Large Medical Institution Research Articles

Abstract 4137587: Need for Testing Standardization and Improved Treatment of Elevated Lipoprotein(a) at a Large Urban Academic Medical Center

Background: Lipoprotein(a) [Lp(a)] is causally linked to ASCVD events and aortic stenosis. Some guidelines now recommend screening of Lp(a) at least once in an adult’s lifetime. Currently, there is inconsistency in measurement modality (mg/dL vs. nmol/L), but most guidelines recommending testing in nmol/L due to less variability and improved standardization. We sought to determine the Lp(a) measurement practices, including testing modality and downstream interventions, at a large academic medical institution. Methods: We evaluated all patient encounter data at UT Southwestern Medical Center (UTSW) between January 1, 2017 to December 31, 2021 for any Lp(a) measurement. High Lp(a) was defined as >50mg/dL or >125 nmol/L. Aggregate data were used to summarize patient demographics, relevant ASCVD co-morbidities, and lipid lowering prescriptions. Chart-review was conducted on patients with high Lp(a) to assess referrals to specialty clinics. Results: From 2017 to 2021, there were 1,065 Lp(a) measurements among 938 patients, representing fewer than 0.1% of all patients with labs at UTSW. Most were ordered by cardiologists (71%). Lp(a) tests ordered by cardiologists increased 69% annually but remained stagnant for other specialties (figure 1, lines). Median Lp(a) levels across all tests were 17mg/dL and 43nmol/L. Lp(a) was high in 30% of all initial tests. A higher proportion of tests ordered in 2021 by cardiologists (84%) were in nmol/L, the recommended standard, compared with other specialties (55%) (figure 1, bars). Patients with high Lp(a) found by a non-cardiologist were infrequently referred to cardiology (16%), and 53% of patients with high Lp(a) were prescribed lipid lowering therapy within 3 months. Conclusion: Lp(a) testing at a major academic medical center was rare and only marginally increased during the 5-year study period. Measurement frequency and assay varied widely between specialties, and there were potential opportunities for downstream interventions. In addition to improving awareness of Lp(a), there is an opportunity to standardize practice patterns regarding its measurement and implications.

Understanding faculty perspectives on health equity curriculum implementation in graduate medical education: a qualitative study.

Despite increased awareness of persistent healthcare disparities, integrating health equity education into medical residency curricula needs urgent expansion. The Accreditation Council for Graduate Medical Education (ACGME) mandates addressing healthcare disparities and social determinants of health, but implementation remains insufficient due to pervasive barriers. To explore residency faculty perspectives at one institution surrounding implementing a health equity curriculum within their programs. Between November 2022 and April 2023, qualitative interviews and focus groups were conducted with residency faculty participants (n = 13) from a large academic medical institution. Participants were recruited via an internal email list directory of program directors. Semi-structured sessions explored faculty perspectives on health equity curriculum implementation. Data analysis utilized template analysis and thematic coding. Faculty perceived barriers included limited time for teaching health equity, challenges in prioritizing health equity content within the curriculum, lack of formal training and expertise, discomfort in leading discussions, and institutional barriers such as resource allocation and lack of buy-in. Findings underscored the need for institutionally supported faculty development and protected learning time for health equity education. Despite participant recruitment and representation limitations, the study provides valuable insights for addressing curricular challenges. This study highlights critical areas for improving health equity curriculum implementation in graduate medical education. Addressing these faculty barriers can enhance resident competency in identifying and addressing healthcare disparities. The study received approval from the Thomas Jefferson Institutional Review Board (IRB #22E.762).

The Experience of Observational Departments’ Functioning for Treatment of Patients with Tuberculosis from COVID-19 Contact and Convalescents after COVID-19

