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Alhaidari S, Alzahrani I, Alhanaee M, Decanini A, Mohamed M, Zepeda-Gomez S, Mathura P, Zhang J, Sandha G. Optimising the indications for biliary stent placement during endoscopic retrograde cholangiopancreatography: a quality improvement initiative to enhance patient care and reduce healthcare resource utilisation. BMJ Open Gastroenterol 2024; 11:e001375. [PMID: 39174029 PMCID: PMC11340697 DOI: 10.1136/bmjgast-2024-001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND A retrospective chart audit was performed to review biliary stent utilisation from January 2020 to January 2021. Non-guideline-based stent insertion was identified in 16% of patients with common bile duct (CBD) stones presenting for endoscopic retrograde cholangiopancreatography (ERCP). To improve this knowledge-practice gap, a quality improvement (QI) intervention was devised and trialled. AIM To synchronise clinical indications for biliary stent insertion in patients with CBD stones in accordance with published guidelines. METHODS Using a QI pre-post study design, chart audits were completed and shared with the ERCP team (n=6). Indication for biliary stent insertion was compared to published guidelines assessed by two reviewers independently (kappa statistic calculated). The QI intervention included an education session and quarterly practice audits. An interrupted time series with segmented regression was completed. RESULTS A total of 661 patients (337 F), mean age 59±19 years (range 12-98 years), underwent 885 ERCPs during this postintervention period. Of 661 patients, 384 (58%) were referred for CBD stones. A total of 192 biliary stents (105 plastic, 85 metal) were placed during the first ERCP (192/661, 29%), as compared with the preintervention year (223/598, 37%, p=0.2). Furthermore, 13/192 stents (7%) were placed not in accordance with published guidelines (kappa=0.53), compared with 63/223 (28%) in the preintervention year (p<0.0001). A 75% reduction in overall avoidable stent placement was achieved with a direct cost avoidance of $C97 500. For the CBD stone subgroup, there was an 88% reduction in avoidable biliary stent placement compared with the preintervention year (8/384, 2% vs 61/375, 16%, p<0.0001). CONCLUSIONS Education with audit and feedback supported the closing of a knowledge-to-practice gap for biliary stent insertion during ERCP, especially in patients with CBD stones. This has resulted in a notable reduction of avoidable stent placements and additional follow-up ERCPs and an overall saving of healthcare resources.
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Affiliation(s)
| | - Ibrahim Alzahrani
- Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudia Arabia
| | - Manar Alhanaee
- Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Alan Decanini
- Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Mahmod Mohamed
- Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | - Pamela Mathura
- Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Julie Zhang
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Gurpal Sandha
- Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
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Odendaal W, Chetty T, Tomlinson M, Goga A, Singh Y, Kauchali S, Marshall C, Hunt X. "If you work alone on this project, you can't reach your target": unpacking the leader's role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19. BMC Health Serv Res 2023; 23:1382. [PMID: 38066525 PMCID: PMC10709890 DOI: 10.1186/s12913-023-10378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
The South African National Department of Health developed a quality improvement (QI) programme to reduce maternal and neonatal mortality and still births. The programme was implemented between 2018 and 2022 in 21 purposively selected public health facilities. We conducted a process evaluation to describe the characteristics and skills of the QI team leaders of well-performing teams. The evaluation was conducted in 15 of the 21 facilities. Facilities were purposively selected and comprised semi-structured interviews with leaders at three time points; reviewing of QI documentation; and 37 intermittently conducted semi-structured interviews with the QI advisors, being QI technical experts who supported the teams. These interviews focused on participants' experiences and perceptions of how the teams performed, and performance barriers and enablers. Thematic data analysis was conducted using Atlas.ti. Variation in team performance was associated with leaders' attributes and skills. However, the COVID-19 pandemic also affected team functioning. Well-performing teams had leaders who effectively navigated COVID-19 and other challenges, who embraced QI and had sound QI skills. These leaders cultivated trust by taking responsibility for failures, correcting members' mistakes in encouraging ways, and setting high standards of care. Moreover, they promoted programme ownership among members by delegating tasks. Given the critical role leaders play in team performance and thus in the outcomes of QI programmes, efforts should focus on leader selection, training, and support.
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Affiliation(s)
- Willem Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa.
