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Evaluating the American College of Surgeons National Surgical Quality Improvement project risk calculator: results from the U.S. Extrahepatic Biliary Malignancy Consortium.
Beal EW, Lyon E, Kearney J, Wei L, Ethun CG, Black SM, Dillhoff M, Salem A, Weber SM, Tran TB, Poultsides G, Shenoy R, Hatzaras I, Krasnick B, Fields RC, Buttner S, Scoggins CR, Martin RCG, Isom CA, Idrees K, Mogal HD, Shen P, Maithel SK, Pawlik TM, Schmidt CR
(2017) HPB (Oxford) 19: 1104-1111
MeSH Terms: Academic Medical Centers, Adult, Aged, Aged, 80 and over, Area Under Curve, Bile Duct Neoplasms, Biliary Tract Surgical Procedures, Cholangiocarcinoma, Databases, Factual, Decision Support Techniques, Female, Gallbladder Neoplasms, Hepatectomy, Humans, Male, Middle Aged, Pancreaticoduodenectomy, Patient Readmission, Postoperative Complications, Predictive Value of Tests, ROC Curve, Reoperation, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States, Young Adult
Show Abstract · Added April 10, 2018
BACKGROUND - The objective of this study is to evaluate use of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online risk calculator for estimating common outcomes after operations for gallbladder cancer and extrahepatic cholangiocarcinoma.
METHODS - Subjects from the United States Extrahepatic Biliary Malignancy Consortium (USE-BMC) who underwent operation between January 1, 2000 and December 31, 2014 at 10 academic medical centers were included in this study. Calculator estimates of risk were compared to actual outcomes.
RESULTS - The majority of patients underwent partial or major hepatectomy, Whipple procedures or extrahepatic bile duct resection. For the entire cohort, c-statistics for surgical site infection (0.635), reoperation (0.680) and readmission (0.565) were less than 0.7. The c-statistic for death was 0.740. For all outcomes the actual proportion of patients experiencing an event was much higher than the median predicted risk of that event. Similarly, the group of patients who experienced an outcome did have higher median predicted risk than those who did not.
CONCLUSIONS - The ACS NSQIP risk calculator is easy to use but requires further modifications to more accurately estimate outcomes for some patient populations and operations for which validation studies show suboptimal performance.
Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
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29 MeSH Terms
Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents.
Martinez W, Lehmann LS, Thomas EJ, Etchegaray JM, Shelburne JT, Hickson GB, Brady DW, Schleyer AM, Best JA, May NB, Bell SK
(2017) BMJ Qual Saf 26: 869-880
MeSH Terms: Academic Medical Centers, Attitude of Health Personnel, Communication, Courage, Cross-Sectional Studies, Female, Humans, Internship and Residency, Male, Patient Safety, Professional Misconduct, Professionalism, Safety Management, United States
Show Abstract · Added May 26, 2017
BACKGROUND - Open communication between healthcare professionals about care concerns, also known as 'speaking up', is essential to patient safety.
OBJECTIVE - Compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.
DESIGN - Anonymous, cross-sectional survey.
SETTING - Six US academic medical centres, 2013-2014.
PARTICIPANTS - 1800 medical and surgical interns and residents (47% responded).
MEASUREMENTS - Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.
RESULTS - Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).
CONCLUSIONS - Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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14 MeSH Terms
Processes for Identifying and Reviewing Adverse Events and Near Misses at an Academic Medical Center.
Martinez W, Lehmann LS, Hu YY, Desai SP, Shapiro J
(2017) Jt Comm J Qual Patient Saf 43: 5-15
MeSH Terms: Academic Medical Centers, Data Analysis, Humans, Medical Errors, Morbidity, Retrospective Studies, Surveys and Questionnaires
Show Abstract · Added May 26, 2017
BACKGROUND - Conferences, processes, and/or meetings in which adverse events and near misses are reviewed within clinical programs at a single academic medical center were identified.
METHODS - Leaders of conferences, processes, or meetings-"process leaders"-in which adverse events and near misses were reviewed were surveyed.