Relevance. To control COVID-19, a net of special infection hospitals and departments was created, a system of medicaments and protective means’ supply was set up, necessary normative and regulatory documentation was developed and overall vaccination of population was performed in Moscow. Within frames of work for prophylaxis of COVID-19 spread in patients with tuberculosis at in-patient units of the State Budgetary Healthcare Institution of Moscow city «The Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health” (hereinafter referred as the Center), observational departments for treatment of patients with tuberculosis from COVID-19 contact and convalescents after COVID-19. Aims. To evaluate specialized observational departments’ work as part of general anti-epidemic control measure system for COVID- 19 at tuberculosis hospitals. Materials and methods. The observational departments’ work within the period of 2020–2022 with 1075 patients treated including 400 patients from COVID-19 contact areas (37.2%) and 675 convalescent patients after COVID-19 (62.8%), was analyzed. The results obtained during the study were statistically treated by means of application program package Microsoft Office 2007. The quantitative parameters with presumably normal distribution were described with mean arithmetic values (M) and standard deviations (SD), and 95% confidence interval (CI 95%). The estimation of significance of differences between outcomes was evaluated with the Pearson χ2 test. The differences were considered to be statistically significant with p < 0,05. Results and discussion. The evaluation data on functioning efficacy of observational departments for patients with tuberculosis from COVID-19 contact and convalescent patients with tuberculosis after COVID-19 within the large medical institution hospital of physiatry profile. Among all patients, 153 of patients who fell ill with COVID-19 (14.2%; 95% CI [12.21–16.38%]) were determined, which lowered the number of COVID-19 areas at in-patient departments of the Center by 11.8%. The mean timeframes of COVID- 19 determination in general were 8.0 days: 5.4 days among contacts from new coronavirus infection areas and 12.4 days among convalescents at the department for the treatment of patients with tuberculosis and new coronavirus infection. The comparative analysis showed that COVID-19 was more frequently determined in tuberculosis patients from the contact with those who fell ill with COVID-19 (p < 0.001) than in convalescents. Conclusions. During medical care for patients of physiatry profile in Moscow city, a wide range of management decisions consisting in the change of routing system in specialized medical care, was taken. Among them, creation and functioning of observational departments for contact persons from COVID-19 areas and convalescents after COVID-19 play a particular role.Creation of such departments within a large medical institution enabled the contemporary isolation of contact persons from COVID- 19 areas and convalescents after COVID-19 and allowed the additional control of nosocomial infection spread

Advantages and Challenges of Health Tourism Development in Croatia

This paper presents the advantages and challenges of Croatia as a health tourism destination. Croatia is a popular tourist destination where tourism significantly contributes to the country's GDP. Health tourism in Croatia is based on natural health resorts, preventative medical and rehabilitation programs, and various wellness offerings. However, the current state of health tourism is not very promising, as large medical institutions (such as clinical hospital centers, general hospitals, and polyclinics) show little interest. Previous guests have expressed dissatisfaction with the lack of innovation in the programs offered and the limited accessibility for persons with special needs. Significant investment in hotel and medical infrastructure is necessary to meet contemporary global tourist demand, including staff education and increased competitiveness in the international market. This research highlights the importance of health tourism as a selective type necessary for the current and future development of tourism at both local and international levels. The objective is to understand the existing potential of the Saint Nicholas Polyclinic and explore possibilities to further valorize health resources. The research methodology included a survey questionnaire, with results displayed graphically. The findings indicate that Croatia has the prerequisites for health tourism development, particularly in medical tourism. Keywords: tourism, health tourism, sanatorium, polyclinic, development

Mid-term outcomes of total hip arthroplasty in patients younger than 30 years.

Total hip arthroplasty (THA) has predominantly been utilized to treat older patients with primary osteoarthritis. However, recent improvements in surgical technique and implant materials have increased implant longevity, making THA a viable option for younger patients (< 30years old). While trend analyses indicate an expanding utilization of THA in younger patients with non-OA diagnoses, current data on mid- and long-term THA outcomes in this population are limited. This study aims to describe the demographics, perioperative data, and implant survivorship of patients younger than 30years undergoing THA. A retrospective study across two large urban academic medical institutions identified 135 patients aged < 30years who underwent 155 primary THAs between 2012 and 2017, with up to 10-year clinical follow-up. Baseline demographics, surgical indications, intraoperative details, and postoperative outcomes were analyzed. The mean age at surgery was 24.9 years (range 18-29). Osteonecrosis of the femoral head (55.5%), developmental hip dysplasia (28.3%), and arthritis (15.5%) were the primary indications. Most surgeries utilized the posterior approach (64.5%), manual technique (65.8%), and Ceramic-on-Polyethylene articulation (71.6%). Seven patients (4.5%) were readmitted within 90-days of surgery, including three non-orthopedic-related readmissions (1.9%) and four orthopedic-related readmissions (2.6%). Dislocations were reported in two patients (1.3%). There were six all-cause revisions (3.9%), four aseptic (2.6%) and two septic (1.3%). Kaplan-Meier analysis showed 10-year survival from implant retaining reoperation was 98.7%, 10-year survival from all-cause revision was 96.1%, and 10-year survival from aseptic revision was 97.4%. With a 10-year aseptic implant survivorship rate of 97.4%, THA is a reliable surgical intervention for patients younger than 30 years of age who have severe hip pathology. Further studies are warranted for a more comprehensive understanding of mid- and long-term survivorship risk factors in this demanding population, facilitating improved risk assessment and informed surgical decisions.

