scholarly journals AN OPERATIONAL PERSPECTIVE OF THE CHANGING PROSTHETICS & ORTHOTICS LANDSCAPE

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jeffrey M. Brandt
Keyword(s):  
Clinical Care ◽  
Standard Of Care ◽  
Early Career ◽  
Sensor Technology ◽  
Care Organization ◽  
Practice Model ◽  
Care Experience ◽  
Cultural Fit ◽  
Advance Care ◽  
Technology Product

Leading the growth of a private prosthetic and orthotic (P&O) practice, as clinician and founder, I developed a unique perspective of this rapidly changing profession. Many positive influences from my early career shaped my vison toward an innovative practice model, as well as the need to elevate the standard of care through education and the use of outcome measures.  As the practice model expanded, advancements were made in electronic health records (EHR), best-in-class outsource fabrication, and clinical research. To better support clinicians and patients served, an organizational structure with an executive team was built. The practice model achieved operational efficiency through documenting best practices, developing a hiring and onboarding process, and establishing key performance indicators aligned with quality clinical care. As a regional clinical care organization, the practice model seized an opportunity to reach more patients through a partnership that brought the optimal strategic and cultural fit. Bringing our innovative P&O practice model together with expertise in lean facility design, scanning, fabrication, sensor technology, product development and clinical care experience from around the world, we can advance care standards and improve the patient experience in exciting new ways. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35996/28414 How To Cite: Brandt JM. An operational perspective of the changing prosthetics & orthotics landscape. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.19. https://doi.org/10.33137/cpoj.v4i2.35996 Corresponding Author: Jeffrey M. Brandt, CPOAbility Prosthetics & Orthotics, 660 West Lincoln Highway, Exton, PA 19341, USA.E-Mail: [email protected] ID: https://orcid.org/0000-0002-7377-9516

scholarly journals Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study

2016 ◽  
Vol 44 (1) ◽  
pp. 194-204 ◽  
Author(s):  
Gary E. Marchant ◽  
Kathryn Scheckel ◽  
Doug Campos-Outcalt
Keyword(s):  
Precision Medicine ◽  
New Technologies ◽  
Clinical Care ◽  
Large Body ◽  
Standard Of Care ◽  
Genetic Profile ◽  
Legal Standards ◽  
Standards Of Evidence ◽  
The Individual

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed.

Resident Physician Experience and Duration of Electronic Health Record Use

2021 ◽  
Vol 12 (04) ◽  
pp. 721-728
Author(s):  
A. Jay Holmgren ◽  
Brenessa Lindeman ◽  
Eric W. Ford
Keyword(s):  
Care Delivery ◽  
Well Being ◽  
Early Career ◽  
Ambulatory Setting ◽  
Care Experience ◽  
Resident Physicians ◽  
Physician Time ◽  
After Hours ◽  
Electronic Health ◽  
The Impact

Abstract Background Electronic health records (EHRs) demand a significant amount of physician time for documentation, orders, and communication during care delivery. Resident physicians already work long hours as they gain experience and develop both clinical and socio-technical skills. Objectives Measure how much time resident physicians spend in the EHR during clinic hours and after-hours, and how EHR usage changes as they gain experience over a 12-month period. Methods Longitudinal descriptive study where participants were 622 resident physicians across postgraduate year cohorts (of 948 resident physicians at the institution, 65.6%) working in an ambulatory setting from July 2017 to June 2018. Time spent in the EHR per patient, patients records documented per day, and proportion of EHR time spent after-hours were the outcome, while the number of months of ambulatory care experience was the predictor. Results Resident physicians spent an average of 45.6 minutes in the EHR per patient, with 13.5% of that time spent after-hours. Over 12 months of ambulatory experience, resident physicians reduced their EHR time per patient and saw more patients per day, but the proportion of EHR time after-hours did not change. Conclusion Resident physicians spend a significant amount of time working in the EHR, both during and after clinic hours. While residents improve efficiency in reducing EHR time per patient, they do not reduce the proportion of EHR time spent after-hours. Concerns over the impact of EHRs on physician well-being should include recognition of the burden of EHR usage on early-career physicians.

scholarly journals THE CLINICAL TRANSLATION OF SENSOR TECHNOLOGY TO IMPROVE PROVIDER AND PATIENT CARE: METHODS AND ACCEPTABILITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S831-S831
Author(s):  
Megan Huisingh-Scheetz ◽  
Qianli Xue ◽  
Jennifer A Schrack
Keyword(s):  
Technology Use ◽  
Social Life ◽  
Clinical Care ◽  
Wearable Sensors ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Living Environment ◽  
Sensor Technology ◽  
Technology Research ◽  
Aging Research

