The impact of a digital solution on tumor board preparation time for nurse navigators.

e18020 Background: A multidisciplinary tumor board (MTB) provides an interdisciplinary approach for decision-making in cancer care. Oncology nurse navigators (NN) have been introduced to facilitate patient access to services and resources, and to improve continuity and coordination of care. Little is known about how digital technologies support this role. Methods: A prospective IRB approved cohort study was undertaken to evaluate NN time preparation for MTBs before and after the implementation of the NAVIFY Tumor Board (NTB) solution at University of Missouri Health Care (MU). Data was collected using a digital time-tracking application. The NTB manual version was implemented via a phased roll-out (Hematology – Apr 9, 2018; Breast May 18, 2018; Gastrointestinal Jul 11, 2018). Subsequently, the integrated version was introduced (Oct 4, 2018). Results: Time preparation for 101 MTBs (828 cases) were evaluated throughout 2018 (35 Breast; 213 cases / 32 GI; 302 cases / 34 Hematology; 313 cases). Data showed NN meeting preparation time decreased for each MTB after the introduction of NTB; further time saving was achieved with NTB integrated version (Table 1). For the Breast MTB there was statistical significance between time preparation pre- & post-NTB (p-value = 0.011) but not between the manual and integrated versions (p-value = 0.118). For the Gastrointestinal MTB, there was no statistical significance between pre- & post-NTB (p-value = 0.214). For Hematology MTB there was statistical significance between the change from the NTB manual version vs. integration (p-value = 0.004). Note before NTB implementation Hematology MTB was not supported by NN. Conclusions: Introduction of the NTB reduced time spent by NNs preparing for 3 different MTBs, EMR integration delivered further time-savings. No discernable learning curve was observed suggesting user-training was sufficient and NTB was easy to learn. A reduction in variance (SD & IQR) for time preparation across all MTBs was seen. This suggests the NTB solution standardized the process for MTB preparation. Less time spent preparing for MTBs gives NNs more time to support patients.

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The impact of a digital solution on case discussion time at tumor boards.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18028 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18028-e18028

Author(s):

Donna Fowler ◽

Lincoln R Sheets ◽

Matthew S Prime ◽

Athanasios Siadimas ◽

Yariv Z Levy ◽

...

Keyword(s):

Decision Making ◽

Interdisciplinary Approach ◽

Tumor Board ◽

P Value ◽

Case Discussion ◽

Patient Case ◽

Tumor Boards ◽

Significant Difference ◽

Case Discussions ◽

The Impact

e18028 Background: A multidisciplinary tumor board (MTB) provides an interdisciplinary approach for decision-making in cancer care. Information factors such as, multiple data sources, incomplete or missing information and teleconferencing failures, have been identified as issues contributing to variability in MTB conduction and impact. Little is known about how digital tumor board solutions can optimize MTB meeting conduction. Methods: A prospective IRB approved cohort study was undertaken to evaluate the time for patient case discussions,before and after the implementation of the NAVIFY Tumor Board (NTB) solution, at University of Missouri Health Care. Data was collected using a digital time-tracking application. The NTB manual version was implemented via a phased roll-out (Breast May 18, 2018; Gastrointestinal (GI) Jul 11, 2018; ENT Oct 30, 2018 – no manual version phase). Subsequently, the integrated version was introduced (Oct 4, 2018) whereby automated electronic medical record (EMR) data extraction was enabled. Results: Patient case discussion time was recorded at 138 MTBs (1109 patient cases) during 2018 (Breast 40 MTB; 236cases / GI 49 MTB; 389 cases / ENT 49 MTBs; 484 cases). Case discussion time significantly reduced at the Breast MTB (6.6mins to 5.3 mins; p-value = 0.01). Case discussion time at ENT MTB and GI MTB showed no significant change (Table 1). Time variance in case discussions significantly decreased post-NTB implementation at the Breast MTB (p-value = 0.008). For the GI & ENT MTBs, there was no significant difference post-NTB implementation (GI p-value =0.199; ENT p-value = 0.511), however, variance was already sma Conclusions: Introduction of the NTB reduced the time spent discussing cases for the Breast MTB, but showed no change forGI MTB and ENT MTB. Interestingly, case discussion times converged to between 5.5 - 6.5 minutesirrespective of the MTB type. Furthermore, variance decreased or was already small, for all MTB types. Both observations suggest that NTB standardized the case discussion process, perhaps because it created a common format for case presentation. A common workflow tool for MTB meeting conduction could ensure availability of all required data, increase efficiency of therapy decision-making, and lead to higher throughput of cases resulting in shorter time-to-treatment.

