Specific Action Items Research Articles

How Additive Manufacturing Empowers Commerce through Effective Data Management

Abstract This article summarizes the outcomes from a NIST-sponsored workshop that examined the additive manufacturing (AM) data management pain points experienced by small- and medium-sized enterprises in interacting with larger organizations and government procurement agencies. Three prominent themes emerged: cost of compliance, technology gaps associated with uncertainty and AM process qualification, and a desire for government leadership to address these issues. The article includes lists of specific action items proposed at the workshop to address these challenges.

To Catch a Glimpse from Afar: MENA Scholars in US International Conferences

Abstract: As a dauntless practitioner of exulansis , I write this Note from the Field in an attempt to unlearn my practice of keeping silent about the challenges of moving across borders. It is based on a survey I did about the challenges and issues (e.g., securing visas and funds) that Middle Eastern and North African (MENA) scholars/researchers sadly encounter when they decide to participate in US conferences. While offering specific action items to the ATHE organizing committee, I remind my fellow MENA colleagues who have experienced disconnect that their sadness should prompt a vivid upsurge of collective attention to the countless possibilities we organizers and participants still have for cosmopolitan friendship while taking joy and grief all in, at once, from afar.

A toolkit for decolonizing global emergency medicine education

One of the tenets of global emergency medicine (GEM) is to create equitable relationships between high-resource and resource-denied countries to promote emergency care for all. Health interventions proposed by those working in GEM too often lack input from local and indigenous communities result in “voluntourism,” research authorship inequity, under-representation and under-valuation of technical expertise and lived experience of leaders from resource-denied countries. We present a decolonization toolkit with specific recommendations that target and disrupt counter-productive power dynamics in GEM education. We held a workshop at the 2022 Society for Academic Emergency Medicine Annual Meeting to collectively develop strategies to address inequalities and increase diversity in GEM education. GEM practitioners were divided into small groups representing five thematic areas and asked to identify specific action items to address inequities related to their theme. Following the workshop, a group of authors reviewed small group responses and data was divided into themed qualitative matrices and recommendations were revised based on targeted literature review. Five thematic areas discussed included access, awareness and cultural humility, language, representation, and recognition. Specific recommendations and action items were created to address inequities related to these themes which can be applied by individuals and institutions in both HICs and LMICs. Despite being a relatively new academic discipline, GEM has replicated colonial structures that are prevalent in global health. However, using targeted recommendations described in our toolkit, individuals, and institutions can build a new framework for GEM that actively combats structural vulnerabilities and academic inequities.

Mental Health Impacts of Climate Change for Birthing People and the Provider's Role.

Mental Health Impacts of Climate Change for Birthing People and the Provider's Role.

Development of metaverse for intelligent healthcare.

The metaverse integrates physical and virtual realities, enabling humans and their avatars to interact in an environment supported by technologies such as high-speed internet, virtual reality, augmented reality, mixed and extended reality, blockchain, digital twins and artificial intelligence (AI), all enriched by effectively unlimited data. The metaverse recently emerged as social media and entertainment platforms, but extension to healthcare could have a profound impact on clinical practice and human health. As a group of academic, industrial, clinical and regulatory researchers, we identify unique opportunities for metaverse approaches in the healthcare domain. A metaverse of 'medical technology and AI' (MeTAI) can facilitate the development, prototyping, evaluation, regulation, translation and refinement of AI-based medical practice, especially medical imaging-guided diagnosis and therapy. Here, we present metaverse use cases, including virtual comparative scanning, raw data sharing, augmented regulatory science and metaversed medical intervention. We discuss relevant issues on the ecosystem of the MeTAI metaverse including privacy, security and disparity. We also identify specific action items for coordinated efforts to build the MeTAI metaverse for improved healthcare quality, accessibility, cost-effectiveness and patient satisfaction.

Under-triage: A New Trigger to Drive Quality Improvement in the Emergency Department.

