Scapulothoracic Stabilization to Reduce Cervical Pain and Headaches: A Case Report

The purpose of this case report was to describe the outcomes of a scapular stabilization program in an adult female with cervical neck pain and headaches.https://soar.usa.edu/flsasummer2018/1007/thumbnail.jp

Interdisciplinary Health Care Evaluation Instruments: A Review of Psychometric Evidence.

Teamwork among health care professionals has been found to improve patient outcomes and reduce burnout. Surveys from individual team members are often used to measure the effectiveness of teamwork performance, as they provide an efficient way to capture various constructs of teamwork. This allows evaluators to better understand team functioning, areas of strength, and to identify potential areas for improvement. However, the majority of published surveys are yet to be validated. We conducted a review of psychometric evidence to identify instruments frequently used in practice and identified in the literature. The databases searched included MEDLINE, EMBASE, CINAHL, and PsycINFO. After excluding duplicates and irrelevant articles, 15 articles met the inclusion criteria for full assessment. Seven surveys were validated and most frequently identified in the literature. This review aims to facilitate the selection of instruments that are most appropriate for research and clinical practice. More research is required to develop surveys that better reflect the current reality of teamwork in our evolving health system, including a greater consideration for patient as team members. Additionally, more research is needed to encompass an increasing development of team assessment tools

Lessons learned from inadequate implementation planning of team-based chronic disease management: implementation evaluation.

BACKGROUND: This study was a retrospective evaluation of an unsuccessfully implemented team-based, chronic disease management program, with an aim to understand more about implementation barriers. The program, the Chronic Disease Management Initiative (CDMI) was a new collaborative model of care for patients with COPD. It utilized customized health information and interactive tools, mainly smartphones, for ongoing disease management. The program\u27s goal was to demonstrate that integrated team-based models of care could improve patient care, as well as reduce readmission rates and emergency department visits. The program planning for CDMI began in 2017, followed by the implementation and evaluation period in 2018. After a 10-month implementation period, the program was unable to enroll a sufficient number of patients to examine if there was an improvement in patient outcomes. METHODS: A retrospective case-study design using multiple data sources was used to gather feedback from participants involved in CDMI. Data collection occurred throughout planning and implementation and continued into early 2019. Semi-structured interviews were conducted, and transcripts were analyzed using NVivo 10 software. This was followed by content analysis. RESULTS: Analysis revealed four key themes as barriers to CDMI\u27s implementation: 1) lack of a needs assessment with key stakeholders; 2) lack of buy-in from medical staff; 3) inadequate patient engagement and; 4) contextual barriers. Planners did not conduct a proper needs assessment, nor include patients in the study design. In addition, there was insufficient consideration for how CDMI should be integrated into the usual COPD care plan, leading to confusion in roles and responsibilities. Poor communication between the implementation team and healthcare providers implementing the program, led to a lack of buy-in and engagement. CONCLUSION: The key themes resonate with what is already known in the literature. This study supports the importance of using a theoretically grounded plan for implementation. Using a model only in the planning stages is insufficient even when an intervention is based on evidence to support higher quality care. It is imperative to consider practical and contextual factors of program implementation and their interactions. By detailing the \u27failed implementation\u27 of this intervention, we hope to share important lessons about the need to plan implementation processes early in program planning

Using Visual Methods to Capture Patient Perspectives in Interprofessional Team-Based Care for Chronic Disease Management

Background: Understanding how patients perceive their role in the healthcare team can improve overall satisfaction of care and health outcomes. However, it has been challenging to capture the diversity of patient experiences using traditional research approaches. The goal of this study was to explore the perspectives of patients involved in an interprofessional team-based chronic disease management program for chronic obstructive pulmonary disease using visual research techniques. Methods: Our visual approach began with patients autonomously drawing (or mapping) experiences with their healthcare team. The maps were explored with the patients through focus group discussions. Maps were inductively coded to identify similarities and differences between participants’ perceptions. Focus group transcripts were first analyzed independently, then compared to and integrated into the map analysis. Findings: Overall, participants (n = 13) were satisfied as patients of team-based care. Participants drew multiple healthcare providers, sources of information, and themselves to represent their teams. Relationships and significance were represented using arrows, the size of each team member, facial expressions, and symbols. Four key elements of effective team-based models of care emerged: 1) effective information sharing, 2) diversity of providers’ roles, 3) empowerment through self-management, and 4) enhanced access to care. Conclusion: This study used visualization methodology to obtain patient feedback on the program’s performance, elicit patients’ experiences, and attempt to mitigate some of the limitations of isolated survey and focus group methodology, subsequently obtaining rich data on team-based care. Our research also informs ongoing quality improvement of the team nbased model for chronic disease management

