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Optimizing Healthcare Efficiency: A Comprehensive Approach to Enhancing Clinical and Administrative Operations
No full textImprovement of organizational efficiency in healthcare is paramount to providing patient- centered care. In the current healthcare landscape, the imperative to enhance operational efficiency has become increasingly pronounced amidst growing complexities and demands. Removing inefficiencies and waste is paramount to ensuring optimal resource utilization and delivering high- quality, cost-effective care to patients. In January of 2023, I joined the UPMC Department of Medicine and have since participated in three important projects that were significant in addressing these inefficiencies. The projects involve creating organizational charts for hospital-based clinics (HBCs) and non-HBCs, carrying out the Pitt Operations Survey, and implementing workflow analysis. This study illustrates through these initiatives how effective it is to use tools like organizational charts, workflows, and surveys to improve organizational efficiency in healthcare settings. The results highlight the importance of using technology and data-driven strategies in today's changing healthcare environment to solve operational issues and enhance patient care outcomes
The relationship of brain derived neurotrophic factor gene methylation and the pain phenotype in women undergoing aromatase inhibitor therapy for breast cancer treatment
No full textIntroduction: The oncologic community’s understanding of pain and cancer treatment is far from reaching definitive answers and correlations that can allow advancements in these treatments and adjuvant therapies. This study’s purpose is to investigate genetic variation and methylation of the BDNF gene and associated pain with Aromatase Inhibitor (AI) therapy treatment for breast cancer and reduction of pain through aerobic exercise.
Methods: This study was a cross-sectional candidate gene association analysis secondary to the EPICC study, a randomized controlled trial examining the effects of aerobic exercise on cognitive function in women diagnosed with breast cancer who will undergo AI therapy. This study's genetic analysis examined the methylation and genetic variability of the BDNF gene, and pain. Pain scores were observed at enrollment, time point 1 (TP1) and time point 2 (TP2), 6 months after usual care or the structured aerobic exercise intervention. The genotyping for rs6265 was analyzed using an Applied Biosystems ™ QuantStudio™ 3 Real-Time PCR System. DNA methylation data for the BDNF gene was taken from the whole genome DNA methylation data collected using the Illumina Infinium Methylation EPIC Beadchip from the two-time points. The pain scores were assessed at the two time points using the Brief Pain Inventory (BPI) and worst pain scores were used for final analysis.
Results: The sample (n=116) consisted of post-menopausal women with an average age of 62 years old. The genotype analyses found a greater percent decrease in reported pain levels in those in the intervention group than those in usual care, with a larger decrease in pain scores found in the homozygous wild type allele (CC) than those who belong to the heterozygous (CT) and homozygous variant (TT). The methylation analysis supports the relationship between increasing BDNF methylation and decrease in pain scores.
Discussion: This study found that rs6265 CC homozygotes, which corresponds to being a Val/Val homozygote, as well as increasing methylation, were associated with decreased pain in postmenopausal women with early-stage breast cancer, particularly in those randomized to the exercise intervention. These findings are consistent with the literature for non-cancer patients.
Conclusion: Our hypothesis was supported as this study supports a role for the BDNF gene in pain in postmenopausal women with early-stage breast cancer
A Prospective Study Assessing Cancer Patients’ Perceptions Regarding the Value of Cancer Genetic Counseling
No full textHereditary Breast and Ovarian Cancer syndrome (HBOC) is a genetic condition that increases the risk for breast, ovarian, and other cancers. Due to the hereditary nature of this condition, genetic services are offered to patients with these types of cancer to help identify if a hereditary component exists. Several studies have previously investigated the attitudes of patients diagnosed with cancer towards genetic counseling and testing; however, recently diagnosed cancer patients have not received similar attention and their perspective towards the value of genetic testing has not been well studied. To fill this gap, this study was designed to further explore the perspective of patients recently diagnosed with breast or ovarian cancer, mainly at the UPMC Magee Women’s Hospital, regarding the value of genetic counseling and to assess their satisfaction levels with the services they received. An initial and a follow-up survey were administered to assess patients’ perspectives and experiences with these services after the initial visit and four weeks later to determine if patients saw these services as valuable and satisfactory. Patients were highly satisfied with the genetic counseling services and indicated that it was beneficial and helpful. Patients also saw the genetic counselor as an advocate, support system, and information provider that helped them make medical decisions, including genetic testing. The results of the study are important in that it promotes programs that offer genetic counseling services to conduct internal assessments to gain insight into their patients’ levels of satisfaction with the services they are receiving. By actively seeking patients’ feedback and addressing concerns, programs can adapt and enhance their services to better cater to the needs and interests of their patients, thus improving public health
Understanding the Role of the Focused Assessment with Sonography for Trauma in Preventing Maternal Morbidity and Mortality due to Postpartum Hemorrhage
No full textObjective: Decreased time to intervention in postpartum hemorrhage (PPH) improves maternal outcomes. Strategies to achieve timely intervention is of great public health importance as maternal mortality rates from PPH in the United States are rising. We sought to identify if using Focused Assessment with Sonography for Trauma (FAST) exams during evaluation of PPH following cesarean delivery affects time to interventions.