Introduction:The emergency department (ED) is a care setting with a high risk for medical error. In collaboration with our nursing colleagues, we identified a new trigger, under-triage, and demonstrated how its implementation could detect and reduce medical errors in the ED.Methods:We defined under-triage as patient visits with an Emergency Severity Index (ESI) score of 4 or 5 (ie, low acuity), and the patient was admitted to the hospital during the same visit. We defined mistriage, or medical error, when nurse-physician dyad reviewers determined that a different ESI level should have been assigned based on the information available at triage. A multidisciplinary team used nominal group technique to build consensus on key drivers and outcome metrics for this new trigger. We randomly selected 267 charts for review utilizing the under-triage trigger.Results:Of the 125,457 patients triaged as level 4 or 5 in 2019 and 2020, 1.1% (n = 1,423) were under-triaged. Of the 267 charts reviewed, 127 were categorized as mistriage, making the under-triage’s positive predictive value trigger 48%. Reviews took 2–10 minutes per chart. We identified 10 categories of under-triage. Nine themes emerged, with four specific and measurable action items mapped to process and outcome metrics.Conclusions:We identify a new, feasible ED trigger, under-triage, that identifies medical error with a high positive predictive value. We identify process and outcome metrics and interventions to improve triage for future patients.

Arrhythmias in Female Patients: Incidence, Presentation and Management.

There is a growing appreciation for differences in epidemiology, treatment, and outcomes of cardiovascular conditions by sex. Historically, cardiovascular clinical trials have under-represented females, but findings have nonetheless been applied to clinical care in a sex-agnostic manner. Thus, much of the collective knowledge about sex-specific cardiovascular outcomes result from post hoc and secondary analyses. In some cases, these investigations have revealed important sex-based differences with implications for optimizing care for female patients with arrhythmias. This review explores the available evidence related to cardiac arrhythmia care among females, with emphasis on areas in which important sex differences are known or suggested. Considerations related to improving female enrollment in clinical trials as a way to establish more robust clinical evidence for the treatment of females are discussed. Areas of remaining evidence gaps are provided, and recommendations for areas of future research and specific action items are suggested. The overarching goal is to improve appreciation for sex-based differences in cardiac arrhythmia care as 1 component of a comprehensive plan to optimize arrhythmia care for all patients.

Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions (SCAI) 2021 think tank.

The Society for Cardiovascular Angiography and Interventions (SCAI) Think Tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community annually for high-level field-wide discussions. The 2021 Think Tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease. Each session was moderated by a senior content expert and co-moderated by a member of SCAI's Emerging Leader Mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialog from a broader base, and thereby aid SCAI, the industry community and external stakeholders in developing specific action items to move these areas forward.

AMERICAN GASTROENTEROLOGICAL ASSOCIATION’S QUALITY LEADERSHIP COUNCIL’S PRACTICE WORK GROUP: A NATIONWIDE INITIATIVE TO REDUCE THE USE OF PRESCRIPTION OPIOID AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE AT A LOCAL LEVEL

Abstract Background and aims The use of opioids among patients with inflammatory bowel disease (IBD) in the United States is increasing and it is associated with higher mortality, re-admissions, healthcare utilization, and disability. The American Gastroenterological Association’s (AGA) Quality Leadership Council’s practice workgroup developed educational materials to educate and modify narcotic prescribing habits of providers treating IBD and change the attitudes and expectations of patients who require analgesics. Methods Council members participated in two 1-hour virtual planning meetings to develop a key driver diagram to illustrate the aims, theories to achieve the aims, and specific action items to change ideas of opioid prescribing practices. Four working groups were created to perform a literature search and create educational resources for providers and patients regarding the risks of opioid use and non-opioid alternatives for pain management. The educational resources were reviewed by the Crohn’s and Colitis Foundation prior to online publication electronic and dissemination to the AGA membership. Results We developed a key driver diagram (Figure 1) to illustrate the components of promoting non-opioid pain management in patients with IBD. Educational materials were developed to 1) Delineate the risk factors for opioid abuse among patients with IBD to prescribers of a controlled substance including; Crohn’s disease, functional gastrointestinal disorders, anxiety, depression, female sex, a history of narcotic abuse, ≥2 previous surgeries, moderate to severe pain, clinical disease activity, sexual, emotional and physical abuse, 2) Recommend alternative therapies for opioids including medications and non-pharmacological treatment alternatives (Table 1), 3) Address salient key points that patients should discuss with their provider if an opioid is prescribed including complications associated with prolonged use of narcotic medications, and 4) Illustrate alternate medical therapy and other techniques for patients including yoga and mindfulness-based techniques, cognitive behavioral therapy, and medical hypnosis. Conclusions Using quality improvement methods, we developed educational materials for patients with IBD and providers treating IBD on opioid avoidance and non-opioid alternative therapy utilizing an evidence-based approach.

Leadership Development in Academic Health Science Centers: Towards a Paradigm Shift.

