Innovations In Patient Care Research Articles

Publications Are Not the Finish Line: Focusing on Societal Rather Than Publication Impact.

Have bibliographical quantification of publications and the subsequent accompanying rewards perverted the incentives of scientists? Are we lost in a publish-or-perish research culture? Alarmingly, ample (bio)medical research findings intended to improve patient outcomes and lead to innovations in patient care never leave the lab (1–3). This widening gap between discovery and implementation undermines the social responsibility of scientists and erodes their public stature. When research findings have the potential to improve the health and well-being of society but are not translated into real-world benefits, it represents a failure of the system and a failure to society. A re-evaluation of the parameters that define scientific success is imperative. Climbing the academic ladder and securing financial support relies heavily on a scientist's productivity, which is typically defined by the number of publications and their bibliometric scores (4, 5). Several groups are working toward developing novel measures for impact, but so far traditional bibliometric evaluation criteria prevail (6, 7). Whilst understandable that a quantitative system of evaluation might fulfill a desire for objectivity, this creates an intrinsically competitive culture in which regularly publishing ever-novel work is key to individual career success and open collaboration is undermined. When novel discoveries are incentivized over refinement and implementation, it becomes strategically disadvantageous to do the work needed to translate discoveries into working strategies that benefit patients, the ultimate goal of translational medicine (1–3). Proper recognition and rewards for aiding efforts to achieve this goal must be advocated for, guided by the principles of social accountability and fostered by the support of key stakeholders (8).

Conquer Panic: a Case Study on Integrating Technology into a Compressed Panic Disorder Treatment for Rural Veterans

In recent years, much of the innovation in patient care at the Veterans Health Administration has focused on improving access to behavioral health treatments. One innovation that can address barriers faced by veterans, especially those living in rural areas, is the use of digital tools such as smartphone applications (apps). This study is a pilot of a newly developed app, entitled Conquer Panic, which is integrated with intensive panic control treatment, a compressed group treatment for panic disorder. Two Operation Enduring Freedom/Operation Iraqi Freedom veterans used the Conquer Panic app as an integrated component of their treatment. Descriptive information obtained from the veterans’ treatment records is presented along with a summary of the veterans’ panic symptoms from pretreatment to 6 months following treatment. In addition, structured feedback given by the veterans concerning the treatment package, as a whole, and the Conquer Panic app are provided. Overall, both veterans indicated favorable opinions of the treatment package and the Conquer Panic app. Benefits of the Conquer Panic app included carry-over of primary treatment components beyond the provider-delivered phase of treatment, accessibility of information before and during actual panic attacks, and ease of use. Also, both veterans demonstrated marked reductions in panic symptom severity following the integrated treatment. Implications of these treatment innovations are discussed along with recommendations and future directions for combining novel service-delivery methods.

Innovation in Patient Care

This poster will provide evidence that supports a novel approach to managing postoperative pain in the pediatric laparoscopic appendectomy patient, specifically reducing with potential for eliminating the use of opioids for this patient population. BACKGROUND Opioid therapy has long represented the foundation of pain management postoperatively. However, as a significant and concerning increase in prescription-opioid-associated morbidity and mortality has emerged, there is an urgent need to balance adequate postoperative pain management with evidence-based prescription processes and to incorporate the use of multimodal pain management plans to both reduce opioid side effects and decrease the amount of unused opioid prescriptions that are available for diversion. Laparoscopic appendectomy for nonperforated appendicitis is among the most common operation in the pediatric population. There is an opportunity to decrease and even eliminate the use of opioids for this patient population using other modalities of pain control. This study further builds on previous work started in 2013 where we found that patients were taking far less opioids for pain than had been prescribed. This resulted in standardizing the amount of opioids prescribed in this patient population to five doses. PURPOSE The purpose of the study will be to describe pain control in the pediatric postoperative nonperforated appendectomy population after discharge from the hospital. Our hope is that we can show adequate pain control in this patient population, specifically using nonopioid modalities for pain control including acetaminophen and ibuprofen. DESIGN/IMPLEMENTATION This is a prospective cohort study. The standard clinical practice regarding the prescription of postoperative medications for pain management will be followed. Patients and their families are instructed to alternate acetaminophen and nonsteroidal anti-inflammatory drugs (Motrin) as necessary after discharge from the hospital. Parents are also offered a prescription for an opioid to fill in the event that their child had breakthrough pain (pain not relieved with acetaminophen or NSAIDs [Motrin]) and instructed to fill the opioid prescription only if they think their child needs an opioid for pain relief. Parents are instructed to keep track on their child's pain medication history on a sheet given to them detailing how many doses of acetaminophen, Motrin, or opioid doses they gave to their child. The medical record will be reviewed retrospectively to determine whether the child received an intraoperative peripheral block. The patients will be approached by the team (surgeon or nurse practitioner) when discharge prescriptions are explained. The study will be described, and the subjects/families will ask if they would participate in this study. If the subject/family consents to participate, they will receive a follow-up telephone call from a member of the team on Postoperative Day 3. In the event that the family cannot be reached on Postoperative Day 3, a follow-up call will be made on Day 4. No other contact will occur after this time. They will be contacted at the best number supplied by the family. The team member will ask about their child's pain experience and about the use of opioid and nonnarcotic pain relievers (acetaminophen and NSAIDs; see Table 1, data collection sheet). Patient education sheets will be provided per usual practice. EVALUATION/OUTCOME Descriptive and correlational statistics will be used for the analysis of this study. This analysis will be used to interpret the appropriateness and efficacy of utilizing this modality of treatment for pain control in this patient population with the outcome of eliminating the use of opioids for pain control.

