US Academic Research Articles

Underutilization of Portable Orders for Life-Sustaining Treatment at Discharge from Hospital: Observational Study at US Academic Trauma Center.

Decisions to limit use of life-sustaining treatment occur frequently during hospitalizations, and portable medical orders (also known as Portable Orders for Life-Sustaining Treatment (POLST)) can ensure that patient preferences regarding resuscitation are followed after discharge. To determine the frequency and predictors of completion of POLST orders for adults with change during hospitalization in resuscitation status to Do Not Resuscitate. Retrospective observational study at level 1 trauma and academic hospital in Minneapolis, MN, USA PARTICIPANTS: All adults (18years or older) hospitalized between June 2017 and June 2018, inclusive, with code status changed from Full Code to DNR. For patients with more than one hospitalization during this study interval, only the first hospitalization when DNR was ordered was included in this analysis. Completion of POLST orders by time of discharge. From 2017 to 2018, 160 adults had a change from Full Code to DNR status during index hospitalization and survived to discharge, most (156 patients) to a nursing care facility. Of these, only 50 (31.2%) had POLST orders provided at discharge. Documentation of informed refusal of intubation in addition to DNR status was a significant predictor (OR 4.1, 99% CI 1.5-11.0) of POLST orders on discharge, as was admission to a medical service compared with non-medical service (OR 3.2, 99% CI 1.1-12.2). Palliative care consultants, rather than primary providers on the hospital services, completed most POLST orders. Despite primary hospital providers engaging in conversations regarding resuscitation and entering DNR orders during hospitalization, the majority of patients in our study discharged to other care facilities without POLST orders. POLST orders are a simple palliative care tool available to primary hospital providers to help ensure continuity of plan of care at discharge for patients who wish to avoid invasive life-sustaining treatments and/or cardiopulmonary resuscitation.

The Influence of Pay Transparency on Inequity, Inequality, and the Performance-Basis of Pay in Organizations

Recent decades have witnessed a growing focus on two distinct income patterns: persistent pay inequity, particularly a gender pay gap, and growing pay inequality. Pay transparency is widely advanced as a remedy for both. Yet we know little about the systemic influence of this policy on the evolution of pay practices within organizations. To address this void, we assemble a novel data set combining detailed performance, demographic and salary data for approximately 100,000 US academics between 1997 and 2017. We then exploit staggered shocks to wage transparency to explore how this change reshapes pay practices. We find evidence that pay transparency causes significant increases in both the equity and equality of pay, and significant and sizeable reductions in the link between pay and individually-measured performance.

Phase II Multicenter Study of Ofatumumab in Combination with Glucocorticoids As a Primary Therapy for Chronic Graft Versus Host Disease

<h3>Introduction</h3> B-cell homeostasis plays an important role in chronic GVHD (cGVHD). The safety and feasibility of anti-CD20 directed B-cell therapy with ofatumumab and glucocorticoids (GC) were previously established in a phase I trial. <h3>Methods</h3> A total of 38 adult patients (pts) with moderate/severe cGVHD were enrolled in phase II trial at 3 academic US centers (02/2014-08/2018). Ofatumumab was given at 1000 mg IV on days 0 and 14 of initial 1 mg/kg/day prednisone (or equivalent) therapy. Primary endpoint was the overall (complete and partial) response rate (ORR) at 6 months as reported by the physician (MD). <h3>Results</h3> Baseline data are summarized in Table. Six-month ORR for 32 evaluable pts was 62.5% (95%CI, 44-79%) by MD report (15.6% CR; 46.9% PR) and by NIH2014 criteria (9.4% CR; 53.1% PR) with good inter-rater reliability (Cohen's kappa=0.73; discordant responses n=4). Given historical benchmark ORR of 60% at 6 months, the trial did not reach its primary endpoint (<i>p</i>=0.4) of 20% improvement with ofatumumab. Subsequent ORR per MD and NIH2014 were 42% and 31% at 12 months (kappa=0.6) and 36% and 32% at 24 months (kappa=0.9). GC discontinuation was successful in 45% and 54% of pts at 12 and 24 months (Figure 1A). Median follow up of survivors was 24 months (range, 0.7-46). Two-year OS and PFS were 74% and 72%. Failure-free survival (FFS) - composite outcome with death, relapse, and second-line immune suppression as events - was 53% at 12 months and 39% at 24 months. Second-line therapy was the most common failure event (13/22, Figure 1B). 14 non-fatal possibly related AEs occurred in 11 pts, including 5 SAEs in 3 pts. 17 infusion-related AEs (all ≤Gr2) occurred, but resolved with symptom management. Bacterial (13 events), fungal (8), and viral (26) infections were observed in 29%, 13%, and 40% of pts, respectively. 9 deaths occurred within 2 years, none of which was deemed related to study therapy. <h3>Conclusions</h3> This multicenter phase II trial did not demonstrate statistical difference in 6 month ORR with ofatumumab+GC vs. GC-based historical benchmark in the frontline therapy of cGVHD. Data on predictors of response, patient-reported outcomes, and immune reconstitution will be presented at the meeting.

