Patient Encounters Research Articles

Implementing Telemedicine into Clinical Training Through Pre-recorded Video Consultations

Although the contribution of real patient encounters to medical education is well known, challenges such as a lack of suitable cases, patients not consenting to student involvement, physical space limitations that prevent every student from participating, the inability to replicate the same patient encounter, and reduced patient admissions to healthcare facilities during extraordinary periods are common obstacles that need to be addressed in clinical education. To overcome these challenges, video consultation (VC) recordings, which were made with the consent of patients having a telemedicine consultation, were collected as an archive of medical interview recordings covering a wide spectrum of pulmonary diseases. These recordings were watched by students in a classroom setting during clinical clerkships, with case discussions interspersed. This article, which also discusses the results of clinical clerkship evaluations, indicates that the use of pre-recorded VC sessions can be an effective tool for teaching good clinical practices through the ideal method of medical interviews, diagnostic approaches, evaluation of test results, communication skills with patients and their relatives, and addressing the socio-psychological aspects and social impacts of diseases. As an innovative attempt, sharing this process at an early stage of development may inspire enthusiasm for implementing this approach and open the field for further development.

Paradoxical bodies: negotiating biomedical fix, responsibility, and care in a weight-loss surgery clinic

AbstractThis ethnographic project explores how inherent discursive and social tensions are expressed and worked out within obesity care at a weight-loss surgical (WLS) clinic. First, complicated doctor and patient encounters occur because WLS follows a medical logic of intervention and is presented as a “biomagical” procedure that miraculously alters the body. Surgeons, however, explain that the surgery’s success depends on patients’ long and hard work. Second, the clinic’s interdisciplinary approach adds more complexity. While expanding the scope of treatment, it blurs the division of labor among professionals and the distinction between body and mind. It also diffuses the responsibility for patients’ lifestyles and recovery among professionals. Third, alongside notions about patients’ autonomy and free choice, their wishes and bodies are constantly channeled, problematized, and negotiated with various family and peer support. While crucial for the surgery’s success, such interconnectedness raises questions about how decision making and social pressures affect the patients’ journey. Thus, WLS is refracted among webs of multiple actors and contradictory perspectives. This complexity invites a reflection on how such tensions and paradoxes destabilize medical power in modifying the body, challenge personal responsibility assumptions, and impact the quality of care.

Study of Knowledge, Attitude, and Practices of Use of Masks among Health-care Workers at a Tertiary Care Center in Mumbai

ABSTRACT Introduction: Airborne transmission of infectious diseases poses a significant public health challenge. Nosocomial outbreaks of airborne infections such as influenza H1N1, H5N1, and drug-resistant tuberculosis (TB) variants have been documented, with substantial morbidity and mortality attributed to inadequate airborne infection control strategies. N-95 respirators and surgical masks (face masks) are the examples of personal protective equipment that are used to protect the wearer from airborne particles and liquid contamination of the face. Aim and Objectives: The aim of this study was to assess the knowledge, practices, and attitude of health-care workers (HCWs) regarding the use of mask, especially N-95 mask. Materials and Methods: A prospective, was conducted over a period of 6 months at a tertiary care hospital. This study was carried out in the department of microbiology of a tertiary care hospital over a period of 6 months. A total of 500 HCWs from various departments of the hospital were included in the study. HCWs were given a questionnaire based on N-95 respirator usage, and participation was voluntary. Results: The analysis of survey data provides insightful perspectives on respondents’ comprehension and attitudes toward airborne infection transmission and the usage of N-95 masks. 68.6% of respondents recognized that all listed diseases (measles, TB, and chickenpox) were spread by the airborne route. 55.6% of respondents correctly acknowledged that all masks, including surgical masks, N-95 masks, and cotton masks, do not offer airborne protection. 76.0% of respondents acknowledged that N-95 masks possess a high filtration efficiency against 0.3-micron particles, 58.3% correctly identified that “N” in N-95 stands for “not resistant to oil,” and 90.8% acknowledged that the N-95 respirator as the most common type of respirators. 41.7% correctly acknowledged that N-95 masks with an exhalation valve are not recommended for use. 22.2% of respondents incorrectly believe that wearing a face mask can lead to carbon dioxide poisoning, and 52.1% of respondents correctly identified that pulmonary TB patients need not be provided with N-95 masks in isolation rooms. 76.8% of respondents understood that fit testing is required every time one dons an N-95 mask. 95.5% of respondents recognized the necessity of hand hygiene before donning and after doffing N-95 masks. 82.7% of respondents agreed regarding the necessity for consultation before N-95 mask usage for chronic lung disease and asthma patients. 93.7% are aware that there is a protocol for donning and doffing N-95 masks. 71.3% of respondents understood that extended use involves wearing the same N-95 respirator for repeated close contact encounters without removing the mask between patient encounters, while 64.4% correctly define reuse as using the same N-95 respirator for multiple encounters but removing it after each encounter.