- Department of Psychiatry, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa.
| | - Terusha Chetty
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Stellenbosch University, Franzi Van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Steve Biko Academic Hospital, Pretoria, Gauteng, South Africa
| | - Yages Singh
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa
| | - Shuaib Kauchali
- Department of Paediatrics and Child Health, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Carol Marshall
- South African National Department of Health, Voortrekker Road, Pretoria, Gauteng, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Stellenbosch University, Franzi Van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
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Felsen A, McClelland A, Kobi M, Bello JA, Burns J. Health Systems Science - A Primer for Radiologists. Acad Radiol 2023; 30:2079-2088. [PMID: 36966069 DOI: 10.1016/j.acra.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery. HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees. The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study.
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Affiliation(s)
- Amanda Felsen
- Albert Einstein College of Medicine, Montefiore New Rochelle Hospital; Bronx, NY
| | - Andrew McClelland
- Department of Radiology, NYU Grossman School of Medicine; New York, NY
| | - Mariya Kobi
- Department of Radiology, Columbia University Medical Center; New York, NY
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center; Bronx, NY; Albert Einstein College of Medicine; Bronx, NY.
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Quan M, Li Z, Ward LP, Feng S, Jing Y, Wang L, Yuan J. A quality improvement project to increase breast milk feeding of hospitalized late preterm infants in China. Int Breastfeed J 2023; 18:45. [PMID: 37612777 PMCID: PMC10463707 DOI: 10.1186/s13006-023-00582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/12/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The breastfeeding rates of late preterm infants are lower than both term and extremely preterm infants. To explore the interventions of increasing full breast milk feeding rate of hospitalized late preterm infants on the 7th day after birth (D7) and evaluate the effect of these quality improvement (QI) interventions. METHODS The full breast milk feeding (amount of enteral breast milk reached 120ml/kg/d on D7) rate of hospitalized late preterm infants during May 2017 and November 2017 was set as the baseline before intervention, and the specific aim of promoting breast milk feeding was put forward. The Pareto Chart was used to analyze the factors that affect breast milk feeding process, as well as the discussion of multidisciplinary experts. Key drivers were constructed, including informational materials and education about breast milk feeding, consultations and support on optimal breast milk initiation, initiating breast milk expression within one hour after birth, accurate measurement and recording of expressed breast milk, stimulating continuous and effective lactation, proper breast pump selection in and out of hospital and sending and preserving of expressed milk to NICU. Control chart was used to monitor the monthly change of full breast milk feeding rate until the aim was achieved and sustained. RESULTS The baseline of full breast milk feeding rate of late preterm infants was 10%, and the aim of QI was to increase the rate to 60% within a two-year period. Control chart dynamically showed the full breast milk feeding rate increased to 80% with the implementation of the interventions, achieved and made the aim of QI sustained. CONCLUSION QI interventions including breast milk feeding education, early postpartum breast milk pumping, kangaroo care to stimulate breast milk secretion, and convenient way of transporting breast milk to NICU, could significantly improve the full breast milk feeding rate of hospitalized late preterm infants.