Cultural, demographic, and other non-demographic factors associated with cancer genetic counseling patients' appointment accompaniment preferences in the United States.

Although the presence of companion(s) in a genetic counseling session can positively influence session dynamics, research has found that some patients prefer to attend their appointments alone. To date, no studies have examined patient accompaniment preferences across different cultural groups in the context of genetic counseling. This quantitative study aimed to identify factors associated with individual preferences in accompaniment at cancer genetic counseling appointments in a sample (N = 130) of Hispanic/Latine (n = 29) and non-Hispanic/Latine White (n = 101) participants at a large academic medical institution. Variables examined included demographics, horizontal and vertical collectivism, and Hispanic and American acculturation. A link to an online questionnaire was emailed to patients who met four criteria: (1) identified as either Hispanic/Latine or non-Hispanic/Latine White; (2) had attended a cancer genetic counseling appointment at UCLA Health to discuss genetic testing options between October 2020 and December 2022; (3) were at least 18 years of age at the time of their appointment; and (4) indicated they were comfortable reading in Spanish or English; responses were anonymous. Logistic regression analyses identified four significant variables in the model associated with accompaniment preferences: individuals with at least one parent born outside of the US, those who attended their appointment in-person, and those with a higher horizontal collectivism score were less likely to want to attend their cancer genetic counseling appointment alone, while the converse was true among those with a higher American acculturation score. These findings highlight cultural and demographic factors that are associated with patient accompaniment preferences unrelated to ethnicity, indicating genetic counselors should not make assumptions regarding accompaniment preferences based solely on cultural or racial/ethnic background. Genetic counselors should incorporate this understanding when assessing patients' accompaniment preferences.

Health information and technology engagement for clinical research and healthcare purposes (HITECH) survey of patients with a history of cancer.

e13672 Background: Digital technology offers oncology clinicians and researchers the ability to more closely monitor patients on therapy, including with electronic patient-reported outcomes (ePROs) and real-time passively collected data (for example: heart rate, oxygen saturation, etc.), via smartphone and wearable devices. In order to realize the potential for these technologies to improve patient experience and outcomes, it is critical that we consider the perspectives of patients to design usable and useful digital monitoring programs. Methods: We conducted a cross-sectional survey of cancer patients from a large academic medical institution to study willingness to use digital devices to collect data and to share discrete types of data for the purposes of medical care or research. A survey including baseline characteristics and questions pertaining to digital technology use was sent to participants enrolled in the UCLA Mental Health and Health Technology Research Registry, from November 2023 to January 2024. Participants were included if they were patients at UCLA, age 18 years and older, owned a smartphone and/or wearable device, and self-reported a history of cancer. The primary outcomes of interest were willingness to collect and share digital device data. We report summary statistics for our population. Results: A total of 690 patients participated in our survey. The majority were female (58.5%), 76.7% non-Hispanic white, 8.8% Hispanic, 5.8% Asian, and 2.0% black. Median age was 69 years old. Nearly all participants reported experience using a patient portal (98.9%). Willingness to collect data using a digital device, for the purposes of clinical care was reported by 93.3% of patients. Similarly, 92.0% were willing to use a device to collect health data for research purposes. Sharing patterns were similar regardless of whether data was intended to be for clinical care or research purposes (Table). Conclusions: The overwhelming majority of patients who own a smartphone and/or wearable are willing to collect health data on their digital device for either clinical care or research. There is a preference for sharing more objective clinical information (vitals and physical activity measurements), and less inclination to share subjective information (daily activity, symptoms, and mood). This could be attributable to the greater effort required to input information as well as skepticism of the usefulness of the subjective data. Notably, we must recognize that some patients are not well-represented in this study population. Their perspectives should also be explored to prevent widening of the digital divide. [Table: see text]

