11210 research outputs found
Sort by
Redesigning Oncology Care: Leveraging Digital Innovation to Advance Nurse-Led Triage Services
No full textIntroduction and Context:
As oncology care grows more complex, timely nurse triage for symptom management is essential. Traditional models that assign triage to ambulatory care nurses as an added responsibility often lead to delays and inefficiencies, potentially affecting outcomes and satisfaction. To address this, a dedicated oncology nurse triage service was proposed to improve access and enhance care delivery.
Implementation Strategy:
This quality improvement initiative aimed to develop a novel care model, integrate a digital workflow into the electronic medical record (EMR), and launch a nurse-led triage service across a large service area. The multi-phase approach began with a needs assessment, stakeholder engagement, and design of evidence-based triage protocols. Phase 2 included building a call center staffed by trained oncology nurses, embedding protocols into the EMR, and standardizing triage pathways. Phase 3 focused on staff training, defining performance metrics, and phased implementation. Metrics included call volume, message handling, response times, and call abandon rates.
Outcomes and Impact:
The service expanded to six practices, with three more planned. Call volumes rose 310% from baseline, while maintaining the target of answering 80% of calls within 60 seconds (m = 81.78%). Call abandon rates dropped by 27% (m = 3.8%). EMR integration improved care continuity and decision-making.
Insights:
A dedicated triage service with embedded digital tools and standardized workflows improved timely access to care. Evidence-based algorithms and structured communication supported safe and efficient responses. Staff engagement and training were key to successful implementation.
Implications:
This model shows how technical and workflow innovations can enhance oncology care. Future efforts include ongoing evaluation, development of a symptom and disposition tracker, and service expansion to further optimize patient care and nurse utilization. Broader adoption of this model may support improved access, patient outcomes, and optimal nurse utilization across oncology practices
Virtual Rounding in the Level II NICU
No full textIntroduction and Context This initiative addresses the challenge of providing 24/7 Neonatology supervision at a Level II regional NICU while meeting AAP guidelines. Traditional in-person rounding was limited by staffing and geography. We implemented the TytoCare™ device—previously used in adult populations—for virtual rounding. This allowed Neonatologists to remotely “see” and “hear” neonates in real time, supporting care quality, continuity, and improved family experiences.
Implementation Strategy All APPs and Neonatologists were trained on TytoCare™, which offers high-resolution video, auscultation, and two-way communication. Following stakeholder approval, the device was deployed for daily rounds, enabling real-time collaboration between the APP and remote Neonatologist. This strategy advanced telehealth in neonatal care while maintaining efficient clinical workflows.
Outcomes and Impact Since October 2024, 69 neonates have been rounded on virtually, avoiding transport to the tertiary NICU. This has improved family-centered care, reduced disruptions, and enhanced care access. Patient and staff feedback has been overwhelmingly positive, affirming the safety, effectiveness, and thoroughness of this virtual care model.
Insights Virtual rounding with TytoCare™ maintained clinical quality and improved resource utilization. It reduced transfers, strengthened APP-Neonatologist collaboration, and highlighted telehealth’s value in extending subspecialty care to regional sites. This approach is ideal for settings with limited on-site Neonatology coverage.
Implications This innovation is transferable to similar Level II NICUs. Broader rollout could reduce healthcare costs and improve access to specialty care. Feedback has been shared with the vendor for device enhancements. Monthly usage tracking continues, and expansion across our health system is under consideration
Abstract 4358422: Comparative efficacy and safety of renal denervation versus spinal cord stimulation in hypertensive patients: A propensity-matched cohort study
No full textComprehensive evidence-based guidelines for regenerative therapies in the management of chronic low back pain: 2025 Update from the American Society Of Interventional Pain Physicians (ASIPP)
No full textBackground: Regenerative medicine is an evolving medical subspecialty dedicated to enhancing the body\u27s natural healing mechanisms to repair or replace damaged tissues. By using autologous or allogeneic biologics, it offers the potential to restore function where conventional therapies have shown limited success. While this field holds great promise and continues to generate enthusiasm among both patients and clinicians, it remains in early stages of clinical validation. Therefore, it must be approached with careful optimism and responsible application, ensuring that its presentation, promotion, and use in clinical settings are grounded in evidence and ethical standards.
Objective: To provide updated, evidence-based recommendations for the role of regenerative therapies in managing moderate to severe chronic low back pain.
Methods: A multidisciplinary panel of experts, convened by the American Society of Interventional Pain Physicians (ASIPP), systematically reviewed the current evidence and incorporated patient perspectives to develop practical, evidence-informed recommendations. The process included defining key clinical questions, reviewing the literature, formulating evidence-based statements, and reaching consensus through structured discussions and formal voting.
