MEDICA@MUSC (Medical University of South Carolina)
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Pandemic Preparation & Response: A Case Study Applying Kotter’s 8 Step Change Management Theory to Improve Pandemic Response in an Acute Care Setting
Get PDFFor healthcare CEOs and leaders, much time is spent planning and strategically assessing our organizations\u27 overall health and status. Planning cycles vary from 1 year to 5 years and, in some cases, 10-year plans. However, with the onset of the COVID-19 pandemic, healthcare leaders have been forced to pivot and embrace a sense of resilience. Today, we are leading and making decisions on a day-to-day basis and even hour-to-hour based on the uncertainty and needs of our organizations and communities we serve. The crisis of a pandemic requires leadership to act swiftly and with a cadence of assurance to all. We are learning in a time of crisis that some processes work, and others do not. Leaders must meet immediate needs and make changes to the status quo that drives the best results. Kotter’s change management model is an 8-step method for implementing change that can significantly improve operational processes. This case study will demonstrate how change management theory can set the framework and guidelines for a response to a pandemic event and hardwire into a new approach for rapid recovery of operations; thus, creating a standard set of guidelines to meet the demands of future pandemic events, which can assist health system leadership in the future
Operationalizing Lewin’s 3-Step Change Model in the Outpatient Setting: A COVID-19 Case Study
Get PDFThe COVID-19 pandemic has disrupted the healthcare industry and forced organizations to fundamentally change their operations to ensure the highest level of safety for both patients and staff alike. The purpose of this study is to analyze the rapid response change process to COVID-19 in an outpatient setting and provide current and future healthcare leaders and organizations elements for consideration in redesigning healthcare delivery during a pandemic. Through a series of semi-structured interviews with Independent American Health Clinic employees, coupled with a thematic analysis, three main themes emerged the organization’s response: environment of care, healthcare operations, and organizational infrastructure. These themes were placed into a framework consisting of Lewin’s 3-Step Change model (unfreezing, moving, and refreezing) to retrospectively analyze an organization’s change efforts in response to COVID-19. The analysis highlighted a nine month period that started just prior to the pandemic declaration and aligned with the early trend of increasing cases and transmission levels. The analysis also outlined distinct challenges presented to the change efforts set by the existing culture of the organization. Additional information provided by participants during the interview process offered supplementary areas for discussion to include pandemic planning and training, the importance of staff resiliency, and the need to continuously monitor and improve business operations. The results showed that while there are many similarities to the conditions for which healthcare organizations needed to respond, the change efforts are unique to each organization
Using the SEIPS Framework to Understand Systems-Level Factors Affecting Obstetric Nurse Decision Making: A Convergent Parallel Mixed Methods Study
Get PDFThe United States has the worst maternal morbidity and mortality in the developed world, with a maternal death rate of 17.3/100,000 live births. Efforts to improve this have not been fruitful. This dissertation suggests that future research with a patient safety focus and human factors framework may improve our understanding of this multifactorial problem and identify new potential solutions for improving this devastating crisis. The first manuscript is a scoping review discussing the use of trigger tools to identify women in labor in need of care escalation. The second manuscript is a realist review describing current approaches to the problem of obstetric failure to rescue. The third manuscript details a convergent parallel mixed methods study looking at the systems-level factors affecting nurses who are caring for women in labor and makes recommendations for systems changes with the potential to improve outcomes
AGE:RAGE Signaling Pathway as a Target in Neuroendocrine Prostate Cancer
No full textProstate cancer, a disease of aging, is the second leading cause of male cancer deaths in the United States and is canonically controlled by androgen expression which is treated with androgen deprivation therapy (ADT) that suppress androgen production, androgen receptor function, or both. The androgen receptor (AR) plays a critical role in cancer development, progression, and therapy response. Recurring cancer cells undergo cellular reprogramming, adopting alternative mechanisms of survival, entering an androgen receptor-independent state, and are then subcategorized as Castration Resistant Prostate Cancers (CRPC). A process known as neuroendocrine differentiation, has been shown to be upregulated in response to ADT. Neuroendocrine prostate cancers (NEPC) experience a lineage conversion from adenocarcinoma to neuroendocrine lineages via genetic and/or epigenetic dysregulation. Patients diagnosed with NEPC have poor outcomes. Advanced Glycation End Products (AGEs) are reactive metabolites that are produced through the Maillard reaction and direct oxidation of biological macromolecules and are associated with chronic pathologies, including prostate cancer. They function in part through binding to the receptor for AGE, RAGE resulting in downstream signaling events. We have previously shown that mice fed a high AGE diet have accelerated tumor growth in vivo