Patients Assess an eConsult Model's Acceptability at 5 US Academic Medical Centers.

Electronic consultation (eConsult), involving asynchronous primary care clinician-to-specialist consultation, is being adopted at a growing number of health systems. Most evaluations of eConsult programs have assessed clinical and financial impacts and clinician acceptability. Less attention has been focused on patients' opinions. We set out to understand patient perspectives and preferences for hypothetical eConsult use at 5 US academic medical centers in the process of adopting an eConsult model. We invited adult primary care patients to participate in focus groups. Participants were introduced to the eConsult model, considered its potential benefits and drawbacks, judged the acceptability of a hypothetical copay, and expressed their preferences for future involvement in eConsult decision making and communication. Thematic analysis was used for data interpretation. One focus group was conducted at each of the 5 sites with a total of 52 participants. Focus groups responded positively to the idea of eConsult, with quicker access to specialty care and convenience identified as key benefits. Approval was particularly high among those with a trusted primary care clinician. Preference for involvement in eConsult decision making and communication varied and enthusiasm about eConsult waned when a hypothetical copay was introduced. Concerns included potential misuse of eConsult and exclusion of the patient's illness narrative in the eConsult exchange. Primary care patients expressed strong support for eConsult, particularly when used by a trusted primary care clinician, in addition to voicing several concerns. Patient involvement in eConsult outreach and education efforts could help to enhance the model's effectiveness and acceptability.

Smartphone Use and Interest in a Spine Surgery Recovery Mobile Application Among Patients in a US Academic Neurosurgery Practice.

Mobile applications (apps) are serving an increasingly important role in healthcare for patients and providers alike. In addition to streamlining active communication of patient-reported outcomes regarding quality of life, pain, and opioid consumption, smartphones equipped with activity tracking afford the opportunity to passively and objectively measure mobility, a key metric of recovery in spine surgery. However, app development is a resource-intensive process. To survey adult neurosurgery patients regarding access to and interest in this platform. In June and July 2017, a paper-based anonymous survey was distributed to patients in the waiting room of the adult neurosurgery clinic of a large US academic medical center. Patients' smartphone use and interest in using a mobile app following spine surgery were the primary and secondary outcomes, respectively. Of 146 included responses, 102 patients (70%) regularly used a smartphone, and this number increased to 77% among patients with a history of spine surgery (n=66, 45% of respondents). Seventy-one percent of patients with previous spine surgery expressed an interest in using a postoperative monitoring and communication app, compared to 81% of patients without prior spine operations (n=80, 55%). Among neurosurgery patients, there is a high level of access to and interest in smartphone apps to aid postoperative recovery. These results are useful for other neurosurgeons considering mobile app development for this purpose.

Creation of a third space endoscopy program at a tertiary academic US medical center

Creation of a third space endoscopy program at a tertiary academic US medical center

Determinants of neoadjuvant chemotherapy use in muscle-invasive bladder cancer.

PurposeCisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is standard of care for muscle-invasive bladder cancer (MIBC). However, NAC is used in less than 20% of patients with MIBC. Our goal is to investigate factors that contribute to underutilization NAC to facilitate more routine incorporation into clinical practice.Materials and MethodsWe identified 5,915 patients diagnosed with cT2-T3N0M0 MIBC who underwent RC between 2004 and 2014 from the National Cancer Database. Univariate and multivariable models were created to identify variables associated with NAC utilization.ResultsOnly 18.8% of patients received NAC during the study period. On univariate analyses, NAC utilization was more likely at academic hospitals, US South and Midwest (p<0.05). Higher Charlson score was associated with decrease use of NAC (p<0.05). On multivariate analysis, treatment in academic hospitals (odds ratio [OR], 1.367; 95% confidence interval [CI], 1.186–1.576), in the Midwest (OR, 1.538; 95% CI, 1.268–1.977) and South (OR, 1.424; 95% CI, 1.139–1.781) were independently associated with NAC utilization. Older age (75 to 84 years old; OR, 0.532; 95% CI, 0.427–0.664) and higher Charlson score (OR, 0.607; 95% CI, 0.439–0.839) were associated with decreased NAC utilization. Sixty-eight percent of patients did not receive NAC because it was not planned and only 2.5% of patients had contraindications for NAC treatment.ConclusionsOur study demonstrates that NAC is underutilized. Decreased utilization of NAC was associated with older patients and higher Charlson score. This underutilization may be related to practice patterns as very few patients have true contraindications.

Endoscopic management of large ileocecal valve lesions over an 18-year interval.

Background and study aims Ileocecal valve (ICV) lesions are challenging to remove endoscopically. Patients and methods This was a retrospective cohort study, performed at an academic tertiary US hospital. Sessile polyps or flat ICV lesions ≥ 20 mm in size referred for endoscopic mucosal resection (EMR) were included. Successful resection rates, complication rates and recurrence were compared to lesions ≥ 20 mm in size not located on the ICV. Results During an 18-year interval, there were 118 ICV lesions ≥ 20 mm with mean size 28.6 mm (44.9 % females; mean age 71.6 years), comprising 9.03 % of all referred polyps. Ninety ICV lesions (76.3 %) were resected endoscopically, compared to 91.3 % of non-ICV lesions ( P < 0.001). However, in the most recent 8 years, successful EMR of ICV lesions increased to 93 %. Conventional adenomas comprised 92.2 % of ICV lesions and 7.8 % were serrated. Delayed hemorrhage and perforation occurred in 3.3 % and 0 % of ICV lesions, respectively, compared to 4.8 % and 0.5 % in the non-ICV group. At first follow-up, rates of residual polyp in the ICV and non-ICV groups were 16.5 % and 13.6 %, respectively ( P = 0.485). At second follow-up residual rates in the ICV and non-ICV lesion groups were 18.6 % and 6.7 %, respectively ( P = .005). Conclusions Large ICV polyps are a common source of tertiary referrals. Over an 18-year experience, risk of EMR for ICV polyps was numerically lower, and risk of recurrence was numerically higher at first follow and significantly higher at second follow-up compared to non-ICV polyps.

Adoption of NISO’s Shared Electronic Resource Understanding (SERU) at US Academic Libraries

Following the emergence of electronic resources (e-resources), librarians developed licensing guidelines, standards, models, and understandings to educate, increase efficiencies, and retain rights afforded by copyright law. To reduce licensing burdens, the National Information Standards Organization (NISO) released the Shared E-Resource Understanding (SERU) in 2008, a set of “understandings” created and agreed upon by libraries and vendors. The author conducted a survey in 2017 of licensing practices and SERU use at libraries. The survey analyzed 108 responses from US academic libraries signing at least one license in the twelve months preceding the survey.