RESULTS - On the basis of responses from all 45 process leaders, processes were classified into (1) Morbidity and Mortality Conferences (MMCs), (2) Quality Assurance (QA) Meetings, and (3) Educational Conferences. Some 22% of the clinical programs used more than one of these three processes to identify and review adverse events and near misses, while 10% had no consistent participation in any of them. Explicit criteria for identifying and selecting cases to be reviewed were used by 58% of MMCs and 69% of QA Meetings. The explicit criteria used by MMCs and QA Meetings varied widely. Many MMCs (54%, 13/24), QA Meetings (54%, 7/13), and Educational Conferences (70%, 7/10) did not review all the adverse events or near misses that were identified, and several MMCs (46%, 6/13), QA Meetings (29%, 2/7), and Educational Conferences (57%, 4/7) had no other process within their clinical program by which to review these remaining cases.
CONCLUSIONS - There was wide variation regarding how clinical programs identify and review adverse events and near misses within the MMCs, QA Meetings, and Educational Conferences, and some programs had no such processes. A well-designed, coordinated process across all clinical areas that incorporates accepted approaches for event analysis may improve the quality and safety of patient care.
Copyright © 2016 The Joint Commission. All rights reserved.
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7 MeSH Terms
Use of a Patient Portal During Hospital Admissions to Surgical Services.
Robinson JR, Davis SE, Cronin RM, Jackson GP
(2016) AMIA Annu Symp Proc 2016: 1967-1976
MeSH Terms: Academic Medical Centers, Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Hospitalization, Humans, Infant, Male, Medical Records Systems, Computerized, Middle Aged, Patient Portals, Surgery Department, Hospital, Tennessee, Young Adult
Show Abstract · Added November 8, 2017
Patient portal research has focused on medical outpatient settings, with little known about portal use during hospitalizations or by surgical patients. We measured portal adoption among patients admitted to surgical services over two years. Surgical services managed 37,025 admissions of 31,310 unique patients. One-fourth of admissions (9,362, 25.3%) involved patients registered for the portal. Registration rates were highest for admissions to laparoscopic/gastrointestinal (55%) and oncology/endocrine (50%) services. Portal use occurred during 1,486 surgical admissions, 4% of all and 16% of those registered at admission. Inpatient portal use was associated with patients who were white, male, and had longer lengths of stay (p < 0.01). Viewing health record data and secure messaging were the most commonly used functions, accessed in 4,836 (72.9%) and 1,626 (24.5%) user sessions. Without specific encouragement, hospitalized surgical patients are using our patient portal. The surgical inpatient setting may provide opportunities for patient engagement using patient portals.
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18 MeSH Terms
The persistent under-utilization of epilepsy surgery.
Englot DJ
(2015) Epilepsy Res 118: 68-9
MeSH Terms: Academic Medical Centers, Epilepsy, Female, Humans, Male
Added August 12, 2016
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5 MeSH Terms
Tackling reproducibility in academic preclinical drug discovery.
Frye SV, Arkin MR, Arrowsmith CH, Conn PJ, Glicksman MA, Hull-Ryde EA, Slusher BS
(2015) Nat Rev Drug Discov 14: 733-4
MeSH Terms: Academic Medical Centers, Animals, Biomedical Research, Drug Discovery, Drug Evaluation, Preclinical, Humans, Reproducibility of Results, Translational Medical Research
Show Abstract · Added February 18, 2016
The reproducibility of biomedical research on novel drug targets has become suspect. Here, we highlight how drug discovery centres embedded in academic institutions, but with a translational imperative, can help address this reproducibility crisis.
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8 MeSH Terms
'Speaking up' about patient safety concerns and unprofessional behaviour among residents: validation of two scales.
Martinez W, Etchegaray JM, Thomas EJ, Hickson GB, Lehmann LS, Schleyer AM, Best JA, Shelburne JT, May NB, Bell SK
(2015) BMJ Qual Saf 24: 671-80
MeSH Terms: Academic Medical Centers, Adult, Attitude of Health Personnel, Factor Analysis, Statistical, Female, Humans, Internship and Residency, Male, Organizational Culture, Patient Safety, Physicians, Professional Misconduct, Psychometrics, Reproducibility of Results, Surveys and Questionnaires, United States
Show Abstract · Added May 13, 2016
OBJECTIVE - To develop and test the psychometric properties of two new survey scales aiming to measure the extent to which the clinical environment supports speaking up about (a) patient safety concerns and (b) unprofessional behaviour.