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Affiliation(s)
- Meiying Quan
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Zhenghong Li
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
| | - Laura Placke Ward
- Division of Neonatology, NICU, Cincinnati Children's Hospital Medical Center, Ohio, United States
| | - Shuju Feng
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Yalin Jing
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Lin Wang
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Jing Yuan
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
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Serafim TT, de Oliveira ES, Maffulli N, Migliorini F, Okubo R. Which resistance training is safest to practice? A systematic review. J Orthop Surg Res 2023; 18:296. [PMID: 37046275 PMCID: PMC10099898 DOI: 10.1186/s13018-023-03781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The combination of resistance training (RT) and aerobic training is believed to achieve the best effects. Several different aerobic training methods have emerged in combination with or as a substitute for traditional RT. This study wished to verify which RT is safest in terms of injury prevalence and incidence. Also, it ascertained the characteristics of the injured subjects, the level of severity of the injuries and what definitions of injuries the available studies use. METHODS This systematic review followed the PRISMA recommendations and was registered in PROSPERO with the number CRD42021257010. The searches were performed in the PubMed, Cochrane and Web of Science, electronic databases using the Medical Subject Headings terms "Resistance training" or "Strength training" or "Crossfit" or "Weightlifting" or "Powerlifting" combined (AND) with "Injury" or "Injuries" or "Sprain" AND "Incidence" or "Prevalence" AND "Epidemiology" or "Epidemiological" in the title or abstract. The last search was performed on March 2023. To be included in the review, the studies had to be available as full text, be clinical trials focusing on epidemiological injuries of resistance training. There was no time limit for the selection of articles. To assess the quality of the studies, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used. RESULTS The initial literature search resulted in 4982 studies. After reading the titles, abstracts and full text, 28 articles were selected for data extraction. Seventeen investigated the injuries in HIFT/CrossFit, three in powerlifting, three in strength training, three in weightlifting and one in strongman. In addition, one study examined the HIFT/CrossFit and weightlifting. The incidence of injuries presented in the studies ranged from 0.21/1000 h to 18.9/1000 h and the prevalence of injuries was 10% to 82%. In the quality assessment for STROBE, five studies were classified at level A, 21 at level B and two at level C. CONCLUSION This systematic review showed that traditional strength training is the safest RT method, and strongman is the least safe regarding injuries. Few studies have been rated highly according to STROBE. Furthermore, few studies have been published on some RT methods. These two factors make it difficult to generalize the results.
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Affiliation(s)
- Thiago Teixeira Serafim
- Physiotherapy Nucleus Orthopedic Trauma of Health and Sports Science of the Santa Catarina State (UDESC), Florianópolis, Brazil
| | - Eliton Stanley de Oliveira
- Physiotherapy Nucleus Orthopedic Trauma of Health and Sports Science of the Santa Catarina State (UDESC), Florianópolis, Brazil
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB England
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, E1 4DG England
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Rodrigo Okubo
- Physiotherapy Nucleus Orthopedic Trauma of Health and Sports Science of the Santa Catarina State (UDESC), Florianópolis, Brazil
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Pediatric Hepatitis C Quality Improvement Project Improves Healthcare Access. J Pediatr Gastroenterol Nutr 2023; 76:371-378. [PMID: 36728827 DOI: 10.1097/mpg.0000000000003690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Incidence of hepatitis C virus (HCV) infection is increasing in women of reproductive age, leading to increased prevalence of HCV infection in children via vertical transmission. This quality improvement (QI) project aimed to increase referrals to and appointments scheduled with a specialty pediatric gastroenterology HCV clinic and the number of eligible children with HCV who completed treatment. METHODS From July 2020 to August 2021, the QI team designed a project using the Model for Improvement and completed Plan Do Study Act cycles to test change ideas to improve HCV awareness and education for medical providers and families; standardize the referral process; track patients; increase clinic capacity; and connect families with community resource care coordination. Referrals to the pediatric HCV clinic, appointments scheduled, no shows, and treatment follow-up were tracked during the project period and a comparison timeframe from July 2019 to June 2020. RESULTS There were improvements in several measures during the project period versus the comparison timeframe, with 80 versus 48 referrals received (66% increase), 115 versus 59 scheduled clinic visits (95% increase), and 7 versus 5 treatment completers (40% increase), along with a small (7%) decline in the proportion of scheduled clinic visits that were no shows. CONCLUSION Application of QI methodology increased medical provider and caregiver awareness and engagement in accessing HCV healthcare available for at-risk children. More QI efforts should be accelerated to identify best practices amidst a nationwide HCV epidemic.
