In-Practice Endocrine Surgery Fellowship: A Novel Training Model

2020 ◽  
pp. 019459982096279
Author(s):  
Hien T. Tierney ◽  
Leslie S. Eldeiry ◽  
Jeffrey R. Garber ◽  
Chia A. Haddad ◽  
Mark A. Varvares ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Training Model ◽  
Time Frame ◽  
Fellowship Training ◽  
Endocrine Surgery ◽  
Community Practice ◽  
Senior Surgeon ◽  
Academic Medical

Objective Endocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in-practice otolaryngologists could result in expert-level training. Study Design Qualitative clinical study with chart review. Setting Urban community practice and academic medical center. Methods Two board-certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively. Results A total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty-seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty-five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient’s primary hyperparathyroidism. Conclusion This is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.

Electronic monitoring of patient-reported adherence and symptoms on oral chemotherapy at an academic and a community site.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 283-283
Author(s):  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Scott M Devlin ◽  
Holly Dowling ◽  
...  
Keyword(s):  
Median Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptom Assessment ◽  
Oral Chemotherapy ◽  
Community Practice ◽  
Financial Toxicity ◽  
Online Tool ◽  
Academic Medical ◽  
Patient Reported

283 Background: Monitoring of toxicity and adherence is often lacking for patients recently started on oral chemotherapy. National guidelines recommend active outreach to patients within a week after treatment start. We developed an online tool to actively reach out to patients newly started on oral chemotherapy at one academic medical center and community practice. Methods: A multi-disciplinary team, including patients, developed an online oral chemotherapy adherence, symptom, and financial toxicity assessment tool within REDCap. We implemented this tool for new oral chemotherapy prescriptions in May 2018 in the gastrointestinal oncology group of an academic medical center and a general community practice. To quantify the impact of this tool on symptom management, we completed a retrospective analysis of patients receiving new oral chemotherapy prescriptions at these same sites, in the 13 months immediately preceding clinical implementation of the online tool, May 2017 to May 2018. Results: In the pre-intervention historical cohort (n = 58) the median time to first symptom assessment by a clinician was 7 days (range 1 – 41 days, SD 7 days), median time to identifying a new or worsening symptom was 10 days (range 1-55 days, SD 10 days), and median time to clinical action regarding a new or worsening symptom was 10 days (range 1-104, SD 20 days). Our first intervention patient used the online tool in May 2018 to report symptoms of “nausea and fatigue,” 4 days after starting oral chemotherapy. This resulted in an oncology clinical nurse calling the patient to review symptom management by phone. Conclusions: The median time to first symptom assessment in our historical control cohort is 7 days, with standard deviation of 7 days, suggesting potential room for improvement. Thus far, the online tool has been completed by one patient. Further data will be reported regarding the uptake of this tool, the tool’s impact on quality measures, and patient reported symptoms, adherence, and financial toxicity.

Reliability and Construct Validity of the Complexity Compression Questionnaire

2014 ◽  
Vol 22 (2) ◽  
pp. 291-301 ◽  
Author(s):  
Ronda G. Hughes ◽  
Linda Fridlington ◽  
Polly Ryan
Keyword(s):  
United States ◽  
Factor Analysis ◽  
Organizational Change ◽  
Construct Validity ◽  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Factor Solution ◽  
Health Records ◽  
Academic Medical

Background and Purpose: The purpose of the study was to evaluate the reliability and construct validity of the Complexity Compression Questionnaire (CCQ), a 28-item instrument designed to explain nurses’ experiences when assuming multiple responsibilities in a compressed time frame. Methods: Data were obtained from 607 registered nurses in an academic medical center in the midwestern United States who participated in a larger study on system-wide organizational change involving upgrading electronic health records. Results: Cronbach’s alpha for the 26-item CCQ, was .91. Exploratory factor analysis supported a 5-factor solution that explained 53.6% of the variance. Conclusions: The CCQ may be a useful tool for measurement of the effects of organizational change on the complexity of the work of nurses.