Results: A total of 35 authors contributed to the development of these guidelines, with 33 experts participating in the formal consensus process. Altogether, 19 recommendations were generated, with all of them achieving 100% agreement. These recommendations were informed by a comprehensive review of systematic reviews, randomized controlled trials (RCTs), and observational studies encompassing a broad range of regenerative therapies.Evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to determine certainty levels. Both qualitative and quantitative analyses were applied to synthesize the best available data, resulting in evidence-based recommendations summarized below.Intradiscal Injections (PRP): Evidence Level: III, Fair; Consensus-Based Clinical Recommendation: ModerateIntradiscal Injections (BMAC): Evidence Level: III, Fair; Consensus-Based Clinical Recommendation: ModerateEpidural Injections (PRP): Evidence Level: III, Fair; Consensus-Based Clinical Recommendation: ModerateFacet Joint Injections (PRP and MSCs): Evidence Level: IV, Limited; Consensus-Based Clinical Recommendation: Moderate Sacroiliac Joint Injections (PRP): Evidence Level: IV, Limited; Consensus-Based Clinical Recommendation: Low Functional Spine Unit Injections Evidence Level: Very Low; Consensus-Based Clinical Recommendation:Low.
Limitations: The primary limitation of these guidelines is the scarcity of high-quality studies, with much of the available evidence derived from small or heterogeneous trials.
Precautions: Regenerative therapies should be considered only after a thorough diagnostic evaluation confirming clinical necessity. Treatment decisions must account for the patient\u27s medical condition, preferences, and expectations. Patients should be fully informed about the nature, potential benefits, risks, and costs of regenerative treatments, most of which are not covered by commercial insurance.These therapies may be used alone or in conjunction with other evidence-based modalities, such as structured exercise, physical therapy, behavioral therapy, or conventional medical management. Clinicians must follow all applicable U.S. Food and Drug Administration (FDA) regulations and adhere to safety and ethical standards outlined in these guidelines.
Conclusion: Based on current evidence, lumbar intradiscal injections of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) are supported by Level III evidence. Lumbar epidural PRP injections are also supported by Level III evidence, while PRP injections for lumbar facet joints and sacroiliac joints are supported by Level IV evidence. Given the emerging status of biologic therapies and the limited quality of existing studies, the panel provides moderate, consensus-based recommendations for the use of all biologics in the lumbar spine
Abstract Sun708: The impact of intra-arrest TEE on epinephrine administration in in-hospital cardiac arrest: A resuscitative TEE collaborative registry (rTEECoRe) study
No full textBreaking age barriers: Neuraxial anesthesia for an intramedullary rod insertion of right femur in a 99-year-old patient
No full textRasburicase repercussions: methemoglobinemia and hemolytic anemia in an African American male with undiagnosed glucose-6-phosphate dehydrogenase deficiency
No full textIntroduction Rasburicase, a recombinant urate oxidase, effectively lowers nephrotoxic uric acid levels in tumor lysis syndrome (TLS). However, its use produces oxidative byproducts that can precipitate hemolysis and methemoglobinemia in patients with glucose-6-phosphate dehydrogenase (G6PD). Although G6PD screening is recommended prior to use in high-risk populations, emergent presentations often preclude timely testing. We report a rare case of simultaneous rasburicase-induced methemoglobinemia and hemolytic anemia in a patient with previously undiagnosed G6PD deficiency. Case Presentation: A 74-year-old African American man with an indeterminate plasma cell dyscrasia and chronic kidney disease presented with 24 hours of abdominal pain, nausea, and emesis. Initial labs revealed elevated creatinine (2.81 mg/dL), BUN (47 mg/dL), uric acid (9.6 mg/dL) and phosphorus (6.3 mg/dL). Computed tomography (CT) of the abdomen and pelvis demonstrated omental carcinomatosis, lymphadenopathy, and distal esophagitis. Hematology consultation recommended rasburicase (3 mg IV) and concurrent G6PD testing for suspected TLS. Within 24 hours, the patient developed progressive asymptomatic hypoxemia requiring 6 L/min supplemental oxygen. Arterial blood gas revealed methemoglobinemia (6.8%) with a hemoglobin decline from 10.4 g/dL to 8.0 g/dL. Shortly after, hemolysis studies revealed indirect-predominant hyperbilirubinemia (2.4 mg/dL), elevated LDH (322 U/L), and evidence of iron overload. However, haptoglobin was initially preserved and repeat peripheral smears showed no schistocytes, Heinz bodies, or bite cells. Ascorbic acid (1,500 mg IV every 6 hours) was initiated and fluid resuscitation reduced due to pulmonary edema. Over the next 48 hours, oxygenation improved but hemoglobin declined to 6.3 g/dL requiring 4 total units of packed red blood cells. By days 3-4, LDH peaked at 532 U/L, haptoglobin fell to \u3c 8 mg/dL, and initial quantitative G6PD assays yielded intermediate deficiency (3.6 and 4.2 U/g Hb, 30-40% of population median). Methemoglobin levels normalized, hemolysis stabilized, and the patient was discharged after 7 days without