scholarly journals Evaluating the Use of Telemedicine in Endocrinology Clinic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A341-A341
Author(s):  
Maryam Nemati ◽  
Archana Reddy ◽  
Syung Jung ◽  
Jessica Nguyen
Keyword(s):  
Quality Of Care ◽  
Clinic Visit ◽  
Time Saving ◽  
Phone Calls ◽  
Number Of Patients ◽  
Before And After ◽  
Endocrinology Clinic ◽  
Clinic Visits

Abstract The COVID-19 pandemic changed patient-physician interaction. As the need to reduce COVID-19 transmission, many clinic providers have converted their in-person visits to video or phone visits. Our endocrinology clinic initiated tele visits early on when the pandemic had just started. Telemedicine may help with patient’s compliance by decreasing various burdens. Some studies show that patients and providers hope telemedicine will continue after the crisis. In this study we evaluated benefits and challenges of telemedicine in our endocrinology clinic. Patients who had a telemedicine endocrinology visit after informed consent were surveyed on 10 questions regarding benefits and limitations of the tele visits compared to the clinic visit. Patient also responded if they want to continue with telehealth after COVID-19 pandemic. Providers also were surveyed about the benefits and limitations of telemedicine and responded if they want to continue with telemedicine after pandemic. We also analyzed no-show rate from January 2020 through May 2020 for 6 weeks before and after the implementation of telemedicine. Among 109 patients who were interviewed 65% declared that they would like to continue with telemedicine after pandemic. Total of 42% of patients prefer video visit and 37% prefer phone calls. Among Interviewers 45% report benefit of spending less time, however 54% stat the time of meeting, itself was about the same. 54% believe they spent less money with telemedicine. 37% of interviewers report no limitation for telehealth while 25% report connection difficulty. 63% of patients state they do not have any difficulty traveling to the hospital. 90% of the patients declare all their question and concerns were responded and 77% stated the quality of care with telemedicine is almost the same via clinic visit. Among providers 75% want to continue telehealth after COVID-19 pandemic. 50% of providers mention patient satisfaction and 25% notice time saving as benefits. 46% of the providers mention lack of physical exam and 40% mention technology connection as the limitation for video visit. 60% of providers believe lack of exam is the limitation of phone visit. 87% of the providers believe the quality of care via phone is not like in clinic visit while 75% of the providers believe the quality of care is similar in video visit compare to in clinic visits. No show rate decreased from 30% to 27% after the implementation of telemedicine in 6 weeks prior and after pandemic. Endocrinology clinic has significant number of patients who need long term close follow up for medication adjustments, symptom checks and counseling. Given patients and providers satisfaction rate, telemedicine can be incorporated as part of regular clinic visits after the Covid crisis ends. Telehealth can be more efficient for both patients and providers but there are challenges which needs to be addressed.

Quality-of-care implications of improving physician communication through a Web-based tool (Teamwork).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 310-310 ◽  
Author(s):  
Alex Pimenta Silva ◽  
Vanessa Dybal Bertoni ◽  
Therese M. Mulvey ◽  
Carlos Sampaio
Keyword(s):  
Quality Of Care ◽  
Treatment Plan ◽  
Large City ◽  
Northeastern Brazil ◽  
Multidisciplinary Teams ◽  
Monday Morning ◽  
Major Step ◽  
Phone Calls ◽  
Number Of Patients

310 Background: Our practice is a community-based multidisciplinary oncology-hematology outpatient clinic located in Northeastern Brazil serving a population of three million. Hospitalizations are frequent events for treatment of complications and for palliative care. Patients are distributed in several different units across five hospitals. A team of oncologists, hematologists and other clinicians is organized in daily shifts for ambulatory consults and hospital visits. The group meets every Monday morning in rounds for case discussion and planning. The number of patients, physicians and hospitals involved poses a communication challenge. Methods: In order to improve communication and quality of care, we created a internet application (Teamwork) which provides a patient table sorted by hospital, room number, assistant physician, last visiting doctor, diagnosis and treatment plan. This information is easily accessible from any internet connected computer, tablet or smartphone with a friendly graphic interface. The doctor who admits or consults with the patient is responsible for daily updates. All the multidisciplinary teams may consult and add information. Results: Data from our program between March 2011 and June 2012 demonstrated that on average 7 physicians visited a mean of 21.8 patients daily in 5 different hospitals. With the use of the online application (Teamwork) improvements in quality of care were noticed, including: 1) Admitted patient information was rapidly available for the team, anywhere; 2) Doctors could immediately identify the physician responsible for the most recent visit, improving communication, optimizing time and reducing uneccessary phone calls to make decisions; 3) Doctors out of town could obtain updated information about their patients and contribute to their care; 4) Statistical information was readily available, providing data for improvement of team organization. Conclusions: The use of a simple online database, easily accessible and updatable represents a major step forward in the quality of care as measured by enhanced communication among providers, making it possible to assist patients in several hospitals, in a large city, with minimal communication stress.

