Validating a Novel Framework to Classify Inpatient Hematology Consultation Requests

Background: Consistent classification of consult requests may lead to more productive, efficient, and collegial conversations about patient care, which can facilitate improved work satisfaction and an enhanced learning environment. We propose an organizing framework of 7 specific consultation types: ideal, obligatory, procedural, S.O.S., confirmatory, inappropriate, and curbside. We aimed to obtain validity evidence for this rubric to consistently classify consultation requests in an academic setting. Methods: A random sample of 100 de-identified hematology oncology consultation requests made through the online consult portal from a single academic center were selected and independently coded as 1 of the 7 consultation types by 3 hematologists and 3 hospitalists. Perfect (same consult assignment by all coders) and partial (same consult assignment by >4/6 coders) concordance was calculated. Perfect and partial (>2/3 coders) inter-rater concordance based on consult subtypes and provider specialty was also calculated. To assess if length of consult request has an impact on the classification of consult, the length of the request was compared across concordant, partially concordant, and discordant requests. Results: Of the 100 consults, perfect concordance was 57%, and partial concordance was 92% (Figure 1). Perfect concordance was 69% amongst hematologists and 78% amongst hospitalists. In cases without perfect concordance (n=43), hematologists agreed with each other 76% of the time, while hospitalists agreed with each other 81% of the time. Of the consults that at least 4 coders classified in the same way, hospitalists were more likely than hematologists to have perfect concordance for ideal consults (89% vs. 66%, respectively; P=0.001) but less likely to have perfect concordance for S.O.S consults (56% vs. 100%, respectively; P=0.003). Hematologists were twice more likely than hospitalists to classify a consult request as S.O.S (26.7% vs. 12.3%, P<0.001), while a greater proportion of hospitalists classified consults as ideal (74% vs. 61%, P=0.007). There was no significant difference in the word count of requests that were perfectly concordant (68+35), partially concordant (65+51), or discordant (39+22) (P=0.18). Conclusion: Hematology oncology consult requests can be classified into a novel rubric of 7 specific subtypes. Overall, partial concordance between primary providers and consultants was high, and perfect concordance was moderate. Hematologists were more likely to classify consult requests as S.O.S (without specific questions) than primary providers. Opportunities exist to utilize the rubric to improve communication between health care providers and to improve the medical education of trainees. Disclosures No relevant conflicts of interest to declare.

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Red Eye: Next Steps for Conducting Research in Knowledge, Attitude and Practice in Ophthalmology

International Journal of Medical Students ◽

10.5195/ijms.2013.21 ◽

2013 ◽

Vol 1 (1) ◽

pp. 24-27

Author(s):

Francisco J. Bonilla-Escobar ◽

Hugo H. Ocampo-Dominguez

Keyword(s):

Medical Education ◽

Health Care Providers ◽

Educational Interventions ◽

Health Sciences ◽

Care Providers ◽

Red Eye ◽

Attitude And Practice ◽

Conducting Research ◽

Knowledge Attitude And Practice

Background: Research in Knowledge, Attitude and Practice (KAP) in health sciences is relevant to health care providers and patients to identify factors to address educational interventions. Methods: A pilot study based on surveys amongst participants in a medical update conference in Cali, Colombia, was conducted to estimate participants’ knowledge on red eye in 2011. Results: The population was composed of medical students and general practitioners, with 72.7% of students being in their final year of their training. The classification of red eye was correct in 47% of respondents and we found errors in the classification of emergency, glaucoma and uveitis.Conclusions: Further research proposals in KAP are required for the recognition of this medical education indicator.

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A descriptive analysis of end-of-life discussions for high-grade glioma patients

Neuro-Oncology Practice ◽

10.1093/nop/npab010 ◽

2021 ◽

Author(s):

Ai Chikada ◽

Sayaka Takenouchi ◽

Yoshiki Arakawa ◽

Kazuko Nin

Keyword(s):

End Of Life ◽

Health Care Providers ◽

Patient Participation ◽

High Grade Glioma ◽

Team Approach ◽

High Grade ◽

Care Providers ◽

Patient Goals ◽

Significant Difference ◽

Eol Care

Abstract Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher’s exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient’s wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.

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The Role of Obesity in Predicting the Clinical Outcomes of COVID-19

Obesity Facts ◽

10.1159/000517180 ◽

2021 ◽

pp. 1-9

Author(s):

Serdar Sahin ◽

Havva Sezer ◽

Ebru Cicek ◽

Yeliz Yagız Ozogul ◽

Murat Yildirim ◽

...

