Jefferson Digital Commons quarterly report: April-June 2019

This quarterly report includes: Articles CREATE Day Presentations Dissertations From the Archives Grand Rounds and Lectures House Staff Quality Improvement and Patient Safety Posters JCIPE Student Hotspotting Posters Journals and Newsletters MPH Capstone Presentations Posters Sigma Xi Research Day What People are Saying About the Jefferson Digital Common

Achieving Green and Healthy Homes and Communities in America

In the Fall of 2010, the National Coalition to End Childhood Lead Poisioning contracted with the National Academy to develop and execute an online dialogue that would examine ways to increase the health, safety, and energy efficiency of low- to moderate-income homes. Since 1999, the National Coalition had worked to improve low- to moderate-income housing through the support and execution of home interventions that addressed multiple issues within a home at one time; an approach that often did not align with other traditional, single-issue housing assistance programs. By 2010, the National Coalition had taken on the leadership of the Green and Healthy Homes Initiative, a public-private partnership focused on integrating funding streams to improve low- to middle-income homes across the country.With plans to expand the GHHI's operations, the National Coalition partnered with the National Academy to conduct the National Dialogue on Green and Healthy Homes, a collaborative online dailogue in which participants were asked to identify challenges to, and innovative practices for, improving the health, safety and energy-efficiency of low- to moderate- income homes. The Dialogue was live from November 4-November 22, 2010, and collected 100 hundred ideas and 362 comments from 320 registered users. Over the course of its two and a half week duration, the Dialogue received more than 2,500 visits from over 1,100 people in 48 states and territories. Key FindingsBy reviewing the feedback received in the Dialogue, the Panel was able to make a number of recommendations on how the green and healthy homes community of practice could increase the health, safety and energy efficiency of homes across the country. These recommendations included: Conduct an evaluation of current housing standards to determine if they meet the Nation's health, safety, and energy efficiency needs; Develop a tiered performance standard for healthy, safe and energy efficient homes; Group government funding streams to better align programs with the comprehensive intervention approach; Develop a long-term funding strategy to support efforts after Recovery Act funding ends; and Educate government decisionmakers and the public on the importance of developing green and healthy homes and communities, and the work that supports that development

The Impact of Discharge Teaching on COPD Readmissions

The purpose of this evidenced-based project was to answer the question: Does using a formalized discharge list identifying key educational topics regarding the patient’s disease process decrease readmission risk for COPD patients? This study used all COPD patients admitted over a two-week period who consented to receiving one-on-one detailed COPD education (n=33). Participants were provided education utilizing a COPD educational tool that addressed topics pertaining to the transition from the hospital back home, inhaler techniques and use, common questions to ask the provider before being discharged, smoking cessation, and identifying the warning signs of an exacerbation were among the few topics covered. One-on-one educational sessions were scheduled at minimum for one hour and available seven days a week. Post-implementation of the evidenced-based project, a simple regression analysis was completed to test the variables of length of stay, age, sex, race, smoking status, and payor source. Based on these statistics, length of stay was the only significant variable. Seven patients who participated in this project were readmitted to the hospital. Readmissions were more common among former smokers and males. In conclusion, utilizing a COPD education tool to provide education had little impact on readmissions alone

Impact of Analytics Applying Artificial Intelligence and Machine Learning on Enhancing Intensive Care Unit: A Narrative Review

Introduction. The intensive care unit (ICU) plays a pivotal role in providing specialized care to patients with severe illnesses or injuries. As a critical aspect of healthcare, ICU admissions demand immediate attention and skilled care from healthcare professionals. However, the intricacies involved in this process necessitate analytical solutions to ensure effective management and optimal patient outcomes. Aim. The aim of this review was to highlight the enhancement of the ICUs through the application of analytics, artificial intelligence, and machine learning. Methods. The review approach was carried out through databases such as MEDLINE, Embase, Web of Science, Scopus, Taylor & Francis, Sage, ProQuest, Science Direct, CINAHL, and Google Scholar. These databases were chosen due to their potential to offer pertinent and comprehensive coverage of the topic while reducing the likelihood of overlooking certain publications. The studies for this review involved the period from 2016 to 2023. Results. Artificial intelligence and machine learning have been instrumental in benchmarking and identifying effective practices to enhance ICU care. These advanced technologies have demonstrated significant improvements in various aspects. Conclusions. Artificial intelligence, machine learning, and data analysis techniques significantly improved critical care, patient outcomes, and healthcare delivery

Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic.

BackgroundThe response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution.ConclusionThe widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease

Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients.

