The impact of an expert exchange-based educational initiative on urologist confidence and knowledge in implementing immunotherapy for bladder cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23001-e23001
Author(s):  
Susan H. Gitzinger ◽  
Bryan Carson Taylor ◽  
Joan B. Fowler ◽  
Vanessa Carranza ◽  
Rebecca Weaver
Keyword(s):  
Bladder Cancer ◽  
Statistical Testing ◽  
Academic Medical Centers ◽  
Educational Activities ◽  
Medical Centers ◽  
Activity Assessment ◽  
Academic Medical ◽  
Post Test ◽  
Chi Square Analysis

e23001 Background: The rapid and robust emergence of the immunotherapy era in bladder cancer has prompted a paradigmatic shift in both early and late-stage bladder cancer management. Given this change, it is imperative that members of the bladder cancer care team, most notably urologists, medical oncologists, and urologic oncologists, be well-equipped to safely and effectively integrate immune checkpoint inhibitors into the treatment armamentarium. Methods: CEC Oncology delivered education at select meetings throughout 2019-2021 including ASCO GU, AUA, and SUO Annual Meetings; in addition to live presentations, the content was streamed live and on-demand on www.ceconceptslive.com and endured on myCME.com. Learning and knowledge was objectively assessed by analyzing pre- and post-test results before and after the educational activities. To determine retention of knowledge over time, follow-up assessments were sent to participants after each live activity. Assessment questions in the form of case studies were utilized to gauge whether participants translated knowledge into practice at follow-up. Statistical testing between pre- and post-tests and from pre-test to follow-up were conducted via chi square analysis with a priori significance set at 0.05. Results: Executed five live educational activities and a spin-off enduring component hosted on myCME.com. 765 total clinicians educated across the live elements of the curriculum. Across the curriculum, over 70% of attendees indicated at post-activity assessment that they would use systemic immunotherapy either primarily or exclusively in their practice compared to just 25% at pre-activity. Among urologists practicing at academic medical centers, confidence in appropriate implementation of immunotherapy increased for all participants, and more specifically, for clinicians practicing at academic medical centers (on a 4-point scale, All Participants demonstrated a confidence increase from 2.70 to 2.91; Academic Medical Center clinicians demonstrated an increase of 2.75 to 3.00); 97% said that the initiative increased their knowledge of ongoing ICI clinical trials in bladder cancer; Attendee ability to appropriately manage an irAE increased substantially from pre-test to post-test assessment (37% vs. 63%; P=.057). Clinicians practicing in community settings are the only attendees who did not exhibit an increase in mean confidence in appropriately implementing immunotherapy at post-activity assessment. Conclusions: Our Expert Exchange Bladder Cancer Curriculum precipitated substantive practice advances related to appropriate implementation of ICI therapy. Many of these advances, however, were specific to academic urologists and urologic oncologists; outcomes analyses have revealed tangible educational gaps among community-based urologists.

A multicenter quality improvement initiative on the impact of pharmacists’ postdischarge follow-up to reduce medication-related acute care episodes

2020 ◽  
Vol 77 (12) ◽  
pp. 938-942
Author(s):  
Lydia Noh ◽  
Kristina Heimerl ◽  
Rita Shane
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Acute Care ◽  
Academic Medical Centers ◽  
Quality Improvement Initiative ◽  
Medical Centers ◽  
Academic Medical ◽  
Risk Patients ◽  
The Impact

Abstract Purpose This multicenter quality improvement initiative aims to measure and quantify pharmacists’ impact on reducing medication-related acute care episodes (MACEs) for high-risk patients at an increased risk for readmission due to drug-related problems (DRPs). Methods This was a prospective, multicenter quality improvement initiative conducted at 9 academic medical centers. Each participant implemented a standardized methodology for evaluating MACE likelihood to demonstrate the impact of pharmacist postdischarge follow-up (PDFU). The primary outcome was MACEs prevented, and the secondary outcome was DRPs identified and resolved by pharmacists. During PDFU, pharmacists were responsible for identification and resolution of DRPs, and cases were reviewed by physicians to confirm whether potential MACEs were prevented. Results A total of 840 patients were contacted by 9 participating academic medical centers during a 6-week data collection period. Of these, 328 cases were identified as MACEs prevented during PDFU by pharmacists, and physician reviewers confirmed that pharmacist identification of DRPs during PDFU prevented 27.9% of readmissions. Pharmacist identified 959 DRPs, 2.8% (27) of which were identified as potentially life threatening. Potentially serious or significant DRPs made up 56.6% (543) of the DRPs, and 40.6% (389) were identified as having a low capacity for harm. Conclusion The results demonstrate that PDFU of high-risk patients reduces DRPs and prevents MACEs based on physician confirmation. Implementation of MACE methodology provides health-system pharmacy departments the ability to demonstrate pharmacists’ value in transitions of care and assist in expanding pharmacist services.