METHOD - Residents from six large US academic medical centres completed an anonymous, electronic survey containing questions regarding safety culture and speaking up about safety and professionalism concerns.
RESULTS - Confirmatory factor analysis supported two separate, one-factor speaking up climates (SUCs) among residents; one focused on patient safety concerns (SUC-Safe scale) and the other focused on unprofessional behaviour (SUC-Prof scale). Both scales had good internal consistency (Cronbach's α>0.70) and were unique from validated safety and teamwork climate measures (r<0.85 for all correlations), a measure of discriminant validity. The SUC-Safe and SUC-Prof scales were associated with participants' self-reported speaking up behaviour about safety and professionalism concerns (r=0.21, p<0.001 and r=0.22, p<0.001, respectively), a measure of concurrent validity, while teamwork and safety climate scales were not.
CONCLUSIONS - We created and provided evidence for the reliability and validity of two measures (SUC-Safe and SUC-Prof scales) associated with self-reported speaking up behaviour among residents. These two scales may fill an existing gap in residency and safety culture assessments by measuring the openness of communication about safety and professionalism concerns, two important aspects of safety culture that are under-represented in existing metrics.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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16 MeSH Terms
Neoadjuvant chemotherapy administration and time to cystectomy for muscle-invasive bladder cancer: An evaluation of transitions between academic and community settings.
Rose TL, Deal AM, Basch E, Godley PA, Rathmell WK, Kim WY, Whang YE, Dunn MW, Wang A, Chen RC, Nielsen ME, Pruthi RS, Wallen EM, Woods ME, Smith AB, Milowsky MI
(2015) Urol Oncol 33: 386.e1-6
MeSH Terms: Academic Medical Centers, Adult, Aged, Aged, 80 and over, Antineoplastic Agents, Carcinoma, Transitional Cell, Community Medicine, Cystectomy, Disease-Free Survival, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Patient Transfer, Proportional Hazards Models, Retrospective Studies, Time-to-Treatment, Urinary Bladder Neoplasms
Show Abstract · Added October 17, 2015
OBJECTIVES - Neoadjuvant chemotherapy (NAC) before radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC). Many patients are referred to an academic medical center (AMC) for cystectomy but receive NAC in the community setting. This study examines if administration of NAC in the community is associated with differences in type of NAC received, pathologic response rate (pT0), and time to cystectomy as compared to NAC administered at an AMC.
METHODS - We performed a retrospective study of patients with MIBC (cT2a-T4-Nx-M0) referred to a single AMC between 1/2012 and 1/2014 who received NAC. We analyzed chemotherapy received, time to cystectomy, pT0, and survival in patients who received NAC in our AMC compared to those treated in the community.
RESULTS - In all, 47 patients were analyzed. A similar total dose of cisplatin (median: 280 mg/m(2) for both groups, P = 0.82) and pT0 rate (25% vs. 29%, P = 0.72) were seen in patients treated in our AMC and the community. However, administration of NAC in the community was associated with a prolonged time to cystectomy compared with that in our AMC (median number of days 162 vs. 128, P<0.01). This remained significant after adjusting for stage, comorbidity status, and distance to the AMC (P = 0.02). Disease-free survival and overall survival did not differ.
CONCLUSION - Patients with MIBC treated with NAC in the community as compared to an AMC received similar chemotherapy and achieved comparable pT0 rates, indicating effective implementation of NAC in the community. However, NAC in the community was associated with longer time to cystectomy, suggesting a delay in the transition of care between settings.
Copyright © 2015 Elsevier Inc. All rights reserved.
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19 MeSH Terms
Using natural language processing to provide personalized learning opportunities from trainee clinical notes.