Study Design: This is a retrospective cohort study of women who underwent a cesarean delivery that was complicated by PPH. Demographic and outcome data were compared between those who received a FAST exam after delivery and those who did not receive a FAST exam as part of their evaluation. The primary outcome was the time to a composite of interventions (admission to the intensive care unit, reoperation, or interventional radiology procedure within 48 hours of delivery) analyzed using Survival Models adjusted for propensity score weights. Secondary outcomes included hysterectomy, length of hospital stay (LOS) and transfusion morbidity.
Results: A total of 1,128 women with PPH following cesarean delivery were included in this analysis. 113 (10.0%) women had a FAST exam as part of their evaluation. Demographic variables were balanced between groups; with the exception of estimated blood loss (p <.0001) and etiology for PPH (p <.0001). Mean time to intervention was 8 hours shorter in the FAST exam group compared to usual care (39.2 hours after delivery versus 47.2 hours after delivery, respectively, p < 0.0001)). After propensity score weighting, the FAST exam group still received interventions 3.8 hours faster than the usual care group (FAST exam: 43.4 hours, versus Usual care: 47.2 hours, p = .026). There was no difference in rate of hysterectomy (FAST 2% vs. usual care 1%, p=1.0). LOS was 1.4 days longer in the FAST group (p < .0001). While transfusion rates were also higher in the FAST exam group (FAST exam: 73% vs. usual care 23%, p <.0001), patients in the FAST group received fewer units of packed red blood cells (p <.0001).
Conclusion: FAST exams may lead to more timely interventions in PPH. Prospective studies are warranted to validate these findings
Automated Grading Using Generative AI
No full textRecent innovations in AI have enabled a wide array of new applications to improve human
lives and productivity. These innovations enable the automation of mundane, and repetitive
tasks to an extent never before seen. In this work we leverage this technology to create a
system which can automate the time-consuming task of grading student homework submis-
sions, while also maintaining a level of quality that students expect. To aid instruction, the
system also provides a summary of common mistakes made by students and for students it
provides individualized written feedback intended to improve learning outcomes, all while
reducing the grading workload for instructors.
In addition to developing the system, we used real student data to evaluate the efficacy
and acceptance of the system. This began with using the system to grade student sub-
missions from archived semesters, and comparing the grades assigned by the TA and our
system. Next we had students in current courses engage with the system with their current
assignments. Students were provided with written feedback shortly after submitting their
homework assignment, and asked to rate how useful they found the feedback. This feedback
was chosen randomly from either the TA or the automatic grading system. Our results
show that the system is capable of automatically grading student submissions with a quality
comparable to a human grader, and provides feedback that students found helpful.
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Evidence-Based Strategies to Increase Racial and Ethnic Diversity in Clinical Trials of Alzheimer’s Disease & Related Dementias (ADRD)
No full textPublic Health Significance: Given the rapidly aging and diversifying U.S. population, prevalence of Alzheimer’s disease and related dementias (ADRD) is projected to increase substantially in the coming decades. This demographic shift, coupled with persistent inequities in resource access and ongoing structural racism, is likely to exacerbate existing health disparities in ADRD burden for communities of color unless substantive systemic changes are implemented.