Development and innovation of system resources to optimize patient care.

Various incremental and disruptive healthcare innovations that are occurring or may occur are discussed, with insights on how multihospital health systems can prepare for the future and optimize the continuity of patient care provided. Innovation in patient care is occurring at an ever-increasing rate, and this is especially true relative to the transition of patients through the care continuum. Health systems must leverage their ability to standardize and develop electronic health record (EHR) systems and other infrastructure necessary to support patient care and optimize outcomes; examples include 3D printing of patient-specific medication dosage forms to enhance precision medicine, the use of drones for medication delivery, and the expansion of telehealth capabilities to improve patient access to the services of pharmacists and other healthcare team members. Disruptive innovations in pharmacy services and delivery will alter how medications are prescribed and delivered to patients now and in the future. Further, technology may also fundamentally alter how and where pharmacists and pharmacy technicians care for patients. This article explores the various innovations that are occurring and that will likely occur in the future, particularly as they apply to multihospital health systems and patient continuity of care. Pharmacy departments that anticipate and are prepared to adapt to incremental and disruptive innovations can demonstrate value in the multihospital health system through strategies such as optimizing the EHR, identifying telehealth opportunities, supporting infrastructure, and integrating services.

Conflict of Interest in Practice Guidelines Panels

Practice guidelines are an important innovation in patient care. According to the 2011 Institute of Medicine (IOM) definition, practice guidelines are “statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.”1 In the United States, guideline programs began in the early 1980s. As guidelines have been used for decisions about insurance coverage and standards for measuring quality of care, they have become increasingly influential, and conflict of interest (COI) in developing guidelines has become an important concern.

Founder of Leg Club model awarded Order of the British Empire in recent Queen's Birthday Honours.

In the recent Queen's Birthday Honours, Ellie Lyndsay (Founder of Leg Club) was awarded an Order of the British Empire (OBE) for services to nursing. The honour recognises her years of hard work and commitment to the Leg Club model, which is now recognised as a viable, replicable and cost-effective way to treat people with lower limb problems. The International Wound Journal family salutes Ellie in both the achievement of this honour and also her dedication to the Leg Club cause. Commencing employment with the NHS in 1977, her nursing experience within the hospital environment included medical, surgical and coronary care. Following several years within a specialist cardiac unit (coronary care unit), she undertook a career change to community nursing in 1988. Ellie was appointed District Nursing Sister in 1994 and obtained her specialist practitioner qualification in 1997, commencing as a Community Practice Teacher in 1998. Ellie conceived and introduced an innovative, social Leg Club model for wound management in the community in 1995, and has since disseminated the concept worldwide. She left the NHS to become an independent specialist practitioner and clinical consultant in December 2002. Ellie established the Lindsay Leg Club Foundation, a registered charity, in September 2005. She has published more than 60 articles, predominantly concerning the Leg Club model and patient empowerment and is regularly invited to speak at UK and international conferences. Ellie has received multiple awards for her Leg Club model, including the 2001 British Journal of Nursing Award for Clinical Practice, the Nursing Standard Nurse 2003 (Wound Care) Award, the 2007 British Journal of Nursing Award for Health Promotion and the 2007 Wounds UK Award for Innovation in Patient Care. In 2011 she received national recognition for her contribution to nursing when she was awarded one of the professions highest distinctions – The British Journal of Nursing Lifetime Achievement Award. She continues to facilitate the introduction of Leg Clubs in the UK, Australia and Europe. Happily, this was further recognised by the award of the OBE, demonstrating national recognition outside of the medical community. Once again we the IWJ family offer our congratulations and gratitude for your life's work in the wound care arena.