Abstract Sensor-based technologies are rapidly emerging and are capable of collecting objective, dynamic, and high resolution health data not captured in the clinical setting. However, the precise clinical applications of such devices are not yet well delineated; extensive challenges to their implementation remain. The objectives of this symposium are to highlight a) opportunities for sensor technology use in clinical practice, b) implementation challenges reported by key stakeholders, and c) an NIH/VA-sponsored initiative to create an open technology research platform to improve aging technology research. Dr. Young will discuss the novel application of wearable sensors for maintaining proper posture/position during patient transfer including the generation of sensor metrics defining proper lifting technique and body mechanics. Dr. Huisingh-Scheetz will report analytic strategies for identifying frailty using wrist-worn accelerometry data collected in the free-living environment in the NIA-supported National Social Life, Health and Aging Project dataset. She will report her work relating hourly activity and between/within subject hourly activity variance to frailty. Ms. Blinka will report qualitative feedback collected from patients, caregivers, and healthcare providers about their perspectives on the utility and challenges of using sensor technology in a clinical context. Dr. Kaye will discuss ongoing developments addressing challenges to implementing technology use in clinical care, with particular attention to the Collaborative Aging Research using Technology (CART) initiative supported by the NIH and VA. Collectively, these presentations will advance sensor technology to improve healthcare delivery.

scholarly journals Framing advance care planning in Parkinson disease

Neurology ◽  
2019 ◽  
Vol 92 (22) ◽  
pp. e2571-e2579 ◽  
Author(s):  
Hillary D. Lum ◽  
Sarah R. Jordan ◽  
Adreanne Brungardt ◽  
Roman Ayele ◽  
Maya Katz ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Advance Care Planning ◽  
Best Practice ◽  
Clinical Care ◽  
Active Role ◽  
Care Planning ◽  
Care Partners ◽  
Interdisciplinary Approaches ◽  
Advance Care ◽  
Partner Perceptions

ObjectiveAdvance care planning (ACP) is a core quality measure in caring for individuals with Parkinson disease (PD) and there are no best practice standards for how to incorporate ACP into PD care. This study describes patient and care partner perspectives on ACP to inform a patient- and care partner-centered framework for clinical care.MethodsThis is a qualitative descriptive study of 30 patients with PD and 30 care partners within a multisite, randomized clinical trial of neuropalliative care compared to standard care. Participants were individually interviewed about perspectives on ACP, including prior and current experiences, barriers to ACP, and suggestions for integration into care. Interviews were analyzed using theme analysis to identify key themes.ResultsFour themes illustrate how patients and care partners perceive ACP as part of clinical care: (1) personal definitions of ACP vary in the context of PD; (2) patient, relationship, and health care system barriers exist to engaging in ACP; (3) care partners play an active role in ACP; (4) a palliative care approach positively influences ACP. Taken together, the themes support clinician initiation of ACP discussions and interdisciplinary approaches to help patients and care partners overcome barriers to ACP.ConclusionsACP in PD may be influenced by patient and care partner perceptions and misperceptions, symptoms of PD (e.g., apathy, cognitive dysfunction, disease severity), and models of clinical care. Optimal engagement of patients with PD and care partners in ACP should proactively address misperceptions of ACP and utilize clinic teams and workflow routines to incorporate ACP into regular care.

scholarly journals COVID-19 mental health care toolkit: an international collaborative effort by Early Career Psychiatrists section

2020 ◽  
Vol 33 (5) ◽  
pp. e100270
Author(s):  
Frances Adiukwu ◽  
Laura Orsolini ◽  
Drita Gashi Bytyçi ◽  
Samer El Hayek ◽  
Jairo M Gonzalez-Diaz ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Clinical Care ◽  
Outpatient Setting ◽  
Early Career ◽  
Collaborative Effort ◽  
Risk Patients ◽  
International Research Team ◽  
Health Field

The collaborative effort of an international research team from the Early Career Psychiatrists section of the World Psychiatry Association has brought about an easy-to-use, quick and stepwise mental health care toolkit for the identification and appropriate referral of those in need of mental health care during the pandemic. This simple guide can be applied in the general outpatient setting and is catered for all healthcare professionals, regardless of their expertise within the mental health field with minimal training. It is our hope that by incorporating this toolkit into our daily clinical care during the pandemic for high-risk patients and patients with non-specific complaints, we will be able to bridge the mental health gap present in our society.