Implementation of a Volunteer Reiki Program at an Academic Medical Center in the Midwest

2020 ◽  
Vol 38 (4) ◽  
pp. 400-409
Author(s):  
Priscilla Jurkovich ◽  
Sara Watson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Care Plans ◽  
Academic Medical ◽  
Average Change ◽  
Research Findings ◽  
Life Force ◽  
Frame Method ◽  
Minute Session

Background: Reiki is a universal life-force energy that promotes healing and relaxation. Reiki requires no equipment or technology, is noninvasive, does not interfere with conventional treatments, is appropriate for all ages, and has no known medical contraindications. There is an emerging preference for nonopioid therapies for symptom management. Within an integrative person-centered holistic care model, nursing care plans include a patient’s whole narrative with physical, mental, emotional, and spiritual elements. The Evidence-Based Practice PICOT Question: Will hospitalized patients of any age (population) receiving one 20-minute session of Reiki (intervention) compared with usual care (comparison) report a change from prerating symptom score (outcome) at the completion of the 20-minute session (time frame)? Method: A total of 1,278 patients received a 20-minute Reiki session with volunteer, certified Reiki practitioners from September 2017 through October 2019. Results: The average symptom prescore was 5.52 and postscore was 2.25, thus showing an average change of −3.17. Conclusions: The authors presented the results that were consistent with research findings from the literature review suggesting that Reiki can decrease pain, general discomfort, anxiety, insomnia, and nausea.

scholarly journals Internal Medicine Residents' Ambulatory Management of Core Geriatric Conditions

2017 ◽  
Vol 9 (3) ◽  
pp. 338-344 ◽  
Author(s):  
Kathryn E. Callahan ◽  
Lindsay A. Wilson ◽  
Juliessa M. Pavon ◽  
James F. Lovato ◽  
Hal H. Atkinson ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Older Adults ◽  
Medical Center ◽  
Academic Medical Center ◽  
Active Management ◽  
Community Practice ◽  
Chart Audit ◽  
Geriatric Conditions ◽  
Academic Medical ◽  
Problem Lists

ABSTRACT Background Adults aged 65 years and older account for more than 33% of annual visits to internal medicine (IM) generalists and specialists. Geriatrics experiences are not standardized for IM residents. Data are lacking on IM residents' continuity experiences with older adults and competencies relevant to their care. Objective To explore patient demographics and the prevalence of common geriatric conditions in IM residents' continuity clinics. Methods We collected data on age and sex for all IM residents' active clinic patients during 2011–2012. Academic site continuity panels for 351 IM residents were drawn from 4 academic medical center sites. Common geriatric conditions, defined by Assessing Care of Vulnerable Elders measures and the American Geriatrics Society IM geriatrics competencies, were identified through International Classification of Disease, ninth edition, coded electronic problem lists for residents' patients aged 65 years and older and cross-checked by audit of 20% of patients' charts across 1 year. Results Patient panels for 351 IM residents (of a possible 411, 85%) were reviewed. Older adults made up 21% of patients in IM residents' panels (range, 14%–28%); patients ≥ 75 (8%) or 85 (2%) years old were relatively rare. Concordance between electronic problem lists and chart audit was poor for most core geriatric conditions. On chart audit, active management of core geriatric conditions was variable: for example, memory loss (10%–25%), falls/gait abnormality (26%–42%), and osteoporosis (11%–35%). Conclusions The IM residents' exposure to core geriatric conditions and management of older adults was variable across 4 academic medical center sites and often lower than anticipated in community practice.

Drug purchase price volatility in an academic medical center

2021 ◽  
Author(s):  
Armando Cortes ◽  
Megan Park ◽  
Bryan C McCarthy
Keyword(s):  
Drug Price ◽  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Purchase Price ◽  
Price Changes ◽  
Price Increases ◽  
Academic Medical ◽  
Price Trends ◽  
The Impact

