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Bhatt N, Yang J, DeBaere L, Wang RS, Most A, Zhang Y, Dayanov E, Yang W, Santacatterina M, Kamberi M, Mojica J, Kamen E, Savitski J, Stein J, Jacobson A. Reducing Length of Stay in Reconstructive Head and Neck Surgery Patients: A Quality Improvement Initiative. Otolaryngol Head Neck Surg 2024. [PMID: 39118499 DOI: 10.1002/ohn.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To investigate whether a new preoperative education and discharge planning protocol reduced unexpected discharge delays for patients undergoing reconstructive surgery for head and neck cancer. METHODS A quality improvement (QI) intervention was implemented in January 2021 with several components to address historically prolonged observed lengths of stay (LOS) with head and neck cancer patients. The intervention added a preoperative educational visit with a head and neck cancer advanced practice provider, a standardized preoperative speech and swallow assessment, a personalized patient care plan document, discussion of inpatient hospital stay expectations, and early discharge planning. The intervention group included patients who underwent the preoperative education protocol from February to December 2021. For comparison, an age and sex-matched control group was constructed from inpatients who had been admitted for similar procedures in the 2 years prior to the QI intervention (2019-2020) and received standard of care counseling. RESULTS Our study demonstrated a significant reduction in observed to expected LOS ratio after implementation of the intervention (1.24 ± 0.74 control, 0.95 ± 0.52 intervention; P = .012). DISCUSSION We discuss a preoperative education QI intervention at our institution. Our findings demonstrate that our intervention was associated with decreased LOS for patients undergoing head and neck reconstructive surgeries. IMPLICATIONS FOR PRACTICE This QI study shows the benefit of a new standardized preoperative education and discharge planning protocol for patients undergoing head and neck reconstructive surgeries.
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Affiliation(s)
- Nupur Bhatt
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Jackie Yang
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Lauren DeBaere
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Ronald Shen Wang
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Allison Most
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Yan Zhang
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Elan Dayanov
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Wenqing Yang
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | | | - Maria Kamberi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Jacqueline Mojica
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Emily Kamen
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Justin Savitski
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - John Stein
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Adam Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
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Choi B, Jang JH, Son M, Lee MS, Jo YY, Jeon JY, Jin U, Soh M, Park RW, Kwon JM. Electrocardiographic biomarker based on machine learning for detecting overt hyperthyroidism. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:255-264. [PMID: 36713007 PMCID: PMC9707932 DOI: 10.1093/ehjdh/ztac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023]
Abstract
Aims Although overt hyperthyroidism adversely affects a patient's prognosis, thyroid function tests (TFTs) are not routinely conducted. Furthermore, vague symptoms of hyperthyroidism often lead to hyperthyroidism being overlooked. An electrocardiogram (ECG) is a commonly used screening test, and the association between thyroid function and ECG is well known. However, it is difficult for clinicians to detect hyperthyroidism through subtle ECG changes. For early detection of hyperthyroidism, we aimed to develop and validate an electrocardiographic biomarker based on a deep learning model (DLM) for detecting hyperthyroidism. Methods and results This multicentre retrospective cohort study included patients who underwent ECG and TFTs within 24 h. For model development and internal validation, we obtained 174 331 ECGs from 113 194 patients. We extracted 48 648 ECGs from 33 478 patients from another hospital for external validation. Using 500 Hz raw ECG, we developed a DLM with 12-lead, 6-lead (limb leads, precordial leads), and single-lead (lead I) ECGs to detect overt hyperthyroidism. We calculated the model's performance on the internal and external validation sets using the area under the receiver operating characteristic curve (AUC). The AUC of the DLM using a 12-lead ECG was 0.926 (0.913-0.94) for internal validation and 0.883(0.855-0.911) for external validation. The AUC of DLMs using six and a single-lead were in the range of 0.889-0.906 for internal validation and 0.847-0.882 for external validation. Conclusion We developed a DLM using ECG for non-invasive screening of overt hyperthyroidism. We expect this model to contribute to the early diagnosis of diseases and improve patient prognosis.
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Affiliation(s)
| | | | - Minkook Son
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Min Sung Lee
- Department of Medical Research, Medical AI Co., Seoul, Republic of Korea
| | - Yong Yeon Jo
- Department of Medical Research, Medical AI Co., Seoul, Republic of Korea
| | - Ja Young Jeon
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Uram Jin
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Moonseung Soh
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Kshirsagar RS, Xiao C, Luetzenberg FS, Luu L, Jiang N. Reducing opioid use in post-operative otolaryngology patients: A quality improvement project. Am J Otolaryngol 2021; 42:102991. [PMID: 33640800 DOI: 10.1016/j.amjoto.2021.102991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In opioid-naive patients, many low-risk surgical procedures are associated with an increased risk of chronic opioid use. The goal of this quality improvement project was to reduce the amount of opioid prescriptions after commonly performed surgeries in otolaryngology. MATERIALS AND METHODS Pre-intervention opioid prescribing state was measured using anonymous provider and patient surveys, as well as pharmacy provider prescription data. Next, this information was used to develop an opioid prescription protocol that both standardized opioid prescribing practices and encouraged multimodal analgesia following routine surgery. Finally, post-intervention data were gathered and compared to pre-intervention data to assess changes in prescribing patterns. RESULTS By patient survey, the worst pain and average pain after surgery (scale of 1-10) were unchanged after the intervention (5.1 to 4.8, p = 0.52; 4.1 to 3.6, p = 0.35, respectively). Post-intervention, 41% of patients reported receiving no opiates, whereas pre-intervention 100% of patients surveyed received opiates. The amount of ibuprofen and acetaminophen prescribed post-intervention increased 113% and 71%, respectively. By survey, the average number of opioid doses decreased from 24.0 ± 7.0 to 18.4 ± 6.6 (p = 0.018). CONCLUSIONS The implementation of a standardized physician opioid prescription protocol did not affect patient pain perceptions, resulted in an increase in multimodal analgesia prescription, and increased provider awareness of opioid over prescription.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
| | - Christopher Xiao
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | | | - Latonia Luu
- Department of Pharmacy, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Nancy Jiang
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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Augustyn A, Reed VI, Ahmad N, Bhutani MS, Bloom ES, Bowers JR, Chronowski GM, Das P, Holliday EB, Delclos ME, Huey RW, Koay EJ, Lee SS, Nelson CL, Taniguchi CM, Koong AC, Chun SG. Implementation of a stereotactic body radiotherapy program for unresectable pancreatic cancer in an integrated community academic radiation oncology satellite network. Clin Transl Radiat Oncol 2021; 27:147-151. [PMID: 33665384 PMCID: PMC7907676 DOI: 10.1016/j.ctro.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Abstract
PDSA methodology was used to implement a pancreas SBRT in an academic satellite network. Oncologic outcomes were favorable with no serious adverse events. This technical note provides groundwork for safe establishment of SBRT pancreas programs.