Keyword(s):

Clinical Outcomes ◽

Health Care Providers ◽

Study Groups ◽

Normal Weight ◽

Overweight And Obesity ◽

Care Providers ◽

Significant Difference ◽

Group A ◽

Group B ◽

Group D

Introduction: The aim of this was to describe the predictors of mortality related to COVID-19 infection and to evaluate the association between overweight, obesity, and clinical outcomes of COVID-19. Methods: We included the patients >18 years of age, with at least one positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction. Patients were grouped according to body mass index values as normal weight <25 kg/m2 (Group A), overweight from 25 to <30 kg/m2 (Group B), Class I obesity 30 to <35 kg/m2 (Group C), and ≥35 kg/m2 (Group D). Mortality, clinical outcomes, laboratory parameters, and comorbidities were compared among 4 groups. Results: There was no significant difference among study groups in terms of mortality. Noninvasive mechanical ventilation requirement was higher in group B and D than group A, while it was higher in Group D than Group C (Group B vs. Group A [p = 0.017], Group D vs. Group A [p = 0.001], and Group D vs. Group C [p = 0.016]). Lung involvement was less common in Group A, and presence of hypoxia was more common in Group D (Group B vs. Group A [p = 0.025], Group D vs. Group A [p < 0.001], Group D vs. Group B [p = 0.006], and Group D vs. Group C [p = 0.014]). The hospitalization rate was lower in Group A than in the other groups; in addition, patients in Group D have the highest rate of hospitalization (Group B vs. Group A [p < 0.001], Group C vs. Group A [p < 0.001], Group D vs. Group A [p < 0.001], Group D vs. Group B [p < 0.001], and Group D vs. Group C [p = 0.010]). Conclusion: COVID-19 patients with overweight and obesity presented with more severe clinical findings. Health-care providers should take into account that people living with overweight and obesity are at higher risk for COVID-19 and its complications.

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CLASSIFICATION SYSTEMS FOR ADOLESCENT AND ADULT SCOLIOSIS

Neurosurgery ◽

10.1227/01.neu.0000320447.61835.ea ◽

2008 ◽

Vol 63 (suppl_3) ◽

pp. A16-A24 ◽

Cited By ~ 36

Author(s):

Justin S. Smith ◽

Christopher I. Shaffrey ◽

Charles Kuntz ◽

Praveen V. Mummaneni

Keyword(s):

Health Care Providers ◽

Research Society ◽

Classification Systems ◽

Adult Scoliosis ◽

Care Providers ◽

Classification Schemes ◽

Scoliosis Research Society ◽

Adult Degenerative Scoliosis ◽

Spinal Abnormality

ABSTRACT OBJECTIVE To review current classification systems for adolescent and adult scoliosis. METHODS The literature was reviewed in reference to scoliosis classification systems for adolescent and adult scoliosis. RESULTS There are multiple classification systems for scoliosis. Classification of scoliosis is dependent on patient age, spinal abnormality, scoliotic curve, and global spinal alignment. To date, classification systems have focused predominantly on adolescent idiopathic scoliosis or adult/degenerative scoliosis; a single classification system evaluating scoliotic deformities of different ages and spinal abnormalities has not been identified. CONCLUSION The importance of scoliosis classification schemes lies in their ability to standardize communication among health care providers. With regard to the classification of adolescent scoliosis, the Lenke system has addressed many of the significant limitations of the King system and is now the standard classification scheme. Classification schemes for adult scoliosis have been reported only recently, and each offers specific advantages (the simple pathogenesis-based system of Aebi, the strong clinical relevance of the Schwab system, and the richly descriptive Scoliosis Research Society system). This article highlights the salient features of currently used scoliosis classification systems.

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A comparison of women’s expectations of labour and birth with the experiences in primiparas and multiparas with normal vaginal delivery

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v4i1.15024 ◽

2016 ◽

Vol 4 (1) ◽

pp. 16-25 ◽

Cited By ~ 1

Author(s):

Manijeh Pirdil ◽

Leila Pirdel

Keyword(s):

