20966 research outputs found
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Project #117: Seconds to Scan: Reducing Stroke Arrival to CT Times
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1021/thumbnail.jp
Project #018: Pre-Risk Stratification Plan
No full texthttps://scholarlycommons.henryford.com/qualityexpo2025/1001/thumbnail.jp
Project #042: Reduction of hip fractures after elective total hip arthroplasty within 90 days
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1004/thumbnail.jp
Project #034: Collaborative Approach to Length of Stay Reduction in Complex Patients
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Project #131: Driving Outcomes: Clinical and Financial Impact of the Diabetes Care Connection at Populance
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1026/thumbnail.jp
Enhancing Radiology Clinical Histories Through Transformer-Based Automated Clinical Note Summarization
No full textInsufficient clinical information provided in radiology requests, coupled with the cumbersome nature of electronic health records (EHRs), poses significant challenges for radiologists in extracting pertinent clinical data and compiling detailed radiology reports. Considering the challenges and time involved in navigating electronic medical records (EMR), an automated method to accurately compress the text while maintaining key semantic information could significantly enhance the efficiency of radiologists\u27 workflow. The purpose of this study is to develop and demonstrate an automated tool for clinical note summarization with the goal of extracting the most pertinent clinical information for the radiological assessments. We adopted a transfer learning methodology from the natural language processing domain to fine-tune a transformer model for abstracting clinical reports. We employed a dataset consisting of 1000 clinical notes from 970 patients who underwent knee MRI, all manually summarized by radiologists. The fine-tuning process involved a two-stage approach starting with self-supervised denoising and then focusing on the summarization task. The model successfully condensed clinical notes by 97% while aligning closely with radiologist-written summaries evidenced by a 0.9 cosine similarity and a ROUGE-1 score of 40.18. In addition, statistical analysis, indicated by a Fleiss kappa score of 0.32, demonstrated fair agreement among specialists on the model\u27s effectiveness in producing more relevant clinical histories compared to those included in the exam requests. The proposed model effectively summarized clinical notes for knee MRI studies, thereby demonstrating potential for improving radiology reporting efficiency and accuracy
AGA Clinical Practice Update on Endoscopic Lifting Agents: Commentary
No full textDESCRIPTION: This American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) reviews endoscopic lifting agents and their use in the gastrointestinal tract.
METHODS: This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership. This CPU underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This expert commentary incorporates important as well as recently published data in this field and reflects the experiences of the authors
Screening and management of portal hypertension and varices in cirrhosis: Expert perspectives
No full textThe prevalence of liver injury, fibrosis, and, in particular, cirrhosis in the United States is increasing in parallel to the current epidemic of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease. As fibrosis advances, portal hypertension occurs, and when the pressure gradient meets or exceeds 10 mm Hg, the patient is at an increased risk for decompensating events such as esophageal varices. The risk of death also increases. Therefore, decreasing the risk of progression to decompensated cirrhosis is an important management goal. The American Association for the Study of Liver Diseases recently published a guidance document to coalesce best practice recommendations for the identification of portal hypertension, for prevention of initial hepatic decompensation, for the management of acute variceal hemorrhage, and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease. In this updated guidance, the new terms advanced chronic liver disease and clinically significant portal hypertension have been proposed for routine use in clinical practice. Following recommendations for advanced chronic liver disease identification, which are largely defined by transient elastography measurements of liver stiffness, guidance is provided on the identification of clinically significant portal hypertension and early administration of nonselective beta-blocker therapy in clinically significant portal hypertension for prophylaxis. Optimal control of active bleeding, the role of preemptive TIPS, and gastric varices management are also addressed. Despite the wealth of information provided, the guidance can be difficult to put into practice, leaving non-liver-focused clinicians with an unmet need for a simplified approach to guidelines in general. To address this issue, a panel of hepatologists met to review and discuss the real-world implications of this new guidance and the result is this expert perspective review. This review aims to facilitate improvements in risk stratification and management of variceal bleeding, streamline controversial and complex issues in the recent guidance in a practical way for clinical use, and make recommendations on how to incorporate this important new guidance document into clinical practice
Risk of severe bacterial infections including TB before and after immediate or deferred antiretroviral therapy: A multicenter, prospective, cohort study
No full textOBJECTIVES: Deferring ART until a CD4 count below cells/mm(3) or other clinical indication in people with HIV (PWH) carries an increased risk of severe bacterial infections and tuberculosis (TB). It is not known if this increased risk is reversed after ART initiation.
METHODS: We analyzed 4,684 adult PWH with CD4 cell counts above 500 cells/mm(3) who were randomized to immediate or deferred ART in the Strategic Timing of AntiRetrovial Treatment (START) trial. In May 2015, the deferred group was offered ART and follow-up continued until December 2021. Cox proportional hazards models were used to compare the risks of severe bacterial infections including TB in the immediate and deferred groups before and after ART initiation in the deferred group.
RESULTS: 217 (4.6%) participants experienced a severe bacterial infection during the entire follow-up period. Pre-2016, the immediate group had a lower rate of severe bacterial infections compared to the deferred group (HR 0.38; 95% CI 0.26, 0.55). During 2016-2021, there was no longer a statistically significant difference (HR 0.75; 95% CI 0.49, 1.16). No differences were observed between clinical or demographic subgroups.
CONCLUSION: The increased risk of severe bacterial infections seen after deferring ART is reversed once ART is initiated
Next Steps in Maximizing Value in Orthopedic Surgery
No full textAs health care continues to shift to value-based reimbursement and away from volume-based reimbursement, there will be increasing emphasis on demonstrating improvement of patient health to justify reimbursement. Orthopedic surgeons that can demonstrate superior quality of care delivered will be in position to improve financial compensation as these 2 metrics become increasingly tightly correlated. In order to deliver high-value care, orthopedic surgeons must be aware of the core tenets of such delivery, including quality, value, and safety. Understanding these core tenets will be critical to providing high-value care and subsequently succeeding in the evolving value-based market