Policy Implementation in Higher Education: The Dynamics of a Fall Break

A case study using mixed methods that critically appraises the implementation of a mental health policy in higher education in the absence of evidence to inform the policy using an exemplar case from one mid-sized post-secondary institution was the motivation for this research. Explanation building was used to iteratively analyse data on rival explanations of the implementation of the fall break policy. Analyses from the surveys revealed that overall, only 36.9 per cent of students perceived an increase in workload before the break and only 29.6 per cent of students perceived an increase in workload after the break. However, the focus groups and professor interviews revealed that the timing of the fall break had an impact on how students and professors experienced the break and their perceptions on its impact on student mental health. If baseline data regarding the implementation of the fall break would have been collected prior to its implementation, we could have possibly avoided the implementation issues that arose. While this research provides an exemplar case of a fall break policy at one post-secondary institution, the policy learning is universal

The FIRST-Optical-VLA Survey for Lensed Radio Lobes

We present results from a survey for gravitationally lensed radio lobes. Lensed lobes are a potentially richer source of information about galaxy mass distributions than lensed point sources, which have been the exclusive focus of other recent surveys. Our approach is to identify radio lobes in the FIRST catalog and then search optical catalogs for coincident foreground galaxies, which are candidate lensing galaxies. We then obtain higher-resolution images of these targets at both optical and radio wavelengths, and obtain optical spectra for the most promising candidates. We present maps of several radio lobes that are nearly coincident with galaxies. We have not found any new and unambiguous cases of gravitational lensing. One radio lobe in particular, FOV J0743+1553, has two hot spots that could be multiple images produced by a z=0.19 spiral galaxy, but the lensing interpretation is problematic.Comment: 38 pages, 18 figures, aastex, accepted to A

Recommendations for Online Teaching

This is a collection of recommendations drawn from a variety of sources, including our colleagues, students, webinars, books, articles, podcasts, and our own experimentation. It is not our expectation that any individual professor would adopt all of these suggestions and indeed no one of us intends to. Instead, we hope that some of these are helpful to you. Some suggestions deal with the nuts and bolts of teaching online while others with how to accomplish broader goals. The general recommendations are broadly applicable to all courses taught online, while the individual class-type recommendations are intended to complement and augment the general recommendations. Additionally, these recommendations will be revised as we continue to learn from our experiences in online instruction

CAR T manufacturing: process modifications for a transformational autologous product on a rapid path to licensure

The transformational impact of CAR T cell therapies on serious diseases demands a rapid path to licensure in order to establish widespread availability to desperate patients. In addition, the complex, labor intensive, and costly patient-specific manufacturing processes for CAR T cell therapies demand process modifications that enable scalability and affordability to maximize availability to patients. There are many options to improve CAR T processes ranging from automation to improved medium composition to simplified closed-system tubing sets. However, the dramatic dose-dependent safety and efficacy activities of these therapies amplifies the need for maintaining product comparability across process changes. This assessment of comparability is challenged by limited knowledge of product Critical Quality Attributes as well as limited availability of patient cells for process development studies. We have developed a comprehensive analytical toolbox that enables the assessment of product impact of process changes along with a risk-based approach to applying a matrix of appropriate tools for each change. This risk-based approach involves the most extensive product analysis for high-risk changes and a relatively restricted product analysis for low-risk changes. In all cases, the product analysis includes assessments of product characteristics that can hypothetically be impacted by the process change. We describe our approach to identifying, prioritizing, and assessing feasibility of process changes along with generating a suitable product comparability dataset to implement the most impactful process changes on an expedited timeline to licensure. We share examples of comparability data and its application to decision making