNT-A for Post-Stroke Spasticity: Guidance on Unmet Clinical Needs from a Delphi Panel Approach

Toxins ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 236
Author(s):  
Alessio Baricich ◽  
Theodore Wein ◽  
Nicoletta Cinone ◽  
Michele Bertoni ◽  
Alessandro Picelli ◽  
...  
Keyword(s):  
Unmet Needs ◽  
Daily Practice ◽  
Delphi Process ◽  
Delphi Panel ◽  
Extensive Literature ◽  
Delphi Consensus ◽  
Patient Centered ◽  
Web Based ◽  
Post Stroke

There is extensive literature supporting the efficacy of botulinum toxin (BoNT-A) for the treatment of post-stroke spasticity, however, there remain gaps in the routine management of patients with post-stroke spasticity. A panel of 21 Italian experts was selected to participate in this web-based survey Delphi process to provide guidance that can support clinicians in the decision-making process. There was a broad consensus among physicians that BoNT-A intervention should be administered as soon as the spasticity interferes with the patients’ clinical condition. Patients monitoring is needed over time, a follow-up of 4–6 weeks is considered necessary. Furthermore, physicians agreed that treatment should be offered irrespective of the duration of the spasticity. The Delphi consensus also stressed the importance of patient-centered goals in order to satisfy the clinical needs of the patient regardless of time of onset or duration of spasticity. The findings arising from this Delphi process provide insights into the unmet needs in managing post-stroke spasticity from the clinician’s perspective and provides guidance for physicians for the utilization of BoNT-A for the treatment of post-stroke spasticity in daily practice.

Measurement of person-centered care delivery of adult oncology in Ontario, Canada.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 223-223 ◽  
Author(s):  
Lesley Moody ◽  
Erica Bridge ◽  
Suman Dhanju ◽  
Brett Nicholls ◽  
Simron Singh
Keyword(s):  
Literature Review ◽  
Focus Groups ◽  
Best Practice ◽  
Assessment Tool ◽  
Care Delivery ◽  
Guideline Implementation ◽  
Healthcare Providers ◽  
Daily Practice ◽  
Modified Delphi ◽  
Strongly Agree

223 Background: In the Ontario, Canada, cancer system, the provincially endorsed Person Centred Care (PCC) Guideline provides recommendations for healthcare providers to implement PCC in the delivery of adult oncology services. However, it is unknown whether healthcare providers have incorporated these recommendations into their daily practice within the Regional Cancer Programs (RCPs). The purpose of this study was to develop an assessment tool to evaluate the implementation of the PCC Guideline in Ontario RCPs. Methods: Tool development consisted of a 3-step process: 1) literature review to identify relevant measures, 2) Modified Delphi with a panel of experts (n = 8), and 3) focus groups with patient/family advisors (n = 5) and RCP PCC leads (i.e., designated individual responsible for PCC deliverables) (n = 7). Results: Through the literature review, two relevant tools were identified ( i.e., Institute for Patient- and Family-Centered Care’s Hospital Assessment Tool and Accreditation Canada’s Cancer Care Standards), resulting in 187 measures deemed appropriate to include in the assessment tool. In round one of the Modified Delphi, each measure was evaluated independently by a panel of experts using a 5-point Likert Scale (1 = strongly disagree to 5 = strongly agree) to assess both the importance and feasibility of each measure. Sixty-seven measures were rated 4 or above by 70% of the experts. Consistent with Modified Delphi best practice, these measures were discussed during the second round with the panel of experts. An additional 33 measures were removed due to similarities/duplications. Nine measures were added. The 42 measures were presented to patient/family advisors and the RCP PCC Leads during focus groups and evaluated based on importance and feasibility of assessing PCC implementation in the RCPs. Wording recommendations were made and two additional measures were added. The final tool includes 44 measures to evaluate PCC implementation within the RCPs. The assessment tool was disseminated to the 14 RCPs in October 2016. Conclusions: The results of this assessment will provide an understanding of the current state of PCC Guideline implementation in Ontario, in order to identify facilitators and barriers to implementation.

scholarly journals Clinical and economic benefits of the Intellispace Portal applications CT TAVI and Spectral CT: Findings from a two-step Delphi panel

