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Patell R, Cool JA, Merchant E, Dodge LE, Ricotta DN, Persaud B, Gomez LK, Yang L, Trainor A, Carney B, William J, Lecker S, Theodore M, Petri C, Horst D, Stein D, Forbath N, Azim A, Hale AJ, Freed JA. Rethinking the consultation paradigm: Validity evidence for a new framework, a multimethods study. J Hosp Med 2024; 19:259-266. [PMID: 38472645 DOI: 10.1002/jhm.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 02/11/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND In-hospital consultation is essential for patient care. We previously proposed a framework of seven specific consultation types to classify consult requests to improve communication, workflow, and provider satisfaction. METHODS This multimethods study's aim was to evaluate the applicability of the consult classification framework to real internal medicine (IM) consults. We sought validity evidence using Kane's validity model with focus groups and classifying consult requests from five IM specialties. Participants attended five 1 h semi-structured focus groups that were recorded, transcribed, and coded for thematic saturation. For each specialty, three specialists and three hospitalists categorized 100 (total 500) random anonymized consult requests. The primary outcome was concordance in the classification of consult requests, defined as the sum of partial concordance and perfect concordance, where respectively 4-5/6 and 6/6 participants classified a consult in the same category. We used χ2 tests to compare concordance rates across specialties and between specialists and hospitalists. RESULTS Five major themes were identified in the qualitative analysis of the focus groups: (1) consult question, (2) interpersonal interactions, (3) value, (4) miscommunication, (5) consult framework application, barriers, and iterative development. In the quantitative analysis, the overall concordance rate was 88.8% (95% confidence interval [CI]: 85.7-91.4), and perfect concordance was 46.6% (95% CI: 42.2-51.1). Concordance differed significantly between hospitalists and specialists overall (p = .01), with a higher proportion of hospitalists having perfect concordance compared to specialists (67.2% vs. 57.8%, p = .002). CONCLUSIONS The consult classification framework was found to be applicable to consults from five different IM specialties, and could improve communication and education.
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Affiliation(s)
- Rushad Patell
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Hematology and Hematologic Malignancies, Boston, Massachusetts, USA
| | - Joséphine A Cool
- Section of Hospital Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Division of General Medicine, Boston, Massachusetts, USA
| | - Elise Merchant
- Tufts University School of Medicine, Harvard Medical School, Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, Massachusetts, USA
| | - Laura E Dodge
- Department of Obstetrics and Gynecology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Daniel N Ricotta
- Section of Hospital Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Division of General Medicine, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Shapiro Institute for Education and Research, Boston, Massachusetts, USA
| | - Brian Persaud
- Department of Medicine, University of Illinois at Chicago Medical Center, Chicago, Illinois, USA
| | - Larissa K Gomez
- Nephrology Associates Inc., East Providence, Rhode Island, USA
| | - Lauren Yang
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston, Massachusetts, USA
| | - Alison Trainor
- Massachusetts General Medical Center, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, USA
| | - Brian Carney
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Hematology and Hematologic Malignancies, Boston, Massachusetts, USA
| | - Jeffrey William
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, Massachusetts, USA
| | - Stewart Lecker
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, Massachusetts, USA
| | - Miranda Theodore
- Massachusetts General Medical Center, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, USA
| | - Camille Petri
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, Massachusetts, USA
| | - Douglas Horst
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Nephrology, Boston, Massachusetts, USA
| | - Daniel Stein
- Brigham and Women's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology & Endoscopy, Boston, Massachusetts, USA
| | - Natalia Forbath
- Center for Health Care Delivery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abdul Azim
- Rutgers Robert Wood Johnson Medical School, Division of Infectious Diseases, Allergy and Immunology, New Brunswick, New Jersey, USA
| | - Andrew J Hale
- University of Vermont Health Network, Burlington, Vermont, USA
| | - Jason A Freed
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Hematology and Hematologic Malignancies, Boston, Massachusetts, USA
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Lohiya A, Dhaniwala N, Dudhekar U, Goyal S, Patel SK. A Comprehensive Review of Treatment Strategies for Early Avascular Necrosis. Cureus 2023; 15:e50510. [PMID: 38226130 PMCID: PMC10788237 DOI: 10.7759/cureus.50510] [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: 11/20/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
Avascular necrosis (AVN), characterised by compromised blood supply leading to bone necrosis, poses a significant challenge in orthopaedic and rheumatologic practice. This review comprehensively examines early AVN treatment strategies, including aetiology and risk factors, clinical presentation, conservative and surgical approaches, emerging therapies, and rehabilitation. Key findings underscore the importance of early detection, personalised treatment plans, and a multidisciplinary approach involving orthopaedic specialists, rheumatologists, and physical therapists. The implications for clinical practice emphasise individualised care, staying abreast of emerging therapies, and patient education. Recommendations for future management strategies highlight the need for imaging technology advancements, regenerative therapies integration, and ongoing research into genetic and molecular pathways. As the field continues to evolve, translating research findings into clinical practice holds promise for improving outcomes and enhancing the overall quality of life for individuals affected by AVN.
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Affiliation(s)
- Ashutosh Lohiya
- Department of Orthopaedics and Traumatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nareshkumar Dhaniwala
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ulhas Dudhekar
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Saksham Goyal
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Siddharth K Patel
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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