Chinese expert consensus on clinical practice of daytime hip arthroplasty

Daytime hip arthroplasty refers to a medical procedure where a patient undergoes admission, surgery, and discharge all within a single day (24 hours). The establishment of daytime hip arthroplasty centers signifies a significant paradigm shift in the development model of modern hospitals. While numerous nationally accredited large medical institutions are undertaking daytime hip arthroplasty in various forms and scales, there remains a lack of standardized system processes and criteria. In this context, the National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Bone and Joint Specialty Committee of the China Ambulatory Surgery Alliance, Joint Surgery Branch of the Chinese Orthopedic Association, and Osteoarthritis Study Group of the Chinese Association of Orthopedic Surgeons have collaboratively organized experts in the relevant field domestically. Leveraging international experiences in daytime hip arthroplasty and integrating them with the clinical practices of well-established medical institutions conducting daytime surgeries in China, they have arrived at consensus recommendations. These recommendations cover the establishment of daytime hip arthroplasty centers, policies, procedures, and perioperative management. The ultimate goal is to provide reference points and guidance for the standardized implementation of daytime hip arthroplasty.

Implementation rate of diabetic self-management education and support for Japanese people with diabetes using the National Database.

People with diabetes are encouraged to receive diabetes self-management education and support (DSMES) appropriately. However, in Japan, the implementation rates of DSMES are not known. DSMES implementation rates were calculated using the National Database of claims data, which included nearly all insurance-covered medical procedures. The study enrolled participants who received regular antidiabetic medications between April 2017 and March 2018. The implementation rates of DSMES-related care were calculated by characteristics, visiting medical facilities and prefectures. In 4,465,513 participants receiving antidiabetic medications (men, 57.8%; insulin use, 14.1%), nutrition guidance (5.6%) was the most frequently provided care type. Insulin users and participants visiting Japan Diabetes Society-certified and large medical institutions had higher implementation rates of nutrition guidance. DSMES-related care might not be provided adequately for Japanese people with diabetes. Further studies are needed to develop an optimal diabetes care system.

Abstract 3888: TOP1 mutations mediate cross resistance to ADCs in metastatic breast cancer

Abstract Background: Antibody-drug conjugates (ADCs) have improved survival for patients with metastatic breast cancer (MBC). In patients with HER2 negative MBC, two ADCs have FDA approval: sacituzumab govitecan (SG) and trastuzumab deruxtecan (T-DXd), both with topoisomerase-I (topo-I) inhibitor payloads. Given the many other ADCs in development, there is great interest in using ADC after ADC to maximize treatment benefit for patients. However, there is limited understanding regarding resistance mechanisms to ADCs and impact on ADC sequencing. We conducted a translational study to address this, and here we report the incidence of TOP1 mutations and clinical impact on ADC sequencing. Methods: All patients with MBC treated with ADCs at a large academic medical institution (Massachusetts General Hospital) who had comprehensive plasma-based genotyping (500 gene GuardantOMNI panel) were included. Since both SG and T-DXd have topo-I inhibitor-based payloads, we particularly focused on TOP1 mutations, variant allele frequency (VAF), and germline/somatic characterization. Incidence of TOP1 mutations in the ADC cohort was compared to The Cancer Genome Atlas (TCGA). Clinical “cross-resistance” was defined as progressive disease (PD) as best response to second ADC (ADC2) or treatment time on ADC2 of less than 60 days. Results: Based on comprehensive plasma-based genotyping we identified 4 distinct TOP1 mutations: S57C, R364H, W401C, G359E, at a frequency of 6.0% (4/67) at the time of disease progression on ADC compared to a frequency of 0.5% described in primary breast cancer in TCGA. Two of the amino acids found to be mutated are known to form direct interactions with the DNA backbone (G359) or the topoisomerase inhibitor itself (R364). For clinical resistance, one patient was briefly on ADC2 but stopped after 1 dose for toxicity; among the other 3 patients, two had cross-resistance to ADC after ADC, with both ADCs containing topo-I inhibitor payloads. Median duration on first ADC was 455 days compared to a median of 52 days for ADC2. Finally, one patient treated sequentially with 3 ADCs (all with topo-I inhibitor payloads) was found to have rising TOP1 VAF with progressive ADC treatments. Conclusion: This is the first report describing emergence of TOP1 mutations under selective pressure from ADCs and the impact on mediating cross-resistance to ADC after ADC with topo-I inhibitor payloads. Novel ADCs with alternative payloads may potentially be more effective when used sequentially after an ADC with a topo-I inhibitor. Further biomarker research is needed to optimize ADC sequencing for patients with TOP1 mutant MBC. Citation Format: Rachel Occhiogrosso Abelman, Haley Barnes, Arielle J. Medford, Annika Putur, Bogang Wu, Caroline Weipert, Geoffrey Fell, Laura M. Spring, Seth A. Wander, Beverly Moy, Andreas Varkaris, Dejan Juric, Leif Ellisen, Ryan Corcoran, Aditya Bardia. TOP1 mutations mediate cross resistance to ADCs in metastatic breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3888.