ProblemIn an era of increasing complexity, leadership development is an urgent need for academic health science centers (AHSCs). The Association of American Medical Colleges (AAMC) and others have described the need for a focus on organizational leadership development and more rigorous evaluation of outcomes. Although the business literature notes the importance of evaluating institutional leadership culture, there is sparse conversation in the medical literature about this vital aspect of leadership development. Defining the leadership attributes that best align with and move an AHSC forward must serve as the foundational framework for strategic leadership development.ApproachIn 2015, the Medical University of South Carolina (MUSC) began a systematic process to approach strategic leadership development for the organization. An interprofessional group completed an inventory of our leadership development programs and identified key drivers of a new institutional strategic plan. A strategic leadership advisory committee designed a series of leadership retreats to evaluate both individual and collective leadership development needs.OutcomesThree key drivers were identified as critical attributes for the success of our institutional strategy. Four specific areas of focus for the growth of the institution’s ideal leadership culture were identified, with specific action items or behaviors developed for our leaders to model. As a result of this foundational work, we have now launched the MUSC Leadership Institute.Next StepsKnowledge of our current leadership culture, key drivers of strategy and our desired collective leadership attributes are the basis for building our institutional leadership development strategy. This will be a longitudinal process that will start with senior leadership engagement, organizational restructuring, new programming and involve significant experimentation. Disciplined, thoughtful evaluation will be required to find the right model. In addition to individual transformation with leadership development, MUSC will measure specifically identified strategic outcomes and performance metrics for the institution.

Proposed Additions to the NCCN Guidelines for Adult Medulloblastoma.

Medulloblastoma is a rare brain tumor that occurs in both children and adults, with patients aged 15 to 39 years accounting for 30% of all cases. In adults, guidelines for diagnosis and treatment are often based on retrospective data and extrapolated from the pediatric experience due to limited availability of prospective trials or registries involving adults. Importantly, adult patients differ from pediatric patients in many aspects, including the molecular features of the tumor and tolerance to treatment. In 2017, the NCI was granted support from the Cancer Moonshot initiative to address the challenges and unmet needs of adults with rare central nervous system (CNS) tumors through the NCI Comprehensive Oncology Network for Evaluating Rare CNS Tumors (NCI-CONNECT). On November 25, 2019, NCI-CONNECT convened a multidisciplinary workshop on adult medulloblastoma. Working groups identified unmet needs in clinical care and research and developed specific action items, including a proposal for inclusion of new items in the NCCN Guidelines for Adult Medulloblastoma, delineated in this review along with the evidence supporting their incorporation. Recommendations included facilitating referral of patients to centers of excellence; promoting patient participation in clinical trials or registries; encouraging use of DNA methylation for confirmation of diagnosis and subgrouping; offering counseling on contraception and fertility preservation; evaluating patients for symptoms and medical management of endocrine, vision, hearing, and neurocognitive deficits; providing psychosocial support and referral to neurorehabilitation; minimizing delays in therapy; and incorporating imaging standards and criteria for progression.

Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions 2020 think tank.

The society for cardiovascular angiography and interventions (SCAI) think tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community for high-level field-wide discussions. The 2020 think tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease (CHD). Each session was moderated by a senior content expert and co-moderated by a member of SCAI's emerging leader mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialogue from a broader base, and thereby aid SCAI and the industry community in developing specific action items to move these areas forward.

Proceedings of the Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) Adult Medulloblastoma Workshop.

Medulloblastoma (MB) is a rare brain tumor occurring more frequently in children in whom research has been primarily focused. Treatment recommendations in adults are mainly based on retrospective data and pediatric experience; however, molecular features and treatment tolerance differ between the 2 age groups. In adults, prognostic tools are suboptimal, late recurrences are typical, and long-term sequelae remain understudied. Treatment has not adapted to molecular classification advances; thus, the survival rate of adult MB has not improved. In 2017, the National Cancer Institute (NCI) received support from the Cancer Moonshot℠ to address the challenges and unmet needs of adults with rare central nervous system tumors through NCI-CONNECT, a program that creates partnerships among patients, health care professionals, researchers, and advocacy organizations. On November 25, 2019, NCI-CONNECT convened leading clinicians and scientists in a workshop to review advances in research, share scientific insights, and discuss clinical challenges in adult MB. Working groups identified unmet needs in clinical trial design, tissue acquisition and testing, tumor modeling, and measurement of clinical outcomes. Participants identified opportunities for collaboration; discussed plans to create a working group of clinicians, researchers, and patient advocates; and developed specific action items to expedite progress in adult MB.