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Kapanadze G, Berg J, Sun Y, Gerdin Wärnberg M. Facilitators and barriers impacting in-hospital Trauma Quality Improvement Program (TQIP) implementation across country income levels: a scoping review. BMJ Open 2023; 13:e068219. [PMID: 36806064 PMCID: PMC9944272 DOI: 10.1136/bmjopen-2022-068219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE Trauma is a leading cause of mortality and morbidity globally, disproportionately affecting low/middle-income countries (LMICs). Understanding the factors determining implementation success for in-hospital Trauma Quality Improvement Programs (TQIPs) is critical to reducing the global trauma burden. We synthesised topical literature to identify key facilitators and barriers to in-hospital TQIP implementation across country income levels. DESIGN Scoping review. DATA SOURCES PubMed, Web of Science and Global Index Medicus databases were searched from June 2009 to January 2022. ELIGIBILITY CRITERIA Published literature involving any study design, written in English and evaluating any implemented in-hospital quality improvement programme in trauma populations worldwide. Literature that was non-English, unpublished and involved non-hospital TQIPs was excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers completed a three-stage screening process using Covidence, with any discrepancies resolved through a third reviewer. Content analysis using the Consolidated Framework for Implementation Research identified facilitator and barrier themes for in-hospital TQIP implementation. RESULTS Twenty-eight studies met the eligibility criteria from 3923 studies identified. The most discussed in-hospital TQIPs in included literature were trauma registries. Facilitators and barriers were similar across all country income levels. The main facilitator themes identified were the prioritisation of staff education and training, strengthening stakeholder dialogue and providing standardised best-practice guidelines. The key barrier theme identified in LMICs was poor data quality, while high-income countries (HICs) had reduced communication across professional hierarchies. CONCLUSIONS Stakeholder prioritisation of in-hospital TQIPs, along with increased knowledge and consensus of trauma care best practices, are essential efforts to reduce the global trauma burden. The primary focus of future studies on in-hospital TQIPs in LMICs should target improving registry data quality, while interventions in HICs should target strengthening communication channels between healthcare professionals.
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Affiliation(s)
- George Kapanadze
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Johanna Berg
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Emergency and Internal Medicine, Skånes universitetssjukhus Malmö, Malmo, Sweden
| | - Yue Sun
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Fontil V, Modrow MF, Cooper‐DeHoff RM, Wozniak G, Rakotz M, Todd J, Azar K, Murakami L, Sanders M, Chamberlain AM, O'Brien E, Lee A, Carton T, Pletcher MJ. Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. J Am Heart Assoc 2023; 12:e024975. [PMID: 36695297 PMCID: PMC9973613 DOI: 10.1161/jaha.121.024975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Uncontrolled blood pressure (BP) remains a leading cause of death in the United States. The American Medical Association developed a quality improvement program to improve BP control, but it is unclear how to efficiently implement this program at scale across multiple health systems. Methods and Results We conducted BP MAP (Blood Pressure Measure Accurately, Act Rapidly, and Partner With Patients), a comparative effectiveness trial with clinic-level randomization to compare 2 scalable versions of the quality improvement program: Full Support (with support from quality improvement expert) and Self-Guided (using only online materials). Outcomes were clinic-level BP control (<140/90 mm Hg) and other BP-related process metrics calculated using electronic health record data. Difference-in-differences were used to compare changes in outcomes from baseline to 6 months, between intervention arms, and to a nonrandomized Usual Care arm composed of 18 health systems. A total of 24 safety-net clinics in 9 different health systems underwent randomization and then simultaneous implementation. BP control increased from 56.7% to 59.1% in the Full Support arm, and 62.0% to 63.1% in the Self-Guided arm, whereas BP control dropped slightly from 61.3% to 60.9% in the Usual Care arm. The between-group differences-in-differences were not statistically significant (Full Support versus Self-Guided=+1.2% [95% CI, -3.2% to 5.6%], P=0.59; Full Support versus Usual Care=+3.2% [-0.5% to 6.9%], P=0.09; Self-Guided versus Usual Care=+2.0% [-0.4% to 4.5%], P=0.10). Conclusions In this randomized trial, 2 methods of implementing a quality improvement intervention in 24 safety net clinics led to modest improvements in BP control that were not statistically significant. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03818659.