Denny JC, Spickard A, Speltz PJ, Porier R, Rosenstiel DE, Powers JS
(2015) J Biomed Inform 56: 292-9
MeSH Terms: Academic Medical Centers, Advance Directives, Aged, Algorithms, Automation, Clinical Clerkship, Clinical Competence, Education, Medical, Educational Measurement, Electronic Health Records, Geriatrics, Hospitals, Veterans, Humans, Learning, Mental Disorders, Middle Aged, Natural Language Processing, Outcome Assessment (Health Care), Reproducibility of Results, Software, Students, Medical, Tennessee, User-Computer Interface
Show Abstract · Added March 14, 2018
OBJECTIVE - Assessment of medical trainee learning through pre-defined competencies is now commonplace in schools of medicine. We describe a novel electronic advisor system using natural language processing (NLP) to identify two geriatric medicine competencies from medical student clinical notes in the electronic medical record: advance directives (AD) and altered mental status (AMS).
MATERIALS AND METHODS - Clinical notes from third year medical students were processed using a general-purpose NLP system to identify biomedical concepts and their section context. The system analyzed these notes for relevance to AD or AMS and generated custom email alerts to students with embedded supplemental learning material customized to their notes. Recall and precision of the two advisors were evaluated by physician review. Students were given pre and post multiple choice question tests broadly covering geriatrics.
RESULTS - Of 102 students approached, 66 students consented and enrolled. The system sent 393 email alerts to 54 students (82%), including 270 for AD and 123 for AMS. Precision was 100% for AD and 93% for AMS. Recall was 69% for AD and 100% for AMS. Students mentioned ADs for 43 patients, with all mentions occurring after first having received an AD reminder. Students accessed educational links 34 times from the 393 email alerts. There was no difference in pre (mean 62%) and post (mean 60%) test scores.
CONCLUSIONS - The system effectively identified two educational opportunities using NLP applied to clinical notes and demonstrated a small change in student behavior. Use of electronic advisors such as these may provide a scalable model to assess specific competency elements and deliver educational opportunities.
Copyright © 2015 Elsevier Inc. All rights reserved.
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23 MeSH Terms
Validation of a Short, 3-Item Version of the Subjective Numeracy Scale.
McNaughton CD, Cavanaugh KL, Kripalani S, Rothman RL, Wallston KA
(2015) Med Decis Making 35: 932-6
MeSH Terms: Academic Medical Centers, Acute Coronary Syndrome, Cross-Sectional Studies, Diabetes Mellitus, Educational Measurement, Emergency Service, Hospital, Health Literacy, Hospitals, Humans, Hypertension, Mathematics, Psychometrics, Renal Dialysis, Renal Insufficiency, Chronic, Reproducibility of Results
Show Abstract · Added July 28, 2015
BACKGROUND AND OBJECTIVE - Efficiency in scale design reduces respondent burden. A brief but reliable measure of numeracy may provide a useful research tool eligible for integration into large epidemiological studies or clinical trials. Our goal was to validate a 3-item version of the Subjective Numeracy Scale (SNS-3).
DESIGN AND SETTING - We examined 7 separate cross-sectional data sets: patients in the emergency department (n = 208), clinic (n = 205), and hospital (n = 460; n = 2053) and patients with chronic kidney disease (n = 147), with diabetes (n = 318), and on hemodialysis (n = 143).
MEASUREMENTS - Internal reliability of the SNS-3 was assessed with Cronbach's α. Criterion validity was determined by nonparametric correlations of the SNS-3 with SNS-8 and other measures of numeracy; construct validity was determined by correlations with measures of health literacy and education.
RESULTS - The SNS-3 had good internal reliability (median Cronbach's α = 0.78) and correlated highly with the full SNS (median ρ = 0.91). The SNS-3 was significantly correlated with other measures of numeracy (e.g., median ρ = 0.57 with the Wide Range Achievement Test 4), health literacy (e.g., median ρ = 0.35 with the Shortened Test of Functional Health Literacy in Adults), and education (median ρ = 0.41), providing good evidence of criterion and construct validity.
CONCLUSION - The SNS-3 is sufficiently reliable and valid to be used as a measure of subjective numeracy.
© The Author(s) 2015.
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15 MeSH Terms