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Treatment of HIV-associated facial lipoatrophy: impact on infection progression assessed by viral load and CD4 count

Anais Brasileiros de Dermatologia ◽

10.1590/abd1806-4841.2013895 ◽

2013 ◽

Vol 88 (4) ◽

pp. 570-577 ◽

Cited By ~ 5

Author(s):

Flávia Machado Gonçalves Soares ◽

Izelda Maria Carvalho Costa

Keyword(s):

Viral Load ◽

Disease Progression ◽

Statistical Significance ◽

Undetectable Viral Load ◽

Fat Distribution ◽

Cd4 Count ◽

Before And After ◽

Facial Lipoatrophy ◽

A Prospective Study ◽

The Impact

BACKGROUND: HIV/AIDS-Associated Lipodystrophy Syndrome includes changes in body fat distribution, with or without metabolic changes. The loss of fat from the face, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome.OBJECTIVES:To evaluate the effect of FL treatment using polymethylmethacrylate (PMMA) implants on disease progression, assessed by viral load and CD4 cell count.METHODS: This was a prospective study of 44 patients treated from July 2009 to December 2010. Male and female patients, aged over 18 years, with clinically detectable FL and who had never been treated were included in the study. PMMA implantation was done to fill atrophic areas. Laboratory tests were conducted to measure viral load and CD4 count before and after treatment.RESULTS: Of the 44 patients, 72.72% were male and 27.27% female, mean age of 44.38 years. Before treatment, 82% of patients had undetectable viral load, which increased to 88.6% after treatment, but without statistical significance (p = 0.67). CD4 count before treatment ranged from 209 to 1293, averaging 493.97. After treatment, the average increased to 548.61. The increase in CD4 count after treatment was statistically significant with p = 0.02.CONCLUSION: The treatment of FL with PMMA implants showed a statistically significant increase in CD4 count after treatment, revealing the impact of FL treatment on disease progression. Viral load before and after treatment did not vary significantly.

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617 Who Benefits the Most from Burn Camps?

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.267 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S162-S163

Author(s):

Jennifer B Radics-Johnson ◽

Daniel W Chacon ◽

Li Zhang

Keyword(s):

Retrospective Review ◽

Burn Injury ◽

Statistical Significance ◽

Categorical Variables ◽

P Value ◽

Continuous Variables ◽

Self Evaluation ◽

Significant Difference ◽

Return Home ◽

The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value< 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

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effects of anemia education using web-based she smart to improve knowledge, attitudes, and practice in adolescent girls

International journal of health & medical sciences ◽

10.21744/ijhms.v5n1.1831 ◽

2022 ◽

Vol 5 (1) ◽

pp. 44-49

Author(s):

Ernawati Ernawati ◽

Yusring Sanusi Baso ◽

Healthy Hidayanty ◽

Syafruddin Syarif ◽

Aminuddin Aminuddin ◽

...

Keyword(s):

Adolescent Girls ◽

Statistical Tests ◽

Sampling Technique ◽

P Value ◽

Growth Disorders ◽

Normal Numbers ◽

Web Based ◽

Before And After ◽

Smart Education ◽

The Impact

Anemia is a state of hemoglobin levels in the bloodless than normal numbers according to the sex and age group. The impact of anemia in adolescents is a decrease in achievement and learning spirit and can cause symptoms such as paleness, lethargy, decreased appetite, and growth disorders. Anemia has an impact not only on the health of adolescent girls but can have a long impact on the health of the mother and fetus. You can see the influence of anemia education on knowledge, attitudes, and practice. Uses the Pre-experimental method with the design of one group pretest and posttest. Sampling technique using purposive sampling with the number of 47 adolescent girls. The research was conducted at Senior High School 12 Makassar in September-October 2021. Data analysis using the McNemar test. From the results of statistical tests showed that there was an influence on the use of web-based she smart education model on the use of adolescent girls about anemia with p-value = 0.000 (p<0.05), attitude p-value = 0.016 (p<0.05) and action p-value = 0.001 (p<0.05). Anemia education using web-based she smart can improve knowledge, attitudes, and practice before and after an intervention.