Abstract B136: Health related social needs of people with cancer underrepresented in clinical trials: Early experience of the Cancer Research Equity and Advocacy through Engagement Initiative (CREATE) clinical trial patient navigation program

Abstract Background: Black and African Americans (AA) remain severely underrepresented in therapeutic oncology clinical trials (TOCTs) and have the highest cancer mortality rates compared to all other groups. Racially biased clinical trial offers, poor physician-patient communication, and social determinants of health largely contribute to these racial inequities. The UNC Lineberger CREATE Clinical Trial Patient Navigation (CTPN) program was established to advance racial equity in TOCT participation. The CTPN program entails clinical trial education, facilitating communication between patients and their medical/research team, identifying barriers to clinical trial participation and connecting patients to resources to address those barriers. Here we describe the health-related social needs and referrals made to address those needs. Methods: The CTPN program employed a targeted proactive approach to reach patients with a new cancer diagnosis who self-identified as Black/African American (AA) or were insured by Medicaid. The patient navigator used the electronic medical record (EMR) to review the oncologist's schedule to identify patients meeting the above criteria. Identified patients received a letter in the mail describing the CTPN program and were offered an in-person clinic visit and/or telephone call with the patient navigator. During these encounters, the patient navigator assessed clinical trial barriers including health-related social needs and made referrals to resources to help address these needs. The CTPN program was initially launched in the thoracic oncology clinic but later became available for direct referrals from all oncology groups. Results: In the first 18 months of the CTPN program, there were 292 patient encounters among183 unique patients who received navigation services. Most patients (83%) were identified through the EMR, 79% identify as Black or AA, 64% have Medicaid. Patients had a diagnosis of lung (62%), head and neck (18%), gynecological (9%), and breast (2%) cancers. Clinical trial related barriers and health-related social needs included lack of clinical trial knowledge (68%), housing (9%), transportation (26%), financial support (18%), and family/caregiver support (14%). CTPN program materials were provided to address clinical trial informational needs (78%), and referrals were made to assist with emotional (13%), logistical (20%), and financial (21%) needs. On average, 2 referrals were made per patient encounter. Conclusion: CTPN can engage Black/AA patients with cancer using a proactive EMR approach to identify patients and may help address health-related social needs to facilitate cancer care and potential clinical trial participation. Future work will evaluate the impact of CTPN on enrollment of Black/AAs in therapeutic cancer clinical trials. Citation Format: Ashley Rankin Collins, Hayley N. Morris, Lauren N. Matthews, Omar N. Buenaventura Gomez, Marjory Charlot. Health related social needs of people with cancer underrepresented in clinical trials: Early experience of the Cancer Research Equity and Advocacy through Engagement Initiative (CREATE) clinical trial patient navigation program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B136.