The ENT emergency clinic: does senior input matter?

2012 ◽  
Vol 127 (1) ◽  
pp. 15-19 ◽  
Author(s):  
A Mirza ◽  
L McClelland ◽  
M Daniel ◽  
N Jones
Keyword(s):  
Quality Of Care ◽  
Discharge Rate ◽  
Surrogate Marker ◽  
Operating Theatre ◽  
Number Of Children ◽  
Discharge Rates ◽  
Time Period ◽  
Number Of Patients

AbstractBackground:Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.Method:Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.Results:The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.Conclusion:The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

scholarly journals Pain management after lung surgery

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Maria Frödin ◽  
Margareta Warrén Stomberg
Keyword(s):  
Quality Of Care ◽  
Pain Management ◽  
Postoperative Pain ◽  
Severe Pain ◽  
Postoperative Pain Management ◽  
Lung Surgery ◽  
Moderate Pain ◽  
Number Of Patients ◽  
Severe Postoperative Pain

Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the participants and severe pain from 11-26%, during their hospital stay. Thirty-nine percent had more pain than expected. After three months, 20% experienced moderate pain and 4% experienced severe pain, while after six months, 16% experienced moderate pain. The desired quality of care goal was not fully achieved. We conclude that a large number of patients experienced moderate and severe postoperative pain and more than one third had more pain than expected. However, 88% were satisfied with the pain management. The findings confirm the severity of pain experienced after lung surgery and facilitate the apparent need for the continued improvement of postoperative pain management following this procedure.

scholarly journals Ordinal outcome analysis improves the detection of between-hospital differences in outcome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. E. Ceyisakar ◽  
N. van Leeuwen ◽  
Diederik W. J. Dippel ◽  
Ewout W. Steyerberg ◽  
H. F. Lingsma
Keyword(s):  
Logistic Regression ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Statistical Power ◽  
Ordinal Scale ◽  
Efficiency Gain ◽  
Number Of Patients ◽  
Dichotomous Outcomes ◽  
Ordinal Outcome

Abstract Background There is a growing interest in assessment of the quality of hospital care, based on outcome measures. Many quality of care comparisons rely on binary outcomes, for example mortality rates. Due to low numbers, the observed differences in outcome are partly subject to chance. We aimed to quantify the gain in efficiency by ordinal instead of binary outcome analyses for hospital comparisons. We analyzed patients with traumatic brain injury (TBI) and stroke as examples. Methods We sampled patients from two trials. We simulated ordinal and dichotomous outcomes based on the modified Rankin Scale (stroke) and Glasgow Outcome Scale (TBI) in scenarios with and without true differences between hospitals in outcome. The potential efficiency gain of ordinal outcomes, analyzed with ordinal logistic regression, compared to dichotomous outcomes, analyzed with binary logistic regression was expressed as the possible reduction in sample size while keeping the same statistical power to detect outliers. Results In the IMPACT study (9578 patients in 265 hospitals, mean number of patients per hospital = 36), the analysis of the ordinal scale rather than the dichotomized scale (‘unfavorable outcome’), allowed for up to 32% less patients in the analysis without a loss of power. In the PRACTISE trial (1657 patients in 12 hospitals, mean number of patients per hospital = 138), ordinal analysis allowed for 13% less patients. Compared to mortality, ordinal outcome analyses allowed for up to 37 to 63% less patients. Conclusions Ordinal analyses provide the statistical power of substantially larger studies which have been analyzed with dichotomization of endpoints. We advise to exploit ordinal outcome measures for hospital comparisons, in order to increase efficiency in quality of care measurements. Trial registration We do not report the results of a health care intervention.

scholarly journals Life after Cell Death—Survival and Survivorship Following Chemotherapy

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2942
Author(s):  
Tamara Mc Erlain ◽  
Aileen Burke ◽  
Cristina M. Branco
Keyword(s):  
Cancer Cells ◽  
Surgical Excision ◽  
Tumour Burden ◽  
Physical Damage ◽  
Term Care ◽  
Treatment Practices ◽  
Number Of Patients ◽  
Cancer Types