Risk Management in a Pandemic Crisis at a Global Non Profit Health Care Organization

2012 ◽  
Vol 1 (4) ◽  
pp. 1-17
Author(s):  
Drew Sugaretty
Keyword(s):  
Health Care ◽  
Risk Management ◽  
Best Practice ◽  
Health Care Organization ◽  
Care Organization ◽  
Practice Model ◽  
Non Profit ◽  
Global Pandemic ◽  
Management Processes

This paper categorizes the risks experienced and voiced by subject matter experts at a pandemic crises event which unfortunately claimed almost 800 lives before it could be controlled. The project was a case study design using multiple methods. Qualitative data was collected by interviewing 22 front-line multicultural crisis practitioners. The unit of analysis was the constructed meaning of the uncertainty and risk management processes experienced by the participants, while they were attempting to control the global pandemic crisis associated with the Severe Acute Respiratory Syndrome outbreak during 2003. Several guiding constructs were researched from the literature review. NVIVO was used to analyze the interview transcripts to build a thematic model of constructed meanings. The result was a best-practice model constructed by the practitioners which they felt improved risk control during a significant global pandemic crisis event considering the lead mitigation agency was a nonprofit health care organization.

scholarly journals Patient Perspectives on Advance Care Planning via a Patient Portal

2019 ◽  
Vol 36 (8) ◽  
pp. 682-687 ◽  
Author(s):  
Sarah R. Jordan ◽  
Adreanne Brungardt ◽  
Phoutdavone Phimphasone-Brady ◽  
Hillary D. Lum
Keyword(s):  
Health Care ◽  
Advance Care Planning ◽  
Clinical Care ◽  
Patient Perspectives ◽  
Medical Decision ◽  
Patient Portal ◽  
Care Planning ◽  
Power Of Attorney ◽  
Regional Health Care ◽  
Advance Care

Background:Patient portals can offer patients an opportunity to engage in the advance care planning (ACP) process outside of clinical visits.Objective:To describe patient perspectives on use of patient portal-based ACP tools.Design:Interviews with patients who used portal-based ACP tools. The tools included an electronic Medical Durable Power of Attorney (MDPOA) form to designate a medical decision maker, a patient-centered educational web page, online messaging, and patient access to completed advance directives stored in the electronic health record (EHR).Setting:Regional health-care system with a common EHR.Measurements:Semistructured interviews with purposefully sampled patients who used the ACP tools. Questions explored motivations for using the tools and perceptions about how the tools fit into ACP. Analysis followed a grounded hermeneutic editing approach.Results:From 46 patients (mean age: 49, 63% female), 4 key themes emerged: (1) individualized explorations of the ACP tools, (2) personal initiation and engagement with ACP tools through the portal, (3) value of connecting ACP portal tools to clinical care, and (4) practicality of the ACP tools. Patients described benefits of communicating with health-care team members who referred them to online ACP tools, as well as having the electronic MDPOA form connected to clinical care.Conclusions:Patients considered the portal-based ACP tools to be practical and feasible to use within the scope of their own ACP experiences. Further study is needed to understand whether portal-based ACP tools increase the quality and quantity of ACP conversations and documentation that is available to inform medical decision-making.

scholarly journals How to Be Savvy About Gender Disparities in Academic Stroke Medicine

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Aleksandra Pikula ◽  
Luciana Catanese ◽  
Cheryl D. Bushnell ◽  
Valeria Caso ◽  
Julie K. Silver
Keyword(s):  
Clinical Care ◽  
Critical Role ◽  
Women's Leadership ◽  
Gender Disparities ◽  
Early Career ◽  
Diagnostic Tools ◽  
Career Stage ◽  
Clinical Practices ◽  
New Treatments

In the past decade, stroke medicine has evolved from discovery of innovative diagnostic tools to implementation of new treatments. These advances are projected to increase the demand for stroke neurologists in academic and clinical practices, but hopefully with equitable opportunities for everyone across the gender spectrum. Academic medicine provides opportunities to participate in clinical care, teaching, research, and administration. The early career stage is short-focused on finding an academic niche and developing new skills that will help you navigate the academic environment. A recent InterSECT article emphasized the critical role of women’s leadership in stroke medicine. In this article, we reflect on workforce gender disparities and provide 5 practical strategies that may help women overcome barriers and advance their work mission.