Psychometric Validation of the Brief Outcome Survey: A Transdiagnostic Tool for Measurement-Based Care

ABSTRACT Background Measurement-based care (MBC) is a fundamental component of evidence-based psychotherapy that has the potential to improve the landscape of behavioral and mental health (BMH) care for youth and families. Objective The purpose of this study was to assess the reliability, validity, and clinical utility of the Brief Outcome Survey (BOS) when used as part of a comprehensive MBC approach during a course of evidence-based psychotherapy. Method The BOS is a three-item transdiagnostic tool designed to measure the impact of youth’s symptoms/conditions on functioning. Demographic and clinical data were obtained via a retrospective chart review of 75,000+ unique patient encounters over a period of 15 years. Internal consistency, test re-test reliability, construct validity, validity generalization, and clinical utility were assessed. Results Data were analyzed from 8,665 youth (Mage = 11.8 years; 57.2% biological female). The internal consistency coefficient (e.g. Cronbach’s alpha) ranged from 0.80–0.83 (first and second BOS administration). The single measure intraclass correlation coefficient was 0.66 (p < .001). Intraclass correlations between the BOS and the PHQ-9, GAD-7, and CY-BOCS were moderate. No significant differences were found by age. Cronbach’s alphas for the age groups ranged from 0.79–0.82. BOS scores were higher at baseline for biological females compared to males, t(8235) = 2.29, p < .001. Similarly, BOS scores were higher at baseline for youth receiving public versus private health insurance benefits, t(8032) = 2.29, p < .05. A one-way ANOVA revealed significant differences in BOS scores by diagnosis group and Cronbach’s alpha for the BOS was above 0.80 across all five diagnosis groups analyzed. Conclusions The BOS demonstrated evidence of strong psychometric properties and clinical utility, as a session-by-session transdiagnostic MBC tool.

Implementation of a clinical pathway for the evaluation of asymptomatic hypertension in the emergency department

IntroductionAccording to the guidelines of the American Heart Association and American College of Emergency Physicians, respectively, there is no indication for immediate lowering of asymptomatic hypertension in the Emergency Department (ED), and no requirement for routine diagnostic testing in these patients. Despite this, asymptomatic hypertension represents a recurring source of referrals for ED evaluation from other healthcare settings, or from patient self-referral, with significant practice variation in the evaluation and treatment of this complaint. MethodsThis is a pre-post study of a pathway to standardize care of patients presenting to a tertiary academic Veteran's Health Administration ED with asymptomatic hypertension. Inclusion criteria were patients with ICD10 codes of hypertension who were confirmed via chart review to have sought care for a complaint of elevated blood pressure readings from 2018 to 2022, with the pathway having been implementing in 2022. Patients were excluded if they had symptoms of possible end organ pathology due to hypertension, such as chest pain, headache, or shortness of breath, or if they were reproductive age women who had not undergone a sterilization procedure. The primary outcome was major adverse cardiovascular event within 30 days of ED visit. Secondary outcomes included: diagnostic tests performed, administration of antihypertensives in the ED, and length of stay. Descriptive statistics and statistical analysis were performed. ResultsThere were a total of 295 unique patients and 324 patient encounters that met the inclusion/exclusion criteria, with 46 encounters that took place after pathway implementation. There were no major adverse cardiovascular events either before or after pathway implementation. Chest radiographs were reduced from 10 % to 0 % (p = 0.005) after pathway respectively. There were also declines in laboratory testing, EKGs, and administration of oral antihypertensives, but these differences were not statistically significant. At no point did any diagnostic testing identify any previously undiagnosed medical conditions. There were no instances of intravenous hypertensives being given after pathway implementation. Despite the reductions in diagnostic testing, there was no change in ED length of stay for patients with asymptomatic hypertension. ConclusionOur findings redemonstrate that patients presenting to the ED with asymptomatic hypertension are at low risk for short-term complications of hypertension, and that diagnostic testing is low yield in this population. While we were able to achieve reductions in unnecessary testing, further work is needed to educate clinicians and improve adherence to evidence based principles when caring for these patients.

A nationwide analysis of 350 million patient encounters reveals a high volume of mental-health conditions in primary care

How many primary-care encounters are devoted to mental-health conditions compared with physical-health conditions? Here we analyzed Norway’s nationwide administrative primary-care records, extracting all doctor–patient encounters occurring during 14 years (2006–2019) for the population aged 0–100 years. Encounters were recorded according to the International Classification of Primary Care. We compared the volume of mental-health encounters against volumes for conditions in multiple different body systems. A total of 4,875,722 patients generated 354,516,291 encounters. One in 9 encounters (11.7%) involved a mental-health condition. Only musculoskeletal conditions accounted for a greater share of primary-care physicians’ attention. The volume of mental-health encounters in primary care equaled encounters for infections, cardiovascular and respiratory conditions and exceeded encounters for pain, injuries, metabolic, digestive, skin, urological, reproductive and sensory conditions. Primary-care physicians frequently treat complex mental-health conditions in patients of every age. These physicians may have a more important role in preventing the escalation of mental-health problems than heretofore appreciated.