Cultivating a Spirit of Inquiry using a Nursing Leading-Following Model

Healthcare systems have cocreated an environment in which the vast majority of nurses in staff positions have not been expected to lead for quality healthcare services. Both the nature of their work and the busyness of their schedules have prevented staff nurses from being available to generate ideas and to lead innovations in patient care and quality work environments. The purpose of this paper is to illuminate how a nursing leading-following model emanating from Parse's humanbecoming theory guided the enrichment of the context and practice of nursing in a large academic health science center by helping leaders to cultivate nurses' capacity to lead research projects that address patient-centered care and quality of work-life. Nurses' participation in an annual nursing research challenge is highlighted to demonstrate what happens when nurses in formal leadership positions focus on cultivating the capacity to lead and the spirit of inquiry among all nurses.

Classroom to Clinic: Merging Education and Research to Efficiently Prototype Medical Devices.

Innovation in patient care requires both clinical and technical skills, and this paper presents the methods and outcomes of a nine-year, clinical-academic collaboration to develop and evaluate new medical device technologies, while teaching mechanical engineering. Together, over the course of a single semester, seniors, graduate students, and clinicians conceive, design, build, and test proof-of-concept prototypes. Projects initiated in the course have generated intellectual property and peer-reviewed publications, stimulated further research, furthered student and clinician careers, and resulted in technology licenses and start-up ventures.

Minimally Invasive Lumbar Decompression for the Treatment of Spinal Stenosis of the Lumbar Spine

SUMMARYLumbar spinal stenosis is one of the most common degenerative diseases of the elderly population, and a major cause of debilitating pain and decreased function. Lumbar spinal stenosis is almost always associated with neurogenic claudication characterized as pain worsened by standing or walking and relieved by lumbar flexion or sitting. While initial treatment of lumbar spinal stenosis may involve conservative therapies, as patients become more symptomatic the traditional treatment path has generally led to open laminectomy and other invasive, potentially destabilizing, procedures. More recently, less invasive alternatives to wide laminectomy have been developed. This article describes a new method of percutaneous lumbar decompression for treatment of neurogenic claudication secondary to lumbar spinal stenosis, the minimally invasive lumbar decompression procedure. We review the steps of successfully decompressing the hypertrophic ligamentum flavum and lamina, thereby alleviating pressure on neural structures. This is a major innovation in patient care and a step to reduce risks while minimizing costs.

Mathematical Modeling of Patient Care

Mathematical Modeling of Patient Care

Machine-learned solutions for three stages of clinical information extraction: the state of the art at i2b2 2010

ObjectiveAs clinical text mining continues to mature, its potential as an enabling technology for innovations in patient care and clinical research is becoming a reality. A critical part of that process is rigid benchmark testing of natural language processing methods on realistic clinical narrative. In this paper, the authors describe the design and performance of three state-of-the-art text-mining applications from the National Research Council of Canada on evaluations within the 2010 i2b2 challenge.DesignThe three systems perform three key steps in clinical information extraction: (1) extraction of medical problems, tests, and treatments, from discharge summaries and progress notes; (2) classification of assertions made on the medical problems; (3) classification of relations between medical concepts. Machine learning systems performed these tasks using large-dimensional bags of features, as derived from both the text itself and from external sources: UMLS, cTAKES, and Medline.MeasurementsPerformance was measured per subtask, using micro-averaged F-scores, as calculated by comparing system annotations with ground-truth annotations on a test set.ResultsThe systems ranked high among all submitted systems in the competition, with the following F-scores: concept extraction 0.8523 (ranked first); assertion detection 0.9362 (ranked first); relationship detection 0.7313 (ranked second).ConclusionFor all tasks, we found that the introduction of a wide range of features was crucial to success. Importantly, our choice of machine learning algorithms allowed us to be versatile in our feature design, and to introduce a large number of features without overfitting and without encountering computing-resource bottlenecks.

