Using an employee resource group to develop GRIT in female healthcare leaders: a case study

Purpose This case study aims to demonstrate how the Greater Leadership Opportunities for Women (GLOW) Mayo Clinic Employee Resource Groups (MERG) has positively impacted leadership development focusing on growth, resilience, inspiration and tenacity (GRIT) and increased advancement for female leaders at Mayo Clinic. It will also establish how the innovative utilization of employee resource groups can positively impact the development of leaders within an institution in general and specially can enhance behaviors related to GRIT. Design/methodology/approach This case study design was used to measure the impact of the GLOW MERG’s interventions through qualitative and quantitative approaches that highlight both process and outcome to increase study validity through complementarity, which “seeks elaboration, enhancement, illustration, clarification of the results from one method with the results from another” (Greene, et al., 1989, p. 259) as well as completeness and context (Onghena et al., 2019; Schoonenboom and Johnson, 2017; Bryman, 2006). Learning outcomes (knowledge), skill accomplishments and attitude development were evaluated within two weeks after each session and annually through standardized surveys sent to participants via email. The surveys were designed to capture key information about the sessions, including the impact of the session content, the willingness and ability of attendees to apply the learning and identification of opportunities for improvement in session design and delivery, as well as measure satisfaction with the activities offered, the frequency and method(s) of communication, barriers to session attendance and particular topics or speakers of interest to members (Appendix 1). Response options included dichotomous scales, Likert-type scales, multi-select and free text. This provided a voluntary response sampling, as post-session surveys were sent to all session attendees and annual surveys were sent to all GLOW MERG members, which allowed individuals to choose if they would respond to the surveys (Creswell and Creswell, 2018). To foster an environment of continuous improvement, plan-do-study-act (PDSA) cycles (Langley et al., 2009) were conducted after every survey by the event planning team and the GLOW MERG Board. Interventions were tested, reviewed and discussed during monthly board meetings and event planning. Improvements were made and results were shared with key stakeholders through regular communication channels. Additionally, 30 past and present GLOW MERG leaders were surveyed to measure their perceived impact of participation in the GLOW MERG interventions using dichotomous scales, multi-select and free text responses (Appendix 2). This targeted purposive sample was selected because of their high level of engagement with the MERG to provide a retrospective evaluation of the success of the GLOW MERG, and its interventions for career advancement related to the development of GRIT attributes, knowledge and skills resulting in career advancement for those who are/have been highly engaged with the MERG. Findings The results spanning the past few years of GLOW MERG interventions has shown that the GLOW MERG has been successful in providing targeted educational events that address the GRIT knowledge, skills and attributes, needed for female health-care leaders to be successful in developing GRIT capabilities. By staying true to its mission and vision, the GLOW MERG has been able to promote, educate and empower female leaders at Mayo Clinic while actively breaking down the barriers that can prevent women from obtaining leadership positions. Research limitations/implications There are several limitations with this case study’s data collection and sampling methods. First, the post-session and annual survey sampling was based mainly on ease of access, with responses obtained from respondents who are more likely to volunteer or those with the strongest opinions. This allowed for potential bias as responses may not be representative of all GLOW MERG member opinions. Furthermore, the purposive sample of present and past GLOW MERG leaders was also subject to volunteer bias and may not have be representative of the GLOW MERG population. Additionally, the case study examined the practices of only one site and MERG group and may not be representative of all sites or employee resources groups. Practical implications The interventions implemented by the GLOW MERG to assist women with developing GRIT knowledge, skills and attributes – barriers women often face in leadership roles – were tested, reviewed and discussed during monthly board meetings and event planning. PDSA cycles were conducted, improvements were made and results were shared with key stakeholders through regular communication channels (Langley et al., 2009). Key lessons learned from these assessments include: One size does not fit all for leadership development. GLOW members have a wide variety of backgrounds, skills and experiences. Repetition is important in the development of GRIT knowledge, skills and attributes associated with GRIT. A one-time event provides attendees with an information overview and the steps to start developing a new skill but no dedicated time to practice and implement that skill. Originality/value The innovative utilization of employee resource groups can positively impact the development of leaders within an institution in general and specially can enhance behaviors related to GRIT.

The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison

Background Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7% (536/9433) no-shows compared to 4.6% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or “clean up” self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5% (7553/8079) of their finalized appointments; only 74.5% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95% CI 4.48-5.37; P<.001). Conclusions Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends.