With increasing interest in stereotactic body radiotherapy (SBRT) for unresectable pancreatic cancer, quality improvement (QI) initiatives to develop integrated clinical workflows are crucial to ensure quality assurance (QA) when introducing this challenging technique into radiation practices. Materials/Methods: In 2017, we used the Plan, Do, Study, Act (PDSA) QI methodology to implement a new pancreas SBRT program in an integrated community radiation oncology satellite. A unified integrated information technology infrastructure was used to virtually integrate the planned workflow into the community radiation oncology satellite network (P – Plan/D – Do). This workflow included multiple prospective quality assurance (QA) measures including multidisciplinary evaluation, prospective scrutiny of radiation target delineation, prospective radiation plan evaluation, and monitoring of patient outcomes. Institutional review board approval was obtained to retrospectively study and report outcomes of patients treated in this program (S – Study). Results: There were 12 consecutive patients identified who were treated in this program from 2017 to 2020 with a median follow-up of 27 months. The median survival was 13 months, median local failure free survival was 12 months and median progression free survival was 6 months from SBRT. There were no acute or late Common Terminology Criteria for Adverse Effects (CTCAE) version 5 toxicities ≥ Grade 3. Conclusion: We report the successful implementation of a community pancreas SBRT program involving multiple prospective QA measures, providing the groundwork to safely expand access to pancreas SBRT in our community satellite network (A – Act).
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Affiliation(s)
- Alexander Augustyn
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Valerie I. Reed
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Neelofur Ahmad
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth S. Bloom
- Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - John R. Bowers
- Department of Radiation Oncology, M.D. Anderson Albuquerque, Albuquerque, NM, United States
| | - Gregory M. Chronowski
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Prajnan Das
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Emma B. Holliday
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Marc E. Delclos
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Ryan W. Huey
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Eugene J. Koay
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Sunyoung S. Lee
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Christopher L. Nelson
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Cullen M. Taniguchi
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Albert C. Koong
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Stephen G. Chun
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
- Corresponding author.
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Yao CMKL, Fu S, Tam S, Kiong KL, Guo T, Zhao H, Giordano SH, Sturgis EM, Lewis CM. Impact of provider type and number of providers on surveillance testing among survivors of head and neck cancers. Cancer 2021; 127:1699-1711. [PMID: 33471396 DOI: 10.1002/cncr.33402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Guidelines for follow-up after head and neck cancer (HNC) treatment recommend frequent clinical examinations and surveillance testing. Here, the authors describe real-world follow-up care for HNC survivors and variations in surveillance testing. METHODS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, this study examined a population-based cohort of HNC survivors between 2001 and 2011 Usage of cross-sectional head and neck imaging (CHNI), chest imaging (CI), positron emission tomography (PET), fiberoptic nasopharyngolaryngoscopy (FNPL), and, in irradiated patients, thyroid function testing (TFT) was captured over 2 consecutive surveillance years. Multivariate modeling with logistic regression analyses was used to assess variations by clinical factors, nonclinical factors, number and types of providers seen and their evolution over time. RESULTS Among 13,836 HNC survivors, the majority saw a medical, radiation, or surgical oncologist and a primary care provider (PCP; 81.7%) in their first year of surveillance. However, only 58.1% underwent either PET or CHNI, 47.8% underwent CHNI, 64.1% underwent CI, 32.5% underwent PET scans, 55.0% underwent FNPL, and 55.9% underwent TFT. In multivariate analyses, patients who followed up with more providers and those who followed up with both a PCP and an oncologist were more likely to undergo surveillance testing (P < .007). However, adjusting for providers seen did not explain the variations in surveillance testing rates based on age, race, education, income level, and place of residence. Over time, there was a gradual increase in the use of PET scans and TFT during surveillance years. CONCLUSIONS In this large SEER-Medicare data study, only half of HNC survivors received the recommended testing, and greater compliance was seen in those who followed up with both an oncologist and a PCP. More attention is needed to minimize variations in surveillance testing across sociodemographic groups.
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Affiliation(s)
- Christopher M K L Yao
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shuangshuang Fu
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samantha Tam
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberley L Kiong
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Theresa Guo
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hui Zhao
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Carol M Lewis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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