Hot topics in interventional cardiology: Proceedings from the Society for Cardiovascular Angiography and Interventions (SCAI) 2019 Think Tank.

The society for cardiovascular angiography and interventions (SCAI) think tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community for high-level field-wide discussions. The 2020 think tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease (CHD). Each session was moderated by a senior content expert and co-moderated by a member of SCAI's emerging leader mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialogue from a broader base, and thereby aid SCAI and the industry community in developing specific action items to move these areas forward.

"How can SCAI and industry partners increase adherence and educate interventionalists on optimal medical therapy?"

"How can SCAI and industry partners increase adherence and educate interventionalists on optimal medical therapy?"

Development of a standardized, citywide process for managing smart-pump drug libraries.

Development and implementation of an interprofessional consensus-driven process for review and optimization of smart-pump drug libraries and dosing limits are described. The Indianapolis Coalition for Patient Safety (ICPS), which represents 6 Indianapolis-area health systems, identified an opportunity to reduce clinically insignificant alerts that smart infusion pumps present to end users. Through a consensus-driven process, ICPS aimed to identify best practices to implement at individual hospitals in order to establish specific action items for smart-pump drug library optimization. A work group of pharmacists, nurses, and industrial engineers met to evaluate variability within and lack of scrutiny of smart-pump drug libraries. The work group used Lean Six Sigma methodologies to generate a list of key needs and barriers to be addressed in process standardization. The group reviewed targets for smart-pump drug library optimization, including dosing limits, types of alerts reviewed, policies, and safety best practices. The work group also analyzed existing processes at each site to develop a final consensus statement outlining a model process for reviewing alerts and managing smart-pump data. Analysis of the total number of alerts per device across ICPS-affiliated health systems over a 4-year period indicated a 50% decrease (from 7.2 to 3.6 alerts per device per month) after implementation of the model by ICPS member organizations. Through implementation of a standardized, consensus-driven process for smart-pump drug library optimization, ICPS member health systems reduced clinically insignificant smart-pump alerts.

National Blueprint for Biodefense, One Year Later: Taking Stock of Biosecurity Efforts and A Call to Action

In October 2015, a bipartisan study panel on biodefense, A National Blueprint for Biodefense made thirty-three recommendations to advance biopreparedness in the United States. A year later in December 2016, a report titled, The Biodefense Indicators: One Year Later, Events Outpacing Efforts to Defend the Nation (The “One Year Later Report”) provides compelling evidence that much work remains to be done. Within the thirty-three recommendations in the original National Blueprint for Biodefense, forty-six specific action items were designated for execution as a short-term action within a year or less. Among these, twenty-seven were not addressed by any action during the past year. Seventeen received partial action while only two of these were deemed completed. Continuing efforts to protect our populations from biological threats is imperative and warrant immediate constructive short-term action.

Interprofessional Care Conferences for High-Risk Primary Care Patients.

As health care systems convert to team-based care, the need to improve interprofessional education is tremendous. In addition to formal instruction, trainees need authentic team-based workplace learning experiences. The authors designed the PACT-ICU (Patient-Aligned Care Team Interprofessional Care Update) conference to provide team-based care to high-risk patients while teaching trainees principles of interprofessionalism and modeling relevant behaviors. Trainees, supervisors, and affiliated support staff from the fields of internal medicine, nurse practitioner, pharmacy, psychology, and nursing all participate in this conference. During the conference, each participant focuses on the narrative of the patient's illness from his/her own professional perspective. A multifaceted care plan with specific action items is the product of the conference. To evaluate this workplace learning opportunity, the authors recorded patient characteristics, plus trainees' participation and satisfaction. Over the first 16 months (2013-2014) of the PACT-ICU, 33 trainees presented 79 patients. Each trainee presented two or three times each academic year. Patients were 90% male; their mean age was 64.5 years (SD 9.3, range 28-92), and their mean calculated 90-day risk of death or hospitalization was 22% (SD 14%, range 1%-45%).Overall, all surveyed trainees (n = 32; 97% response rate) expressed satisfaction, reporting that the conference was "helpful" or "very helpful" in developing treatment plans. Further assessment of change in trainee behavior related to interprofessional team care, patient-level outcomes (e.g., quality of care and utilization), and factors facilitating dissemination of the model to other academic clinic settings is necessary.