Detecting cardiomyopathies in pregnancy and the postpartum period using ECG

Background Cardiovascular disease (CVD) has been identified as a major threat to maternal health in the US and UK with cardiomyopathy being one of the most common acquired CVD in the pregnant and postpartum period. Diagnosing cardiomyopathy in pregnancy is challenging due to an overlap of cardiovascular symptoms with normal pregnancy symptoms. Purpose The purpose of this study was to evaluate the effectiveness of an ECG based deep learning model in identifying cardiomyopathy among pregnant and postpartum women. Methods We utilized an ECG based deep learning model to detect cardiomyopathy in a cohort of pregnant or postpartum women seen at multiple hospital sites. Model performance was evaluated using area under the curve (AUC), accuracy, sensitivity, and specificity. We compared the diagnostic probabilities of the deep learning model with natriuretic peptides and a multivariable model consisting of demographic and clinical parameters. Results 1,807 women were included. 7%, 10% and 13% had LVEF ≤35%, &lt;45% and &lt;50% respectively. The ECG based deep learning model identified cardiomyopathy with an AUC of 0.92 for left ventricular ejection fraction (LVEF) ≤35%, 0.89 for LVEF &lt;45% and 0.87 for LVEF &lt;50%. For LVEF ≤35%, AUC was higher in Black (0.95) and Hispanic (0.98) women compared to white (0.91). Natriuretic peptides and the multivariable model had AUCs of 0.85 and 0.72 respectively. Conclusions A deep learning model effectively identifies cardiomyopathy in pregnant or postpartum women, outperforms natriuretic peptides and traditional clinical parameters with the potential to become a powerful initial screening tool for cardiomyopathy in the obstetric care setting. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): This study was made possible using resources supported by the Mayo Clinic Women's Health Research Center and the Mayo Clinic Building Interdisciplinary Research Careers in Women's Health (BIRCWH) Program funded by the National Institutes of Health (NIH), grant number K12 HD065987. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

“Real-life” data of the efficacy and safety of belantamab mafodotin in relapsed multiple myeloma—the Mayo Clinic experience

Belantamab mafodotin is a highly selective targeted therapy for multiple myeloma. It targets the B cell maturation antigen (BCMA) on plasma cells and showed promising results in several randomized clinical trials. We report the outcomes of 36 patients treated at Mayo Clinic. Our cohort received a median of eight prior lines of therapy. Six patients received belantamab in combination with other medications (pomalidomide, cyclophosphamide, thalidomide), 13 patients (36%) were 70 years or older, two patients had a creatinine of >2.5 mg/dL, and one patient was on dialysis. All three patients with renal failure received full dose belantamab. Chimeric antigen receptor (CAR-T) therapy was used prior to belantamab in seven patients and none of them responded to belantamab therapy. The overall response rate (ORR) was 33% (CR 6%, VGPR 8%, PR 19%), like the ORR reported in the DREAMM-2 trial. Keratopathy developed in 16 patients (43%), grade 1 in six patients, grade 2 in seven patients, and grade 3 in three patients. Eight percent discontinued therapy due to keratopathy. The median PFS and OS was 2 months and 6.5 months, respectively.

649 Clinicians miss diagnosis: it wasn’t a tako-tsubo syndrome, nowadays it is a recurrent tako-tsubo syndrome

Aims Tako-Tsubo syndrome is an usual form of acute cardiomyopathy characterized by reversible left ventricle apical ballooning which occurs in the absence of significant coronary artery disease. Rarely an increase in catecholamines due to pheochromocytoma could lead to Tako-Tsubo syndrome. Here we report a clinical case of undetected pheochromocytoma which led to Tako-Tsubo syndrome in an adult female patient. Methods and results A 60 years old female presented at our emergency department with chest pain, increase in cardiac troponin levels and hypo-akinesia of the apical segments at the echocardiography. She was admitted with acute coronary syndrome suspicious. He had history of acute coronary syndrome with non-obstructive coronary arteries (MINOCA) in the 2017. Coronary angiography performed at 24 h from admission, again showed non-obstructive coronary disease, whereby we reviewed the previous MINOCA diagnosis into recurrence Tako-Tsubo syndrome diagnosis. During hospitalization she presented parossistic sinus tachycardia refractory to beta-blocker and ivabradine combined therapy. Cardiac magnetic resonance was performed and confirmed Tako-Tsubo syndrome, furthermore showed a surrenalic mass. Contrast-enhanced abdomen computed tomography and high levels of metanephrines suggested pheochromocytoma diagnosis. One month later she underwent left surrenectomy surgery. Histological examination confirmed pheochromocytoma. The last echocardiography didn’t show kinesia abnormalities with normal left ventricular function. Conclusions Our case illustrates the importance of understanding the correlation between Tako-tsubo syndrome and pheochromocytoma, especially in patients with increased activity of the sympathetic nervous system. Until recently, according to Tako-Tsubo syndrome Mayo Clinic criteria, our patient wouldn’t had receive a Tako-Tsubo syndrome diagnosis because pheochromocytoma was an exclusion criteria. Since 2018, Inter-TAK criteria replaced Mayo Clinic criteria including Tako-Tsubo syndrome expression of pheochromocytoma. Referring to our annoying title we always have to consider Tako-Tsubo syndrome into MINOCA differential diagnosis.