Quality of Neurologic Care in the United States: Initial Report From the Axon Registry

Objective:To provide the initial description of quality of outpatient US neurologic care as collected and reported in the Axon Registry.Methods:We describe characteristics of registry participants and the performance of neurology providers on 20 of the 2019 Axon Registry quality measures. From the distribution of providers’ scores on a quality measure, we calculate the median performance for each quality measure. We test for associations between quality measure performance, provider characteristics, and intrinsic measure parameters.Results:There were 948 neurology providers who contributed a total of 6,480 provider-metric observations. Overall, the average quality measure performance score at the provider level was 66 (median 77). At the measure level (n=20), the average quality measure performance score was 53 (median 55) with a range of 2-100 (interquartile range of 20-91). Measures with a lower complexity category (e.g., discrete orders, singular concepts) or developed through the specialty’s qualified clinical data registry (QCDR) pathway had higher performance distributions. There was no difference in performance between Merit-based Incentive Payment System (MIPS) and non-MIPS providers. There was no association between quality measure performance and practice size, measure clinical topic/neurological condition, or measure year of entry.Conclusions:This cross-sectional assessment of quality measure performance in 2019 Axon Registry data demonstrates modest performance scores and considerable variability across measures and providers. More complex measures were associated with lower performance. These findings serve as a baseline assessment of quality of ambulatory neurologic care in the US and provide insights into future measure design.

Erectile dysfunction in patients with anxiety disorders: a systematic review

Men with anxiety disorders have been identified as high risk of developing erectile dysfunction (ED). The aim of this review is to define the prevalence and severity of ED in the male anxiety disorder population. A literature search of three electronic databases (PubMed, Embase and PsychINFO) and a grey literature registry was conducted. Inclusion criteria were studies that investigated adult males, documented diagnosis of anxiety disorders made by a qualified psychiatrist and use of a validated tool to diagnose ED such as International Index of Erectile Function or ICD-10/DSM-IV. The search yielded 1220 articles and 12 studies were selected. The anxiety disorders investigated were post-traumatic stress disorder, obsessive–compulsive disorder, social phobia/social anxiety disorder and panic disorder. We found that the median [IQR] prevalence of ED was 20.0 [5.1–41.2]% and the median [IQR] International Index of Erectile Function-5 scores were 17.62 [13.88–20.88], indicating a mild to moderate severity. Our review suggests a high prevalence of ED in the anxiety disorder population and ED may be more severe in this cohort, therefore advocating this is an important clinical topic. However, the evidence is limited due to the high heterogeneity between the studies and more research is required in this field.

BMJ Best Practice

BMJ Best Practice is an evidence-based point of care tool that helps support clinical decisions by providing the latest and highest quality research available to clinicians. The target audience for this resource is anyone delivering health care services. Currently, BMJ Best Practice is available as an institutional subscription in the United States. The resource includes clinical summaries based on the latest evidence, drug information, clinical calculators, evidence-based tool kits, and patient leaflets. The content provided goes through a rigorous editorial process by expert reviewers who have been required to disclose any financial conflicts. This process can however be relatively time consuming therefore updates that do not pose an immediate harm to patient care could potentially take anywhere from 1 to 3 months to be reflected in the clinical topic overviews. Overall, the tools and content provided on the platform are reliable and easy to navigate for the end user.

Faculty Evaluations Provide Solutions to Online Teaching of Evidenced-Based Practice

Background: The purpose of this report is to provide solutions to improving online course teaching for the challenging topic of Evidenced-Based Practice.Evidence-based practice courses five weeks in length with assignments that would enlist the creativity of the student if allowed to conduct a clinical project.Methods: The student was given a choice on a hypothetical patient and clinical topic to base their research on for the course. Virtual meetings and video recordings were used to conduct the course.Results: An improvement from a 3.1 to a 3.8 on course evaluations and 3.9 on faculty evaluations by students which gave a conformation that the student obtained knowledge from this course online environment.Conclusion: An understanding of the learner needs is incredibly important and an emphasis on audiovisual format which enhances knowledge acquisition of complex course content. As instructors, innovative thinking, and application of course content delivery is needed for today’s student.