Information exchange networks for chronic illness care in primary care practices: an observational study

BackgroundInformation exchange networks for chronic illness care may influence the uptake of innovations in patient care. Valid and feasible methods are needed to document and analyse information exchange networks in healthcare settings. This observational study aimed to examine the usefulness of methods to study information exchange networks in primary care practices, related to chronic heart failure, diabetes and chronic obstructive pulmonary disease.MethodsThe study was linked to a quality improvement project in the Netherlands. All health professionals in the practices were asked to complete a short questionnaire that documented their information exchange relations. Feasibility was determined in terms of response rates and reliability in terms of reciprocity of reports of receiving and providing information. For each practice, a number of network characteristics were derived for each of the chronic conditions.ResultsTen of the 21 practices in the quality improvement project agreed to participate in this network study. The response rates were high in all but one of the participating practices. For the analysis, we used data from 67 health professionals from eight practices. The agreement between receiving and providing information was, on average, 65.6%. The values for density, centralization, hierarchy, and overlap of the information exchange networks showed substantial variation between the practices as well as between the chronic conditions. The most central individual in the information exchange network could be a nurse or a physician.ConclusionsFurther research is needed to refine the measure of information networks and to test the impact of network characteristics on the uptake of innovations.

Government to offer cash prizes for innovations in patient care

Government to offer cash prizes for innovations in patient care

Physician Responses to the Malpractice Crisis: From Defense to Offense

Medical science brings innovations in patient care at an astounding pace today - new chemotherapeutic agents, coated stents, and minimally invasive surgery are just few recent examples. For physicians, though, the specter of malpractice liability can overshadow the marvel of practicing in this era. Many physicians are working in a volatile liability environment; they face spiraling costs for malpractice insurance, have difficulties purchasing liability coverage at any price, and see record payouts in a growing number of claims against their colleagues. The American Medical Association (AMA) has declared that at least 20 states are currently in a malpractice “crisis,” with another 24 states showing early signs of an impending crisis.There have been two comparable periods of instability in the last thirty years, but these predecessor crises differ from the current one in important ways. First, while physicians mainly experienced dwindling options for obtaining coverage in the mid-1970s (i.e., availability) and exorbitant prices in the mid-1980s (i.e., affordability), the current crisis appears to have elements of both availability and affordability.

An appraisal of the cost benefit of magnetic resonance imaging in Nigeria

Magnetic Resonance Scanning has revolutionized the imaging world since its invention about two decades ago. Despite its proven efficacy in patient care, it is largely non-available in the Nigeria healthcare system. This article discusses the worldwide distribution of this modality, highlights its diagnostic efficacy and emphasizes the need for Nigeria to join other countries of the world that are already utilizing this innovation in patient care. Measures at sustaining the availability of these services are suggested.

High-Tech Home Care in Deutschland: Herausforderung für rechtliche Regulierungssysteme

Zusammenfassung Der Zuwachs an biomedizinischen, pharmakologischen und technologischen Kenntnissen und Möglichkeiten hat in den letzten Jahrzehnten z« beachtlichen Innovationen in der Patientenversorgung geführt. Selbst aufwendige technikintensive Pflege- und Versorgungsleistungen können heute immer öfter aus dem stationären in den ambulanten Sektor ausgelagert werden, wordurch den zumeist chronisch- und schwer kranken Patienten ein Verbleib in ihrem häuslichen Umfeld ermöglicht wird. International hat sich die als High-Tech Home Care bezeichnete Form der häuslichen Versorgung weitgehend durchgesetzt. In Deutschland erweist sich deren Einführung hingegen als ein besonders komplizierter Prozess. Aufgrund einiger Spezifika des deutschen Gesundheitswesens trifft die High-Tech Home Care auf viele Hindernisse, zu denen auch eine Reihe bislang unbeantworteter rechtlicher Herausforderungen zählen. Basierend auf Teilergebnissen eines am Institut für Pflegewissenschaft seit 1998 durchgeführten Forschungsprojektes zur häuslichen Infusionstherapie (HIT) werden relevante Hindernisse benannt und rechtlicher Regulierungsbedarf aufgezeigt. Als Ergebnis zeigt sich, dass in Deutschland zunächst adäquate Voraussetzungen geschehen und rechtliche Herausforderungen bewältigt werden müssen, um an internationale Entwicklungen anknüpfen und auch hierzulande den Patienten die mit der High-Tech Home Care verbundenen Versorgungsoptionen erschließen zu können.

