scholarly journals Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Donald Likosky ◽  
Steven J Yule ◽  
Michael R Mathis ◽  
Roger D Dias ◽  
Jason J Corso ◽  
...  
Keyword(s):  
Adverse Events ◽  
Technical Skills ◽  
Assessment Tools ◽  
Complication Rates ◽  
University Of Michigan ◽  
Electronic Health Record Data ◽  
Institutional Review ◽  
Computer Based ◽  
The University ◽  
The Relationship

BACKGROUND Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. OBJECTIVE The objectives of this study are to (1) investigate the relationship between peer assessments of intraoperative technical skills and nontechnical practices with risk-adjusted complication rates and (2) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and nontechnical practices. METHODS This multicenter study will use video recording, established peer assessment tools, electronic health record data, registry data, and a high-dimensional computer vision approach to (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based nontechnical practices and variability in risk-adjusted patient adverse events; and (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven, computer-based assessments to automate the measurement of important intraoperative determinants of risk-adjusted patient adverse events. RESULTS The project has been funded by the National Heart, Lung and Blood Institute in 2019 (R01HL146619). Preliminary Institutional Review Board review has been completed at the University of Michigan by the Institutional Review Boards of the University of Michigan Medical School. CONCLUSIONS We anticipate that this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon’s technical skills and operating room team member nontechnical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/22536

scholarly journals Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study

10.2196/22536 ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. e22536
Author(s):  
Donald Likosky ◽  
Steven J Yule ◽  
Michael R Mathis ◽  
Roger D Dias ◽  
Jason J Corso ◽  
...  
Keyword(s):  
Adverse Events ◽  
Technical Skills ◽  
Assessment Tools ◽  
Complication Rates ◽  
University Of Michigan ◽  
Electronic Health Record Data ◽  
Institutional Review ◽  
Computer Based ◽  
The University ◽  
The Relationship

Background Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. Objective The objectives of this study are to (1) investigate the relationship between peer assessments of intraoperative technical skills and nontechnical practices with risk-adjusted complication rates and (2) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and nontechnical practices. Methods This multicenter study will use video recording, established peer assessment tools, electronic health record data, registry data, and a high-dimensional computer vision approach to (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based nontechnical practices and variability in risk-adjusted patient adverse events; and (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven, computer-based assessments to automate the measurement of important intraoperative determinants of risk-adjusted patient adverse events. Results The project has been funded by the National Heart, Lung and Blood Institute in 2019 (R01HL146619). Preliminary Institutional Review Board review has been completed at the University of Michigan by the Institutional Review Boards of the University of Michigan Medical School. Conclusions We anticipate that this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon’s technical skills and operating room team member nontechnical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. International Registered Report Identifier (IRRID) PRR1-10.2196/22536

Effects of decoupling on spectra of seismic waves

1962 ◽  
Vol 52 (1) ◽  
pp. 123-131
Author(s):  
D. E. Willis ◽  
James T. Wilson
Keyword(s):  
Seismic Waves ◽  
High Explosive ◽  
Atomic Energy Commission ◽  
University Of Michigan ◽  
Frequency Spectra ◽  
Spherical Cavities ◽  
Significant Difference ◽  
The University ◽  
Relationship Of ◽  
The Relationship

Abstract A series of controlled high explosive shots were conducted by the Atomic Energy Commission in a salt mine near Winnfield, Louisiana, to investigate seismic decoupling theories. Two recording stations were used by the University of Michigan at various distances between 1.1 and 14.7 kilometers for a majority of these shots. Frequency analyses of the magnetic tape recordings were made and the results are presented showing the relationship of the frequency spectra as a function of charge size, distance from the source, and coupled vs decoupled shots. The smaller decoupled shots detonated in the large spherical cavities were observed to have somewhat higher predominate frequencies than the equivalent size coupled shots. A change in cavity size produced no significant difference in the shape of the spectra of the large decoupled shots.