Abstract Purpose Inpatient drug purchase price trends at an 811-bed academic medical center are described. Summary Recent highly publicized drug price increases by pharmaceutical manufacturers have generated public interest in regulatory solutions to reduce drug costs. Monitoring drug price changes through internal dashboards has been demonstrated to aid in purchasing decisions to reduce the impact of drug price changes on inpatient pharmacy drug budgets. In this research, University of Chicago Medicine created an internal dashboard to detail specific inpatient drug purchase price trends. Dashboard data input included all medications purchased through the organization’s group purchasing organization over a 25-month time frame. A total of 69,245 drug purchases of 2,432 unique medications and/or dosage strengths were analyzed in the study. Within the 25-month time period, 706 medications (29%) had a net drug purchase price increase, while 898 (37%) had a net drug purchase price decrease. The range of net price percentage changes for medications with price increases was 0.01% to 733.6%; the range for medications with price decreases was 0.01% to 97.5%. Conclusion Relative to previous purchase prices, drug purchase prices decreased or remained the same more often than they increased over a 25-month time frame. However, drug purchase price percentage changes were far greater for medications whose prices increased rather than decreased.

Assessment of a pharmacy technician medication history program

2020 ◽  
Author(s):  
Danielle E Baker ◽  
Meredith K Hollinger ◽  
Katherine D Mieure
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Medication List ◽  
Medication History ◽  
Prescribing Pattern ◽  
Medication Discrepancies ◽  
Time Service ◽  
Pharmacy Technician ◽  
Academic Medical

Abstract Purpose To determine the percentage of unintentional prior-to-admission (PTA) medication list discrepancies captured by second-source verification. Methods A prospective, randomized, controlled intervention was conducted on all patients admitted to a large academic medical center with a PTA medication list completed by a pharmacy technician from December 2018 through January 2019. Excluded patients included those admitted as observation status or discharged prior to the time of second-source verification. The following data was collected: patient’s medical record number, age, admission date and time, service admitted to, date and time of completed PTA medication list, date and time of second-source verification, type of second-source verification, medication name, dose, route, frequency, formulation, and confidence level of pharmacy technician completing the initial PTA medication list. Second-source verification was conducted on all medications from a patient’s PTA medication list after completion by a pharmacy technician. Results There were a total of 992 medications from the 200 randomly assigned patients with a completed PTA medication list by a pharmacy technician during the study time frame. Of these medications, 116 (11.7%) contained a discrepancy identified by second-source verification. The most common type of discrepancy was omission (67%) followed by dosing, frequency, and formulation. The median time to complete second-source verification was 9 minutes (interquartile range, 5-17 minutes). Conclusion Second-source verification at the time of hospital admission helps identify medication discrepancies and may improve medication use safety and prescribing pattern and, accordingly, may contribute to reducing medication errors.

scholarly journals Quality Improvement Training in a Variety of Cancer Care Delivery Settings: Experiences From a Comprehensive Cancer Center, an Academic Medical Center, and Community Practices

2018 ◽  
Vol 14 (12) ◽  
pp. e815-e822 ◽  
Author(s):  
Jessica A. Zerillo ◽  
Victoria Carballo ◽  
Carole K. Tremonti ◽  
Orinta Kalibatas ◽  
Brian M. Cummings ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quantitative Methods ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Training Model ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Academic Medical ◽  
Oncology Practice

Purpose: Training clinical and supportive staff in quality improvement (QI) theory and use of QI tools has the potential to improve oncology care delivery. We report our combined experience of providing training to oncologists in a variety of local settings and assess the effect of the training on individual participants and for institutions. Methods: Multidisciplinary oncology teams at a comprehensive cancer center, an academic medical center, and community practices were led through experiential QI training that spanned several months. The curriculum included didactic training sessions that attendees applied to their local project-based work and that required plan-do-study-act cycles. The curriculum was adapted to the smaller practice setting through use of a workbook and a reduced focus on quantitative methods. All teams were supported by coaches and provided final presentations to leadership. The self-rated abilities of trainees to use 15 QI tools were assessed with a pre/post training survey that had five response categories (information, skill, knowledge, understanding, and wisdom). Local institutional and external project presentations were tracked. Results: During 7 years, 129 trainees participated in 56 QI projects. All of the 15 QI tools had 80% of trainees rate themselves in the top three categories (knowledge, understanding, and wisdom) after the training; none met this threshold before. Multiple projects were presented in institutional and external settings. Most projects targeted three of the four domains of the ASCO Quality Oncology Practice Initiative certification program standards. Conclusions: We implemented and sustained QI training programs in a variety of cancer delivery settings. The flexible training model should be easily adoptable by others.

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