Cardiovascular disease management and healthcare delivery for people experiencing homelessness: a scoping review

BackgroundPeople experiencing homelessness have increased prevalence, morbidity, and mortality of cardiovascular disease (CVD), attributable to several traditional and non-traditional risk factors. While this burden is well-known, mainstream CVD management plans and healthcare delivery have not been developed with people experiencing homelessness in mind nor tailored to their unique context. The overall objective of this work was to explore and synthesize what is known about CVD management experiences, programs, interventions, and/or recommendations specifically for people experiencing homelessness.MethodsWe conducted a scoping review to combine qualitative and quantitative studies in a single review using the Arksey and O’Malley framework and lived experience participation. We performed a comprehensive search of OVID Medline, Embase, PsychINFO, CINAHL, Web of Science, Social Sciences Index, Cochrane, and the grey literature with key search terms for homelessness, cardiovascular disease, and programs. All dates, geographic locations, and study designs were included. Articles were analyzed using conventional content analysis.ResultsWe included 37 articles in this review. Most of the work was done in the USA. We synthesized articles’ findings into 1) barriers/challenges faced by people experiencing homelessness and their providers with CVD management and care delivery (competing priorities, lifestyle challenges, medication adherence, access to care, and discrimination), 2) seven international programs/interventions that have been developed for people experiencing homelessness and CVD management with learnings, and 3) practical recommendations and possible solutions at the patient encounter level (relationships, appointment priorities, lifestyle, medication), clinic organization level (scheduling, location, equipment, and multi-disciplinary partnership), and systems level (root cause of homelessness, and cultural safety).ConclusionsThere is no ‘one-size-fits all’ approach to CVD management for people experiencing homelessness, and it is met with complexity, diversity, and intersectionality based on various contexts. It is clear, however, we need to move to more practically-implemented, community-driven solutions with lived experience and community partnership at the core. Future work includes tackling the root cause of homelessness with affordable housing, exploring ways to bring cardiac specialist care to the community, and investigating the role of digital technology as an avenue for CVD management in the homeless community. We hope this review is valuable in providing knowledge gaps and future direction for health care providers, health services research teams, and community organizations.

From Fax to Secure File Transfer Protocol: The 25-Year Evolution of Real-Time Syndromic Surveillance in England.

The purpose of syndromic surveillance is to provide early warning of public health incidents, real-time situational awareness during incidents and emergencies, and reassurance of the lack of impact on the population, particularly during mass gatherings. The United Kingdom Health Security Agency (UKHSA) currently coordinates a real-time syndromic surveillance service that encompasses 6 national syndromic surveillance systems reporting on daily health care usage across England. Each working day, UKHSA analyzes syndromic data from over 200,000 daily patient encounters with the National Health Service, monitoring over 140 unique syndromic indicators, risk assessing over 50 daily statistical exceedances, and taking and recommending public health action on these daily. This English syndromic surveillance service had its origins as a small exploratory pilot in a single region of England in 1999 involving a new pilot telehealth service, initially reporting only on "cold or flu" calls. This pilot showed the value of syndromic surveillance in England, providing advanced warning of the start of seasonal influenza activity over existing laboratory-based surveillance systems. Since this initial pilot, a program of real-time syndromic surveillance has evolved from the single-system, -region, -indicator pilot (using manual data transfer methods) to an all-hazard, multisystem, automated national service. The suite of systems now monitors a wide range of syndromes, from acute respiratory illness to diarrhea to cardiac conditions, and is widely used in routine public health surveillance and for monitoring seasonal respiratory disease and incidents such as the COVID-19 pandemic. Here, we describe the 25-year evolution of the English syndromic surveillance system, focusing on the expansion and improvements in data sources and data management, the technological and digital enablers, and novel methods of data analytics and visualization.

