Multimodal Quality Research Articles

Blind Multimodal Quality Assessment of Low-Light Images

Blind Multimodal Quality Assessment of Low-Light Images

232 A Multimodal Quality Improvement Intervention to Reduce Head and Cervical Spine Trauma Imaging

232 A Multimodal Quality Improvement Intervention to Reduce Head and Cervical Spine Trauma Imaging

Reducing Clostridioides difficile Infections in a Medical Intensive Care Unit: A Multimodal Quality Improvement Initiative.

Clostridioides difficile (C. diff) infection causes significant morbidity for hospitalized patients. A large medical intensive care unit had an increase in C. diff infection rates. The aim of this project was to reduce the C. diff polymerase chain reaction (PCR) test positivity rate and the rate of C. diff PCR tests ordered. Rates were compared between preintervention (July 2017 to December 2019) and postintervention (January 2021 to December 2022) timeframes. Unit leadership led a robust quality improvement project, including use of quality improvement tools such as A3, Gemba walks, and plan-do-study-act cycles. Interventions were tailored to the barriers identified, including standardization of in-room supply carts; use of single-packaged oral care kits; new enteric precautions signage; education to staff, providers, and visitors; scripting for patients and visitors; and use of a C. diff testing algorithm. Statistical process control charts were used to assess for improvements. The average rate of C. diff PCR test positivity decreased from 34.9 PCR positive tests per 10 000 patient days to 12.3 in the postintervention period, a 66% reduction. The average rate of PCR tests ordered was 28 per 1000 patient days in the preintervention period; this decreased 44% to 15.7 in the postintervention period. We found clinically significant improvements in the rate of C. diff infection and PCR tests ordered as a result of implementing tailored interventions in a large medical intensive care unit. Other units should consider using robust quality improvement methods and tools to conduct similar initiatives to reduce patient harm and improve care and outcomes.

Multimodal Quality Initiatives in Sepsis Care: Assessing Impact on Core Measures and Outcomes.

Providing timely and effective care for patients with sepsis is challenging due to delays in recognition and intervention. The Surviving Sepsis Campaign has developed bundles that have been shown to reduce sepsis mortality. However, hospitals have not consistently adhered to these bundles, resulting in suboptimal outcomes. To address this, a multimodal quality improvement sepsis program was implemented from 2017 to 2022 in a large urban tertiary hospital. The aim of this program was to enhance the Severe Sepsis and Septic Shock Management Bundle compliance and reduce sepsis mortality. At baseline, the Severe Sepsis and Septic Shock Management Bundle compliance rates were low, at 25%, with a sepsis observed/expected mortality ratio of 1.14. Our interventions included the formation of a multidisciplinary committee, the appointment of sepsis champions, the implementation of sepsis alerts and order sets, the formation of a Code Sepsis team, real-time audits, and peer-to-peer education. By 2022, compliance rose to 62%, and the observed/expected mortality ratio decreased to 0.73. Our approach led to improved outcomes and hospital rankings. These findings underscore the efficacy of a comprehensive sepsis care initiative, emphasizing the importance of interdisciplinary collaboration. A multimodal hospital-wide sepsis performance program is feasible and can contribute to improved outcomes. However, further research is necessary to determine the specific impact of individual strategies on sepsis outcomes.

Improving Antibiotic Overuse in Primary Care: A Multimodal Quality Improvement Project.

Antibiotic overuse has increased over time related to provider knowledge gaps about best practices, provider perception of patient expectations on receiving an antibiotic, possible pressure to see patients in a timely fashion, and concerns about decreased patient satisfaction when an antibiotic is not prescribed. The Centers for Disease Control and Prevention estimates that up to 30% of antibiotics are inappropriately prescribed in the outpatient setting. This quality improvement project consisted of a multimodal approach to decrease inappropriate antibiotic prescribing for viral upper respiratory infections (URIs) by using provider education, passive patient education, and clinical decision support tools based on Centers for Disease Control and Prevention recommendations and the Be Antibiotic Aware tool. Following implementation, there was an 11% decrease in viral URI antibiotic prescribing, from a rate of 29.33% to 18.33% following the multimodal implementation. The use of evidence-based education and treatment guidelines was found to decrease inappropriate antibiotic prescribing for patients diagnosed with viral URIs.