scholarly journals 2384. The Relationship Between Rifaxamin Use and the Prevalence of Clostridiodes difficile and Vancomycin-Resistant Enterococcus in Patients with Advanced Liver Disease

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S823-S823
Author(s):  
Francisco Alberto. De Jesus ◽  
Kristi Kuper ◽  
Alyzeh Haider ◽  
Joachim Sackey ◽  
Diana Finkel
Keyword(s):  
Liver Disease ◽  
Academic Medical Centers ◽  
Complex Care ◽  
Hospital Type ◽  
Community Hospitals ◽  
Advanced Liver Disease ◽  
Medical Centers ◽  
Academic Medical ◽  
Chi Square Analysis ◽  
The Relationship

Abstract Background Rifaximin (RFX) is a minimally absorbed antibiotic that achieves high concentrations after administration in the gut lumen. Previously, RFX showed activity against Clostridiodes difficile (C. difficile) recurrences post treatment with little overall impact on the normal fecal microbiota. Additional studies have found that while exposure to systemic antibiotics was associated with infection with multi drug-resistant organisms, such as VRE, exposure to only RFX was not. RFX has become widely used in hospitalized patients with advanced liver disease (ALD) who have refractory hepatic encephalopathy, but the impact of therapy on the occurrence of C. difficile and VRE is not well established. Methods ALD patients in the Vizient Clinical Database-Resource Manager (CDB-RM®) were identified based on ICD 10 and MS-DRG codes from January to December 2018. The data were further stratified based on receipt of RFX, documentation of C. difficile or VRE, and hospital type (academic medical centers, complex care medical centers or community hospitals). Wilcoxon signed-rank test was used to compare C. difficile rates while paired samples t-test was used to compare VRE. Chi-square analysis was used to evaluate differences in RFX use by hospital type. Results A total of 527,534 cases from 419 acute care hospitals were included in the ALD cohort. The frequency of C. difficile occurrence in patients who received RFX was lower than those who did not receive RFX (3.8% vs 4.3%, respectively, P = 0.25), However, VRE frequency was significantly lower in those that received RFX (0.43 cases per 10,000 patient-days) vs. the overall ALD population (2.3 cases per 10,000 patient-days) (P < 0.05). Percentage of ALD cases receiving RFX in the academic medical centers, complex care medical centers and community hospitals was 11.94%, 4.87%, and 8.76%, respectively (P < 0.05). Conclusion Patients with ALD who received RFX had a significantly lower frequency of documented VRE. There was a trend in the reduction in documented C. difficile, but this did not reach statistical significance. Utilization of RFX varied significantly by institutional type. These results support further studies on the relationship between receipt of RFX and protective effects against C. difficile and VRE in patients with ALD. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial

2021 ◽  
Vol 10 ◽  
pp. 216495612110010
Author(s):  
Julia Loewenthal ◽  
Natalie L Dyer ◽  
Marla Lipsyc-Sharf ◽  
Sara Borden ◽  
Darshan H Mehta ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Psychological Health ◽  
Well Being ◽  
Academic Medical Centers ◽  
Controlled Study ◽  
Medical Centers ◽  
Resident Physicians ◽  
Academic Medical

Background and Objective Mind-body interventions (MBIs) have been shown to be effective individual-level interventions for mitigating physician burnout, but there are no controlled studies of yoga-based MBIs in resident physicians. We assessed the feasibility of a yoga-based MBI called RISE (resilience, integration, self-awareness, engagement) for residents among multiple specialties and academic medical centers. Methods We conducted a waitlist controlled randomized clinical trial of the RISE program with residents from multiple specialty departments at three academic medical centers. The RISE program consisted of six weekly sessions with suggested home practice. Feasibility was assessed across six domains: demand, implementation, practicality, acceptability, adaptation, and integration. Self-reported measures of psychological health were collected at baseline, post-program, and two-month follow-up. Results Among 2,000 residents contacted, 75 were assessed for eligibility and 56 were enrolled. Forty-four participants completed the study and were included in analysis. On average, participants attended two of six sessions. Feasibility of in-person attendance was rated as 28.9 (SD 25.6) on a 100-point visual analogue scale. Participants rated feasibility as 69.2 (SD 26.0) if the program was offered virtually. Those who received RISE reported improvements in mindfulness, stress, burnout, and physician well-being from baseline to post-program, which were sustained at two-month follow-up. Conclusion This is the first controlled study of a yoga-based MBI in residents. While the program was not feasible as delivered in this pilot study, initial analyses showed improvement in multiple measures of psychological health. Residents reported that virtual delivery would increase feasibility.