Languages other than English in a pediatric ED: Documentation, extended stays, and revisits

ObjectiveGiven the increasing proportion of patients and caregivers who use languages other than English (LOE) at our institution and across the U.S, we evaluated key workflow and outcome measures in our emergency department (ED) for patients and caregivers who use LOE. MethodsThis was a retrospective, cross-sectional study of patients and caregivers who presented to a free-standing urban pediatric facility. We used electronic health record data (EHR) and interpreter usage log data for our analysis of language documentation, length of stay, and ED revisits. We assessed ED revisits within 72-h using a multivariable logistic regression model adjusting for whether a primary care provider (PCP) was listed in the EHR, whether discharge was close to or on the weekend, and insurance status. We restricted our analysis to low-acuity patient encounters (Emergency Severity Index (ESI) scores of 4 and 5) to limit confounding factors related to higher ESI scores. ResultsWe found that one in five patients and caregivers who use LOE had incorrect documentation of their language needs in the EHR. Using interpreter usage data to most accurately capture encounters using LOE, we found that patient encounters using LOE had a 38-min longer length of stay (LOS) and twice the odds of a 72-h ED revisit compared to encounters using English. ConclusionThese results highlight the need for better language documentation and understanding of factors contributing to extended stays and increased revisits for pediatric patients and caregivers who use LOE.

Intermittent versus continuous intravenous epoprostenol for the treatment of digital ischemia

Digital ischemia can be a painful complication of Raynaud’s phenomenon or systemic sclerosis, which is caused by narrowing of blood vessels in the toes and hands. Epoprostenol is a potent vasodilator that may be used to treat digital ischemia in this patient population. Our institution provides epoprostenol infusion using two different administration techniques: a 30-h continuous infusion option and a 5-day intermittent 6-h infusion. In this retrospective chart review, we compared two administration techniques of intravenous epoprostenol administered to patients with digital ischemia. The primary outcome was to compare the efficacy of intravenous epoprostenol 30-h continuous infusion versus 5-day intermittent infusion, as defined by the presence of treatment failure. Between June 2019 and June 2020, 72 adult patient encounters met the inclusion criteria (intermittent: n = 20; continuous: n = 52). The primary outcome did not achieve a statistically significant difference between the two groups: intermittent 20% versus continuous 33.3% p = 0.390, odds ratio = 0.57 (95% confidence interval = 0.17–1.90). Adverse reactions were documented in 28% of patients across both treatment groups, and there was no difference detected when treatment groups were compared (25% vs 28.8%). Patients who received the 5-day infusion experienced a significantly longer average length of stay, with a mean of 8.9 days versus 3 days for those treated with the continuous 30-h infusion ( p &lt; 0.05; 95% confidence interval = 2.15–9.47). This study determined that the efficacy and safety profiles of the two administration techniques may not be comparable. Each protocol offers advantages over the other, and selection should be guided by patient history and risk factors to optimize management.

Patient Feedback Applied in Undergraduate Dental Education for Individual Student Development and Assessment: A Scoping Review.

Active involvement of patients in healthcare professional education is well established, taking a variety of forms. There is a steer towards patient feedback informing the development of dental students and while there is recognition of its potential value to individual students, challenges exist related to collection and use. What is unclear is, within a dental education setting, the extent and use of patient feedback to individual students. A scoping review was conducted to assess and map the volume and characteristics of the research/literature in this area. Systematic searches of bibliographic databases Ovid MEDLINE(R), Scopus, ERIC and Embase were conducted, and wider literature (Google Scholar) was searched. Screening was conducted based on eligibility criteria and a customised data charting form was used. The electronic and citation tracking searches identified 1021 studies. After duplicates were removed, 778 studies were screened by title and abstract, and 718 studies were found to be irrelevant to the current review. Sixty full-text studies were assessed for eligibility, 46 studies were excluded, and 14 studies were included for data charting. This review has identified that patient feedback has been captured through both simulated and real patient encounters. There was a bias towards feedback generated through simulated patient encounters. Feedback was reported to support the development of a range of skills, most frequently communication and patient management. Challenges that were identified by researchers related to staff/student engagement and available resources.