“I Am Unhide-able”: Conditions of Visibility in The Poet X

Abstract Within Latinx literary studies, young adult literature remains on the margins of scholarship. Yet if the overwhelming popularity of Elizabeth Acevedo’s award-winning novel-in-verse, The Poet X (2018), is any indication, then the genre of Latinx young adult literature offers important insights into contemporary Latinx literatures and cultures. This article argues that The Poet X leverages its multimodal qualities to deconstruct the hierarchies of knowledge that render Afro-Latinx subjects, especially young women, both invisible and hypervisible. As slam poetry allows Xiomara, the fifteen-year-old protagonist, to alter these conditions of visibility in her coming-of-age narrative, Acevedo’s book about the medium—a novel of page poems that are the textual source of performance poems housed online—also manifests social change, for Acevedo’s book has helped to shift Latinx young adult literature into a politics of inclusion and a register of empowerment. By centering a young, Dominican, Afro-Latina woman, The Poet X resists the homogenization of Latinidad by turning to slam poetry as a creative outlet of self-reclamation. Drawing from Diana Taylor’s The Archive and the Repertoire: Performing Cultural Memory in the Americas (2003), the article contends that the literary and performatic qualities of the poems in the text demonstrate why Latinx young adult literature is crucial to Latinx literary studies more broadly. Ultimately, Acevedo’s multimodal poetic project extends its account of Xiomara’s slam experience to uphold Afro-Latinx youth, and Afro-Latinx girls especially, as creators of worlds and makers of knowledge that disrupts traditional constructions of Latinidad.

Description of tea quality using deep learning and multi-sensor feature fusion

To address the problem of the lack of rapid discrimination technology for comprehensive evaluation of product quality and grade in the field of tea quality control, this study uses near-infrared spectroscopy, electronic eye, electronic tongue, and electronic nose technology to sense the external and internal quality sensing characteristics of tea leaves, and realizes comprehensive evaluation of four quality factors such as "color, aroma, taste and shape" of tea leaves through cross-sensor multimodal quality characteristics data fusion. For the first time, a comprehensive method for assessing the grade quality of tea based on deep learning algorithms combining cross-sensor multimodal fusion features such as color, texture, shape, optical, electronic tongue, and electronic nose is established. The results showed that the constructed deep convolutional neural network (CNN) classification model had a misclassification rate of only 0.86% in the prediction set, which was better than the modeling results based on traditional classification methods. This study reveals that the CNN algorithm can effectively evaluate the quality grade of tea samples and realize the digital evaluation of multiple evaluation factors of tea sensory quality.

Parent–child shared reading of scratch-and-sniff books: the communicative affordance of olfaction

ABSTRACT This study extends the research on shared book reading (SBR) by specifically examining the role of smell in parent–child SBR sessions observed at home. Drawing on qualitative methods, we analysed the verbal engagement of ten Norwegian families and their three to five-year-olds reading an olfactory book (the scratch-and-sniff book Peter Follows His Nose). We followed socio-semiotic theorisations (Kress and Van Leeuwen 2002), to critically evaluate the role of olfaction as a communicative resource in SBR. We outline the principal ways in which smell fulfils three linguistic metafunctions during adult–child SBR with olfactory storybooks: the interpersonal function of signalling individual interests, the textual function of creating a dialogic space and the ideational function of revealing divergent interpretations. We propose that olfaction can be seen as a semiotic mode in SBR, which similarly to colour, has distinct grammar and systematic communication properties, with unique multimodal qualities.

CIDO: Chaotically Initialized Dandelion Optimization for Global Optimization

Metaheuristic algorithms are widely used for problems in many fields such as security, health, engineering. No metaheuristic algorithm can achieve the optimum solution for all optimization problems. For this, new metaheuristic methods are constantly being proposed and existing ones are being developed. Dandelion Optimizer, one of the most recent metaheuristic algorithms, is biology-based. Inspired by the wind-dependent long-distance flight of the ripening seed of the dandelion plant. It consists of three phases: ascending phase, descending phase and landing phase. In this study, the chaos-based version of Chaotically Initialized Dandelion Optimizer is proposed for the first time in order to prevent Dandelion Optimizer from getting stuck in local solutions and to increase its success in global search. In this way, it is aimed to increase global convergence and to prevent sticking to a local solution. While creating the initial population of the algorithm, six different Chaotically Initialized Dandelion Optimizer algorithms were presented using the Circle, Singer, Chebyshev, Gauss/Mouse, Iterative and Logistic chaotic maps. Two unimodal (Sphere and Schwefel 2.22), two multimodal (Schwefel and Rastrigin) and two fixed-dimension multimodal (Foxholes and Kowalik) quality test functions were used to compare the performances of the algorithms. When the experimental results were analyzed, it was seen that the Chaotically Initialized Dandelion Optimizer algorithms gave successful results compared to the classical Dandelion Optimizer.