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 153
Author(s):  
Mahdi Veillet-Chowdhury ◽  
James E. Harvey ◽  
Peter S. Wang ◽  
Saswat Panda ◽  
Mark Connolly ◽  
...  
Keyword(s):  
Work Experience ◽  
Economic Benefits ◽  
Delphi Panel ◽  
Spectral Ct ◽  
Modified Delphi ◽  
Transcatheter Aortic Valve ◽  
Quadruple Aim ◽  
Time Savings ◽  
Valve Implantation

Background: IntelliSpace Portal (ISP) is an advanced visualization platform that offers a single integrated solution designed to help physicians work more efficiently. This study aimed to develop a consensus statement on the clinical and economic benefits of two Intellispace Portal (ISP) applications (computed tomography (CT) transcatheter aortic-valve implantation (TAVI) and Spectral CT) applications. Methods: A modified Delphi method of two rounds of queries was used in a panel of 17 experts (11 for Spectral CT and 8 for CT TAVI). The experts were identified via referral and selected to achieve a balanced representation of subject matter experts. The Delphi process was conducted online using the MESYDEL platform. Two rounds of Delphi queries were conducted between July 22 and October 14, 2019. All data was collected prospectively. Results: Areas of consensus represented contribution of ISP applications toward quadruple aim goals. Consensus was reached that the Spectral CT application led to more confident decision making, improved diagnosis capabilities leading to better treatment paths, and a better work experience. Panelists noted that they required fewer tests to make a diagnosis using Spectral CT. The majority of physicians (63%) agreed that CT TAVI led to time savings for ‘device sizing’ results, and 75% of physicians agreed that the tool resulted in a better work experience. Conclusions: The increased diagnostic confidence of spectral information could eliminate the need for many follow-up scans in patients, resulting in clinical benefit to the patient in terms of reduced exposure to radiation and economic benefit to healthcare systems in reducing the number of additional scans. The staff satisfaction goal of the quadruple aim is also satisfied by Spectral CT and CT TAVI leading to a better work experience in our panelist physicians. This may result in indirect benefits such as reduced rates of physician burnout and greater provider satisfaction.

scholarly journals WeChat-based health education to improve health knowledge in three major infectious diseases among residents: a multicentre case-controlled protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037046
Author(s):  
Yan Qiu ◽  
Hongli Qin ◽  
Meike Ying ◽  
Kaijin Xu ◽  
Jingjing Ren
Keyword(s):  
Infectious Disease ◽  
Health Education ◽  
Infectious Diseases ◽  
Primary Outcome ◽  
Health Knowledge ◽  
Nationwide Survey ◽  
Ethics Committee ◽  
Internet Users ◽  
Improve Health

IntroductionHealth literacy (HL) in infectious diseases is inadequate in China. Since the first nationwide survey of HL conducted in China, great efforts have been made. However, the rate of HL in infectious diseases was 16.06% in 2017. In contrast, with an HL rate of 15.85% in 2008, no significant effect was observed over 10 years. With an increasing number of internet users, we aim to assess the effects of WeChat-based health education for the promotion of partial HL-health knowledge in infectious diseases.Methods and analysisA total of 2160 residents aged 15–69 years old will be enrolled in this study. The primary outcome measures will be the rate of health knowledge in infectious disease. The follow-up period is 3 years.Ethics and disseminationThe study protocol was approved by the Research Ethics Committee of the First Affiliated Hospital, College of Medicine, Zhejiang University. The findings of this study will be submitted to a peer-reviewed journal.

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

A Review of Selected Adult Congenital Heart Diseases Encountered in Daily Practice

2020 ◽  
Vol 16 ◽  
Author(s):  
Farhan Bajwa ◽  
Syed M Jafri ◽  
Karthik Ananthasubramaniam
Keyword(s):  
Surgical Procedures ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Daily Practice ◽  
Congenital Heart Diseases ◽  
Congenital Diseases ◽  
Adult Congenital ◽  
The Common ◽  
Adult Congenital Heart Diseases

: The advancement in corrective surgical procedures and anaesthesia technology has resulted in the increase survival of patients with Congenital Heart Diseases (CHD). Most of the surviving CHD patients have successfully reached adulthood and those surviving adults now outnumber the infants born with the CHD. Unfortunately, the surviving adults with CHD do not get proper care due to either inconsistent follow up or not getting care from a specialist in the field of CHD. It is imperative for general practicing clinicians to be aware of the congenital diseases as well as the current clinical recommendations. This manuscript reviews some of the common congenital diseases seen in adults such as cardiac shunts, left heat obstructive lesions and aortopathies.

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