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Reply to: Correction to external evaluation of a commercial artificial intelligence-augmented digital auscultation platform in valvular heart disease detection using echocardiography as reference standard.
No full textAppropriate use of tissue sampling and somatostatin receptor PET imaging in the diagnosis of pancreatic neuroendocrine tumors: results of an International Delphi Consensus.
No full textBACKGROUND: Current guidelines lack clarity regarding the appropriate use of preoperative ultrasound-guided (EUS) biopsy and receptor positron emission tomography (SSTR PET) imaging for pancreatic neuroendocrine tumors (PNETs). This study aims to reach expert consensus on the optimal sequencing of SSTR PET and EUS biopsy in the diagnostic workup and management of patients with suspected PNETs.
METHODS: A three-round modified Delphi process was used. A multidisciplinary panel of experts was recruited via snowball sampling. A set of 22 baseline statements pertaining to diagnostic workup, imaging, and biopsy was developed based on literature review and feedback obtained through a focus group. Survey rounds were conducted electronically and anonymously. A panel of international experts was asked to indicate whether they agreed, disagreed, or lacked the appropriate background to answer each statement. Of the 55 experts invited, 38 (69%) accepted to participate. Consensus was achieved with \u3e 80% agreement.
RESULTS: Response rates were 97%, 100%, and 100% in rounds 1, 2, and 3, respectively. Following rounds 1 and 2, 29 final statements achieved consensus in the following three domains: diagnostic workup (15 statements), imaging (nine statements), and tissue sampling (five statements). Cronbach\u27s alpha value, a measure of internal consistency, was 0.91 and 0.85 for rounds 1 and 2, respectively. The final set of statements achieved a 95% approval rate in round 3.
CONCLUSION: This international Delphi study provides expert consensus-based guidance on the appropriate use of EUS biopsy in the diagnostic workup of PNETs in the era of SSTR PET imaging
Optimizing Rapid Response Team Efficiency Through Structured Data Analysis
No full texthttps://digitalcommons.providence.org/swedish_fish_2025/1016/thumbnail.jp
Impact of Gum Chewing on Postoperative Ileus Following Open Heart Surgery
No full texthttps://digitalcommons.providence.org/swedish_fish_2025/1014/thumbnail.jp
Evaluating Use and Outcomes of an Infusion Pump-EHR Interface System
No full textPurposes/Aims: The purpose of this program evaluation is to assess the effectiveness of an infusion pump-EHR interface system, Alaris Interoperability, on the incidence of medication errors, consistency of staff utilization, accuracy of documentation, staff satisfaction and clinical outcomes in an inland northwest intensive care unit (ICU).
Rationale/Background: Medication errors are preventable events that account for nearly half of all medical injuries, with an annual global estimated cost of $42 billion USD (WHO, 2023; WHO, n.d.).
In spring 2023, a 197-bed community hospital implemented Alaris Interoperability, a program intended to standardize intravenous medication administration. This program created a virtual interface between infusion pumps and the electronic health record (EHR), allowing for automatic calculation of drip rates, volumes & dosages. This new workflow sought to reduce medication errors and improve documentation accuracy by removing manual input by the RN. With its high patient acuity and increased utilization of infusion pumps, the ICU was selected to evaluate system usability and patient outcomes. Since implementation, there have been technical challenges, difficulties in staff training, and varying compliance regarding this change in practice. Many staff members are dissatisfied with the education they received and the functionality of the program itself, leading to inconsistent utilization amongst employees. If this software is bypassed or used incorrectly, this may lead to errors in medication administration, documentation inaccuracy and potential patient harm.
Approach/Methods: The CDC program evaluation framework guided this project. Incorporating the framework’s six steps, medication error incidence before & after implementation was measured via internal data reports; quarterly data was reviewed for 18 months pre- and post-implementation in the intensive care setting to measure program impact. Internal reports measuring usability rates documented compliance amongst ICU RN’s. Chart reviews were completed by an internal third party to measure the rate of intravenous infusion verification through the EHR. Average length of stay before & after implementation was measured using internal data reports. The project lead developed an evidence-based Likert-type survey which was distributed to ICU staff to measure attitudes regarding the program; these questionnaires assessed Alaris Interoperability value, ease of use, effectiveness in decreasing medication errors and effect on workload/workflow. Open-ended questions were used to gather qualitative responses from staff.