Abstract 14101: A Correction Score for Comparison of Aortic Calcification in Post-contrast and Non-contrast Measurements From Computed Tomography Scans

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Steven R Horbal ◽  
Edward Brown ◽  
Brian A Derstine ◽  
Peng Zhang ◽  
Andrea H Rossman ◽  
...  
Keyword(s):  
Pearson Correlation ◽  
Aortic Calcification ◽  
University Of Michigan ◽  
Variance Inflation Factor ◽  
Post Contrast ◽  
Abdominal Aortic ◽  
Pixel Value ◽  
Inflation Factor ◽  
The University ◽  
The Relationship

Introduction: Aortic calcification can be utilized to assess cardiovascular risk. While contrast is useful for vascular enhancement in diagnostic imaging, enhancement creates heterogeneity between post and non-contrast scans and limits their direct comparability. Hypothesis: We hypothesized that post and non-contrast aortic calcification measures will correlate, and a correction score can be developed for statistical comparability. Methods: Retrospective CT-scans were obtained from the University of Michigan. Participants (N=330) received abdominal scans with and without contrast enhancement within 120 calendar days. Analytic Morphomics was used to obtain vertebral-indexed measurements of aortic calcium area, and aortic wall obfuscation percentage. Calcification was specifically identified as regions with a given morphology and pixel value five standard deviations above the defined central lumen zone. Pearson correlation and multiple linear regression were used to explain the relationship between aortic measurements with and without contrast. Regressions include calcification percent (Model 1), and area (Model 2). Independent variables were non-contrast measurements and dependent variables were contrast measurements, age, and sex. Results: Correlations of calcification percent ranged from 0.86 at T11 and 0.94 and L2. Correlations of calcification area ranged from 0.66 at T12 to 0.84 at L3. In Model 1, for every percent increase in post-contrast calcification, non-contrast calcification percent increased by 11% (β=1.11, p <0.001, R2=0.85). In Model 2, for every mm2 increase in post-contrast calcification area, non-contrast calcification area increased by 0.45 mm2 (β=1.45, p <0.001, R2=0.69). Variance inflation factor for Model 1 was 1.08 and 1.07 for Model 2. Conclusion: In conclusion, this research proposes a correction score for comparisons of abdominal aortic calcification measurements in post-contrast and non-contrast scans.

Patterns of alcohol consumption and psychiatric disorders among Ontario adults

1997 ◽  
Vol 24 (3) ◽  
pp. 533-556 ◽  
Author(s):  
Helen Ross ◽  
Jürgen Rehm ◽  
Gordon Walsh
Keyword(s):  
Mental Health ◽  
Alcohol Consumption ◽  
Psychiatric Disorders ◽  
Problem Drinking ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
University Of Michigan ◽  
And Gender ◽  
The University ◽  
The Relationship

This study examined the relationship between patterns of alcohol consumption, including problem drinking, and psychiatric disorders in the general population. The paper utilizes data on 8,116 adults age 15–64 living in households who were interviewed for the Ontario Health Survey and the Mental Health Supplement. The University of Michigan Composite International Diagnostic Interview (UM-CIDI) was administered by trained lay interviewers to generate lifetime DSM-III-R diagnoses. Unlike previous studies, the results of this study provided no evidence of a U-shaped or J-shaped curve or relationship between alcohol use and mental health. Lifetime abstainers had the lowest risks for all mental disorders examined, while former at-risk drinkers (those who had not had a drink in the previous year but at one time regularly drank more than 12 drinks a week) had the highest risks, even after adjustment for age and gender.

The War against Catholicism: Liberalism and the Anti-Catholic Imagination in Nineteenth-Century Germany. By Michael B. Gross. Ann Arbor, MI: The University of Michigan Press. 2004. Pp. 376. $70.00 (cloth); $24.95 (paper). ISBN 0-472-11383-6 (cloth); 0-472-03130-9 (paper).

2006 ◽  
Vol 39 (2) ◽  
pp. 311-314
Author(s):  
Siegfried Weichlein
Keyword(s):  
Nineteenth Century ◽  
Religious Conflict ◽  
University Of Michigan ◽  
Ann Arbor ◽  
And Gender ◽  
The University ◽  
The Relationship

In recent years, a growing literature on nationalism has highlighted cultural and gender topics. At the same time, religion, most prominently Catholicism, has attracted the intellectual energy of more and more scholars. To date, however, the relationship between nationalism and religion has been undervalued. Helmut Walser Smith's study German Nationalism and Religious Conflict was one of the first to relate religious conflict to the character of German nationalism. Michael B. Gross now analyzes the relationship between German liberalism and religion.