379 Safety and Efficacy of Peroral Endoscopic Myotomy (POEM) in Patients ≥ 65 Years at a Single Academic Tertiary Care Center

INTRODUCTION: Peroral endoscopic myotomy (POEM) has been proven to be effective for treating esophageal dysmotility disorders. Herein is a report of the safety and efficacy of POEM in patients aged ≥65 years at an academic US tertiary care center. METHODS: Medical charts of all patients aged ≥65 years that underwent POEM between December 2014 and October 2018 were retrospectively reviewed. Demographic data, clinical data and treatment outcomes were obtained. POEMs were performed by multidisciplinary teams each including 1 of 2 endoscopists (HG, RE) and 1 of 3 surgeons (KP, PN, JK). Clinical success was defined as Eckardt score ≤ 3 and improvement of symptoms. RESULTS: During the study period, 62 patients were included. The mean age of patients was 72.3 ± 5.7 years (range 65-89 years; 42% women). Mean BMI was 29.8 kg/m2. Indications for POEM included Achalasia 88.7%, diffuse esophageal spasm (DES) 6.5%, Jackhammer esophagus 3.2% and esophagogastric junction outflow obstruction (EGJOO) 1.6%. There were 2 intraoperative complications documented (pneumothorax and anaphylaxis to medication). Mean pretreatment IRP was 24.1. Pretreatment Eckardt score was 6.98 ± 2.2 compared with posttreatment Eckardt score of 1.25 ± 2 (P &lt; 0.05). Clinical success (Eckardt score ≤3) was achieved in 88.7% of patients. Mean myotomy length 13.8 cm (posterior orientation of myotomy 75.8%). Median hospitalization duration was 1.9 days. Postoperative complications included 1 patient with esophageal leak on postoperative esophagram, 1 patient with esophageal stricture, and 1 patient with both stricture and leak. No deaths occurred. Six patients with persistent symptoms post POEM required through-the-scope dilation to achieve improvement in symptoms. CONCLUSION: POEM can be safely carried out in symptomatic elderly patients ≥ with esophageal dysmotility disorders. An excellent clinical response (88.7%) was noted in this patient cohort.

Serum lactate poorly predicts central venous oxygen saturation in critically ill patients: a retrospective cohort study

BackgroundSerum lactate and central venous oxygen saturation (ScvO2) are commonly used and commonly recommended as markers of tissue oxygenation in shock states. Medical literature has both explicitly stated and implied that the two biomarkers are interchangeable in the management of patients with shock. However, there have been relatively few direct comparisons of these tests in clinical circumstances, and the relationship between them is uncertain. The objective of our study was to evaluate whether simultaneous or near-simultaneous measurements of lactate and ScvO2 reveal a consistent relationship between these two biomarkers.MethodsA retrospective cohort study was conducted in an urban, academic US hospital. All adults in ICUs between March 2007 and March 2017 who had a lactate measurement and ScvO2 or mixed venous oxygen saturation (SvO2) measurement made +/− 1 h from the lactate were included. Linear and non-linear correlations of ScvO2 and lactate were assessed in a variety of shock states.ResultsTwo thousand sixty-two patients were included. Lactate and ScvO2 correlated poorly (r2 = 0.0041, p = 0.0019). This was true for patients with ScvO2 ≤ 65% (r2 = 0.0431, p < 0.001), patients with normal kidney and liver function (r2 = 0.0517, p < 0.001), and septic shock patients (r2 = 0.0037, p = 0.17). For patients with an O2 extraction ratio ≥ 50%, lactate and ScvO2 were strongly correlated (r2 = 0.93, p = 0.0019), but these patients represented only 2.8% of patients in whom the ratio could be calculated.ConclusionsLactate can predict ScvO2 when patients are at or below the critical oxygen delivery threshold, but relatively few shock patients meet this criterion. In the overall population of critically ill patients, serum lactate predicts ScvO2 poorly, even after controlling for factors that may affect lactate production. Lactate and ScvO2 should not be assumed to be interchangeable markers of tissue oxygenation/perfusion.