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Effects of Extracorporeal Membrane Oxygenation Initiation on Oxygenation and Pulmonary Opacities

The Journal of Critical Care Medicine ◽

10.2478/jccm-2020-0040 ◽

2021 ◽

Vol 7 (1) ◽

pp. 6-13

Author(s):

Kiran Batra ◽

Manish Mohanka ◽

Srinivas Bollineni ◽

Vaidehi Kaza ◽

Prabhakar Rajiah ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

P Value ◽

Limited Data ◽

Hospital Survival ◽

Membrane Oxygenation ◽

Pulmonary Physiology ◽

Before And After ◽

Laboratory Variables ◽

The Difference ◽

The Impact

Abstract Introduction There is limited data on the impact of extracorporeal membrane oxygenation (ECMO) on pulmonary physiology and imaging in adult patients. The current study sought to evaluate the serial changes in oxygenation and pulmonary opacities after ECMO initiation. Methods Records of patients started on veno-venous, or veno-arterial ECMO were reviewed (n=33; mean (SD): age 50(16) years; Male: Female 20:13). Clinical and laboratory variables before and after ECMO, including daily PaO2 to FiO2 ratio (PFR), were recorded. Daily chest radiographs (CXR) were prospectively appraised in a blinded fashion and scored for the extent and severity of opacities using an objective scoring system. Results ECMO was associated with impaired oxygenation as reflected by the drop in median PFR from 101 (interquartile range, IQR: 63-151) at the initiation of ECMO to a post-ECMO trough of 74 (IQR: 56-98) on post-ECMO day 5. However, the difference was not statistically significant. The appraisal of daily CXR revealed progressively worsening opacities, as reflected by a significant increase in the opacity score (Wilk’s Lambda statistic 7.59, p=0.001). During the post-ECMO period, a >10% increase in the opacity score was recorded in 93.9% of patients. There was a negative association between PFR and opacity scores, with an average one-unit decrease in the PFR corresponding to a +0.010 increase in the opacity score (95% confidence interval: 0.002 to 0.019, p-value=0.0162). The median opacity score on each day after ECMO initiation remained significantly higher than the pre-ECMO score. The most significant increase in the opacity score (9, IQR: -8 to 16) was noted on radiographs between pre-ECMO and forty-eight hours post-ECMO. The severity of deteriorating oxygenation or pulmonary opacities was not associated with hospital survival. Conclusions The use of ECMO is associated with an increase in bilateral opacities and a deterioration in oxygenation that starts early and peaks around 48 hours after ECMO initiation.

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Developing a Dashboard Software for the ICUs and Studying its Impact on Reducing the Ventilator-Associated Pneumonia

The Open Medical Informatics Journal ◽

10.2174/1874431101812010042 ◽

2018 ◽

Vol 12 (1) ◽

pp. 42-50

Author(s):

Mohammad Fathi ◽

Hamid Moghaddasi ◽

Azamossadat Hosseini ◽

Monir Ebrahimi Aghdam

Keyword(s):

User Satisfaction ◽

Pilot Project ◽

Point Of View ◽

P Value ◽

Ventilator Associated Pneumonia ◽

Healthcare Organizations ◽

Survey Tool ◽

Usability Assessment ◽

Before And After ◽

The Impact

Objective: Ventilator-Associated Pneumonia (VAP), a lung infection developing in patients on a ventilator in Intensive Care Units (ICU), is the second most common nosocomial infection and a leading cause of morbidity and mortality in ICUs. To reduce the incidence rate of VAP complication, many healthcare organizations have already developed certain strategies and guidelines. However, there are still high rates of VAP infections mainly due to: conflicting guidelines from different sources, implementing the guidelines at different times and conditions, different ICU caregivers at different shifts, and of course the human mistakes. Methods: The present study aimed to develop a dashboard to help reducing VAP incidences in ICUs. To achieve the objective of the research, first, the VAP prevention guidelines were compiled. The object-oriented analysis approach was adopted for designing of the dashboard software. To assess the impact of the developed dashboard on the reduction of VAP events, a pilot hospital was selected and a pilot project was prepared. For the dashboard usability assessment based on user satisfaction, a questionnaire was developed as the survey tool. Conclusion: The dashboard was developed and put into operation in a pilot ICU. The results from the t-test (with a probable error of 0.05 percent) indicated a meaningful difference between the number of VAP patients before and after the dashboard implementation with p-value ˂ 0.02. Also, the developed software was evaluated from a usability point of view based on user satisfaction, with health professionals and caregivers of the pilot ICU as the users of the software. The total score was equivalent to 95 percent, falling within the acceptable range of 75-100 percent.