‘The Wooden Heads of the People’: Arnold Daly and Bernard Shaw

2006 ◽  
Vol 22 (1) ◽  
pp. 54-69 ◽  
Author(s):  
Leigh Woods
Keyword(s):  
The Other ◽  
University Of Michigan ◽  
The People ◽  
Theatre Studies ◽  
The University ◽  
Bernard Shaw ◽  
Marked Points ◽  
The Relationship

Once Arnold Daly and Bernard Shaw had got through their baptisms of fire in the transatlantic theatre of the 1890s, the circumstances for their future collaboration must have seemed propitious to them both. However, the Irish-American's inflexibility and the Anglo-Irishman's passion for control led to the fracturing of the relationship within the span of a few years in the first decade of the new century. The exposure of their work – in tandem in American vaudeville and later as competitors on the English variety stage – marked points of their disagreement and quirks in their difficult personalities as they scrambled for audiences who rarely appreciated them as much as both felt they deserved. Leigh Woods, Head of Theatre Studies at the University of Michigan, explores the breakdown of a partnership that launched one man on a course to oblivion and the other on a path to greater glory.

Comparison of venous thromboembolism risk stratification models in a high risk otolaryngology patient cohort

2019 ◽  
Vol 29 (5) ◽  
pp. 129-134
Author(s):  
Tristan Tham ◽  
Peter Costantino
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Scoring Systems ◽  
Neck Surgery ◽  
Assessment Tools ◽  
University Of Michigan ◽  
Data Collection Process ◽  
The Mean ◽  
The University

Our objective was to compare the venous thromboembolism outcomes in two of the most commonly utilised venous thromboembolism assessment tools, the Caprini system and the University of Michigan system, in a high risk head and neck surgery population. Currently, there is a lack of data reporting the validation of well known scoring systems in this patient population. Established risk factors for venous thromboembolism were included in the data collection process. We retrospectively evaluated all patients with the Caprini Risk Assessment and the University of Michigan Health System (UMHS) Scores. Out of all the risk factors, only length of surgery was found to be associated with venous thromboembolism. The mean Caprini scores in those with and without venous thromboembolism were 8.00 ± 3.00 and 6.86 ± 1.45, respectively. The mean UMHS scores in those with and without venous thromboembolism were 6.85 ± 1.28 and 6.54 ± 1.20, respectively. Both scoring systems were not found to be associated with venous thromboembolism.

scholarly journals Clinical Testing in Diabetic Peripheral Neuropathy

1994 ◽  
Vol 21 (S4) ◽  
pp. S3-S7 ◽  
Author(s):  
Eva L. Feldman ◽  
Martin J. Stevens
Keyword(s):  
Clinical Practice ◽  
Diabetic Neuropathy ◽  
Complex Disease ◽  
Diabetic Polyneuropathy ◽  
Screening Instrument ◽  
Assessment Tools ◽  
University Of Michigan ◽  
The University ◽  
Brief Screening ◽  
Screening And Diagnosis

Abstract:Diabetic polyneuropathy is a complex disease of progressive nerve fiber loss. Initial screening and diagnosis in clinical practice usually depend on assessment of subjective complaints. A need exists for objective, simple, and reproducible assessment tools that can be readily used in clinical practice. The importance of early diagnosis is highlighted by the recent North American Diabetes Control and Complications Trial where intensive insulin therapy reduced the risk of developing diabetic neuropathy by 61%. At the University of Michigan, we have developed an outpatient neuropathy program. Patients are given a questionnaire and a brief screening examination, designated the Neuropathy Screening Instrument. Diabetic neuropathy is confirmed and staged in patients with a positive Neuropathy Screening Instrument, by a quantitative neurologic examination and nerve conduction studies, designated the Diabetic Neuropathy Score. The Michigan program has been compared with well-established instruments and has been found to be sensitive and reproducible for screening and diagnosis. We believe the program provides a valuable tool for the clinician in the practice setting and should allow diagnosis and intervention earlier in the course of diabetic neuropathy.

A Use of the University of Michigan

2019 ◽  
pp. 164-182
Author(s):  
Ethan Schrum
Keyword(s):  
Economic Development ◽  
Development Economics ◽  
Behavioral Science ◽  
Peace Corps ◽  
University Of Michigan ◽  
University Of Chicago ◽  
University Administrators ◽  
Economics Department ◽  
The University ◽  
The Relationship

Chapter 5 examines how Samuel P. Hayes, Jr., an early Point Four official who later helped design the Peace Corps, tried to “use” the University of Michigan to establish a program of multidisciplinary organized research on economic development, the Center for Research on Economic Development (CRED). The resistance he encountered from university administrators and economics department colleagues suggests that traditional academic norms did not always yield completely to interdisciplinary organized research. Yet the establishment of CRED, which had parallels at the University of Chicago, Vanderbilt, and Yale, suggests the importance of economic development as a focus for organized research in the instrumental university. This chapter also provides an account of the new subfield of development economics and of the relationship between the economics discipline and the behavioral science paradigm.

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