Assessment of Findings/Outcomes: Average medication error rate (per 10,000 billed doses) pre intervention was 0.75 (σ 1.16), while the average medication error rate post-intervention was 0.89 (σ 1.10). There were three documented infusion-related medication errors since Oct 2023; Alaris Interoperability was over-rode in all three instances. Staff compliance increased from 80% to 92% between June 2023 and Nov 2024. 90 charts were audited to assess documentation accuracy; only 44% of RNs completed IV drip verification per policy. Average LOS pre-intervention was 2.93 days (σ 0.24), while average LOS post-intervention was 3.07 days (σ 0.30). Regarding staff attitudes, 18 survey responses were received comprising a 46% response rate. 72% of respondents agree/strongly agree that Alaris Interoperability eases charting, while 17% agree/strongly agree that they need more training on Alaris Interoperability. Staff reported improved charting efficiency, but cite disrupted workflow, challenges with drip verification & inconsistent use amongst nurses. Confounding variables may have affected LOS, including the implementation of in-house dialysis. Contextual med error data is unavailable prior to Oct 2023 due to a change in reporting systems, thus, the true impact of Alaris Interoperability on med error rate is unknown.
Conclusion: Further investigation is necessary; software has only been in use for 18 months; thus, its impact may not be fully realized. Verification compliance should be augmented to improve documentation accuracy & team-based culture is necessary for successful use of the technology. Further education may be indicated for staff regarding importance of drip verification/policy and other units should be investigated to understand the broader impac
Improved healthcare utilization and economic outcomes of chronic subdural hematoma treatment with middle meningeal artery embolization compared to conventional surgical drainage.
No full textBACKGROUND: Middle meningeal artery embolization (MMAE) emerges as an alternative to conventional surgical drainage (CSD) for chronic subdural hematomas (cSDH). Several studies have suggested that MMAE improves the cost efficacy of cSDH treatment. However, further comprehensive analyses of the outcomes and healthcare costs of MMAE are necessary.
METHODS: Merative MarketScan Research Database from 2017-2022 was used to compare demographics, reoperation rates, complications, healthcare utilization, and payments of patients being treated with CSD, CSD and adjunctive MMAE, or standalone MMAE for cSDH or nontraumatic subdural hemorrhage.
RESULTS: From 2017-2022, there were 2108 patients who underwent CSD (
CONCLUSIONS: The reduced complications, infection rate, hospital utilization, and costs observed in this study support MMAE as a promising treatment option in the arsenal for cSDH management
Durability of response of UGN-101: Longitudinal follow up of multicenter study.
No full textPURPOSE: UGN-101, a reverse thermal mitomycin gel for upper tract instillation, recently became the first FDA approved treatment for upper tract urothelial carcinoma (UTUC). However, the durability of UGN-101 treatment has not been well described. Here we present long term outcomes from our multi-institutional cohort for patients who initially responded to treatment.
MATERIALS AND METHODS: We identified patients from a multi-institutional database with UTUC who had a negative endoscopic evaluation following either adjuvant or chemoablative UGN-101 induction. Recurrence and progression data for those patients was reviewed. Kaplan-Meier survival analysis was performed, stratified by relevant clinical features.
RESULTS: We identified 56 renal units that met the inclusion criteria of which 93% had low-grade disease while 4 cases had high-grade UTUC. With a median follow-up of 23.5 months, 21.4% of renal units experienced a recurrence, with 65% of renal units recurrence-free at 36 months. Three patients experienced eventual progression of disease leading to mortality, however only 1 of these patients had presumed low-grade UTUC and did not undergo nephroureterectomy on recurrence due to solitary kidney.
CONCLUSIONS: UGN-101 treatment has excellent durability in patients who initially respond to the treatment. Further study is needed to better understand the long term outcomes of this novel therapy and also the risks/benefits of maintenance therapy in this setting. Caution should be used in patients with high-grade disease who appear to be at higher risk of relapse and death despite initial response
What Matters in Psoriatic Arthritis: A Comparison of Patient and Clinician Perspectives.
No full textOBJECTIVE: This study aimed to expand the understanding of the patient with psoriatic arthritis (PsA) experience and to compare/contrast patient and clinician prioritization of PsA dimensions.
METHODS: We conducted four patients with PsA focus groups across three US rheumatology practices using mixed methods to identify attributes of PsA important to patients. Combination with extant attributes of PsA identified by a steering committee created a comprehensive list of attributes. In separate patient and physician Delphi exercises, participants distributed 100 points across items on the list according to importance as a dimension of PsA.
RESULTS: Fifty-one items describing PsA were generated. Thirty-eight patients and 13 clinicians completed the last Delphi rating exercise. Patients distributed points across a wider range of items than physicians. Using group mean score per item, prioritization was compared between groups. Items with the top 10 mean scores for both groups included arthritis, disease activity, pain, fatigue, physical function, and spine symptoms. Other prioritized domains showed disparity: access to care, daily activities, stiffness, future health uncertainty, and sleep quality for patients versus specific disease skin and joint manifestations, comorbidities, structural damage, and disease management goals for clinicians.
CONCLUSION: Although concordance between patient and clinician perspectives regarding what matters in PsA was seen, significant areas of discordance were uncovered. Patients highlighted concerns about care access and uncertainty about the future and impact on aspects of life beyond physical symptoms, issues not usually discussed in a clinical visit. These differential prioritizations highlight opportunities for improvement in patient-clinician communications and delineate the need for more patient-centered research