Anabolic-androgenic steroids in sport

Introduction and objective Anabolic-androgenic steroids (AAS) are a group of doping substances. They cause muscle hypertrophy and an increase in strength. Moreover, they may lead to dangerous side effects. Knowledge of the side effects of AAS use is necessary because in clinical practice we often encounter patients who decide to supplement with steroids. The aim of the study is to present information on the epidemiology, mechanism of action, methods of detecting AAS, the impact of the substance on the male and female body, and a description of organ side effects, highlighting: the cardiovascular system, the nervous system and the psyche. Review methods Literature search was conducted in the PubMed database with inclusion criteria ‘free full texts’ and publications date between 2015 – 2024. A total of 7272 results were found; 30 publications were ultimately included in the review. Abbreviated description of the state of knowledge Overusing AAS is very popular among people training at the gym. They have an anabolic effect on muscle tissue. They contribute to infertility in men and masculinization in women. Stimulation of androgen receptors above physiological doses of AAS leads to vascular changes that, in extreme cases, may lead to sudden cardiac death. Moreover, they accelerate brain aging. An increase in aggression and risky sexual behavior has been observed among people using doping. The diagnostic material used in anti-doping tests is urine and blood serum. Summary AAS abuse is a serious public health problem. Men who want to improve their figure and decide to use doping are particularly at risk. Due to the easy availability of steroids, society should be made aware of the negative effects of steroid use.

Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes

Sickle cell disease (SCD), a clinically heterogenous genetic hemoglobinopathy, is characterized by painful vaso-occlusive episodes (VOEs) that can require hospitalization. Patients admitted with VOEs are often initially resuscitated with normal saline (NS) to improve concurrent hypovolemia, despite preclinical evidence that NS may promote erythrocyte sickling. The comparative effectiveness of alternative volume-expanding fluids (eg, lactated Ringer [LR]) for resuscitation during VOEs is unclear. To compare the effectiveness of LR to NS fluid resuscitation in patients with SCD and VOEs. This multicenter cohort study and target trial emulation included inpatient adults with SCD VOEs who received either LR or NS on hospital day 1. The Premier PINC AI database (2016-2022), a multicenter clinical database including approximately 25% of US hospitalizations was used. The analysis took place between October 6, 2023, and June 20, 2024. Receipt of LR (intervention) or NS (control) on hospital day 1. The primary outcome was hospital-free days (HFDs) by day 30. Targeted maximum likelihood estimation was used to calculate marginal effect estimates. Heterogeneity of treatment effect was explored in subgroups. A total of 55 574 patient encounters where LR (n = 3495) or NS (n = 52 079) was administered on hospital day 1 were included; the median (IQR) age was 30 (25-37) years. Patients who received LR had more HFDs compared with those who received NS (marginal mean difference, 0.4; 95% CI, 0.1-0.6 days). Patients who received LR also had shorter hospital lengths of stay (marginal mean difference, -0.4; 95% CI, -0.7 to -0.1 days) and lower risk of 30-day readmission (marginal risk difference, -5.8%; 95% CI, -9.8% to -1.8%). Differences in HFDs between LR and NS were heterogenous based on fluid volume received: among patients who received less than 2 L, there was no difference in LR vs NS; among those who received 2 or more L, LR was superior to NS. This cohort study found that, compared with NS, LR had a small but significant improvement in HFDs and secondary outcomes including 30-day readmission. These results suggest that, among patients with VOEs in whom clinicians plan to give volume resuscitation fluids on hospital admission, LR should be preferred over NS.

Retrospective Cohort Analysis of the Relationship Between Emergency Department Length of Stay and Timing of First Laboratory Orders.