Diferencias entre las recomendaciones y la práctica clínica en la infección por Clostridium difficile

ObjectivesThe first aim was to determine whether patients are being treated in accordance with the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (IDSA/SHEA) Clostridium difficile guidelines and whether adherence impacts patient outcomes. The second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation. Material and methodsA retrospective, descriptive study was conducted over a 36 month period, on patients with compatible clinical symptoms and positive test for C. difficile toxins A and/or B in stool samples, in an internal medicine department of a tertiary medical centre. Patient demographic and clinical data (outcomes, comorbidity, risk factors) and compliance with guidelines, were examined ResultsA total of 77 patients with C. difficile infection were identified (87 episodes). Stratified by disease severity criteria, 49.3% of patients were mild-moderate, 35.1% severe, and 15.6% severe-complicated. Full adherence with the guidelines was observed in only 40.2% of patients, and was significantly better for mild-moderate (71.0%), than in severe (7.4%) or severe-complicated patients (16.6%) (P<.003). Adherence was significantly associated with clinical cure (57% vs 42%), fewer recurrences (22.2% vs 77.7%), and mortality (25% vs 75%) (P<.01). The stratification of severity of the episode, and the adequacy of antibiotic to clinical severity, need improvement. ConclusionsOverall adherence with the guidelines for management of Clostridium difficile infection was poor, especially in severe and severe-complicated patients, being associated with worse clinical outcomes. Educational interventions aimed at improving guideline adherence are warranted.

More Older Adults Needed in Cancer Trials

Cancer research must include more older adult participants because the evidence base for treating this patient population is too sparse, according to an American Society of Clinical Oncology position statement published online in the Journal of Clinical Oncology. Key evidence is lacking because older adults are usually excluded from clinical trials, even though most cancer patients are 65 and older. Both patients and their clinicians are forced to base treatment plans on data from younger, healthier patients, from studies that often don't even consider endpoints that matter most to them: not just survival rates but quality of life measures and rates of functional independence. ‘We need to see clinical trials that mirror the age distribution and health risk profile of patients with cancer.’ Moreover, older adults respond differently than younger adults to cancer treatments because age-associated physiologic changes, higher incidence of comorbidities, and greater use of medications may interact with cancer therapies. “We need to see clinical trials that mirror the age distribution and health risk profile of patients with cancer,” said Arti Hurria, MD, coauthor of the statement and director of the cancer and aging research program at City of Hope, Duarte, CA, and her associates. The position statement includes five recommendations and 16 specific action items to achieve this goal. First, the cancer research community — regulatory agencies, study funders, and researchers — must expand eligibility criteria so that more older adults can participate in studies. A rationale must be provided for all restrictions based on age, performance status, or comorbidities. And funders such as the National Cancer Institute and the National Institute on Aging should incentivize research that includes older adults. Second, research design and infrastructure must be used to incentivize the inclusion of older adults. For example, Medicare could cover the off-label use of cancer therapies in older patients in selected trials, and research databases could be encouraged to collect information pertaining to older patients. Third, the Food and Drug Administration should be given authority to both incentivize and require studies to include older adults. For example, the agency could reward drug manufacturers for including older patients in trials of new cancer therapies by granting them 6-month patent extensions, or it could encourage the development of new agents by expediting their review. Alternatively, the FDA could limit the compensation available to manufacturers that don't include older study subjects. And the FDA should include geriatrics experts on its advisory boards, such as the Oncology Drug Advisory Committee. Fourth, clinicians should encourage the recruitment of their older patients into clinical trials. The single most important predictor of whether or not a cancer patient enrolls in a study is that his or her clinician has recommended it. And one way to increase such recommendations is to increase reimbursement for the time and effort it takes clinicians to find and explain relevant studies to patients. Finally, professional journals should incentivize researchers to report on the substantial data they already collect about older study subjects, but do not analyze or report on. And professional journals should include geriatric oncology experts on their editorial boards and as peer reviewers, to ensure that cancer research results are applicable to the majority of people who have cancer, according to the position statement (J Clin Oncol 2015 July 20 [doi:10.1200/JCO.2015.63.0319]). This position statement was supported by a subcommittee of the American Society of Clinical Oncology's cancer research committee. Mary Ann Moon is a Frontline Medical News freelance writer based in Clarksburg, MD.