Health Care ◽

Vaginal Delivery ◽

Health Care Providers ◽

Normal Vaginal Delivery ◽

Care Providers ◽

Medical College ◽

Childbirth Experience ◽

Significant Difference ◽

Negative Expectations

Background: Maternal childbirth expectations play an important role in determining a woman’s response to her childbirth experience. Women need to be helped to develop realistic and positive expectations and identify the factors that influence these expectations.Objective: The aim of this study was to compare woman’s expectations and experiences of childbirth.Methods: This descriptive-comparative study was carried out in Tabriz Alzahra Hospital from 2006 to 2007. For this purpose, a total of 600 primiparas and multiparas women who were candidates for vaginal delivery, were randomly selected and interviewed. The data were collected by questionnaire.Results: Comparison of the means of mothers expectation and experience of labor and birth between the two groups demonstrated a statistically significant difference (p<0.05). The findings indicated a number of differences exist between primiparas and multiparas women in relation to expectations and experiences of birth when compare two groups. The majority of women had negative expectations and experiences of childbirth.Conclusion: The evaluation and understanding of birth expectations and experiences as positive and negative is priority of maternity system. Antenatal educators need to ensure that pregnant women are appropriately prepared for what might actually happen to limit this expectation-experience gap. Health-care providers should improve the quality of antenatal care which can change negative childbirth expectations and experiences of womenJournal of Kathmandu Medical College, Vol. 4(1) 2015, 16-25

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The Effect of "Pathway" to Diagnosis for Childhood ITP on Caregiver Quality of Life at Time of Diagnosis

Blood ◽

10.1182/blood-2019-125686 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2174-2174

Author(s):

Michelle Neier ◽

Michele P. Lambert ◽

Rachael F. Grace ◽

Kerry Hege ◽

Stephanie Chiu ◽

...

Keyword(s):

Health Care ◽

Health Care Provider ◽

Health Care Providers ◽

Care Provider ◽

Research Funding ◽

Care Providers ◽

Significant Difference ◽

Time To Diagnosis ◽

The Impact

Background: Immune thrombocytopenia (ITP) is an immune mediated bleeding disorder characterized by isolated thrombocytopenia. ITP can have a variety of presentations from asymptomatic to life threatening bleeding. Although childhood ITP is most often a self-resolving illness which can be closely observed without intervention, it can be associated with significant impact on quality of life (QoL). Prospective studies of QoL in ITP patients show that there is not always a correlation with treatment or disease severity. The pathway from initial presentation to final diagnosis varies and may include encounters with emergency room, primary care or specialty providers. There have been no published studies to date showing the impact of factors prior to the diagnosis of ITP on treatment decision making and QoL. Objective: To identify the role of physician-patient and physician-caregiver interactions on the QoL and emotional well-being of patients and their families. Ascertaining the impact of pre-diagnosis factors may provide an opportunity to improve access and quality of care provided. Methods: The ITP Consortium of North America (ICON) "Pathways" study was a multicenter observational prospective cohort study focused on the pathways to diagnosis of ITP. The study was supported by a Foundation for Morristown Medical Center Research Fund Grant. Subjects were included if they had presumed primary ITP and were age >12 months to <18 years. Subjects were excluded if they had secondary ITP, including Evans syndrome. Treatment was determined by the physician. Subjects were consented and presented with questionnaires to be completed at the conclusion of the initial hematology visit. The hematologist also completed survey data at that time. Survey data forms included demographic form, physician form, Peds QL Family Impact Questionnaire, Kids ITP tools (KIT) Parent Impact Report and parent proxy report, and child (patient) KIT self-report. There was a parent questionnaire which included a question about worry with a scale from 0 to 10. Study data were collected and managed using REDCap electronic data capture tools hosted at Atlantic Health System. Correlation between variables were calculated using Pearson coefficient or Spearman's rho depending on the distribution of the data variables. Results: Sixty subjects and caregivers were enrolled at 6 ICON centers; 52 were eligible for inclusion. The majority (40%) had Grade 1 bleeding. Most patients (82%) were seen in outpatient hematology clinic by the hematologist and had been referred by the emergency room (73%). The median time to consultation with a hematologist from onset of symptoms was 7 days (1-199) and the median time to diagnosis by hematologist from initial contact with a health care provider was 5 days (0-154). Most subjects had seen 2 health care providers prior to the hematologist. KIT proxy report cumulative scores were a mean of 76.03 (SD 14.72). There was no significant difference between the time to diagnosis or the time from initial encounter with health care provider to hematologist and initial level of worry (p=0.70 and 0.90, respectively). There was also no significant difference between the time to diagnosis or the time from initial encounter with health care provider to hematologist and KIT proxy scores (p=0.96 and 0.50, respectively). However, there was a significant decline in level of worry (scale 0-10) prior to the hematologist visit (median 8, range 1-10) to after the visit (median 4, range 1-10). The association between number of medical providers encountered prior to diagnosis and KIT proxy scores was not significant (p=0.45) (Table). Conclusions: In this study at 6 teaching institutions, we were unable to detect a significant difference in proxy-reported KIT scores relative to the number of health care providers seen or time from diagnosis until the first encounter with the hematologist. We were, however, able to detect a significant change in the level of caregiver worry pre- and post- visit with the pediatric hematologist, supporting a benefit of specialist care to the caregivers of children with ITP. This study was limited by its small sample size and retrospective design. ITP is considered a benign disease but is associated with a significant amount of worry and impact on QoL for patients and caregivers which warrants further investigation. Disclosures Lambert: CSL Behring: Consultancy; Amgen: Consultancy, Other; Bayer: Other: Ad boards; Novartis: Other: Ad boards, Research Funding; Shionogi: Consultancy; Kedrion: Consultancy; Sysmex: Consultancy; AstraZeneca: Research Funding; PDSA: Research Funding. Grace:Agios Pharmaceuticals, Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding.