Background The efficiency of patient management in the Emergency Department (ED) is critical for optimizing healthcare delivery.Provider in triage (PIT) and similar ED flow models attempt to expedite throughput by decreasing the amount of time between patient arrival and initial order placement.The exact relationship between ED length of stay (LOS) and the timing of the first laboratory order, however, is unclear.The varying speed at which clinicians of different ages place laboratory orders and move patients through an ED also is understudied. Methods A retrospective analysis was conducted using SQL from the Clarity data archive to pull all patient encounters in 2023. Linear regression models using Analysis ToolPak in Microsoft Excel were used to create and examine the relationship between LOS and the timing of the first laboratory order. Secondary outcomes using the same models were created to analyzethe impact of clinician age on LOS and the relationship between clinician age and the timing of first laboratory orders. Results Two hundred sixty-nine thousand eight hundred and eight ED visits were reviewed across three academic and 17 community emergency departments. We report a weak but statistically significant positive relationship between the timing of the first laboratory order and LOS (R² = 0.0378, p < 0.001). Secondary outcomes indicated a very weak negative correlation between clinician age and LOS (R² ≈ 0, p < 0.001) and no significant relationship between clinician age and the timing of the first laboratory order (R² ≈ 0, p > 0.05). Conclusion The timing of the first laboratory order is a significant, albeit weak, predictor of LOS in the ED. Clinician age has minimal impact on LOS and does not significantly influence the timing of the first laboratory order.

Tranq Dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl/xylazine

BackgroundTreating opioid use disorder has reached a new level of challenge. Synthetic opioids and xylazine have joined the non-medical opioid supply, multiplying the complexities of caring for individuals in emergency departments (ED). This combination, known as ‘tranq dope,’ is poorly described in literature. Inadequate withdrawal treatment results in a disproportionately high rate of patient-directed discharges (also known as against medical advice dispositions, or AMA). This study aimed to describe a cohort of individuals who received a novel order set for suspected fentanyl and xylazine withdrawal in the ED. MethodsThis is a descriptive study evaluating a cohort of ED patients who received withdrawal medications from a novel protocol and electronic health record order set. Individuals being assessed in the ED while suffering from withdrawal were eligible. Individuals under age 18, on stable outpatient MOUD or who were pregnant were excluded. Treatment strategies included micro-induction buprenorphine, short acting opioids, non-opioid analgesics, and other adjunctive medications. Data collected included: demographics including zip code, urine toxicology screening, order set utilization and disposition data. Clinical Opiate Withdrawal Scale (COWS) scores were recorded, where available, before and following exposure to the medications. ResultsThere were 270 patient encounters that occurred between September 14, 2022, and March 9, 2023 included in the total study cohort. Of those, 66 % were male, mean age 37 with 71 % residing within Philadelphia zip codes. 100 % of urine toxicology screenings were positive for fentanyl. Of the 177 patients with both pre- and post-exposure COWS scores documented, constituting the final cohort, patients receiving medications had their COWS score decrease from a median of 12 to a median of 4 (p < 0.001). The AMA rate for this cohort was 3.9 %, whereas the baseline for the population with OUD was 10.7 %. Recorded adverse effects were few and resolved without complication. ConclusionsFentanyl and xylazine withdrawal are challenging for patients and providers. A novel tranq dope withdrawal order set may reduce both COWS scores and rate of patient-directed discharge in this cohort of patients, though further investigation is needed to confirm findings.

Age has an independent association with total cost of care in adults admitted to pediatric hospitals.

Previous studies in adults admitted to pediatric hospitals primarily investigated associations between complex chronic condition characteristics and patient outcomes. Our study explored the association of age with length of stay (LOS) and total cost in these adults, accounting for other patient factors. Using the Pediatric Health Information System, we included 1,215,736 patient encounters from 2021 to 2022. Unadjusted and adjusted analyses were performed using bivariable and multivariable log-linear regression. There was a significant positive association between age and total cost, with adults 18-20 years having 13% higher total cost (95% confidence interval [CI]: 12%-15%), 21-25 years with 25% higher total cost (95% CI: 22%-29%), and 25-99 years having 72% higher total cost (95% CI: 66%-79%) than 1-17 years. Our findings suggest expanding upon the existing status quo to identify the most appropriate environment to care for this unique and growing population, especially given the anticipated reduction in pediatric beds and subspecialty expertise.

