Multiple Sclerosis and MyChart Messaging: A Retrospective Review Evaluating Its Use

Background: Understanding patterns of MyChart (Epic Systems Corp) messaging has the potential to alter clinical practice. However, because most research evaluating its use has been conducted in limited contexts, utilization patterns in patients with multiple sclerosis (MS) remain unclear. We characterized factors associated with high rates of MyChart messaging in patients with MS. Methods: We performed a retrospective cross-sectional analysis of adult patients in an academic outpatient clinic’s database (N = 439). Inclusion criteria were one or more clinic visits and MS diagnosis. We extracted demographic and disease-specific characteristics and MyChart messaging information. Results: MyChart users in the database totaled 74% (n = 324). MyChart users were more often younger, had shorter duration since diagnosis, had lower Patient-Determined Disease Steps scores, and were more likely to be using high-efficacy disease-modifying therapies than nonusers. Messaging rates were positively correlated with total number of unique medications (R = 0.17, P = .003) and negatively correlated with age (R = –0.11, P = .018). Conclusions: Although research has implicated arm-hand disability and impaired vision as barriers to patient portal use, these findings suggest the relationship between MS-specific disease burden and MyChart utilization is also a function of underlying medical complexity in capacities beyond physical disability. These data may serve as groundwork for investigation into other disease-specific settings and for quality improvement research to mitigate these high rates in at-risk patients, optimizing provider time investment, clinic productivity, and patient safety and preventing health care provider burnout.

Safely Enhancing Surgical Ward Patient Flow in the Bed Shortage Era by a structured daily Multi-Disciplinary Board Round. A Quality Improvement Research Report.

Acute hospital bed shortage is a serious concern worldwide, constantly involving high-dependency units (HDU), where the non-availability of postoperative beds results in surgery cancellation. In the acute medicine context, the SAFER Red2Green initiative has shown to enhance patient flow.Local problem At the Royal London hospital, in 2016, hospital-initiated cancellations peaked at over 50% weekly due to the inability of high dependency Units (HDU) to discharge step-down patients to the general surgical wards, where bed occupancy was close to 100% and the average length of stay was stable on average close to 7 (+/- 8.6) days.Methods. This was a service improvement research to enhance patient flow which adapted the SAFER Red2Green model to a surgical ward (SAFER Surgery Red2Green). This before-after study involving all 2017 digestive surgery admissions was divided into a three-month feasibility phase followed by a nine-month pilot phase, versus the year 2016 (pre-intervention). Outcome measures: weekly discharges, length of stay (LOS), surgery cancellations, feasibility of a “theatre go” policy, HDU step-downs, 30-day readmissions.Interventions1) Systematic communication of key care plan from the afternoon ward rounds by surgical teams to the nurse in charge; 2) 10 AM Monday-to-Friday multi-disciplinary senior-team daily board round, addressing updated key care plan aimed at early discharges, appropriateness of each inpatient day, causes of delays; 3) hospital and site managers weekly attendance. Results. At three months: +67% discharges/week (p=0.001), -20% LOS (p=0.023), +21% HDU step-downs, (p=0.205). At one year: +10.7% HDU step-downs (p=0.197), increased probability of earlier discharge (p=0.023), -60% hospital-initiated cancellations from 38 to 15 (p>=1), a “Theatre go” policy has been active since month 6. Failed discharges kept at 1.3 %. The MDT board round staff satisfaction rate was over 80%, with key actors’ attendance over 75%. Conclusions. The Barts SAFER Surgery R2G model safely enhanced patient flow and reduced cancellations and unnecessary nurse staff time. It requires senior medical and nursing commitment, however, is designed for any surgical specialty, and has proven sustainable. It warrants further validation.

Mapping the Field in Stress, Anxiety, and Postpartum Depression in Mothers of Preterm Infants in Neonatal Intensive Care

Objective: The main aim of this study was to describe and conduct a bibliometric analysis of the state of research on stress, anxiety, and postpartum depression in mothers of preterm infants in the Neonatal Intensive Care Unit. Background: Women affected by premature births are particularly exposed to mental health difficulties in the postpartum period. The desire to comprehend and the growing interest in research on stress, anxiety, and postpartum depression in mothers of preterm infants in neonatal intensive care have led to a substantial rise in the number of documents in this field over the last years. Thus, it makes it vital to regularly review the state of knowledge on this phenomenon in order to identify progress and constraints, to stimulate reflection, and to encourage progress in future research. Method: This study examined 366 articles published in the Scopus database (1976–2020). Keyword analysis was also used to identify hot research trends to be developed in future studies. This study complies with the PRISMA-Scr guidelines for quality improvement research in the EQUATOR network. Results: Our results reveal that research in this field is in a period of high production and allows this flourishing body of work to be organized into different periods, highlighting the most important themes. In such a way, our research enriches the lively field by presenting a comprehensive understanding of the field. Discussion: The key contribution of this study is the development of a conceptual map of research on stress, anxiety, and postpartum depression in mothers of preterm infants in neonatal intensive care units.

Base on the Public Scientific Quality Improvement Research on Risk Early Warning of Online Shopping

In order to improve the scientific quality of the public, the Chinese Association for Science and Technology has put forward a call to combine popular science education with leisure and entertainment. In view of the fact that online shopping involves a wide range of areas, and the people pay more attention to it, the paper completed the innovation of online shopping risk warning science knowledge, the design of popular science mechanism and the dissemination of popular science knowledge. The paper used complex network’s knowledge discovery methods and decision theory to design online shopping risk warning science knowledge; Using the complex network public opinion dissemination trust analysis realize the dissemination of popular science knowledge and promote the improvement of the public's quality of popular science. The spread of risk early warning science knowledge in the network shows that the risk early warning mechanism designed can achieve the purpose of improving public science knowledge when the reward and punishment measures are appropriate.

Modern Clinical Text Mining: A Guide and Review

Electronic health records (EHRs) are becoming a vital source of data for healthcare quality improvement, research, and operations. However, much of the most valuable information contained in EHRs remains buried in unstructured text. The field of clinical text mining has advanced rapidly in recent years, transitioning from rule-based approaches to machine learning and, more recently, deep learning. With new methods come new challenges, however, especially for those new to the field. This review provides an overview of clinical text mining for those who are encountering it for the first time (e.g., physician researchers, operational analytics teams, machine learning scientists from other domains). While not a comprehensive survey, this review describes the state of the art, with a particular focus on new tasks and methods developed over the past few years. It also identifies key barriers between these remarkable technical advances and the practical realities of implementation in health systems and in industry. Expected final online publication date for the Annual Review of Biomedical Data Science, Volume 4 is July 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Overview of Literature on RMC and Applications to Tanzania

Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse. The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents. Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.

Overview of Literature on RMC and Applications to Tanzania

Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse. The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents. Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.