Graph-Driven Generative Models for Heterogeneous Multi-Task Learning

We propose a novel graph-driven generative model, that unifies multiple heterogeneous learning tasks into the same framework. The proposed model is based on the fact that heterogeneous learning tasks, which correspond to different generative processes, often rely on data with a shared graph structure. Accordingly, our model combines a graph convolutional network (GCN) with multiple variational autoencoders, thus embedding the nodes of the graph (i.e., samples for the tasks) in a uniform manner, while specializing their organization and usage to different tasks. With a focus on healthcare applications (tasks), including clinical topic modeling, procedure recommendation and admission-type prediction, we demonstrate that our method successfully leverages information across different tasks, boosting performance in all tasks and outperforming existing state-of-the-art approaches.

A structured classification of the types of pain research studies accessed by different health professionals involved in pain management

Objectives: The aim of this study was to describe the information access behaviours of clinicians involved in pain management with respect to their use of a pain evidence resource and to determine the areas of professional differences. Methods: Users (n = 258) of a free pain evidence alerting service (PAIN+) were enrolled in this study. The users regularly received email alerts about newly published clinical articles about pain that were pre-appraised for scientific merit and clinical relevance. A sample of up to 10 abstracts retrieved by each user were retrieved and classified using a descriptive classification system to describe the types of research, pain subtypes, interventions and outcomes that were reported in the accessed studies. Frequencies and chi-square tests were performed to compare access behaviours across professions. Results: A total of 258 participants viewed 2311 abstracts. More than 52% of abstracts viewed were primary clinical studies; the majority (87%) addressed treatment effectiveness and were quantitative research (99.8%). The most commonly accessed clinical topic (58%) related to musculoskeletal pain and the most accessed pain type was chronic pain (76%). Drugs, injections and rehabilitation therapy were most commonly addressed in accessed intervention studies. Differences in professional focus were reflected in access: physicians/nurses accessed studies on injections (23%) and drugs (26%) and nurses accessed surgical studies, whereas other professions rarely did. Physiotherapists (PTs) and occupational therapists (OTs) preferentially accessed studies on rehabilitation. OTs and psychologists preferentially accessed the available studies on cognitive interventions; OTs accessed more ergonomic studies. Psychologists most accessed educational and psychosocial intervention studies. There were no differences in access across professions to multidisciplinary interventions. Conclusion: While access partially reflects the content of the pain repository, professional differences in access were evident that related to the nature of the intervention, type of pain and the research design. Multidisciplinary evidence repositories may need to consider how to include and meet varied information needs.

A BioHackathon on the challenges of aging: Rapid need-finding and solution modeling in a student-led event

The Biointerfaces Interlaboratory Committees, the student organization for the Biointerfaces Institute at the University of Michigan, organized and executed an 8 hour “BioHackathon” on the broadly defined clinical topic of ‘Aging.’ The event began with experts in the field (a clinician and an engineer) highlighting the areas of greatest need in which engineers could improve the lives of the aging population. Attendees separated into teams based on shared interests in pursuing specific needs, and rapidly developed need statements and solution models to help the elderly. Solutions ranged from a smart toothbrush to help detect pneumonia in early stages, to small clothing pads to help reduce the impact of falls on hip fractures. Based on a follow-up anonymous internet survey, the attendees indicated they enjoyed the event, and would likely attend a similar event in the future. We conclude by reflecting upon the event, and suggest ways in which we could improve the style of the event for future hackathons.

Comparing retrieval of systematic review searches in health sciences areas using two major databases

Purpose Effective literature searches are critical to researchers and health care professionals. To conduct literature searches, clinicians, researchers and nurses rely primarily on a few major databases (PubMed, Cochrane, CINAHL, etc.) to retrieve information. However, there is a lack of literature on the comparative efficiencies of major databases for systematic review results on a clinically related topic. This paper aims to fill that gap in the literature. Design/methodology/approach Cochrane Handbook (2011) defines systematic review as a review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research and to collect and analyze data from the studies that are included in the review. In this paper, search results of systematic reviews on a clinical topic between two major databases – PubMed and Cochrane Library – are compared. Findings Searching within PubMed for key terms in the titles and abstracts of articles is important to include in any systematic review, in addition to searching Medical Subject Heading terms. After applying filters, PubMed retrieved 130 systematic reviews that matched the criteria. In Cochrane Library, the searches were performed on the chosen topic using Boolean and phrase searching: text field searches resulted in 251 reviews. The search was further narrowed by subject, which yielded 20 reviews. It is strongly recommended to use multiple health-care specialty databases, check for duplicate reviews in the results and not limit results to English-only publications. Practical implications This paper can be used to introduce new researchers and/or students to methods for conducting systematic reviews using two or more databases on a chosen topic. Originality/value This paper fills a gap in the literature regarding comparative efficiencies of major databases for systematic review results on clinically related topics.