Adoption and utilization of NGS-based molecular profiling in community-based oncology practices: Insights from Sarah Cannon.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18064-e18064
Author(s):  
Andrew McKenzie ◽  
Daniel Schlauch ◽  
Yasha Sharma ◽  
David R. Spigel ◽  
Howard A. Burris ◽  
...  
Keyword(s):  
Clinical Care ◽  
Community Setting ◽  
Standard Of Care ◽  
Molecular Profiling ◽  
Community Based ◽  
Sequencing Technologies ◽  
Community Oncology ◽  
Medical Oncologists ◽  
Tumor Types ◽  
Ngs Data

e18064 Background: As the price of NGS-based sequencing technologies falls, adoption of those technologies is predicted to increase. To date, a survey of the adoption and utilization of NGS-based technologies as a part routine oncology clinical care has not been performed. Thus, a comprehensive analysis of physician adoption and utilization of commercial NGS testing in the community-setting between 2012 and 2018 was performed. Methods: Medical Oncologists in the Sarah Cannon Research Institute network ordered commercially-available NGS-based molecular profiling for their patients as standard of care. Data use agreements were initiated between SCRI, affiliated medical oncology practices, and commercial NGS testing providers, and patient NGS data were subsequently analyzed starting in 2012. Results: Community-based NGS testing rates within the Sarah Cannon network were 5.75/month in 2012 and 440/month in 2018. Plasma-based NGS testing began in 2014 and comprised 4.9% of total testing compared to 40.1% in 2018. The number of oncologists ordering molecular profiles increased from 11 in 2012 to 269 in 2018. Physician test utilization grew from an average of 6 tests/physician to 22 tests/physician in 2012 and 2018, respectively. NGS tests were performed on 34 different tumor types and biopsies were taken from both primary (~40%) and metastatic (~60%) sites . Tissue-based tests averaged 14 mutations/sample while plasma-based tests averaged 4 mutations/sample. There was a 74% decrease in median time between biopsy collection and NGS test results between 2012 and 2018 (131 and 34 days, respectively), indicating a shift toward the use of fresh – non-archival – tissue in recent years. Conclusions: These data establish NGS-based testing trends in community oncology practices and show that NGS-based tumor testing utilization has increased in the community-setting between 2012 and 2018. NGS testing is performed on a wide array of tumor types and oncologists utilize fresher biopsies.

scholarly journals Recommendations for Treating Males: An Ethical Rationale for the Inclusion of Testicular Self-Examination (TSE) in a Standard of Care

2015 ◽  
Vol 12 (3) ◽  
pp. 539-545 ◽  
Author(s):  
Michael J. Rovito ◽  
Janna Manjelievskaia ◽  
James E. Leone ◽  
Michael Lutz ◽  
Chase T. Cavayero ◽  
...  
Keyword(s):  
Task Force ◽  
Clinical Care ◽  
Significant Risk ◽  
Standard Of Care ◽  
Health Practitioner ◽  
Ethical Implications ◽  
Legal Term ◽  
Health Practitioners ◽  
Care Guidelines ◽  
Self Examination

The phrase “standard of care” is primarily a legal term representing what procedure a reasonable person (i.e., health practitioner) would administer to patients across similar circumstances. One major concern for health practitioners is delivering and advocating for treatments not defined as a standard of care. While providing such treatments may meet certain ethical imperatives, doing so may unwittingly trigger medical malpractice litigation fears from practitioners. Apprehension to deviate, even slightly, from the standard of care may (seem to) put the practitioner at significant risk for litigation, which, in turn, may limit options for treatment and preventive measures recommended by the practitioner. Specific to testicular treatment, certain guidelines exist for cancer, torsion, vasectomy, and scrotal masses, among others. As it relates to screening, practitioner examination is expected for patients presenting with testicular abnormalities. Testicular self-examination (TSE) advocacy, however, is discouraged by the U.S. Preventive Services Task Force, which may prompt a general unwillingness among health practitioners to promote the behavior. Considering the benefits TSE has beyond cancer detection, and the historical support it has received among health practitioners, it is paramount to consider the ethical implications of its official “exclusion” from preventive health and clinical care recommendations (i.e., standard of care). Since good ethics should lead practitioner patient care guidelines, not fear of increased malpractice risks, we recommend the development of a standard of care for counseling males to perform TSE.

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