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Affiliation(s)
- Valy Fontil
- University of California San FranciscoSan FranciscoCA
| | | | | | | | | | | | - Kristen Azar
- University of California San FranciscoSan FranciscoCA
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Malone S, Newland J, Kudchadkar SR, Prewitt K, McKay V, Prusaczyk B, Proctor E, Brownson RC, Luke DA. Sustainability in pediatric hospitals: An exploration at the intersection of quality improvement and implementation science. FRONTIERS IN HEALTH SERVICES 2022; 2:1005802. [PMID: 36925889 PMCID: PMC10012775 DOI: 10.3389/frhs.2022.1005802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
Background Although new evidence-based practices are frequently implemented in clinical settings, many are not sustained, limiting the intended impact. Within implementation science, there is a gap in understanding sustainability. Pediatric healthcare settings have a robust history of quality improvement (QI), which includes a focus on continuation of change efforts. QI capability and sustainability capacity, therefore, serve as a useful concept for connecting the broader fields of QI and implementation science to provide insights on improving care. This study addresses these gaps in understanding of sustainability in pediatric settings and its relationship to QI. Methods This is a cross-sectional observational study conducted within pediatric academic medical centers in the United States. Clinicians surveyed worked with one of three evidence-based clinical programs: perioperative antimicrobial stewardship prescribing, early mobility in the intensive care unit, and massive blood transfusion administration. Participants completed two assessments: (1) the Clinical Sustainability Assessment Tool (CSAT) and (2) a 19-question assessment that included demographics and validation questions, specifically a subset of questions from the Change Process Capability Questionnaire, a QI scale. Initial descriptive and bivariate analyses were conducted prior to building mixed-effects models relating perceived QI to clinical sustainability capacity. Results A total of 181 individuals from three different programs and 30 sites were included in the final analyses. QI capability scores were assessed as a single construct (5-point Likert scale), with an average response of 4.16 (higher scores indicate greater QI capability). The overall CSAT score (7-point Likert scale) was the highest for massive transfusion programs (5.51, SD = 0.91), followed by early mobility (5.25, SD = 0.92) and perioperative antibiotic prescribing (4.91, SD = 1.07). Mixed-effects modeling illustrated that after controlling for person and setting level variables, higher perceptions of QI capabilities were significantly related to overall clinical sustainability. Conclusion Organizations and programs with higher QI capabilities had a higher sustainability capacity, even when controlling for differences at the individual and intervention levels. Organizational factors that enable evidence-based interventions should be further studied, especially as they relate to sustainability. Issues to be considered by practitioners when planning for sustainability include bedside provider perceptions, intervention achievability, frequency of delivery, and organizational influences.
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Affiliation(s)
- Sara Malone
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Jason Newland
- Pediatric Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Pediatrics, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kim Prewitt
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Virginia McKay
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Beth Prusaczyk
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Enola Proctor
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, United States
| | - Ross C Brownson
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, United States
| | - Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Dunn H, Lofgren MA, Reyes J, Dirks M. Perspectives, experiences, and opinions precepting advanced practice registered nurse students. Nurs Outlook 2022; 70:559-561. [DOI: 10.1016/j.outlook.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
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Improving Care Delivery: Location Timestamps to Enhance Process Measurement of a Clinical Workflow. Pediatr Qual Saf 2021; 6:e475. [PMID: 34589649 PMCID: PMC8476056 DOI: 10.1097/pq9.0000000000000475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022] Open
Abstract
Supplemental Digital Content is available in the text. Traditional quality improvement (QI) strategies to describe workflow processes rely primarily upon qualitative methods or human-driven observations. These methods may be limited in scope and accuracy when applied to time-based workflow processes. This study sought to evaluate the utility of integrating objective time measurements to augment traditional QI strategies using procedural sedation workflow in a pediatric emergency department as an archetype.
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Verma P, Kumar V, Mittal A, Gupta P, Hsu SC. Addressing strategic human resource management practices for TQM: the case of an Indian tire manufacturing company. TQM JOURNAL 2021. [DOI: 10.1108/tqm-02-2021-0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aims to identify SHRM (strategic human resource management) essential practices for the TQM (total quality management) program regarding an Indian tire manufacturing company and formulate an inclusive interrelationship to prioritize them.Design/methodology/approachSemistructured interview with ten experts from the company was made to give SHRM practices scores. The SLR (systematic literature review) and TOPSIS (technique for order of preference by similarity to ideal solution) techniques are used to establish the model for 12 key practices and rank them afterward.FindingsThe findings clearly show that strategic planning and staffing, teamwork and leadership development have appeared as the top three essential practices. Simultaneously, performance measurement and evaluation, work design and analysis and promotion are identified as the bottom three practices. These essential practices are identified as contributing attributes.Practical implicationsThe findings prioritize the SHRM practices as contributing attributes that help other tire manufacturing industries identify their key practices. Moreover, it provides the necessary inputs comprised of ten experts' decisions to become more active and well prepared.Originality/valueThe novelty of this study is to identify the key practices by using SLR and measured by the TOPSIS method to rank and consider a tire manufacturing company as a case-based approach to gain high productivity and competitive advantage.