Effect of live education targeted to genetic counselors on knowledge and competence.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11035-11035
Author(s):  
Vanessa Carranza ◽  
Susan H. Gitzinger ◽  
Bryan Carson Taylor ◽  
Joan B. Fowler
Keyword(s):  
Genetic Testing ◽  
Parp Inhibitor ◽  
A Priori ◽  
Genetic Counselors ◽  
Statistical Testing ◽  
Healthcare Team ◽  
Post Test ◽  
Chi Square Analysis ◽  
Germline Testing

11035 Background: Rapid advancements in genomics and sequencing technologies have presented a growing need for experts in the field of genetics to translate results and optimize patient care. As knowledge regarding DNA mutations and the technology to properly detect them continuously advances, it will be vital that genetic counselors play a larger role in the oncology healthcare team. Methods: These activities were designed to target genetic counselors involved in the diagnosis, management and genetic counseling of patients who have or are at risk for DDR-mutated cancers, attending live symposia at the 2018 & 2019 American College of Medical Genetics & Genomics Annual Meeting. Learning and knowledge was objectively assessed by analyzing pre- and post-test results before and after the educational activities. To determine retention of knowledge over time, follow-up assessments were sent to participants after each live activity. Assessment questions in the form of case studies were utilized to gauge whether participants translated knowledge into practice at follow-up. Statistical testing between pre- and post-tests and from pre-test to follow-up were conducted via chi square analysis with a priori significance set at 0.05. Results: Evaluations were collected from N = 275 (onsite) participants. Improved learners, as determined by significant ( P < 0.05) increases in correct responses, were observed in several specific topic areas: When to consider germline testing (2018 participants: 53.33% pre-test vs. 87.5% post-test; 2019 participants: 42.55% pre-test vs. 84.72% post-test). Patients most likely to benefit from a PARP inhibitor based on genetic testing results (2018 participants: 50% pre-test vs. 93.75% post-test; 2019 participants: 75.49% pre-test vs. 94.37% post-test). However not all improvement was sustained at follow-up: When it is appropriate to consider germline testing (2018 participants: 64.44% at follow-up – not significant ( P= 0.138); 2019 participants: 85% at follow-up ( P< 0.001). Patients most likely to benefit from a PARP inhibitor based on genetic testing results (2018 participants: 68.89% at follow-up – not significant ( P= 0.140); 2019 participants: 65% at follow-up – not significant ( P= 0.329). Conclusions: This analysis shows that live accredited education can significantly improve the knowledge and competence of genetic counselors in multiple areas surrounding the use of germline testing to guide treatment recommendations. Results also suggest that ongoing education in clinically appropriate scenarios is warranted.

scholarly journals Resident and Preceptor Perceptions of Preceptor Integration Into Resident Clinic Scheduling Templates

2017 ◽  
Vol 9 (4) ◽  
pp. 497-502
Author(s):  
Halle G. Sobel ◽  
Rachel Swigris ◽  
Karen M. Chacko ◽  
Alison Landrey ◽  
Monica McNulty ◽  
...  
Keyword(s):  
Interpersonal Relationships ◽  
Academic Medical Centers ◽  
Traditional Model ◽  
Residency Programs ◽  
Resident Perceptions ◽  
Medical Centers ◽  
Complex Patients ◽  
Academic Medical

ABSTRACT Background  Some internal medicine residency programs on X+Y schedules have modified clinic preceptor schedules to mimic those of the resident cohort (resident matched). This is in contrast to a traditional model, in which preceptors supervise on the same half-day each week. Objective  We assessed preceptor and resident perceptions of the 2 precepting models. Methods  We surveyed 44 preceptors and 97 residents at 3 clinic sites in 2 academic medical centers. Two clinics used the resident-matched model, and 1 used a traditional model. Surveys were completed at 6 months and 1 year. We assessed resident and preceptor perceptions in 5 domains: relationships between residents and preceptors; preceptor familiarity with complex patients; preceptor ability to assess milestone achievements; ability to follow up on results; and quality of care. Results  There was no difference in perceptions of interpersonal relationships or satisfaction with patient care. Preceptors in the resident-matched schedule reported they were more familiar with complex patients at both 6 months and 1 year, and felt more comfortable evaluating residents' milestone achievements at 6 months, but not at 1 year. At 1 year, residents in the resident-matched model perceived preceptors were more familiar with complex patients than residents in the traditional model. The ability to discuss patient results between clinic weeks was low in both models. Conclusions  The resident-matched model increased resident and preceptor perceptions of familiarity with complex patients and early preceptor perceptions of comfort in assessment of milestone achievements.

Unplanned Reoperation and Implant Revision After Total Wrist Arthroplasty

Hand ◽  
2020 ◽  
pp. 155894471989881 ◽  
Author(s):  
Taylor M. Pong ◽  
Wouter F. van Leeuwen ◽  
Kamil Oflazoglu ◽  
Philip E. Blazar ◽  
Neal Chen
Keyword(s):  
Risk Factors ◽  
Implant Removal ◽  
Academic Medical Centers ◽  
Implant Design ◽  
Factors Associated ◽  
Medical Centers ◽  
Total Wrist Arthroplasty ◽  
Academic Medical ◽  
Related Risk ◽  
Wrist Arthroplasty

Background: Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. Methods: In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Results: Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed ( P = .08). There were no risk factors associated with reoperation or implant removal. Conclusion: Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.

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