A 10-year retrospective cohort of diabetic patients in a large medical institution: Utilizing multiple machine learning models for diabetic kidney disease prediction.

As the prevalence of diabetes steadily increases, the burden of diabetic kidney disease (DKD) is also intensifying. In response, we have utilized a 10-year diabetes cohort from our medical center to train machine learning-based models for predicting DKD and interpreting relevant factors. Employing a large dataset from 73,101 hospitalized type 2 diabetes patients at The First Affiliated Hospital of Zhengzhou University, we analyzed demographic and medication data. Machine learning models, including XGBoost, CatBoost, LightGBM, Random Forest, AdaBoost, GBDT (gradient boosting decision tree), and SGD (stochastic gradient descent), were trained on these data, focusing on interpretability by SHAP. SHAP explains the output of the models by assigning an importance value to each feature for a particular prediction, enabling a clear understanding of how individual features influence the prediction outcomes. The XGBoost model achieved an area under the curve (AUC) of 0.95 and an area under the precision-recall curve (AUPR) of 0.76, while CatBoost recorded an AUC of 0.97 and an AUPR of 0.84. These results underscore the effectiveness of these models in predicting DKD in patients with type 2 diabetes. This study provides a comprehensive approach for predicting DKD in patients with type 2 diabetes, employing machine learning techniques. The findings are crucial for the early detection and intervention of DKD, offering a roadmap for future research and healthcare strategies in diabetes management. Additionally, the presence of non-diabetic kidney diseases and diabetes with complications was identified as significant factors in the development of DKD.

Using the Objective Key Result Method to Reduce the Rate of Biomedical Waste in Medical Institutions

Taiwan has been an active participant in waste recycling for a long period of time due to the need for resource sustainability. The country believes it can one day eventually achieve the goal of zero waste through the effective use of strategies such as source reduction, resource recovery, reuse, and recycling. Despite Taiwan’s long‐standing commitment to waste recycling for purposes of resource sustainability, achieving the goal of zero waste remains an immense challenge. Therefore, putting into effect the previously mentioned strategies will obviously be necessary in order to realize this goal. However, the effective implementation of these strategies requires both comprehensive planning and coordination, particularly in large medical institutions. Here, we have aimed to promote waste reduction throughout the entire hospital system in Taiwan using 3 strategies: (1) standardizing the colors of garbage bags, marking patterns of waste, and reviewing and establishing an internal audit mechanism on a regular basis; (2) the systematic monitoring of individual departments with regard to on waste consumption, brands, and materials while linking departments to the procurement source management team. In addition, any related hardware has been upgraded, precisely controlled, and automatically uploaded to the cloud system for an improved intelligent management system. In addition, the Department of Nutrition has adjusted the handling of ingredients and consumption patterns of hospital employees in order to reduce food waste; and (3) with regard to the disposal of medical waste, medical centers will be consolidating and advancing the knowledge and ability of all hospital personnel through education and training programs established for them. After the implementation of this program to promote awareness, the ratio of biological waste percentage in regard to total hospital waste dropped from 37.3% in 2018 to 33.6% in 2022, with a 49% decrease being seen in food waste, and a 99.32% increase being realized in green designated procurement items. Such an efficient management of medical waste has no doubt been extremely beneficial to the hospital.

의료관광만족도 확대를 위한 시설입지 요인 분석

As the competition for survival of medical institutions is rapidly changing due to the expansion and expansion of large medical institutions and the entry of foreign medical institutions into Korea, it is urgently needed to strategically respond to the importance of medical management to secure differentiated competitiveness. Therefore, as a management strategy in medical services, domestic medical institutions have been carrying out activities in various ways in order to measure physical service factors, medical service factors and patient satisfaction.&#x0D; In this study, the following conclusions were drawn based on the results of the patients who had been hospitalized using a medical institution. First, the design, cleanliness, convenience, provision and use of medical institutions were analyzed to improve patient satisfaction. Second, medical services were analyzed to increase patient satisfaction. Third, it was analyzed that the patient 's satisfaction is higher due to the physical service and medical service of the medical institution. As a result, we have focused on the physical service factors of medical institutions as a marketing strategy to increase patient satisfaction of medical institutions. However, recent patients can be found to be more satisfied with patients' services than physical services. It is expected that the satisfaction of the patients will be higher if the service of the medical personnel is increased during the future medical treatment.