2147. Multi-modal Quality Improvement Study to Reduce C. difficile Detection and Infections in Hospitalized Children

Abstract Background Our institution identified rising rates of Clostridiodes difficile (C. difficile) results and infections, which coincided in part with the introduction of gastrointestinal panels (GIP) testing. We aimed to reduce the rate of positive C. difficile results and hospital-acquired infections (HAI) by 20%. Methods We engaged key stakeholders to identify key drivers, develop interventions, and evaluate outcomes through several plan-do-study-act cycles. We conducted a multi-modal intervention that involved 1) provider education, 2) C. difficile clinical pathway development, 3) improved preventative cleaning measures, and 4) electronic medical record (EMR)-based GIP changes including a) added option for GIP with or without C. difficile (run on same testing platform, but C. difficile results were suppressed if not ordered), and b) built in testing restrictions with optional approval process (Table 1). Our population included all hospitalized children (< 18 years old) who had a stool test performed at a large quaternary-care children’s hospital over 30 months (2018-2020). Our primary outcomes were 1) rate of C. difficile positive results and 2) C. difficile HAI rates (defined as a positive test and symptom onset on or after day three of admission; adjudicated in real-time as part of routine surveillance) per 10,000 patient-days (PDs). Our process measure was the rate of testing capable of detecting C. difficile per 10,000 PDs. As a balancing measure, we evaluated the proportion of suppressed results that were ultimately released based on judgement of a infectious disease specialist who monitored these results in real-time for 7 months. Results We identified 2,001 stool tests performed for 1,982 encounters (Table 2). After education and EMR-based changes, we found special cause variation with a 44% decrease in the rate of positive C. difficile results and 55% decrease in HAI rates (Figures 1,2). There was a 44% decrease in testing for C. difficile, and only 2% (2/89) of suppressed results were ultimately released based on expert monitoring. The majority of patients (76%) with suppressed C. difficile results had a coinfection or were < 1 old. Conclusion Education coupled with EMR-based testing changes resulted in an impactful and sustained decrease in C. difficile detection and HAI rates. Disclosures Samuel R. Dominguez, MD PhD, Biofire DIagnostics: Advisor/Consultant|Biofire DIagnostics: Grant/Research Support|DiaSorin Molecular: Advisor/Consultant|Karius: Advisor/Consultant|Pfizer: Grant/Research Support.

A Review of Approaches for Assessing Multimodal Quality of Service

Prompted by a need to respond to increasing traffic congestion, national, state, and local organizations have called for increased multimodal planning. This changing focus has added more complexity, data needs, and desire for supportive analytical tools to the transportation planning process overall. Multimodal performance methodologies are needed that can be readily applied. This article provides an analysis of existing methodologies to assess quality of service and related concerns for pedestrian, bicycle, and transit modes. It explores the methodologies in the context of supply-side considerations and provides considerations for their use. By placing transit-level service in line with pedestrian and bicycle, it brings all the modes together, making management easier.

“One does not simply categorize a meme”: A dual classification system for visual-textual internet memes

Internet memes are a popular and long-standing genre of discourse on social media platforms, used to express everything from emotional states to political opinions. Dancygier and Vandelanotte (2017) define internet memes as intertextual, multimodal discourses that combine text with images. In order to capture and compare these rapidly-changing discourses, we propose a descriptive dual classification system for memes with two components: meme composition and multimodal quality. Meme composition categorizes memes by their structure—beyond the individual images they employ—and thus explains how memes recontextualize images and text to create new meanings. Multimodal quality serves to describe the way(s) that the text interacts with the image in the meme: as a caption, label, and/or utterance. Combining one meme composition with one or more multimodal qualities classifies an individual meme structurally and provides a basis for explaining its intertextuality, modality, and meaning-making. We apply the dual classification system to English language data collected in its naturally-occurring context on the social media platform Instagram from 2019 to 2021. Analysis of these data shows that the dual classification system is a flexible and robust approach which provides a vocabulary for discussing the creative agency exerted by meme creators in a wide range of communities. We argue that the dual classification system affords researchers the ability to study memes linguistically across a variety of platforms and over time.

Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy: Impact of Drug Resistance, Traumatic Brain Injury, and Comorbidity.

Epilepsy is defined by the occurrence of multiple unprovoked seizures, but quality of life (QOL) in people with epilepsy is determined by multiple factors, in which psychiatric comorbid conditions play a pivotal role. Therefore, understanding the interplay between comorbid conditions and QOL across epilepsy phenotypes is an important step toward improved outcomes. Here, we report the impact of QOL across distinct epilepsy phenotypes in a cohort of post-9/11 veterans with high rates of traumatic brain injury (TBI). This observational cohort study from the Veterans Health Administration included post-9/11 veterans with epilepsy. A process integrating an epilepsy identification algorithm, chart abstraction, and self-reported measures was used to classify patients into 1 of 4 groups: (1) epilepsy controlled with medications, (2) drug-resistant epilepsy (DRE), (3) posttraumatic epilepsy (PTE), or (4) drug-resistant PTE (PT-DRE). Summary scores for 6 QOL measures were compared across the groups after adjustment for age, sex, and number of comorbid conditions. A total of 529 survey respondents with epilepsy were included in the analysis: 249 controls (i.e., epilepsy without DRE or PTE), 124 with DRE, 86 with PTE, and 70 with PT-DRE. DRE was more common in those with PTE compared with those with nontraumatic epilepsy (45% vs 33%, odds ratio 1.6 [95% CI 1.1-2.4], p = 0.01). Patients with PTE and PT-DRE had significantly more comorbid conditions in health records than those with nontraumatic epilepsy. Those with both PTE and DRE reported the lowest QOL across all 6 measures, and this persisted after adjustment for comorbid conditions and in further linear analyses. Among those with PTE, DRE prevalence was significantly higher than prevalence of nontraumatic epilepsies. PTE was also associated with higher burden of comorbidity and worse overall QOL compared to nontraumatic epilepsies. People with PTE are distinctly vulnerable to the comorbid conditions associated with TBI and epilepsy. This at-risk group should be the focus of future studies aimed at elucidating the factors associated with adverse health outcomes and developing antiepileptogenic therapies.

An In Situ Mock Code Program in the Pediatric Intensive Care Unit: A Multimodal Nurse-Led Quality Improvement Initiative.

Lifesaving resuscitation is required for approximately 1 in 100 patients in the pediatric intensive care unit. Certification renewal alone is insufficient to guarantee adequate knowledge, skills, and confidence among staff members involved in infrequent resuscitation events. Knowledge and skill gaps were identified in pediatric intensive care unit staff members involved in patient resuscitation events. The primary aim of this quality improvement project was to optimize patient resuscitations through improved staff performance and coordination between interdisciplinary roles. A multidisciplinary committee was created to develop, implement, and evaluate a mock code program. Surveys were administered before and after the intervention to assess self-perceived resuscitation performance and program effectiveness. Code sheets were analyzed for documentation quality and adherence to pediatric advanced life support guidelines. The committee used a multimodal approach to education, including high-and low-fidelity in situ mock code simulations and supplemental educational events. From September 2018 through January 2020, the committee conducted 65 events for almost 500 participants. Nurses' levels of self-reported confidence in initiating pediatric advanced life support interventions and identifying cardiac rhythms increased, as did perceived level of competence and knowledge. Most unit staff members considered the mock code program to be "very to extremely effective" in increasing resuscitation competence, confidence, communication, teamwork, and role clarity. Adherence to recommended resuscitation behaviors improved, as did code sheet documentation quality. An in situ mock code program using a multimodal approach to education can be a successful educational adjunct to biennial pediatric advanced life support certification.