BackgroundLittle is known about the relative efficacy of open (OGR) vs endoscopic (EGR) gluteal tendon repair of gluteal tendon tears in minimizing pain and restoring function. Our aim is to compare these 2 surgical techniques and quantify their impact on clinical outcomes.MethodsAll patients undergoing gluteal tendon tear repair at our institution between 2015 and 2018 were retrospectively reviewed. Pain scores, limp, hip abduction strength, and the use of analgesics were recorded preoperatively and at last follow-up. The Hip disability and Osteoarthritis Outcome Score Junior and Harris Hip Score Section1 were obtained at last follow-up. Fatty degeneration was quantified using the Goutallier-Fuchs Classification (GFC). Statistical analysis was conducted using one-way analysis of variance and t-tests.ResultsForty-five patients (mean age 66, 87% females) met inclusion criteria. Average follow-up was 20.3 months. None of the 10 patients (22%) undergoing EGR had prior surgery. Of 35 patients (78%) undergoing OGR, 12 (27%) had prior hip replacement (75% via lateral approach). The OGRs had more patients with GFC ≥2 (50% vs 11%, P = .02) and used more anchors (P = .03). Both groups showed statistical improvement (P ≤ .01) for all outcomes measured. GFC >2 was independently associated with a worst limp and Harris Hip Score Section 1 score (P = .05). EGR had a statistically higher opioid use reduction (P < .05) than OGR. Other comparisons between EGR and OGR did not reach statistical significance.ConclusionIn this series, open vs endoscopic operative approach did not impact clinical outcomes. More complex tears were treated open and with more anchors. Fatty degeneration adversely impacted outcomes. Although further evaluation of the efficacy of EGR in complex tears is indicated, both approaches can be used successfully

Using visual analytics to develop situation awareness in astrophysics

We present a novel collaborative visual analytics application for cognitively overloaded users in the astrophysics domain. The system was developed for scientists who need to analyze heterogeneous, complex data under time pressure, and make predictions and time-critical decisions rapidly and correctly under a constant influx of changing data. The Sunfall Data Taking system utilizes several novel visualization and analysis techniques to enable a team of geographically distributed domain specialists to effectively and remotely maneuver a custom-built instrument under challenging operational conditions. Sunfall Data Taking has been in production use for 2 years by a major international astrophysics collaboration (the largest data volume supernova search currently in operation), and has substantially improved the operational efficiency of its users. We describe the system design process by an interdisciplinary team, the system architecture and the results of an informal usability evaluation of the production system by domain experts in the context of Endsley's three levels of situation awareness

Utilizing artificial intelligence in perioperative patient flow:systematic literature review

Abstract. The purpose of this thesis was to map the existing landscape of artificial intelligence (AI) applications used in secondary healthcare, with a focus on perioperative care. The goal was to find out what systems have been developed, and how capable they are at controlling perioperative patient flow. The review was guided by the following research question: How is AI currently utilized in patient flow management in the context of perioperative care? This systematic literature review examined the current evidence regarding the use of AI in perioperative patient flow. A comprehensive search was conducted in four databases, resulting in 33 articles meeting the inclusion criteria. Findings demonstrated that AI technologies, such as machine learning (ML) algorithms and predictive analytics tools, have shown somewhat promising outcomes in optimizing perioperative patient flow. Specifically, AI systems have proven effective in predicting surgical case durations, assessing risks, planning treatments, supporting diagnosis, improving bed utilization, reducing cancellations and delays, and enhancing communication and collaboration among healthcare providers. However, several challenges were identified, including the need for accurate and reliable data sources, ethical considerations, and the potential for biased algorithms. Further research is needed to validate and optimize the application of AI in perioperative patient flow. The contribution of this thesis is summarizing the current state of the characteristics of AI application in perioperative patient flow. This systematic literature review provides information about the features of perioperative patient flow and the clinical tasks of AI applications previously identified

The Impact of a Revised Discharge Process from Acute Care to Home Care on Hospital Utilization in Children with Single Ventricle Heart Disease

Problem Description: It is estimated that approximately ~0.5%, or ~400,000, of all U.S. children, are identified as having complex chronic conditions (CCC) and account for as much as one-third, or ~$100 billion, of health care spending for all children. The goal of this quality improvement (QI) project was to identify the impact of a revised discharge process for children with Single Ventricle Heart Disease (SVHD) on hospital utilization rates and the parent’s perception of discharge readiness during the interstage period. The QI project was conducted in a 44-bed cardiac care unit within a 336-bed freestanding pediatric, academic medical center in a large urban area. The participants of the project are the parents or guardians of the children with SVHD, not the children themselves. Interventions: The outputs of the QI project included the development of a discharge bundle, which consisted of four specific aspects; 1. Assignment of a specific outpatient nurse coordinator; 2. Revised discharge education; 3. Utilization of remote home monitoring; and 4. Completion of a telemedicine encounter within 48 hours of discharge. Data reports were developed to measure hospital utilization rates and parent’s perception of discharge readiness was measured utilizing two validated surveys, the Quality of Discharge Teaching Scale and the Patient Readiness for Hospital Discharge Study. Results: This QI project was well received by all members of the clinical team as well as the parents. A total of five patients were enrolled with 100$140,050 down from $164,088 in the pre-bundle discharge group, a decrease of 15%. There was no statistical difference in parent’s perception of discharge readiness, however, subjective data gathered from families was extremely positive. Interpretation: Implementing new IT solutions at any organization is often time-consuming and challenging; this was no different for this QI project. Although the implementation of the home monitoring portion of this project took longer than expected, the outcome was a comprehensive, well-configured system that has provided a framework by which LCH could follow when future initiatives are identified Conclusion: This project demonstrated the benefits and considerations that exist when implementing a revised discharge process for SVHD patients during the interstage period. Benefits came in the form of the telemedicine encounter and the ability of the nurse coordinator to address and visualize concerns related to feeding, breathing, and socialization. The acceptance of this QI project by all members of the clinical team and families suggest the need for a longitudinal review of the impact of this initiative