Review of “Global Surgery: Effective Involvement of US Academic Surgery” by Mock C et al in Ann Surg 268:557–563, 2018

Journal of Craniofacial Surgery: September 2019 - Volume 30 - Issue 6 - p 1920 doi: 10.1097/SCS.0000000000005238

GAPcare: the Geriatric Acute and Post-acute Fall Prevention Intervention\u2014a pilot investigation of an emergency department-based fall prevention program for community-dwelling older adults

BackgroundFalls are the leading cause of fatal and non-fatal injuries among older adults. Older emergency department (ED) patients who present for evaluations after falls have a 30% higher risk of falling again in the subsequent 6 months than age-matched controls. Although EDs frequently evaluate older adults after their falls, the typical evaluation consists of an injury assessment alone. As such, an opportunity is lost to assess and address the potential causes of falls in this vulnerable population. In this manuscript, we present a multidisciplinary fall prevention protocol for a pilot study of older adult ED patients who recently sustained a fall (GAPcare: the Geriatric Acute and Post-acute Fall Prevention Intervention).MethodsGAPcare is a randomized single-blinded pilot study. Participants in GAPcare are 120 older adults (≥ 65 years old) who present to 1 of 2 academic US EDs after a fall. We randomly assign participants 1:1 to an intervention or a usual care (control) arm. In the intervention arm, the patient’s ED physician, a pharmacist, and a physical therapist (PT) collaborate to identify and address any risk factors that may have contributed to the fall. Intervention arm participants and their caregivers return home with a medication-related action plan to taper or stop potentially inappropriate medications and to address polypharmacy and a PT assessment and plan. Participants in the usual care arm receive standard assessments and care in the ED and a home safety brochure. Participants in both study arms complete fall calendars for 6 months to document the number of falls and healthcare visits during follow-up. The primary outcome is feasibility of the GAPcare fall prevention intervention (number and proportion of screened participants who are eligible, recruited, and retained; impact on ED length of stay), while the secondary outcome is to estimate its initial efficacy.DiscussionThe GAPcare-ED fall prevention intervention has the potential to promote older adult-sensitive care for millions of Americans presenting to EDs after falls and establish a protocol for a future large-scale randomized controlled trial on this topic.Trial registrationClinicalTrials.gov, NCT03360305. Trial registration date: December 4, 2017. Protocol version: 1

Blind User Experiences of US Academic Libraries can be Improved by More Proactive Reference Service Delivery

A Review of:&#x0D; Mulliken, A. (2017). There is nothing inherently mysterious about assistive technology: A qualitative study about blind user experiences in US academic libraries. Reference &amp; User Services Quarterly, 57(2), 115-126. https://doi.org/10.5860/rusq.57.2.6528 &#x0D; Abstract&#x0D; Objective – To explore blind users’ experiences with academic libraries.&#x0D; Design – Qualitative questionnaire.&#x0D; Setting – Academic libraries within the United States of America.&#x0D; Subjects – 18 individuals who are legally blind, have experience relying on a screen reader to access the internet, and have used an academic library either online or in person within the previous two years.&#x0D; Methods – An open-ended questionnaire was administered via telephone interview. Interviews were recorded, transcribed and analysed using an inductive approach to identify themes using Hill et al.’s (2005) approach.&#x0D; Main Results – The author found seven themes in the interview data: experiences working with reference librarians in person, difficulty with library websites, screen reader use during reference transactions, preferences for independence, using chat, interactions with disability officers, and challenges of working with citation styles. &#x0D; Conclusion – The study concluded that academic libraries and librarians should be more proactive when approaching reference services for blind users. The author offered suggestions for practice about how to improve blind user experiences of academic libraries.

Patient Eligibility for Transoral Endocrine Surgery Procedures in the United States