Multimodal Quality Improvement Intervention With Dedicated Patient Flow Manager to Reduce Emergency Department Length of Stay and Occupancy: Interrupted Time Series Analysis

IntroductionCrowding in the emergency department is a problem worldwide that can affect patient safety and clinical outcomes. The aim of this project was to evaluate a multimodal quality improvement intervention with a new patient flow manager to reduce ED length of stay and ED bed occupancy. MethodsThis single-site interrupted time-series analysis study was conducted in a tertiary hospital emergency department in South Korea. Interventions for a novel system load-balancing approach included a data-driven patient flow tracking informatics system, adding medical specialists, point-of-care creatinine testing (when required before diagnostic imaging) with dedicated imaging test slots for emergency patients, and introducing patient flow managers. Records of adult patients visiting the emergency department from January 2016 to March 2020 were included. Outcomes were ED length of stay and ED bed occupancy. Regression discontinuity analysis of an interrupted time series was used adjusting for seasonality and the number of patients per staff. ResultsA total of 46,494 patients in the preintervention period and 151,802 patients in the postintervention period were included. After the intervention, ED length of stay decreased by 4.07 hours, whereas the slope indicated a return to preintervention levels over time. Monthly average ED bed occupancy decreased by 34.6%, and the slope remained consistent over time. DiscussionThe multimodal quality improvement intervention that included a patient flow manager was an effective intervention to reduce the ED length of stay and the ED bed occupancy at the study site. The change for length of stay may not sustain over time without further intervention.

Quality Improvement Intervention Bundle Using the PUPPIES Acronym Reduces Pressure Injury Incidence in Critically Ill Patients.

To assess whether a quality improvement bundle focusing on prevention is effective in reducing pressure injury (PI) incidence or costs or delaying PI onset. A combined retrospective/prospective cohort study was performed at an academic tertiary care ICU on all patients admitted with a length of stay longer than 48 hours and Braden scale score of 18 or less. Following retrospective data collection (preintervention), a multimodal quality improvement bundle focusing on PI prevention through leadership initiatives, visual tools, and staff/patient education was developed, and data were prospectively collected (postintervention). Statistical and cost analyses were performed comparing both cohorts. A total of 930 patients met the study inclusion criteria (preintervention, n = 599; postintervention, n = 331). A significant decrease in PI incidence was observed from preintervention (n = 37 [6%]) to postintervention (n = 7 [2%], P = .005). This led to a predicted yearly cost savings of $826,810. Further, a significant increase in time to PI occurrence was observed from preintervention (mean, 5 days) to postintervention (mean, 9 days; P = .04). Staff were compliant with the bundle implementation 80% of the time. Implementation of the quality improvement bundle focused on multimodal PI prevention in critically ill patients led to a significant reduction in PI incidence, increased time to PI occurrence, and was cost-effective.

Entextualizing high energy texts: an exploration of modal shift on a Chinese online video-sharing website Bilibili

Abstract Recently, there has been a surging interest in meaning-making processes in Chinese social media. However, most studies focus on the current contexts, ignoring the process of entextualization, that is, how semiotic resources have been decontextualized from the original/prior contexts and recontextualized in the current Chinese social media context. This paper intends to fill this gap by studying an example of entextualization coupled with modal shift. Specifically, an oral warning – initially a line frequently uttered in a Japanese animation serial – has been reshaped and reused to type comments in various video scenes and for various meanings on a Chinese video-sharing website Bilibili ( https://www.bilibili.com/ ). Drawing on selective notions in computer-mediated communication and social semiotic multimodality, this paper analyses a set of these comments, which we call high energy texts, focusing on their multimodal quality and the meaning-making processes involved. We suggest that new possibilities are generated during the modal shift (i.e. from speech to writing); in particular, warning acts carried out through high energy texts have been transformed into a collective social action that is recognized and understood by Bilibili users, the participation of which enables the users to build alignment and enact different identities. Our paper showcases how a social semiotic multimodal perspective can enrich our understanding of the semiosis in Chinese social media.

A Systematic Review of Asthma Readmission Risk Factors

A Systematic Review of Asthma Readmission Risk Factors

P041 Successful Reduction in Opioid Prescription for IBD Flare in the Emergency Department: A Retrospective Study and Quality Improvement Initiative.

