Inappropriate electrolyte repletion for patients undergoing endoscopic procedures

At Thomas Jefferson University Hospital (TJUH), there has been a perceived necessity among housestaff and fellows to routinely check and replete serum potassium and magnesium for inpatients prior to endoscopic procedures In addition, there was an unwritten policy that these electrolytes needed to be aggressively repleted, with a goal potassium above 4.0 and magnesium above 2.0 Contributing factors include absence of clear policy, fear of adverse outcomes during procedures, and fear of delay of procedures leading to increased hospital stay This practice has led to unwarranted lab draws, costs of lab tests and electrolyte riders, and possible delayed procedures Goals Clarify policies regarding electrolyte repletion Determine frequency of inappropriate electrolyte checking and repletion Determine monetary cost of this action Decrease frequency of inappropriate electrolyte lab check and repletionhttps://jdc.jefferson.edu/patientsafetyposters/1023/thumbnail.jp

Sources of Measurement Error in an ECG Examination: Implications for Performance-Based Assessments

Objective: To assess the sources of measurement error in an electrocardiogram (ECG) interpretation examination given in a third-year internal medicine clerkship. Design: Three successive generalizability studies were conducted. 1) Multiple faculty rated student responses to a previously administered exam. 2) The rating criteria were revised and study 1 was repeated. 3) The examination was converted into an extended matching format including multiple cases with the same underlying cardiac problem. Results: The discrepancies among raters (main effects and interactions) were dwarfed by the error associated with case specificity. The largest source of the differences among raters was in rating student errors of commission rather than student errors of omission. Revisions in the rating criteria may have helped increase inter-rater reliability slightly however, due to case specificity, it had little impact on the overall reliability of the exam. The third study indicated the majority of the variability in student performance across cases was in performance across cases within the same type of cardiac problem rather than between different types of cardiac problems. Conclusions: Case specificity was the overwhelming source of measurement error. The variation among cases came mainly from discrepancies in performance between examples of the same cardiac problem rather than from differences in performance across different types of cardiac problems. This suggests it is necessary to include a large number of cases even if the goal is to assess performance on only a few types of cardiac problems

Fitting the Means to the Ends: One School’s Experience with Quantitative and Qualitative Methods in Curriculum Evaluation During Curriculum Change

Curriculum evaluation plays an important role in substantive curriculum change. The experience of the University of Texas Medical Branch (UTMB) with evaluation processes developed for the new Integrated Medical Curriculum (IMC) illustrates how evaluation methods may be chosen to match the goals of the curriculum evaluation process. Quantitative data such as ratings of courses or scores on external exams are useful for comparing courses or assessing whether standards have been met. Qualitative data such as students’ comments about aspects of courses are useful for eliciting explanations of observed phenomena and describing relationships between curriculum features and outcomes. The curriculum evaluation process designed for the IMC used both types of evaluation methods in a complementary fashion. Quantitative and qualitative methods have been used for formative evaluation of the new IMC courses. They are now being incorporated into processes to judge the IMC against its goals and objectives

How Perioperative Clinics at Duke University Can be Utilized to Narrow the Gap of Health Disparities in African American Populations: A Narrative Review

An issue often explored in today’s social climate is racial inequalities in our healthcare system and the strong negative outcomes it has on minority patient populations. This is a result of a combination of social factors not limited to, healthcare resources available to these patients, implicit bias by providers, discrimination of patient population, and a system of healthcare perpetuating continued injustices. Research has shown the operating room is no exception, but recent advances in perioperative medicine may be a key to eliminating barriers to equitable healthcare for patients of color. The purpose of this narrative review is to bring awareness to the utility of using perioperative clinics to bring equitable health care to patients of color who are historically at an increased risk of post-operative complications. Innovation of these multidisciplinary clinics is not only a huge stepping-stone in the field of anesthesia, but also an avenue to narrow the gap in health disparities amongst patients of color. Perioperative clinics utilize objective data to assess a patient’s readiness for surgery and minimize physician bias while boosting access to healthcare for disadvantaged patient populations