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Improving Self-Confidence of Military Medical Providers With Joint Procedure Simulation: A Pilot Study

Military Medicine ◽

10.1093/milmed/usab319 ◽

2021 ◽

Author(s):

Victoria m.f Mank ◽

Zhaohui Arter ◽

Jeffrey Mank ◽

Ki Suk Eum ◽

Jefferson Roberts

Keyword(s):

Pilot Study ◽

Simulation Training ◽

Statistical Significance ◽

Military Medicine ◽

P Value ◽

Medical Providers ◽

Medical Provider ◽

Self Confidence ◽

Before And After ◽

Military Facilities

ABSTRACT Introduction Military medical providers are a unique population that encounter different environments across the world. From hospital clinics to war zones, these providers must perform procedures and rely on their training and skill to help their patients. This pilot study aimed to assess the self-confidence of military medical providers performing joint aspiration and injection before and after a simulation workshop in both clinical and austere settings. Methods In 2016, 25 military physicians from various military facilities participated in a 1-hour knee arthrocentesis and injection and shoulder injection workshop. Education was provided on the knee and shoulder anatomy and various approaches to performing the procedures before the hands-on portion of the workshop. Surveys assessing self-reported confidence levels by performing the procedures in the clinic and austere settings were completed before and after simulation training. Results The results were analyzed and grouped based on the provider experience level, simulation environment, and specific procedure performed. There was a statistical significance seen in the shoulder arthrocentesis group, which included all participating providers, with a P-value of <.01 in the clinic setting and a P-value of <.001 in the austere setting. In the knee aspiration simulation, there were also improvements in the provider confidence, but it was not statistically significant with P-values of .36 and .14 in the clinical and austere settings, respectively. Conclusion Simulation training can lead to increased medical provider self-confidence in performing musculoskeletal joint aspirations and injections in both clinic and austere settings. The military medicine demographics have had little research in joint injections and provider confidence to date. This pilot study was one of the first to evaluate this unique population. The methods used in this study, and the positive data collected on provider confidence, can be used in larger studies, encompassing other medical providers to increase the confidence of providers throughout various fields of medicine.

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Digital Tumor Board Solutions Have Significant Impact on Case Preparation

JCO Clinical Cancer Informatics ◽

10.1200/cci.20.00029 ◽

2020 ◽

pp. 757-768

Author(s):

Richard D. Hammer ◽

Donna Fowler ◽

Lincoln R. Sheets ◽

Athanasios Siadimas ◽

Chaohui Guo ◽

...

Keyword(s):

Care Center ◽

Tumor Board ◽

Preparation Time ◽

Implementation Phase ◽

Health Care Center ◽

Multiple User ◽

Tumor Boards ◽

User Groups ◽

The Impact ◽

Nose And Throat

PURPOSE Multidisciplinary tumor boards (TBs) are the gold standard for decision-making in cancer care. Variability in preparation, conduction, and impact is widely reported. The benefit of digital technologies to support TBs is unknown. This study evaluated the impact of the NAVIFY Tumor Board solution (NTB) on TB preparation time across multiple user groups in 4 cancer categories: breast, GI, head and neck (ie, ear, nose, and throat, or ENT), and hematopathology. METHODS This prospective study evaluated TB preparation time in multiple phases pre- and post-NTB implementation at an academic health care center. TB preparation times were recorded for multiple weeks using a digital time tracker. RESULTS Preparation times for 59 breast, 61 GI, 36 ENT, and 71 hematopathology cancer TBs comparing a pre-NTB phase to 3 phases of NTB implementation were evaluated between February 2018 and July 2019. NTB resulted in significant reductions in overall preparation time (30%) across 3 TBs pre-NTB compared with the final post-NTB implementation phase. In the breast TB, NTB reduced overall preparation time by 28%, with a 76% decrease in standard deviation (SD). In the GI TB, a 23% reduction in average preparation time was observed for all users, with a 48% decrease in SD. In the ENT TB, a 33% reduction in average preparation time was observed for all users, with a 73% decrease in SD. The hematopathology TB, which was the cocreation partner and initial adopter of the solution, showed variable results. CONCLUSION This study showed a significant impact of a digital solution on time preparation for TBs across multiple users and different TBs, reflecting the generalizability of the NTB. Adoption of such a solution could improve the efficiency of TBs and have a direct economic impact on hospitals.