Представления медицинских сестер о возрастной эволюции качеств субъекта: динамика, ресурсы

The relevance of the study is determined the following: increase in the duration of a person’s working life and the expansion of the articulate components of its quality create a socially and psychologically significant “second reality”, by which we mean subjective ideas about one’s profession, about one’s career, and about their social success. The research purpose is to study the ideas of the professional activity subjects about the age-related evolution of their qualities. The article hypothesizes the following ideas: 1) The subjects’ ideas about their professional and working life act as conditions that affect the dynamics of their professional evolution. 2) Social experience acts as a factor that influences the subjects’ ideas about the age-related evolution of their qualities. Participants: nurses (N = 82), women aged from 21 to 67, Regional Clinical Hospital No. 1 named after Professor S. V. Ochapovsky (Krasnodar). Methods (tools): the locus of subjective control was determined by means of the subjective control questionnaire (SCQ) (J. Rotter adapted by E. F. Bazhina, S. A. Golykina, A. M. Etkind); the original author’s methodology (“Dynamics of Professional Career Questionnaire”) (L. A. Sizova, V. A. Tolochek), which includes several groups of the most informative questions (previously tested and characterized by satisfactory reliability as the technique ‘items’): A) ideas about the dynamics of positive development, that is the development of professionally important qualities at the age of 20–65: 1) learning ability; 2) intuition in the professional sphere; 3) physical performance; 4) intellectual performance. B) ideas about the dynamics of the negative phenomena increase at the age of 20–65: 1) occupational destructions; 2) occupational diseases; 3) life crises. The third set of questions (C) is focused on the respondents’ reflection on the role of various “factors” in their professional development. Such factors as parents, relatives, friends, family members, work groups, special circumstances, science, art, and religion are considered. The fourth block (D) took into account the socio-demographic and official job-position characteristics of the respondents. Results: working hypotheses have been confirmed. The research shows that: 1) the use of the original author’s methodology made it possible to identify important “nodes” in the studied connections and determinants, and to identify both typical and professionally specific features of the dynamics of the subjects’ age-related evolution; 2) when getting the task of presenting their integral working life, people adequately describe its overall dynamics. At the same time, the level of reflection in the sample as a whole seems to be insufficient, adequate not in every aspect; 3) the subjects’ assessments (nurses of a large medical institution) of the role of external conditions, which optimize and/or aggravate the dynamics of evolution/involution of their qualities and functions, are liable to the powerful influence of indirect factors (media, etc.). This reflects the relevant tasks of correcting negative distortions of social perception of fragments of social reality, as well as the real possibilities of managing people’s ideas about their professional career. Main conclusions: the issue of professional careers in the areas with a “flat hierarchy” is of current importance and requires further study.

The current status and implications of the medical insurance fee schedule in Japan

Background: Korea has the most rapidly aging population in the world. Medical costs for the elderly are quickly increasing, which raises concerns about the sustainability of health insurance finances. Accordingly, the need to allocate limited medical resources efficiently has increased, with improving the fee schedule seen as an effective way to achieve this. Japan has experienced a super-aging society for at least 20 years prior to Korea and has been successful in improving its fee schedule. Korea’s fee schedule, however, needs to overcome the challenge of being relatively limited in type and simplicity.Current Concepts: The new patient consultation fee in Japan is the same regardless of the type of medical institution and is approximately 40% higher than found in Korea. In the case of established patient consultations, the fee for medical institutions with fewer than 200 beds are substantially higher than for large medical institutions, thereby suppressing re-examination at large hospitals. Japan’s additional points consist of 71 types of items, which is more diverse than Korea’s 28 types, and the additional points for children under six years of age, holidays, and late nights are set significantly higher than that found in Korea.Discussion and Conclusion: Japan designed its fee schedule to structurally reduce the consumption of medical resources and to effectively compensate for the behavior of medical providers. This policy is a standard which Korea’s fee schedule should aim for. In the future, it will be necessary to prepare measures to respond to the super-aging environment through detailed research concerning Japan’s fee schedule.