Background & Objectives: Despite the disproportionate impact on racial and ethnic minorities, these groups remain consistently underrepresented in ADRD research trials. Addressing this gap requires evidence-based recruitment strategies to enhance research participation among these populations. The overall goal of this essay was to identify such strategies; first through a review of the existing literature, and second in a secondary analysis of recruitment data from an ongoing ADRD trial.
Methods: A comprehensive literature review explored research participation prevalence among racial and ethnic minorities, factors influencing participation, and effective recruitment strategies or interventions. The secondary analysis examined recruitment data from an ongoing ADRD trial for older Black adults to evaluate the efficacy of various recruitment approaches.
Results: Results from the critical literature synthesis found several effective recruitment strategies including community-oriented outreach, diverse research team composition, word-of- mouth referrals, and monetary compensation. Results from the secondary data analysis corroborated community outreach as an effective method for recruiting and retaining Black/African American older adults, while also highlighting the considerable financial investments required for such activities.
Implications: Future ADRD research trials should carefully select recruitment strategies based on study objectives and resource constraints. Prioritizing community outreach for participant recruitment is essential, while also balancing cost-effective alternatives such as traditional advertising. Overall, this essay found that recruitment science, in the context of ADRD research, is still in its early stages. Further research, in addition to meaningful engagement with community stakeholders, remains imperative to determine the most effective recruitment strategies. Institutional-level policies and initiatives play a pivotal role in disseminating valuable resources to researchers and monitoring clinical trial diversity over time
Further Investigation of the First-Tier Status of Fragile X Testing for Pediatric Neurodevelopmental Disorders: Diagnostic Yield and a Comprehensive Chart Review
No full textBackground and Objective. Fragile X Syndrome (FXS) is a neurodevelopmental disorder (NDD) characterized by intellectual disability, certain physical features, and family history of NDDs. Current American College of Medical Genetics and American Academy of Pediatrics guidelines recommend first-tier FXS genetic testing for pediatric patients with NDDs. Prior research suggests FXS testing is better suited as a second-tier test due low diagnostic yield, or offered in cases where a patient’s clinical picture and family history are suggestive of FXS. The purpose of this study is to determine which patient characteristics are indicators of a FXS diagnosis in order to inform ordering practices and create a more personalized approach to testing.
Methods. Diagnostic yield was calculated for 1835 pediatric patients (0-21 years) at UPMC Children’s Hospital of Pittsburgh from 2018 to 2023. Based on power analysis, retrospective chart review of all full mutation, premutation, and gray zone results and a randomized selection of 300 negative results was performed. Information related to clinical diagnosis, family history, noted physical features, and previous genetic testing was collected. Fisher’s exact test was used to determine statistical associations between these characteristics and a positive test result.
Results. There were 10 total full mutation individuals (7 males, 3 females) and one full mutation mosaic male, resulting in a diagnostic yield of 0.6%. Among individuals with a NDD, the only physical features associated with a positive result were typical facies and recurrent otitis media. Both a family history of maternal NDDs and an abnormal FXS test result in up to a third degree relative were associated with a positive test result.