continued ascorbic acid. Discussion: Rasburicase catalyzes uric acid oxidation, generating hydrogen peroxide that can overwhelm antioxidant defenses in G6PD-deficient erythrocytes, causing methemoglobinemia and hemolytic anemia. Although these risks are well documented, concurrent presentation is uncommon (fewer than 50 cases) and is associated with significant (10%) mortality. In emergent TLS, rasburicase is often administered before G6PD results are available, underscoring the need for proactive monitoring for hypoxemia and evolving hemolysis. Early hemolytic markers may be discordant or lag behind clinical deterioration, complicating timely diagnosis. Standard methemoglobinemia therapies, such as methylene blue and hyperbaric oxygen, are contraindicated in G6PD deficiency because of their oxidative potential. In this case, high-dose intravenous ascorbic acid safely corrected methemoglobinemia without worsening hemolysis, supporting its role as an alternative when conventional therapies are unsuitable./ Conclusion: This case illustrates the dual risk of hemolysis and methemoglobinemia with rasburicase in unrecognized G6PD deficiency. It emphasizes the need for pre-treatment G6PD screening in at-risk populations, the potential for discordant early laboratory findings in hemolytic anemia, and the role of ascorbic acid as a therapeutic option when standard treatments are contraindicate
Initial experience with a deep learning algorithm for detecting posterior circulation large vessel occlusion on non-contrast CT: Abstract 472
No full textEvaluation of a deep learning tool for detecting large vessel occlusion and intracranial hemorrhage on noncontrast computed tomography scans
No full textBACKGROUND: The purpose of this study is to assess the accuracy of automated artificial intelligence (AI) deep‐learning‐based modules in predicting suspected intracranial hemorrhage (ICH) or anterior circulation large vessel occlusion (LVO) on noncontrast computed tomography (NCCT) studies.
METHODS: We conducted a multicenter international retrospective cohort study, involving 6 stroke centers from the United States and Europe. We included patients in whom an acute stroke was suspected on admission and who underwent an NCCT and a CT angiography when ICH was not observed. Two neuroradiologists and a third one in case of discrepancies retrospectively evaluated all images and established the presence of ICH on NCCT and LVO on computed tomography angiography (ground truth). All NCCT scans were analyzed using 2 automated AI deep‐learning modules (Methinks, Barcelona, Spain) to assess the presence of ICH or LVO.
RESULTS: To assess the performance of the NCCT‐ICH module, a total of 200 patients were included in the study. The neuroradiologist\u27s evaluation confirmed the presence of ICH in 97 cases (48.5%). To assess the performance of the NCCT‐LVO module, 382 patients were analyzed, with the neuroradiologist identifying a LVO in 141 cases (36.9%). The AI module for NCCT‐ICH detection demonstrated a sensitivity of 94.9% (95% CI]: 88.4%–98.3%) and specificity of 99.0% (95% CI: 94.7%–99.9%) with an area under the receiver operating characteristic curve of 0.974 (95% CI: 0.94–0.99). The LVO detection AI module on NCCT demonstrated a sensitivity of 81.6% (95% CI: 74.2–87.6), and specificity of 87.1% (95% CI: 82.2–91.1) with an area under the receiver operating characteristic of 0.915 (95% CI: 0.88–0.94).
CONCLUSIONS: The AI modules demonstrated high sensitivity and specificity in predicting ICH and LVO, suggesting their potential in offering support in clinical decisions in stroke networks immediately after NCCT is performed
Effect of biofire blood culture identification 2 (BCID2) panel versus a matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) rapid incubation protocol on time to optimal therapy in patients with positive blood cultures
No full textRapid diagnostic technology (RDT) is a valuable tool that can be used to optimize antimicrobial therapy for patients with bloodstream infections. Several technologies for rapid organism identification exist including matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) and the BioFire® Blood Culture Identification 2 (BCID2) Panel. This multicenter, retrospective, cohort study compared results from patients with a positive blood culture, in which primary identification was performed via a rapid incubation MALDI-TOF protocol (Rapid MALDI-TOF MS) compared to the BCID2 molecular identification Panel. The primary outcome was time to optimal therapy (TTOT). A total of 221 patients were included (Rapid MALDI-TOF MS = 117; BCID2 Panel = 104). Utilization of the BCID2 Panel compared to Rapid MALDI-TOF MS significantly reduced overall TTOT (21.1 h vs. 41.1 h, p \u3c 0.01). This significant reduction in TTOT with the BCID2 Panel was observed with gram-negative bacteremia (4 h vs. 37 h, p \u3c 0.01) and gram-positive bacteremia (17.8 h vs. 41.1 h, p \u3c 0.01), but was not statistically significant for blood cultures deemed contaminants (42 h vs. 43.5 h, p = 0.58). Time to effective therapy (TTET) was improved with the BCID2 Panel although not statistically significant (1.5 h vs. 7.5 h, p = 0.06). No differences were observed with hospital length of stay or clinical failure. Utilization of the BCID2 Panel significantly decreased time to optimal antimicrobial therapy compared to Rapid MALDI-TOF MS for patients with positive blood cultures