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Lichvar A, Chandran MM, Do V, Rendulic T, Szczepanik A, Pierce D, Park JM. Entrustable professional activities for pharmacy students: A primer for solid organ transplant preceptors. Am J Health Syst Pharm 2021; 78:zxab320. [PMID: 34350946 DOI: 10.1093/ajhp/zxab320] [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: 08/03/2021] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The role of a solid organ transplant pharmacist is multifaceted and translates to diverse experiential and elective learning experiences that can be provided to pharmacy learners. Here we provide a guide to integrating pharmacy students into patient care and other pharmacist activities in solid organ transplantation. SUMMARY Thoughtful incorporation of learners into clinical practice and clinical research creates a positive learning environment for pharmacy students that can foster the development of core skills necessary for students to become "practice-ready" and "team-ready" pharmacy graduates and can equip them with valuable skills to incorporate into the specialty practice areas and careers they pursue. To help develop these educational experiences, attention to the list of core entrustable professional activities (EPAs) established by the American Association of Colleges of Pharmacy can help create a rich environment of learning with carefully cultivated tasks. Furthermore, learners can serve as transplant pharmacist extenders to assist in overall patient care and multidisciplinary involvement on the transplant team. This article serves as a "how-to" guide for applying the EPA framework to integrating pharmacy students in patient care and other pharmacist activities in solid organ transplantation and other specialty practice areas. CONCLUSION As pharmacy preceptors design and operationalize their teaching to incorporate EPAs, they can benefit from recommendations tailored to specialty practice areas such as solid organ transplantation. Students may start and finish these experiences at different EPA levels, but continuance of training will allow them to achieve the final EPA level across the 6 EPA domains.
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Affiliation(s)
- Alicia Lichvar
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, and Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Vincent Do
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Trisann Rendulic
- Department of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Amanda Szczepanik
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Dana Pierce
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeong M Park
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, and Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
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Braun BI, Chitavi SO, Suzuki H, Soyemi CA, Puig-Asensio M. Culture of Safety: Impact on Improvement in Infection Prevention Process and Outcomes. Curr Infect Dis Rep 2020; 22:34. [PMID: 33288982 PMCID: PMC7710367 DOI: 10.1007/s11908-020-00741-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
Purpose Safety culture is known to be related to a wide range of outcomes, and measurement of safety culture is now required for many hospitals in the U.S.A. In previous reviews, the association with outcomes has been limited by the research design and strength of the evidence. The goal of this review was to examine recent literature on the relationship between safety culture and infection prevention and control-related (IPC) processes and healthcare-associated infections (HAIs) in U.S. healthcare organizations. We also sought to quantitatively characterize the challenges to empirically establishing these relationships and limitations of current research. Recent Findings A PubMed search for U.S. articles published 2009–2019 on the topics of infection prevention, HAIs, and safety culture yielded 448 abstracts. After screening, 55 articles were abstracted for information on purpose, measurement, analysis, and conclusions drawn about the role of safety culture in the outcome. Approximately ½ were quality improvement (QI) initiatives and ½ were research studies. Overall, 51 (92.7%) concluded there was an association between safety culture and IPC processes or HAIs. However, only 39 studies measured safety culture and 26 statistically analyzed safety culture data for associations. Though fewer QI initiatives analyzed associations, a higher proportion concluded an association exists than among research studies. Summary Despite limited empirical evidence and methodologic challenges to establishing associations, most articles supported a positive relationship between safety culture, improvement in IPC processes, and decreases in HAIs. Authors frequently reported experiencing improvements in safety culture when not directly measured. The findings suggest that associations between improvement and safety culture may be bi-directional such that positive safety culture contributes to successful interventions and implementing effective interventions drives improvements in culture. Greater attention to article purpose, design, and analysis is needed to confirm these presumptive relationships.