Conclusions. Diagnostic yield of FXS testing was low and consistent with reported literature. Results of this study suggest that a patient should have multiple features suggestive of FXS, including a NDD, physical features, or family history, for FXS testing to be ordered first-tier. Future guidelines for FXS testing should consider the financial cost of testing and the availability of other, more comprehensive genetic tests. From a public health perspective, guideline modifications will result in cost savings and reduce unnecessary testing, benefiting the patient, healthcare institution, and insurance payor
Perspectives of People with Cystic Fibrosis Considering Parenthood Surrounding Prenatal and Preconception Genetic Counseling and Testing
No full textPeople with Cystic fibrosis (pwCF) are living longer and increasingly considering their reproductive options. Currently there are many genetic testing options available for pwCF and their reproductive partners. Genetic counselors can help educate pwCF about these options and support them through the decision-making process. This study explored the role of genetics in the reproductive decisions of pwCF and their perspectives surrounding prenatal genetic counseling and testing. We conducted and recorded semi-structured telephone interviews with a national sample of pwCF age 18 years or older recruited from the CF Foundation Community Voice platform. We utilized Dedoose software and applied inductive thematic analysis to code the interview transcripts and elicit themes. We interviewed a total of 21 participants (age range 18-74 years, 76% women, 95% White, 5% Hispanic). 57% are parents and 33% are considering parenthood. Key themes included: (1) PwCF understood the genetics of CF (2) PwCF have differing views on the concern of passing CF onto biological children (3) The influence of carrier testing on biological parenthood decision making; (4) Participants were aware of the role of genetic counselors and valued gaining knowledge about CF genetics and feeling prepared for potential children with CF, but only half previously met with a genetic counselor; and (5) PwCF believe genetics information (including recessive inheritance, personal mutations, and modulator eligibility) should be presented during childhood/adolescence and reinforced when interested in family planning. PwCF expressed a broad range of views on the role of genetics in their
reproductive decisions. Although there is recognition of the role of genetic counseling and desire for knowledge from genetic testing, such services are underutilized. Our findings highlight the importance of a personalized, client-centered approach to offering genetic testing and providing genetic counseling services to pwCF. This research benefits public health by investigating the views of pwCF on how to better provide genetic counseling and testing services to pwCF. Future work should develop patient-, provider-, or systems-based interventions to best integrate high-quality genetics and genetic counseling care into the CF team for all pwCF
RNA SEQUENCING ANALYSIS TO DISCOVER DIFFERENTIALLY EXPRESSED OPEN READING FRAMES IN MULTICELLULAR VS UNICELLULAR S. CEREVISIAE
No full textMulticellular yeast biofilms can pose a risk to patients when formed on implanted medical devices or when presented as skin infections in immunosuppressed patients. Because the Saccharomyces cerevisiae species of yeast can exist in a multicellular or unicellular form, it is ideal for studying the genetic differences between the two phenotypes. Insights about the genetic mechanisms behind the multicellular phenotype in yeast can aid in combatting multicellular yeast infections and improving public health. To explore the open reading frame (ORF) expression differences between multicellular and unicellular strains of S. cerevisiae, I conducted a differential expression analysis with RNA sequencing data of the strains using DESeq2 and annotated the up- and down-regulated ORFs to known genes where possible. I identified 798 differentially expressed ORFs and investigated the functions of 14 with the greatest differentiation that had known functions. To gain insight into involved biological processes, I identified the most prominent Gene Ontology terms enriched with differentially expressed genes in the multicellular vs the unicellular strains. In the multicellular strain, I found enriched biological processes including reproduction, sporulation, and meiosis. Genes most up-regulated in the multicellular strain encoded proteins involved in chromosome synapsis, recombination, and the MAPK pathway. Biological processes enriched in the unicellular yeast included protein folding, response to heat, and transmembrane transport of sugars and carbohydrates. Genes that were down-regulated in the multicellular strain when compared to the unicellular included a glucose transporter and an RNA stabilizer that can affect gene expression. With improved annotation of novel ORFs and further exploration of the differentially expressed genes and significant biological pathways enriched for the differential expression between the two phenotypes, researchers may be able to target factors that pro-mote multicellular yeast biofilm development. Therapies that inhibit the formation of the multi-cellular phenotype could mitigate infections in the skin or on implants
Improving Quality of Care Through Investments in Employee Education & Development
No full textWith the expansive increase in staffing challenges at hospitals across the country, investment in the employees of the hospital is critical. Surgical services generate one of the highest streams of revenue for a hospital and provide invaluable care; thus, it is important to ensure that their operations are running at the highest efficiency possible. The staff who run the operating rooms (OR) are the engine that drives the entire hospital. Their efforts, whether they are a nurse, surgical technician (ST), certified registered nurse anesthetist (CRNA), or sterile processing department tech (SPD tech) cannot be forgotten. The OR can operate efficiently only when these departments are working well together. This paper examines how investments into the training of SPD and Surgical technicians helped improve performance in the OR and SPD allowing higher quality of care to be provided for patients in the surgical services department of UPMC Presbyterian