Transoral endocrine surgery (TES) allows thyroid and parathyroid operations to be performed without leaving any visible scar on the body. Controversy regarding the value of TES remains, in part owing to the common belief that TES is only applicable to a small, select group of patients. Knowledge of the overall applicability of these procedures is essential to understand the operation, as well as to decide the amount of effort and resources that should be allocated to further study the safety, efficacy, and value of these operations. To determine what percentage of US patients undergoing thyroid and parathyroid surgery are eligible for TES using currently accepted exclusion criteria. Cross-sectional study of 1000 consecutive thyroid and parathyroid operations (with or without neck dissection) performed between July 1, 2015, and July 1, 2018, at 3 high-volume academic US thyroid- and parathyroid-focused surgical practices (2 general surgery, 1 otolaryngology-head and neck endocrine surgery). Eligibility for TES was determined by retrospectively applying previously published exclusion criteria to the cases. The primary outcome was the percentage of thyroid and parathyroid cases eligible for TES. Secondary outcomes were a subgroup analysis of the percentage of specific types of cases eligible and the reasons for ineligibility. The mean (SD) age of the 1000 surgical patients was 53 (15) years, mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 29 (7), and 747 (75.0%) of the patients were women. Five hundred fifty-eight (55.8%) of the patients were eligible for TES. Most patients with thyroid nodules with cytologically indeterminate behavior (165 of 217 [76.0%]), benign thyroid conditions (166 of 240 [69.2%]), and primary hyperparathyroidism (158 of 273 [57.9%]) were eligible for TES, but only 67 of 231 (29.0%) of patients with thyroid cancer were eligible. Among all 1000 cases reviewed, previous neck operation (97 of 441 [22.0%]), nonlocalized primary hyperparathyroidism (78 of 441 [17.7%]), and need for neck dissection (66 of 441 [15.0%]) were the most common reasons for ineligibility. More than half of all patients undergoing thyroid and parathyroid surgery in this study were eligible for TES. This broad applicability suggests that a prospective multicenter trial is reasonable to definitively study the safety, outcomes, and cost of TES.

Evidence-Based Community Fall Prevention Programs at Senior Centers Near 10 US Academic Centers.

The Centers for Disease Control and Prevention recommends that patients at risk of falling engage in evidence-based community fall prevention programs (EBCFPPs). EBCFPPs are often delivered in senior centers (SCs). This is the first independent assessment of availability of EBCFPPs in SCs. Cross-sectional study of four types of EBCFPPs in the 25-mile radius of 10 US academic centers (ACs). SCs. SCs. None. Number and types of EBCFPPs offered at SCs. Across the 10 ACs, 249 SCs were sampled. Of the SCs, 35% offered zero, 54% offered at least one, 9% offered at least two, and 2% offered at least three EBCFPPs. Tai Chi of any type was offered in 59.8%, A Matter of Balance was offered in 8.9%, Stepping On was offered in 8.0%, and Staying Active and Independent for Life was offered in 1.2% of SCs sampled. SCs near Columbia University offered all four of the programs, while those near the University of Utah, Johns Hopkins University, and Seattle University only offered three of the programs. In univariate analysis, the number of local SCs was significantly associated with quantity of EBCFPPs (odds ratio [OR] = 2.2; 95% confidence interval [CI] = 1.9-2.6; P < .001), but not with diversity of EBCFPPs (OR = 1.0; 95% CI = 1.0-1.1; P = .13). In multivariate regression, city, sex distribution, and average household income did not correlate with the overall number or the diversity of EBCFPPs, whereas locales with more SCs offered more EBCFPPs (OR = 2.2; 95% CI = 1.7-2.9; P < .001). A significant number of SCs still do not offer any EBCFPPs. From those that do, few offer a diversity of these programs. Opportunities exist to increase access to EBCFPPs in SCs.

Changes in Vedolizumab Utilization Across US Academic Centers and Community Practice Are Associated With Improved Effectiveness and Disease Outcomes.

BackgroundVedolizumab effectiveness estimates immediately after Food and Drug Administration (FDA) approval for ulcerative colitis (UC) and Crohn’s disease (CD) are limited by use in refractory populations. We aimed to compare treatment patterns and outcomes of vedolizumab in 2 time frames after FDA approval.MethodsWe used 2 data sets for time trend analysis, an academic multicenter vedolizumab consortium (VICTORY) and the Truven MarketScan database, and 2 time periods, May 2014–June 2015 (Era 1) and July 2015–June 2017 (Era 2). VICTORY cumulative 12-month clinical remission, corticosteroid-free remission, and mucosal healing rates, and Truven 12-month hospitalization and surgery rates, were compared between Eras 1 and 2 using time-to-event analyses.ResultsA total of 3661 vedolizumab-treated patients were included (n = 1087 VICTORY, n = 2574 Truven). In both cohorts, CD and UC patients treated during Era 2 were more likely to be biologic naïve. Compared with Era 1, Era 2 CD patients in the VICTORY consortium had higher rates of clinical remission (31% vs 40%, P = 0.03) and mucosal healing (42% vs 58%, P < 0.01). These trends were not observed for UC. In the Truven database, UC patients treated during Era 2 had lower rates of inflammatory bowel disease–related hospitalization (22.4% vs 9.6%, P < 0.001) and surgery (17.2% vs 9.4%, P = 0.008), which was not observed for CD.ConclusionSince FDA approval, remission and mucosal healing rates have increased for vedolizumab-treated CD patients, and vedolizumab-treated UC patients have had fewer hospitalizations and surgeries. This is likely due to differences between patient populations treated immediately after drug approval and those treated later.