Identification of Choroidal Vascular Abnormalities in Patients with Hereditary Hemorrhagic Telangiectasia (HHT)

Purpose: To evaluate the frequency of ocular imaging in patients with HHT at a large academic medical institution; characterize the choroidal vascular changes on indocyanine green angiography (ICGA) and optical coherence tomography (OCT); and explore the relationship of these ocular features with HHT genotypes and systemic manifestations. Methods: Retrospective review of patients with HHT who were seen in the Mayo Clinic ophthalmology department between 2011 to 2021. Results: Of the 71 patients with HHT identified, 7 (10%) individuals had qualifying imaging defined as radial or raster spectral-domain OCT scans and/or ICGA. 4 (57%) patients had enlarged choroidal vessels detected on OCT and/or ICGA. 3 (43%) patients had retinal telangiectasias. Patients with choroidal changes (mean age 67 years) had the endoglin gene mutation, gastrointestinal arteriovenous malformations (AVM), and facial and mucocutaneous telangiectasias. In contrast, patients without choroidal changes (mean age 45 years) included the activin A receptor type-like kinase 1 gene mutation. Conclusion: Only a small proportion of patients with HHT undergo ophthalmic imaging at our institution. The presence of choroidal abnormalities is associated with the endoglin gene mutation, older age, corroborating retinal vascular changes, and increased systemic manifestations.

Creation and Establishment of the State Emergency Medical Services and Disaster Medicine Services in Russia (to the 100th Anniversary of the N.V. Sklifosovsky Research Institute for Emergency Medicine)

After the October Revolution of 1917, the creation of the state healthcare and medical education system in the country played a decisive role in the organization of emergency medical services (EMS) in Moscow on the basis of the former Sheremetev Hospital which later became a large multidisciplinary medical institution — N.V. Sklifosovsky Institute of Emergency Medicine (since 1943 — N.V. Sklifosovsky Research Institute for Emergency Medicine), — and the city EMS station as a part of it.In the pre-war period, the working out of the main principles for the EMS provision was critically important for the development of the services. It became possible to solve scientific and methodological problems related to the training of specialists. The Institute grew into a large institution, research in the field of emergency medicine was carried out at the world level. This contributed to the organization of a network of EMS institutions in the country during 1926–1935.The years of the Great Patriotic War of 1941–1945 enriched the practice of providing emergency medical care, including during mass patient admission.In the post-war years (1946–1970s), the Institute became the leading institution on the problems of EMS in the country. Corresponding divisions were created within the Institute, and on its basis — “Emergency Medicine” scientific and practical association, research and organizational structures of the USSR Ministry of Health, the RSFSR Ministry of Health and the USSR Academy of Medical Sciences. Thanks to this, outstanding results were achieved in the EMS organization: the specialty of “emergency medicine physician” was introduced; emergency hospitals were created in a number of the country’s regions; government programs for EMS provision were successfully implemented; а large number of regulatory documents were prepared to facilitate the further EMS development.N.V. Sklifosovsky Research Institute for Emergency Medicine was among the main initiators of the disaster medicine service, which made it possible to fundamentally solve its organizational and technical problems. Thus, a significant contribution was made to the foundation of this service in Moscow and around the country.At the current stage (from 1992 to the present), EMS improvement has been continued, many developments turned out to be relevant for this services in the Russian Federation. In particular, the created structure of the Institute’s admission and intensive care unit remained the flagship among emergency care institutions in the country for about 20 years. The state program “Improving medical care for road accident victims” was successfully implemented. The Institute’s departments are being actively specialized, making it possible to obtain fundamentally new scientific and practical results for widespread implementation.Since 2011, “Scientific achievements in the field of emergency medical care in the Russian Federation” - collections of research works - have been published annually. The information presented in them can be used throughout the country.The experience in treatment for the novel coronavirus infection COVID-19 allowed the Institute to begin a new page in the history of emergency medical services.The recent opening of an emergency inpatient complex at the Institute contributed to optimizing the work of the hospital’s resuscitation and intensive care units and expanding their treatment and diagnostic capabilities.For more than 10 years, the public and consolidating activities of the scientific and practical society of emergency medicine specialists have been effective. Its work primarily concerns the organization and conduct of scientific and practical events, especially congresses of emergency medicine physicians, as well as the publication of Sklifosovsky Journal Emergency Medical Care, which has unifying significance for a large number of Russian specialists in the field of EMS. The decisions made at the congresses and conferences became the basis for expanding the introduction of advanced medical technologies in the Russian regions, as well as for carrying out important structural reforms in EMS institutions.One of the main achievements of the N.V. Sklifosovsky Research Institute for Emergency Medicine is the creation of the state EMS as a separate branch of healthcare in the country. Over the 100 years of the Institute’s activity, the foundations of its theory and practice have been developed, moreover, a contribution of world significance was made to the EMS development, thereby strengthening the scientific foundation for the activities of the Institute for many years to come.