To prevent cancer cells replacing and outnumbering their functional somatic counterparts, the most effective solution is their removal. Classical treatments rely on surgical excision, chemical or physical damage to the cancer cells by conventional interventions such as chemo- and radiotherapy, to eliminate or reduce tumour burden. Cancer treatment has in the last two decades seen the advent of increasingly sophisticated therapeutic regimens aimed at selectively targeting cancer cells whilst sparing the remaining cells from severe loss of viability or function. These include small molecule inhibitors, monoclonal antibodies and a myriad of compounds that affect metabolism, angiogenesis or immunotherapy. Our increased knowledge of specific cancer types, stratified diagnoses, genetic and molecular profiling, and more refined treatment practices have improved overall survival in a significant number of patients. Increased survival, however, has also increased the incidence of associated challenges of chemotherapy-induced morbidity, with some pathologies developing several years after termination of treatment. Long-term care of cancer survivors must therefore become a focus in itself, such that along with prolonging life expectancy, treatments allow for improved quality of life.

scholarly journals Understanding contributors to quality of care in long-term care and changes under COVID-19

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 960-960
Author(s):  
Sara Luck ◽  
Katie Aubrecht
Keyword(s):  
Quality Of Care ◽  
Long Term Care ◽  
The United States ◽  
Control Measures ◽  
Qualitative Description ◽  
Care Staff ◽  
Term Care ◽  
The Impact

Abstract Nursing home facilities are responsible for providing care for some of the most vulnerable groups in society, including the elderly and those with chronic medical conditions. In times of crisis, such as COVID-19 or other pandemics, the delivery of ‘regular’ care can be significantly impacted. In relation to COVID-19, there is an insufficient supply of personal protective equipment (PPE) to care for residents, as PPE not only protects care staff but also residents. Nursing homes across the United States and Canada have also taken protective measures to maximize the safety of residents by banning visitors, stopping all group activities, and increasing infection control measures. This presentation shares a research protocol and early findings from a study investigating the impact of COVID-19 on quality of care in residential long-term care (LTC) in the Canadian province of New Brunswick. This study used a qualitative description design to explore what contributes to quality of care for residents living in long-term care, and how this could change in times of crisis from the perspective of long-term care staff. Interviews were conducted with a broad range of staff at one LTC home. A semi-structured interview guide and approach to thematic analysis was framed by a social ecological perspective, making it possible to include the individual and proximal social influences as well as community, organizations, and policy influencers. Insights gained will improve the understanding of quality of care, as well as potential barriers and facilitators to care during times of crisis.

Impact of Business Process Re-Engineering (BPR) Implementation on Customer Satisfaction in E-Commerce Companies

2018 ◽  
Vol 16 (4) ◽  
pp. 41-52
Author(s):  
Gutama Kusse Getele ◽  
Arrive Tsitaire Jean
Keyword(s):  
Customer Satisfaction ◽  
Random Sample ◽  
Customer Service ◽  
Business Process ◽  
Primary Data ◽  
Survey Questionnaire ◽  
Time Saving ◽  
Before And After

The objective of this article is to analyse the implementation of BPR in e-commerce platforms by measuring the level of customer satisfaction. The issues tested involve: how customers perceive the BPR objectives in e-commerce platforms; time used for diverse transactions before and after BPR; awareness and usage of BPR services provided by e-commerce platforms; satisfaction about the e-commerce platform services after BPR; BPR impact on customers, employees and e-commerce platform performance; advantages of BPR in e-commerce platforms and; difficulties faced by the customers after BPR in the e-commerce platform. Primary data was used through a survey questionnaire on a random sample of 402 student customers of Taobao and JD.com. The results found that time saving is significantly positive on implementation of BPR; following customers perceived a better quality of customer service. The sample student customers perceived that the BPR has a greater impact on customers than on employees, as well as on the performance of a platform.

scholarly journals Investigational Immunotherapeutics for B-Cell Malignancies

2010 ◽  
Vol 28 (5) ◽  
pp. 884-892 ◽  
Author(s):  
Alfonso Quintás-Cardama ◽  
William Wierda ◽  
Susan O'Brien
Keyword(s):  
Monoclonal Antibodies ◽  
B Cell ◽  
Acquired Resistance ◽  
Long Term Outcomes ◽  
Clinical Value ◽  
B Cell Malignancies ◽  
Therapeutic Algorithms ◽  
Number Of Patients

The use of rituximab-based chemoimmunotherapy regimens has remarkably improved the response rates, long-term outcomes, and quality of life of patients with B-cell malignancies. However, a substantial number of patients exhibit either primary or acquired resistance to rituximab, which suggests that novel immunotherapeutics with distinct mechanisms of action are necessary. A series of monoclonal antibodies with specificity against different surface antigens expressed on malignant B cells (eg, CD22, CD23, CD40, CD70) and novel immunotherapeutics (eg, bispecific monoclonal antibodies, small-modular immunopharmaceuticals, T-cell engagers) are currently in clinical or final preclinical stages of development. Although these agents offer reason for optimism, considerable challenges lie ahead in establishing their real clinical value, as well as in integrating them into current therapeutic algorithms for patients with B-cell malignancies. This review describes some of the most promising investigational immunotherapeutics for the treatment of B-cell malignancies.

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