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Affiliation(s)
- Barbara I Braun
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Salome O Chitavi
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Hiroyuki Suzuki
- Department of Internal Medicine - Infectious Diseases, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Caroline A Soyemi
- Neihoff School of Nursing, Loyola University Chicago, Chicago, IL USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, Iowa City, IA USA.,Present Address: Department of Infectious Diseases, Hospital Universitari de Bellvitge: L'Hospitalet de Llobregat, Barcelona, Catalunya Spain
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Creation of a chemotherapy-induced nausea/vomiting dashboard to improve outcomes for pediatric cancer patients. Support Care Cancer 2020; 29:1549-1555. [PMID: 32734390 DOI: 10.1007/s00520-020-05652-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Two of the most common acute side effects of chemotherapy are nausea and vomiting. Nausea and vomiting impact quality of life, nutritional status, and ability to tolerate further chemotherapy. Parents of pediatric oncology patients rank nausea as one of the most bothersome treatment-related symptoms. METHODS Utilizing Quality Improvement methodology, we developed a dashboard interface to facilitate extraction of data from the electronic medical record (EMR), which is presented via a visual display that summarizes the type of chemotherapy and antiemetic medications, use of as needed medications, and number of episodes of emesis. RESULTS This dashboard interface allows for rapid and efficient identification of patients whose antiemetic regimen is mismatched for the emetogenicity of ordered chemotherapy, thus providing a timely opportunity to modify the antiemetic regimen based on published guidelines before administration of chemotherapy drugs. It also allows measurement of the effectiveness of the antiemetic regimen in terms of the number of break through emesis and the need for as needed medications. CONCLUSIONS A novel CINV dashboard was created, which visually conveys complex information about antiemetics, chemotherapy emetogenicity, as needed medications, and breakthrough vomiting for inpatient pediatric oncology patients.
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Abstract
This article examines approaches for improving the efficiency and effectiveness of quality metrics currently in use in neonatal care. Desirable characteristics of quality metrics are discussed, the criteria and process for their development are presented, and the uses and limitations of current neonatal outcome and process metrics are explored together with approaches for improving metric performance. Discussion includes enhancing quality metrics through optimizing improvement readiness, sustaining improvements once achieved, and use of improvement science methods to improve metric validity.
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Affiliation(s)
- James I Hagadorn
- Division of Neonatology, Connecticut Children's Medical Center, 282 Washington Street, Hartford CT 06106, USA; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Kendall R Johnson
- Division of Neonatology, Connecticut Children's Medical Center, 282 Washington Street, Hartford CT 06106, USA; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Deanna Hill
- Department of Nursing, Connecticut Children's Medical Center, Hartford, CT, USA
| | - David W Sink
- Division of Neonatology, Connecticut Children's Medical Center, 282 Washington Street, Hartford CT 06106, USA; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
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CORR Insights®: What is the Accuracy and Reliability of the Peritubercle Lucency Sign on Radiographs for Early Diagnosis of Slipped Capital Femoral Epiphysis Compared With MRI as the Gold Standard? Clin Orthop Relat Res 2020; 478:1060-1061. [PMID: 32217861 PMCID: PMC7170679 DOI: 10.1097/corr.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Neelankavil J, Goeddel LA, Dwarakanath S, Methangkool E, Feinman JW, Harvey R, Hatton K, Kostibas MP, Shah R, Ho J, Patel PA, Howard-Quijano J, Nyhan D, Augoustides JG. Mentoring Fellows in Adult Cardiothoracic Anesthesiology for Academic Practice in the Contemporary Era—Perspectives From Mentors Around the United States. J Cardiothorac Vasc Anesth 2020; 34:521-529. [DOI: 10.1053/j.jvca.2019.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 12/14/2022]