Adoption of a proven quality improvement bundle for eras in emergency general surgery in a us healthcare system

Objectives: Emergency general surgery (EGS) is a major source of morbidity and mortality in the United States. EGS patients account for 50% of surgical mortality, and care expenditures in this population are expected to exceed $40 billion by 2040. The US has no nationally recommended EGS care bundle, with highly variable outcomes between hospitals. The UK ELPQuic study used an evidence based bundle to significantly reduce mortality. We sought to implement such a bundle at an academic US healthcare system.

RECOGNISING A PRIVACY-INVASION TORT: THE CONCEPTUAL UNITY OF INFORMATIONAL AND INTRUSION CLAIMS

AbstractThis article presents the novel view that “inclusion into seclusion” and “public disclosure of embarrassing facts” (“misuse of private information” (“MOPI”) in the UK), which both the academic commentary and US case law treat as two separate legal actions, occupy the same conceptual space. This claim has important practical ramifications. No further development of the law is required to realise an actionable intrusion tort as part of the UK's MOPI tort. The argument is defended in doctrinal and theoretical terms and by reference to both UK and US law. It is presented in three forms: first, in negative terms, that the orthodox distinction between the two claims (informational privacy and intrusion) is unsustainable; second, in positive terms, that both guard against the same wrong (unwarranted privacy invasion) and the same harm (mental distress), in a way that is distinctive from other privacy actions and legal claims based upon the autonomy value; finally, in pragmatic terms, that MOPI's mature jurisprudence is sufficiently flexible and dynamic to recognise intrusion-only claims using its existing legal framework.

The Emergence of Population Health in US Academic Medicine

In response to rapidly growing interest in population health, academic medical centers are launching department-level initiatives that focus on this evolving discipline. This trend, with its potential to extend the scope of academic medicine, has not been well characterized. To describe the emergence of departments of population health at academic medical centers in the United States, including shared areas of focus, opportunities, and challenges. This qualitative study was based on a structured in-person convening of a working group of chairs of population health-oriented departments on November 13 and 14, 2017, complemented by a survey of core characteristics of these and additional departments identified through web-based review of US academic medical centers. United States medical school departments with the word population in their name were included. Centers, institutes, and schools were not included. Departments were characterized by year of origin, areas of focus, organizational structure, faculty size, teaching programs, and service engagement. Opportunities and challenges faced by these emerging departments were grouped thematically and described. Eight of 9 population health-oriented departments in the working group were launched in the last 6 years. The 9 departments had 5 to 97 full-time faculty. Despite varied organizational structures, all addressed essential areas of focus spanning the missions of research, education, and service. Departments varied significantly in their relationships with the delivery of clinical care, but all engaged in practice-based and/or community collaboration. Common attributes include core attention to population health-oriented research methods across disciplines, emphasis on applied research in frontline settings, strong commitment to partnership, interest in engaging other sectors, and focus on improving health equity. Tensions included defining boundaries with other academic units with overlapping areas of focus, identifying sources of sustainable extramural funding, and facilitating the interface between research and health system operations. Departments addressing population health are emerging rapidly in academic medical centers. In supporting this new framing, academic medicine affirms and strengthens its commitment to advancing population health and health equity, to improving the quality and effectiveness of care, and to upholding the social mission of medicine.