Effect of Preoperative Corticosteroids on Postoperative Glucose Control in Total Joint Arthroplasty

BackgroundDexamethasone is a commonly used perioperative medication for the management of postoperative nausea and vomiting following total joint arthroplasty (TJA). However, concerns have been raised about its potential to cause hyperglycemia. This study aimed to investigate the impact of dexamethasone administration on glucose levels and complications in both diabetic and nondiabetic patients undergoing TJA. MethodsWe performed a retrospective review of 1928 patients who underwent primary total knee and hip arthroplasty procedures at a large tertiary medical institution. Patients were divided into 2 groups based on whether they received preoperative dexamethasone. Postoperative blood glucose values and variability were measured, and data on complications were collected. We performed statistical analysis using descriptive analysis, multivariate logistic regression models, negative binomial regression, and a subset analysis to assess the impact of dexamethasone dose on postoperative glycemic control. ResultsPreoperative dexamethasone did not significantly increase the mean glucose, fasting glucose, glucose variability, or 90-day complications in both the diabetic and nondiabetic groups. Nondiabetic patients who received dexamethasone had a significantly lower rate of intensive care unit admission (P < .01). Additionally, patients who received dexamethasone had a significantly shorter length of hospital stay compared to those who did not (P < .001). ConclusionsPreoperative dexamethasone administration is a safe and effective method for preventing postoperative nausea and vomiting in patients undergoing TJA without significant adverse effects on glucose levels, glucose variability, or infection rates in both diabetics and nondiabetics. Preoperative dexamethasone decreases postoperative length of stay.

Evaluation of an Advanced Practice Provider Onboarding and Development Program.

To evaluate the impact of implementing a comprehensive secondary onboarding and development program within a hospital medicine group at a large tertiary academic medical institution. This was a mixed-methods study with physician and advanced practice providers (APPs) at an academic medical institution. For quantitative methods, improvement in competencies was determined using a pre-and posttest for APPs and pre- and postevaluation scores from collaborating physicians. APPs also participated in a pre- and post-self-assessment. For qualitative methods, experiences in the secondary onbo.arding and development program were assessed using semistructured interviews. For quantitative results, there were a total of 25 APPs who completed the pre- and posttest and were evaluated by at least 9 physicians. The average pretest score for APPs was 71.7% and the average posttest score was 83.0%. The average score for physicians' evaluations of APPs was 4.24/5 and increased to 4.38/5 in the postprogram evaluations. The average score for APP self-assessment pretraining was 3.52/5 and after the 12-month onboarding training, average scores increased to 3.84/5. For qualitative results, 4 APPs and 6 physicians were interviewed. Three of the APPs reported having more confidence in treating patients, whereas 1 APP viewed the program as a refresher course. All of the APPs mentioned that they would recommend the program to other APPs. Physicians reported that the program was beneficial in standardizing the care provided among the different types of APPs (physician assistants and nurse practitioners). All of the physicians also would recommend the program to other physicians and APPs.

Factors influencing second victim experiences and support needs of OB/GYN and pediatric healthcare professionals after adverse patient events

There is growing recognition that clinical and nonclinical healthcare professionals may become “second victims” following adverse patient events, medical errors, or patient-related injuries. In addition to the trauma-associated symptoms experienced by second victims, unprocessed second victim experience (SVE) can lead to burnout and leaving the healthcare workforce. To better understand the risk factors and support needs of affected healthcare professionals after a SVE, we conducted in-depth qualitative interviews with twelve staff in obstetrics &amp; gynecology and pediatrics at a large academic medical institution in the upper Midwest of the U.S. Several participants indicated that it was not the patient outcome itself that precipitated the SVE, but associated factors such as moral distress or communication challenges. Participants discussed the role of their work unit culture in post-SVE processing, expressing that units perceived as blame-seeking or where adverse events were not openly discussed, hindered their recovery. While desired support mechanisms were individualized, participants stressed the importance of immediate and proactive support, such as through a peer support program, and long-term support mechanisms for lingering symptoms. As attrition of the healthcare workforce continues to be a significant concern, it is essential that we understand and meet the post-SVE support needs of affected staff, to promote holistic care following adverse patient events.