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Impact of High Temperature on Post-Exercise Albuminuria in Dogs

Animals ◽

10.3390/ani10111988 ◽

2020 ◽

Vol 10 (11) ◽

pp. 1988

Author(s):

Urszula Pasławska ◽

Barbara Szczepankiewicz ◽

Aleksandra Bednarska ◽

Robert Pasławski

Keyword(s):

High Temperatures ◽

Healthy Adult ◽

Statistical Significance ◽

Abdominal Ultrasound ◽

Strenuous Exercise ◽

Movement Activity ◽

Post Exercise ◽

Intensive Exercise ◽

Before And After ◽

The Impact

The literature suggests that strenuous exercise and exposure to high temperatures may cause physiologic proteinuria, but to our knowledge there have been no studies that have assessed the effect of high temperatures on the occurrence of post-exercise albuminuria in dogs. The goal of the study was to assess the impact of high temperatures on the occurrence of albuminuria. Thirteen healthy adult dogs—eight female (62%) and five male (38%) had to run 5 km at a temperature of 25 °C in grasslands which took about 30–40 min. Dogs underwent clinical examinations: echocardiography, abdominal ultrasound, blood hematology and biochemistry and urinalysis, including the ratio of albumin to creatinine (UAC). Baseline UAC was on the borderline of statistical significance for female dogs, but not for male dogs, before and after exercise. UAC was 0.31 ± 0.56 mg/mmol for female dogs and 0.36 ± 0.60 mg/mmol in male dogs before exercise. Immediately after exercise, UAC was 0.51 ± 0.58 mg/mmol in female dogs and 0.31 ± 0.40 mg/mmol in male dogs. Thus, a period of about 30–40 min of intensive exercise at high temperatures (25 °C) did not lead to increased albuminuria. This suggests that there is no need to limit the movement activity before urine tests in dogs, even at high temperatures, before urinalysis.

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The Impact of a Policy-Based Multicomponent Nutrition Pilot Intervention on Young Adult Employee’s Diet and Health Outcomes

American Journal of Health Promotion ◽

10.1177/0890117118784447 ◽

2018 ◽

Vol 33 (3) ◽

pp. 342-357 ◽

Cited By ~ 3

Author(s):

Désirée Schliemann ◽

Michelle McKinley ◽

Jayne V. Woodside

Keyword(s):

Young Adult ◽

P Value ◽

Insurance Company ◽

Diet Intervention ◽

Work Related ◽

Paired Samples ◽

Before And After ◽

Strict Diet ◽

Pilot Intervention ◽

The Impact

Purpose: Evaluate the effect of a policy-based, multicomponent workplace diet intervention on young adult employees’ diet and health. Design: A 6-month, single-armed pilot study with before and after assessments. Setting: Insurance company in Belfast, Northern Ireland. Participants: Employees who worked at the company throughout the intervention period were included. Employees were excluded if pregnant, breast-feeding, or following a strict diet. Intervention: Multicomponent diet intervention: ban of unhealthy foods brought into the premises, free fruit, education, individual advice, and further support. Measures: Mixed-methods approach: Diet-, health-, and work-related measures were assessed quantitatively. The campaign was evaluated quantitatively (via questionnaire) and qualitatively (via semistructured interviews). Analysis: Changes in measures were analyzed using paired samples t tests. Interviews were analyzed using thematic analysis. Results: Sixty (75.9%) staff completed all assessments. Males reduced their sugar intake on working days (−8.7% of total energy standard deviation [SD]: 20.1; P value <.01). Systolic blood pressure reduced in males and females (−3.3 SD: 9.9; P value <.05 and −8.0 SD: 7.7; P value <.001, respectively); 85.2% of staff strongly agreed/agreed that they appreciated the healthy eating ethos. This was supported by the qualitative analysis which furthermore suggested that the education, team support, individual advice, and free fruit were beneficial. Conclusion: Influencing workplace policies and offering additional dietary support could lead to meaningful changes in employees’ diet and health and may change workplace culture.

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