and can induce neuroendocrine differentiation in vitro. In this study, using mouse and human models of prostate cancer representing prostate adenocarcinoma and NEPC respectively. We examined the AGE:RAGE signaling pathway in response to AGE using pharmacological inhibitors of AGE (aminoguanidine) and RAGE (TTP488), as potential therapeutic approaches to inhibit and/or reverse NED. We found that in prostate adenocarcinoma cells, AGE-mediated increases in NED were mitigated by pharmacological inhibition of both AGE and RAGE. We found that in NEPC cells inhibition of AGE or RAGE decreased the expression of neuroendocrine markers ENO2 and MYC. However, only RAGE inhibition, not AGE inhibition, was able to mitigate AGE-mediated restoration of ENO2 and MYC in this model. These data implicate these pharmacological inhibitors may have therapeutic potential for rare and lethally aggressive NEPC
The Development of a Space-Time Mixture Model and a Bi-Level Feature Selection Model with Applications to Neurological Data
No full textThe observational study of subjects with neurological disease gives rise to complex data. This dissertation, consisting of three aims, concerns the development of statistical models to address these complex data. Aim one of this dissertation concerns the complex data scenario where we wish to model counts of multiple diseases over space and time that rep- resent progressive stages of neurodegeneration. Counts of multiple diseases over space and time are likely to be correlated. Therefore an appropriate model for these disease count data should account for this correlation. We thus propose a novel Bayesian space-time disease count model which can account for the correlation between multiple diseases. We demonstrate that this novel model provides superior prediction of counts of multiple diseases over space and time. Aim two of this dissertation concerns the complex data scenario where we wish to identify subject feature data that are associated with longitudinal outcome data of subject cognition. These longitudinal outcome data are irregularly-spaced over time, these feature data may be time-invariant, and these feature data may have group structure. Therefore an appropriate feature selection model should specify a covariance structure for these longitudinal outcome data which is a function of time separation, should specify time-varying feature parameters, and should account for group structure in these feature data. We thus propose a novel Bayesian feature selection model which can account for these complexities. We demonstrate that this novel model provides excellent feature selection performance as well as superior prediction of irregularly-spaced longitudinal outcome data. Novel statistical models are underused due in part to a lack of dissemination. Therefore, aim three of this dissertation concerns the development of an R software package that implements our Bayesian feature selection model from aim two. This software package promotes a rigorous and reproducible model-fitting workflow, facilitates the seamless summarization and visualization of clinically-relevant model results, and disseminates our feature selection model for use in the analysis of complex data e.g. stemming from the observational study of neurological disease
Evaluation of the Maxillary Skeletal Transverse Dimension in Untreated Orthodontic Patients
Get PDFIntroduction: Currently, there is no consensus in the orthodontic or OMFS literature regarding diagnosis of transverse dental arch discrepancies and to what extent discrepancies in underlying maxillary and mandibular transverse jaw dimensions are an etiology. In addition, there is an absence of discussion regarding possible differences in maxillary anterior versus posterior transverse jaw discrepancies. The purpose of this investigation was to: 1) evaluate a dental cast versus CBCT method for diagnosing skeletal transverse discrepancies, 2) assess whether dental cast or CBCT determined posterior transverse discrepancies differ from anterior transverse discrepancies, and 3) assess if any differences exist in skeletal transverse discrepancies between patients with Class I, II and III skeletal malocclusions. Methods: Retrospective data including intraoral scans of the maxillary and mandibular arches and CBCT scans were collected from 40 patients prior to orthodontic treatment. The sample was divided into CI (12 subjects), CII (18 subjects) and CIII (10 subjects) subgroups based on their skeletal anteroposterior diagnosis. Using maxillary and mandibular digital casts, dental arch widths were measured at the canines, first premolars and first molars and the measurements adjusted for optimal tooth inclinations. CBCT measurements were also made between the right and left first molars (M), first premolars (P) and canines (C) at the following vertical levels: 1) the estimated center of resistance of the tooth, 2) the root apices and 3) an estimated center of basal bone. Finally, a posteroanterior ephalogram was rendered from each subject’s CBCT scan and the distance between right and left Jugale was compared to the distance between right and left Antegonion. The differences between maxillary and mandibular measurements (Δ) on the digital models, CBCTs and PA cephalograms were compared. Results: For the digital cast analysis Δ at each location (canine, premolar and molar) was significantly different, however, the average Δ for each location was not significantly different between subgroups. For the CBCT analysis, there were significant differences between each location (p\u3c.0001) but no consistency between vertical points for each location. Additionally, the average Δ was significantly different between subgroups at each location, indicating no correlation. For the PA cephalogram analysis, no significant differences were found in the average skeletal widths or the average Δ between subgroups. We found no significant correlation between Δ at each location on the digital models and CBCTs. Conclusions: When maxillary skeletal transverse discrepancies are present, they often differ between the anterior and posterior. Transverse discrepancies were not significantly different between skeletal Class I, Class II and Class III subjects. No maxillary and mandibular skeletal landmarks were identified to assess transverse skeletal discrepancies. A dental cast analysis appears to be a more effective method for assessing transverse jaw discrepancies