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Virtual Reality Module Depicting Catheter-Associated Urinary Tract Infection as Educational Tool to Reduce Antibiotic Resistant Hospital-Acquired Bacterial Infections

University of the Future: Re-Imagining Research and Higher Education ◽

10.29117/quarfe.2020.0250 ◽

2020 ◽

Author(s):

Yosra M Mekki ◽

Mohamed M Mekki ◽

Mohamed Hamammi ◽

Susu Zughaier

Keyword(s):

Medical Education ◽

Virtual Reality ◽

Antibiotic Resistance ◽

Learning Outcomes ◽

Health Care Providers ◽

Resistant Bacteria ◽

Educational Tool ◽

Care Providers ◽

Antibiotic Resistant ◽

Hospital Acquired

Introduction: Virtual reality (VR) and augmented reality (AR) are used as simulation models in student-patient interactive medical education and shown to enhance learning outcomes. The rise in global burden of infectious diseases and antibiotic resistance world-wide prompt immediate action to combat this emerging threat. Catheter associated urinary infections (CAUTI) are the leading cause of hospital-acquired infections. The aim of this research is to develop a virtual reality (VR) based educational tool depicting the process of CAUTI caused by antibiotic resistant bacteria. The VR-CAUTI module is designed to provide insights to health care providers and community which help in reducing the burden of antibiotic resistant infections. Material and methods: The VRCAUTI module is designed using tools including Blender, Cinema4D and Unity to create a scientifically accurate first-person interactive movie. The users are launched inside a human bladder that needs to be drained. They can witness the insertion of a medical catheter into the bladder to drain the urine. Bacteria adhere to the catheter to establish colonization and infection. An interaction between antibiotic molecules and bacteria in the biofilm is observed later. After designing the 3D models, a highlight of the interaction between models, taken from the storyboard, is used to determine the necessary animation. Moreover, dialogue that facilitates the understanding of infections and antibiotic resistance is recorded. This is followed by the assembly of the module on Unity, and enrichments such as lights and orientation. Results and conclusion: This VRCAUTI module is the proof-of-concept for designing detailed VR based scientifically very accurate medical simulation that could be used in medical education to maximize learning outcomes. VR based modules that have the potential to transform and revolutionize learning experience and render medical education compatible with the IoT in the current 4th industrial revolution.

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Preclinical and clinical validation of a novel injected molded swab for molecular assay detection of SARS-CoV-2 virus

10.1101/2021.10.19.21265200 ◽

2021 ◽

Author(s):

Chiara Elia Ghezzi ◽

Devon R Hartigan ◽

Justin Hardick ◽

Rebecca Gore ◽

Miryam Adelfio ◽

...

Keyword(s):