Mitigating Misinformation Toolkit: Addressing COVID-19 Misinformation Through Interprofessional Learning and Collaboration Using a Standardized Patient-Based Educational Module.

Medical mis- and disinformation are on the rise and impact patient health outcomes. The complexity of modern medicine and health care delivery necessitates that care be delivered by an interprofessional team of providers well versed in addressing this increased prevalence of medical misinformation. Health professions educational curricula often lack opportunities for students to learn how to address medical misinformation, employ advanced communication techniques, and work collaboratively. Based on literature and our previous qualitative research, we created a module offering prework learning on COVID-19 and addressing misinformation through advanced communication techniques and interprofessional collaboration. After completing prework, students participated in a standardized patient encounter addressing COVID misinformation. Health professions student dyads completed a preencounter planning huddle and together interviewed a standardized patient. Students received global and checklist-based feedback from standardized patients and completed pre- and postsession self-assessments. Twenty students participated (10 third-year medical, nine third-year pharmacy, one fourth-year pharmacy). Key findings included the following: Nine of 15 survey questions demonstrated statistically significant improvement, including all three questions assessing readiness to have difficult conversations and six of 10 questions assessing interprofessional collaboration and team function. Students participating in this novel curriculum advanced their readiness to address medical misinformation, including COVID-19 vaccine disinformation, with patients and coworkers to improve health decision-making and patient care. These curricular methods can be customized for use with a range of health professions learners.

Athletic Training Students’ Use of Evidence-Based Practice Professional Behaviors During Clinical Experiences: A Report From the Association for Athletic Training Education Research Network

With the incorporation of evidence-based practice (EBP) during patient care as a curricular content standard, professional programs must prepare athletic training students (ATSs) for the application of EBP during the delivery of patient care. We aimed to examine ATSs’ implementation of professional behaviors associated with EBP during patient encounters (PEs). Through a multisite panel design, we tracked numerous factors associated with PEs experienced by 363 ATSs of 12 professional athletic training programs. Generalized estimating equation models were used to analyze the likelihood that students included EBP behaviors during 30,522 PEs. Clinical site type (p &lt; .001), student role (p &lt; .001), and encounter length (p &lt; .001) were associated with all three EBP professional behaviors while clinical site type (p &lt; .001) was also associated with whether the ATS asked a question of a clinician, including their preceptor. Program administrators seeking to promote the greatest opportunities for ATSs to implement EBP during patient care should seek clinic-based or other nonacademic site types that promote longer PEs in which students can perform or assist their preceptor.

Impact of a Novel Virtual Rounding Queue Software on Nurse and Family Presence for Rounds in the Neonatal Intensive Care Unit: A Pilot Study

ObjectiveCoordinating getting everyone in the room at the same time for family-centered rounds (FCR) is challenging. The objective of this study was to determine if using a virtual queue that notifies nurses and families in real time when to expect the rounding team could impact their presence on rounds. MethodsWe observed rounds on two NICU teams for six weeks before and after implementation of a novel rounding software, Q-rounds™, that shares real-time updates on when the team will arrive and allows families to RSVP to join remotely when they can’t be there in person. Observers collected metrics pertinent to FCR including nurse and family presence (in-person or remotely) and duration of rounds and used chi-squared and two group t-tests for analysis. ResultsRounds were observed for 165 patient encounters pre-implementation and 179 patient encounters post-implementation, with an average rounding duration of 10.3 minutes (SD 6.5) and 10.4 minutes (SD 6.3) per patient respectively (P =0.91). The proportion of nurses who were present for the entirety of the rounding discussion increased from 18.8% to 58.2% (P < 0.001). Family presence on rounds increased from 20.0% (95% CI, 13.9-26.1) to 43.0% (95% CI, 35.8-50.3; P < 0.001). The percentage of families that participated in rounds remotely increased from 15.2% to 55.8% (P < 0.001). ConclusionsThis observational study showed that the use of a novel rounding software was associated with a significant increase in family presence for rounds and nurse presence for the entirety of rounds without increasing rounding duration.