Evidence-Based Guidelines and Critical Pathways for Quality Improvement

Clinical practice guidelines have a long and distinguished tradition in pediatrics. Currently, the American Academy of Pediatrics has developed more than 15 practice guidelines and more than 250 clinical policy statements. In the past, practice guidelines have been used to improve care through the dissemination of evidence-based, clinically effective practices to pediatric practitioners. In the current environment this purpose has been broadened to include cost reduction, standardization of practice, and reduction of medical liability. This has led to both confusion and distrust on the part of the pediatrician. Practice guidelines are best understood as a tool to insure that children receive evidence-based care. They are best used in association with a set of outcome and performance measures that provide feedback to clinicians and allow for modification of the guidelines to meet the needs of the local patient population. The quality of practice guidelines is directly dependent on the quality of the medical evidence supporting the recommendation. Unfortunately only a small percentage of the evidence supporting practice guidelines comes from randomized clinical trials with the majority of the evidence coming from expert clinical panels. The success of practice guidelines in improving care for children has yet to be convincingly demonstrated. Currently, there is a dearth of well designed studies that document the effectiveness of practice guidelines. Their ultimate effectiveness will depend on both an improved evidence base and effective strategies for rapid dissemination of the recommendations. The development of evidence-based practice guidelines does not insure that it will have a major impact on physician practice. In the past, effective dissemination of new knowledge has been a long process, often taking years. This cycle time can be dramatically shortened through the development of networks of practice sites that share knowledge and experience in the implementation of practice guidelines and the use of strategies that take advantage of key groups in the dissemination process. When used appropriately, practice guidelines can provide an important adjunct to clinical research by facilitating the dissemination of new clinical findings and can provide an important platform for encouraging innovations in patient care.

The top 10 recent innovations in patient care in the trauma ICU.

The top 10 recent innovations in patient care in the trauma ICU.

In search of excellence

Atrilogy of ambitious White Papers, the implementation of the Culyer Report (Department of Health (DoH) 1994) and the 1996 Research Assessment Exercise (RAE96) are providing a complex environment for all those associated with primary and community care. In response to the Culyer Report, both acute and community NHS trusts are forming research and development departments charged with maximising research income. Clinical and academic alliances are being forged throughout the country to take advantage of the funding opportunities, but the most successful will be those that received high ratings in RAE96. Primary Care: The Future – Choice and Opportunity (DoH 1996a) has set the agenda for the foreseeable future with its central proposal to deregulate general practice, but the established organisations will be the ones most favoured to undertake the extensive research and development opportunities that will arise through these DoH initiatives. Innovations in patient care must be supported by published evidence that can contribute to RAE2000 if organisations are to prosper.

Innovations in Patient Care: Changing Clinical Practice and Improving Quality

In the traditional hospital organization, administrators supply the resources while physicians determine their use. Given this dichotomy, a partnership between clinicians and hospital management is essential for efforts to enhance the quality of care while controlling costs. To foster this partnership, in 1986 the University of Rochester's Strong Memorial Hospital developed its Innovations in Patient Care (IPC) program, which several other medical centers have duplicated. CURRENT STATUS AND LOGISTICS: Hospital operating revenues of approximately $175,000 per year are provided to both fund proposals and support core IPC staff. Clinical staff submit proposals to study innovations to promote higher quality care and/or the efficient and appropriate use of diagnostic and therapeutic services. Many of the 77 projects funded to date have led to important changes in clinical practice. One study, whose principal investigator was assistant director of emergency medicine, showed that structured, condition-specific (for example, asthma, pharyngitis, lacerations, and isolated closed-head injury) quicksheets improved documentation of clinical findings, resource use, and clinical practice. A study organized by the leadership of surgical nursing revealed that a nursing case management model led to reductions in patient length of stay and increases in nurse satisfaction. Another study, designed by a fellow in neonatalogy, developed and tested guidelines for the use of head ultrasounds in screening very-low-birthweight infants for intraventricular hemorrhage. IPC programs, which integrate well with initiatives in total quality management, can be effectively used to change clinical practice and improve the quality and efficiency of patient care.