Predicting HPV Vaccination Coverage Rates Using Indicators of Health Department Clinic Access: A Case Study with South Carolina and Georgia
Get PDFSince its introduction in 2006, the human papilloma virus (HPV) vaccine has made substantial developments. The use of the vaccine was expanded to include males. The completion dose series was decreased from three to two shots, if started before the age of 15. The cost of the vaccine is fully covered by private insurance and public programs for various ages ranging from 9 to 26 years old1. With these improvements the HPV vaccine has the capability to safely and significantly prevent and reduce many cancers that cause the deaths of women and men across the United 1,2. Therefore, the underuse of the HPV vaccine is a serious but correctable threat to progress against cancer3,4. During 2012-2016, an estimated average of 34,800 HPV-attributable cancers were diagnosed each year. Among these estimated cancers, 92% were attributable to the HPV types that are included in the 9-valent HPV vaccine and could have been prevented if HPV vaccine recommendations were followed5. However, HPV vaccination rates across the U.S. remain low6. Using public health data sources, choropleth maps, new variables of Health Department (HD) clinic access and prediction modeling, this research advanced the field of health services research by informing the third goal of the President’s Cancer Panel 2012-2013 report: maximize access to HPV vaccination3. The short-term impact of this research quantified and located HPV vaccination for adolescents, in addition to highlighting prognostic indicators of access and identifying barriers to HPV vaccination uptake among HD clinics at the county level in Georgia. The long-term impact of this research provided greater insight for targeting efforts to optimize HPV vaccine uptake at the county level in South Carolina and in other states with low HPV vaccination coverage. This research demonstrated the important use of small area estimation by public health professionals in states with low HPV vaccination coverage and limited or no immunization registry data for small geographic areas. This research provided valuable data toward the access of vaccination services and the dissemination and implementation of HPV vaccination interventions at the county level. Ultimately the findings from this study may be used to predict correlations to the incidence of HPV-associated cancers, which may help reduce public health costs, morbidity and mortality related to HPV infections in the United States
The Role of Technology in Health Professions Education During the COVID-19 Pandemic
No full textThe COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Prior to the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward
Exploring Health Care Students\u27 Perceptions about Race and Privilege: A Case Study of a Peer Education Program
No full textIntroduction. Amid the racial unrest stemming from the summer of 2020, many institutions are having difficult conversations about race and the impact of racism. Methods. Interdisciplinary health care students met once a month for one hour to discuss privilege, race/racism, leadership, and advocacy and their influence on health equity. Participants evaluated the program to share their perspectives on each topic. Conventional content analysis of the participants\u27 data revealed several themes concerning topics related to health inequities. Results. Four participants completed PEP, and three participants completed the program evaluation survey (75% response rate). Students described privilege in a positive context, using words like freedom, special right/advantage, and opportunity. Race was viewed as (1) a way to discriminate, (2) a man-made concept used to establish racial hierarchy, and (3) insignificant due to complexity of human beings. Program strengths included topics, guest speakers, and open dialogue. Recommended changes included allotting more time for dialogue and increasing the frequency of monthly meetings. Students described their experience in PEP as eye-opening and liberating . Conclusions. To be an influential and empathetic leader in health care, one must understand the impact that privilege and race/racism have on equitable health care. Further, effective leadership and advocacy can facilitate allyship with those whose voices are marginalized. Students in or entering health care professions can benefit from difficult peer discussions about race and privilegehttps://medica-musc.researchcommons.org/posters/1023/thumbnail.jp
The World is Changing and So Are the Boards
No full textLocal hospital and systems continue to merge. Over time, and as a result of mergers, the role of hospital boards have changed resulting in 2-boards with split in governance responsibilities between the not for profit local and the system boards. We explore answers to three questions to provide insight for local boards and systems boards prior to merger: 1) when there is a merger, how do culture, values and community need impact board decision making; 2) which board roles and responsibilities should be addressed first, and 3) do culture and roles differ for system and legacy boards