Opioid use is associated with increased mortality, emergency department (ED) utilization, 30-day readmission rates and decreased quality-of-life in patients with inflammatory bowel disease (IBD). Opioid use in the ED for acute IBD presentations has not been well characterized in the literature. Safe, evidence-based, and effective pain management guidance for IBD flares is needed to promote opioid stewardship in the ED. We performed a retrospective cohort study of adult patients who presented to an academic tertiary center ED with IBD flares from June 2019 through December 2019. Demographic and disease specific information and ED course, including analgesic use and numeric rating pain scores at ED presentation and discharge, were collected from the medical record. We designed and implemented a multimodal quality improvement intervention consisting of an evidenced-based IBD pain guideline, customized electronic health record order-set, Gastroenterology (GI) consult note smart-phrase and clinician education to promote opioid stewardship. The impact of our intervention was measured with a repeat retrospective analysis from December 2020 through April 2021. Run charts were generated to correlate the timing of interventions to changes in opioid exposure and prescription. Seventy-one patients were included in the pre-intervention cohort. A total of 78% of patients who presented to the ED with IBD flare were prescribed opioid(s) with an average of 29.3 morphine milligram equivalence (MME) per ED stay. Approximately half (49%) of patients did not receive any non-opioid analgesic and 13% patients received an opioid prescription at ED or hospital discharge. In the post-intervention cohort consisting of 49 patients, there was a significant reduction in the proportion of patients receiving opioids (45% vs. 78%; p < 0.001) and a significant reduction in the average total opioid administration (10.8 vs. 22.6 MME; p < 0.001). For each month during the post-intervention period, the proportion of patients who received an opioid in the ED and the average total opioid administered remained less than the median of the entire study period, which represents a nonrandom pattern. The use of a non-opioid analgesic, IV acetaminophen, was significantly increased (27% vs 3%; p < 0.001) and the risk of new or recurrent gastrointestinal bleeding was negligible in both cohorts (0% vs. 1%; p = 1.0). There was no significant difference between the average pain score (4.9 vs. 5.4 [10-point-scale]; p=0.440) and the difference between reported triage and final ED pain scores (-1.8 vs. -2.0; p=0.729). Furthermore, there was a significant reduction in GI consultation (35% vs. 58%; p <0.016) and a non-significant reduction in hospital admission (63% vs. 80%; p=0.058). Almost 80% of patients who present to ED with IBD flare are prescribed opioids, while only half of patients receive non-opioid analgesics. Also concerning was the high rate of opioid prescription at ED or hospital discharge. A multimodal intervention successfully reduced the proportion and amount of opioid prescribing in the ED without compromising pain control or increasing the risk of GI bleeding. This was also associated with a significant increase in a non-opioid analgesic administration and a significant decrease in GI service consultation. These findings support the role of implementing an evidence-based IBD pain management guideline with electronic prescribing support and education in the ED setting for acute IBD flares. Additional research is needed to determine long-term benefits of reduced opioid exposure in this population.

Quality Improvement Initiative to Improve Healthcare Providers’ Attitudes towards Mothers with Opioid Use Disorder

Individuals with opioid use disorder often report feelings of shame and describe feeling judged negatively. These feelings are especially true for pregnant women with opioid use disorder. The Ohio Perinatal Quality Collaborative conducted a multimodal quality improvement initiative for infants born with Neonatal Abstinence Syndrome (NAS). An important component of the project was focused on improving staff attitudes toward mothers of infants with NAS. The Ohio Perinatal Quality Collaborative implemented an education program for healthcare providers at 39 participating hospital units regarding opioid use as a chronic disease and principles of nonjudgmental, trauma-informed care. Healthcare providers partnered with the mother of infants with NAS in the care of the infant and connected with local community resources. This work was a subcomponent of an overall multimodal quality improvement project. Healthcare provider attitudes were measured with the "Attitude Measurement: Brief Scales" questionnaire anonymously, at 3 different time points throughout the project. Attitude change was measured by pretraining and posttraining scores. ANOVA methods were used to compare individual items and a summary score across the 3 surveys. Summary scores improved significantly from 18.99 at baseline (January-March 2014) to 19.94 (P < 0.0001) in February 2015 and were maintained at 20.05 in July 2016. A nonjudgmental attitude toward mothers of infants with NAS is an important component of compassionate care. Improving healthcare provider attitudes can benefit a mother of an infant with NAS and help preserve the mother-infant dyad.