Health Care Providers ◽

Medical Devices ◽

Clinical Studies ◽

Nasal Swab ◽

Cost Effective ◽

Slight Reduction ◽

Care Providers ◽

Significant Difference ◽

Injection Molded

During the COVID-19 public health emergency, many actions have been undertaken to help ensure that patients and health care providers had timely and continued access to high-quality medical devices to respond effectively. The development and validation of new testing supplies and equipment, including collection swab, help expand the availability and capability for various diagnostic, therapeutic, and protective medical devices in high demand during the COVID-19 emergency. Here, we report the validation of a new injection-molded anterior nasal swab, ClearTip™, that was experimentally validated in a laboratory setting as well as in independent clinical studies in comparison to gold standard flocked swabs. We have also developed an in vitro anterior nasal tissue model, that offers an efficient and clinically relevant validation tool to replicate with high fidelity the clinical swabbing workflow, while being accessible, safe, reproducible, time and cost effective. ClearTi™ displayed a greater efficiency of release of inactivated virus in the benchtop model, confirmed by greater ability to report positive samples in a clinical study in comparison to flocked swabs. We also quantified in multi-center pre-clinical and clinical studies the detection of biological materials, as proxy for viral material, that showed a statistically significant difference in one study and a slight reduction in performance in comparison to flocked swabs. Taken together these results underscore the compelling benefits of non-absorbent injected molded anterior nasal swab for COVID-19 detection, comparable to standard flocked swabs. Injection-molded swabs, as ClearTip™, could have the potential to support future swab shortage, due to its manufacturing advantages, while offering benefits in comparison to highly absorbent swabs in terms comfort, limited volume collection, and potential multiple usage.

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Preclinical Validation of a Novel Injection-Molded Swab for the Molecular Assay Detection of SARS-CoV-2

Diagnostics ◽

10.3390/diagnostics12010206 ◽

2022 ◽

Vol 12 (1) ◽

pp. 206

Author(s):

Chiara E. Ghezzi ◽

Devon R. Hartigan ◽

Justin P. Hardick ◽

Rebecca Gore ◽

Miryam Adelfio ◽

...

Keyword(s):

Health Care Providers ◽

Medical Devices ◽

Clinical Studies ◽

Cost Effective ◽

Care Providers ◽

Nasal Tissue ◽

Significant Difference ◽

Injection Molded ◽

Development And Validation

During the COVID-19 public health emergency, many actions have been undertaken to help ensure that patients and health care providers have timely and continued access to high-quality medical devices to respond effectively. The development and validation of new testing supplies and equipment, including collection swabs, has helped to expand the availability and capability for various diagnostic, therapeutic, and protective medical devices in high demand during the COVID-19 emergency. Here, we report the initial validation of a new injection-molded anterior nasal swab, ClearTip™, that was experimentally validated in a laboratory setting as well as in independent clinical studies in comparison to gold standard flocked swabs. We have also developed an in vitro anterior nasal tissue model which offers a novel, efficient, and clinically relevant validation tool to replicate the clinical swabbing workflow with high fidelity, while being accessible, safe, reproducible, and time- and cost-effective. ClearTip™ displayed greater inactivated virus release in the benchtop model, confirmed by its greater ability to report positive samples in a small clinical study in comparison to flocked swabs. We also quantified the detection of biological materials, as a proxy for viral material, in multi-center pre-clinical and clinical studies which showed a statistically significant difference in one study and a reduction in performance in comparison to flocked swabs. Taken together, these results emphasize the compelling benefits of non-absorbent injection-molded anterior nasal swabs for COVID-19 detection, comparable to standard flocked swabs. Injection-molded swabs, as ClearTip™, could have the potential to support future swab shortages, due to its manufacturing advantages, while offering benefits in comparison to highly absorbent swabs in terms of comfort, limited volume collection, and potential multiple usage.

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Perceived Health Status in Rural Manufacturing Workers

Workplace Health & Safety ◽

10.1177/2165079918794206 ◽

2018 ◽

Vol 67 (2) ◽

pp. 78-86

Author(s):

Stacy Logsdon ◽

M. Laurie Branstetter ◽

Eve Main

Keyword(s):

Health Status ◽

Occupational Health ◽

Health Care Providers ◽

Retrospective Chart Review ◽

Perceived Health ◽

Care Providers ◽

Perceived Health Status ◽

Biometric Data ◽

Objective Health ◽

Significant Difference

Manufacturing workers comprise 8.8% of the total U.S. workforce representing a sizable population for disease prevention and health promotion by occupational health nurses within worksite wellness programs. The purpose of this study was to examine the relationship between perceived health status and objective health status including existing chronic disease among rural manufacturing workers. Rural manufacturing workers ( n = 114) completed a general health survey and consented to a retrospective chart review. All were participants in a direct incentive wellness program with biometric data available. The majority of participants were males between the ages of 46 and 60 years, and nearly half of the sample had a college degree. A statistically significant difference was observed between number of chronic diseases and lower perceived health status. These findings have implications for occupational health nurses and other health care providers to identify workers at risk for chronic illness through self-perceived health status assessment.

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