Separating Oil-Water Nanoemulsions using Flux-Enhanced Hierarchical Membranes

Membranes that separate oil-water mixtures based on contrasting wetting properties have recently received significant attention. Separation of nanoemulsions, i.e. oil-water mixtures containing sub-micron droplets, still remains a key challenge. Tradeoffs between geometric constraints, high breakthrough pressure for selectivity, high flux, and mechanical durability make it challenging to design effective membranes. In this paper, we fabricate a hierarchical membrane by the phase inversion process that consists of a nanoporous separation skin layer supported by an integrated microporous layer. We demonstrate the separation of water-in-oil emulsions well below 1 μm in size. In addition, we tune the parameters of the hierarchical membrane fabrication to control the skin layer thickness and increase the total flux by a factor of four. These simple yet robust hierarchical membranes with engineered wetting characteristics show promise for large-scale, efficient separation systems.MIT Energy InitiativeShell Oil CompanyMIT Energy Initiative (Fellowship

Factors Associated with Access to Immunotherapy and Its Impact on Survival in Mucosal Melanoma

Mucosal melanoma is rare, comprising only 1.4% of all melanomas in the United States. Yet it is associated with a worse prognosis compared to cutaneous melanoma due to aggressive biology and advanced stage at diagnosis with a reported 5-year survival rate of less than 30%. Although there are no established guidelines for the treatment of mucosal melanoma, immunotherapy has been increasingly used for the management of advanced mucosal melanoma

Design thinking for community-provider collaboration: Designing a culture- and user-friendly refugee wellness center

Background: Designing South Philadelphia’s first permanent healthcare facility dedicated to refugee health presents a unique opportunity to integrate cultural sensitivity with principles of community health. Design thinking (human-centered design) is a promising strategy to address health and social justice concerns through the development of innovative products and services that prioritize population needs. This project utilized design thinking to inform suggestions to the design of Hansjörg Wyss Wellness Center that promote a culturally sensitive and welcoming environment in order to improve healthcare outcomes for the refugee population in Philadelphia. Methods: Standard qualitative data gathering methods were used to gather insight into the needs of the South Philadelphia refugee population. Seven focus groups were conducted with patient populations (7 ethnic groups) and community partners. Data were coded independently by four members of the research team, organized into themes, and presented to stakeholders. Stakeholders (physicians, architects, designers, and community representatives) participated in a “Design Sprint” which utilized design thinking exercises to ideate and rapidly prototype solutions to common barriers refugees face to health and wellness. Results: Common barriers to access to healthcare reported in the focus groups include: lack of adequate language interpretation (navigating appointments and understanding medical terminology), long wait times, and transportation. Incorporation of health education resources, space for community events, mental health care, and space/activities for children were commonly suggested priorities for services in the wellness center. Design sessions produced prototypes acceptable to community and staff and informed the architects who have iterated and finalized the blueprint for the wellness center. Conclusions: Engaging end-users and stakeholders through design thinking is an effective strategy to gather community insight, achieve cultural sensitivity, and to promote health equity for underserved patient populations. The current project was limited by lack of measurable outcomes of patient satisfaction, as the center is still under development

Applying design thinking for community-provider collaboration: Designing a culture- and user-friendly refugee wellness center

Background: Designing South Philadelphia’s first permanent healthcare facility dedicated to immigrant and refugee health presents a unique opportunity to integrate cultural sensitivity with principles of community health. Philadelphia is a city saturated with many medical institutions and hospitals, yet there are large health disparities within miles of each other. Bringing together healthcare providers with a common goal of improving community health needs from a cultural standpoint can be tasking, even when all are on the same page. Design thinking is an underexplored perspective that has the potential to address these concerns in an efficient way that improves both provider and patient satisfaction. Objective: Using Design thinking to transform the Hansjorg- Wyss wellness center into a culturally diverse and welcoming environment for patients will ultimately improve healthcare outcomes for the immigrant population in Philadelphia. Methods: Seven focus groups were conducted to gather insight and feedback from patient populations, community partners, architects, and healthcare providers. We conducted a healthcare “design sprint,” with the various stakeholders involved to implement design thinking to ideate solutions for the new wellness center Results: Common barriers to access to healthcare reported in the focus groups include: lack of adequate language interpretation, long wait times, and transportation issues. Common findings among the different focus groups were a desire for services such as health education, spaces for community events, mental health services, and activities for children. Design sessions produced prototypes acceptable to community and staff and suitable for use by architects. Conclusions: Design thinking is a useful tool to merge community interests with healthcare delivery when building a culturally sensitive wellness center