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Haut ER, Aboagye JK, Shaffer DL, Wang J, Hobson DB, Yenokyan G, Sugar EA, Kraus PS, Farrow NE, Canner JK, Owodunni OP, Florecki KL, Webster KLW, Holzmueller CG, Pronovost PJ, Streiff MB, Lau BD. Effect of Real-time Patient-Centered Education Bundle on Administration of Venous Thromboembolism Prevention in Hospitalized Patients. JAMA Netw Open 2018; 1:e184741. [PMID: 30646370 PMCID: PMC6324387 DOI: 10.1001/jamanetworkopen.2018.4741] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Numerous interventions have improved prescription of venous thromboembolism (VTE) prophylaxis; however, many prescribed doses are not administered to hospitalized patients, primarily owing to patient refusal. OBJECTIVE To evaluate a real-time, targeted, patient-centered education bundle intervention to reduce nonadministration of VTE prophylaxis. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled, preintervention-postintervention comparison trial included 19 652 patient visits on 16 units at The Johns Hopkins Hospital, Baltimore, Maryland, from April 1 through December 31, 2015. Data analysis was performed from June 1, 2016, through November 30, 2017, on an intention-to-treat basis. INTERVENTIONS Patients on 4 intervention units received a patient-centered education bundle if a dose of VTE prophylaxis medication was not administered. Patients on 12 control units received no intervention. MAIN OUTCOMES AND MEASURES Conditional odds of nonadministration of doses of VTE prophylaxis (primary outcome) before and after the intervention on control vs intervention units. Reasons for nonadministration (ie, patient refusal and other) and VTE event rates (secondary outcomes) were compared. RESULTS A total of 19 652 patient visits where at least 1 dose of VTE prophylaxis was prescribed were included (51.7% men; mean [SD] age, 55.6 [17.1] years). Preintervention and postintervention groups were relatively similar in age, sex, race, and medical or surgery unit. From the preintervention period to the postintervention period, on intervention units, the conditional odds of VTE prophylaxis nonadministration declined significantly (9.1% [95% CI, 5.2%-16.2%] vs 5.6% [95% CI, 3.1%-9.9%]; odds ratio [OR], 0.57; 95% CI, 0.48-0.67) compared with no change on control units (13.6% [95% CI, 9.8%-18.7%] vs 13.3% [95% CI, 9.6%-18.5%]; OR, 0.98; 95% CI, 0.91-1.07; P < .001 for interaction). The conditional odds of nonadministration owing to patient refusal decreased significantly on intervention units (5.9% [95% CI, 2.6%-13.6%] vs 3.4% [95% CI, 1.5%-7.8%]; OR, 0.53; 95% CI ,0.43-0.65) compared with no change on control units (8.7% [95% CI, 5.4%-14.0%] vs 8.5% [95% CI, 5.3%-13.8%]; OR, 0.98; 95% CI, 0.89-1.08; P < .001 for interaction). On intervention units, the conditional odds of nonadministration owing to reasons other than patient refusal decreased (2.3% [95% CI, 1.5%-3.4%] vs 1.7% [95% CI, 1.1%-2.6%]; OR, 0.74; 95% CI, 0.58-0.94), with no change on control units (3.4% [95% CI, 2.7%-4.4%] vs 3.3% [95% CI, 2.6%-4.2%]; OR, 0.98; 95% CI, 0.87-1.10; P = .04 for interaction). No differential effect occurred on medical vs surgical units (OR, 0.86; 95% CI, 0.60-1.23; P = .41 for interaction). There was no statistical difference in the proportion of VTE events among patients on intervention vs control units (0.30% vs 0.18%; OR, 0.60; 95% CI, 0.16-2.23). CONCLUSIONS AND RELEVANCE In this study, a targeted patient-centered education bundle significantly reduced nonadministration of pharmacologic VTE prophylaxis in hospitalized patients. This novel strategy improves health care quality by leveraging electronic data to target interventions in real time for at-risk patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02402881.
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Affiliation(s)
- Elliott R. Haut
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
- Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jonathan K. Aboagye
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dauryne L. Shaffer
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deborah B. Hobson
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth A. Sugar
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Peggy S. Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Norma E. Farrow
- Department of Surgery, Duke University, Durham, North Carolina
| | - Joseph K. Canner
- Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oluwafemi P. Owodunni
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine L. Florecki
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristen L. W. Webster
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine G. Holzmueller
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter J. Pronovost
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael B. Streiff
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D. Lau
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Three-dimensional localization and targeting of prostate cancer foci with imaging and histopathologic correlation. Curr Opin Urol 2018; 28:506-511. [DOI: 10.1097/mou.0000000000000554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Yu JPJ, Kuner AD, Kennedy TA. Characteristics of Durable Quality Improvement: A 6-Year Case Study. J Am Coll Radiol 2018; 15:1749-1752. [PMID: 30031615 DOI: 10.1016/j.jacr.2018.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- John-Paul J Yu
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin; the Neuroscience Training Program, Wisconsin Institutes for Medical Research, University of Wisconsin-Madison, Madison, Wisconsin; and the Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Anthony D Kuner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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