bluuebunny/crossref_metadata_2025_split huggingface dataset:
CONNECT Workshops to Enhance Physician and Patient Experience: Interviews Reveal the Physician Perspective
Authors: Scott Jennifer E. , Jacob-Files Elizabeth , Baden Harris P. 
Published: June 2019

Introduction:
Physicians’ relationships with patients are a critical determinant of job satisfaction, and patients who experience compassionate care have better outcomes. The CONNECT workshop at Seattle Children’s teaches communication strategies to optimize both patient and physician experience. This article describes participants’ experiences during the workshops and the impact on their subsequent behaviors and satisfaction.

Methods:
Thirteen semistructured interviews were conducted with physicians, representing 11 specialties. Researchers used a series of immersion-crystallization cycles through which they iteratively immersed themselves in the data by reviewing all transcripts and coming up with key themes. According to thematic findings, they adjusted the interview guides, adding or deleting probes. After crystallizing an initial list of key themes, they created a codebook, coded using qualitative analysis software and met after coding each transcript to discuss their codes, add, and change codes, and recode when necessary.

Results:
Researchers identified 2 thematic responses concerning workshop experience. Physicians valued colleague interaction (Theme A) and appreciated the nonprescriptive curriculum (Theme B). Likewise, 3 themes reflecting workshop impact also emerged. Physicians reported the workshop encouraged presence and self-awareness during patient encounters (Theme C). They learned to address patient-driven concerns (Theme D), and learned empathetic strategies to connect more deeply with patients (Theme E).

Conclusion:
This study offers perspectives from a diverse group of physicians concerning their experience with the communication workshop, including the opportunity for physicians to focus on self-discovery, authenticity, connect on a deeper level with colleagues, and adopt key strategies to enhance interactions with patients.
Implementation and Evaluation of a Standard Operating Procedure for Pediatric Infliximab Infusions
Authors: Kelly Maureen M. , Turner Barbara S. , Kappelman Michael D. , Lee Eun Jeong , Gulati Ajay S. 
Published: June 2019

Background:
The purpose of this quality improvement project was to decrease care variation regarding infliximab delivery at a pediatric inflammatory bowel disease (IBD) center. This variation was driven by differences in provider and nurse practices within 2 distinct infliximab administration units in our center. Following the development of an infusion protocol, the primary project goal was to assess improvement in the submission and completion of a protocol-specific preinfusion safety checklist.

Methods:
The infusion protocol was developed based on the standard of care and expert physician opinion. A safety checklist was created to screen for active IBD symptoms and infection. We utilized continuous quality improvement to evaluate and guide the implementation of this preinfusion checklist. Checklist completion was assessed monthly over 15 months. We also conducted focus group interviews with infusion nurses and physicians to solicit qualitative protocol feedback.

Results:
We used standard run chart rules and identified a shift in the median completion rate for both units, with no trends or astronomical points. The baseline period was defined as the 6-month post-checklist implementation. The median baseline completion rate for 1 unit was 46%, and during the subsequent 9 months, the rate increased to 81%. In the other unit, the median baseline completion rate was 91%, and during the succeeding 9 months, the rate was 95%. Focus group feedback included themes of quality, communication, safety, and efficiency and helped improve the protocol.

Conclusions:
Feasibility was established for a standardized protocol to improve completion of a preinfusion safety checklist in children with IBD who receive infliximab. Nurse and physician focus group feedback was important for guiding protocol refinements.
A Project-based Curriculum for Driving Organization-wide Continuous Improvement
Authors: Harte Lory D. , Reddy Mamta , Marshall Lisa K. , Mroczka Kevin J. , Mann Keith J. 
Published: June 2019

Background:
Creating the capacity and capability for meaningful improvement in healthcare quality is a challenge many organizations face. Before 2012, Children’s Mercy sponsored 20 leaders to obtain advanced improvement training from peer organizations. Recognizing an opportunity to build upon this momentum, we developed an organization-wide curriculum for teaching continuous improvement.

Methods:
A steering committee was created in 2011 to define, advise, and oversee education in improvement science. We agreed upon a framework for improvement, a program name [Continuous Quality and Practice Improvement (CQPI)], and a phased curriculum development approach, beginning with a project/experiential learning based course (Team CQPI). Course evaluation for Team CQPI consisted of a standard evaluation of objectives, pre- and post-course assessment, qualitative feedback, and serial assessment of project progress using the Team Assessment Score (TAS). The curriculum committee monitored improvement.

Results:
From 2012 to 2017, 297 people participated in the project-based course, completing a total of 83 projects. TAS improved throughout the 4-month project-based course, from an average starting score of 1 (“forming a team”) to 2.7 (“changes tested”). The average TAS at 12 months following completion of the Team CQPI course was 3.5 (“improvement”) out of 5.

Conclusions:
Development of a comprehensive curriculum for driving continuous improvement has resulted in a measurable change in TAS scores representative of local improvement efforts.
Increasing Trichomonas vaginalis testing for high-risk adolescents a pediatric emergency department
Authors: Stukus Kristin S. , Buckingham Don , Cohen Daniel M. 
Published: June 2019

Background:
Trichomonas is a common sexually transmitted infection (STI) among adolescents, causing vaginal discharge, pelvic pain, and dysuria. Affected individuals have increased susceptibility to other STIs and may have pregnancy complications. A quality improvement project was developed to increase trichomonas testing among high-risk adolescent patients from 40% in July 2014 to 100% by December 31, 2014, and sustain over 6 months.

Methods:
An interdisciplinary team (providers and support staff) was assembled to address this objective. We collected 6 months of baseline data. Deploying the Institute for Healthcare Improvement Model for Improvement, we formulated an aim statement and identified key drivers. We used cause analysis to identify interventions for each problem area. Multiple Plan-Do-Study-Act cycles were undertaken, and results were monitored using control charts. Interventions included increasing awareness and education for clinical staff; changing computer order entry for the test; using order sets for STI; and adding a Licensed Professional Initiated Protocol to nurse ordering practice. These interventions were all done in conjunction with feedback to providers for individual missed cases.

Results:
Over 18 months, the trichomonas testing rate rose with each intervention: from 25% (January 2014) to 98% (December 2014), which we have sustained through June 2015.

Implications and Contributions:
This article demonstrates the successful use of quality improvement methodology to increase rates of Trichomonas vaginalis testing among at-risk adolescent patients. Increased testing results in increased detection and improved treatment and sexual health for our patients.

Conclusion:
Improving the trichomonas testing process in the pediatric emergency department results in higher screening rates among high-risk adolescent patients.
Transforming an Autism Pediatric Research Network into a Learning Health System: Lessons Learned
Authors: Murray Donna S. , S. Anixt Julia , Coury Daniel L. , Kuhlthau Karen A. , Seide Janet , Kelly Amy , Fedele Angie , Eskra Diane , Lannon Carole 
Published: June 2019

Introduction:
The Autism Speaks Autism Treatment Network that serves as the Autism Intervention and Research Network on Physical Health (ATN/AIR-P) has a mission to improve the health and well-being of children with Autism Spectrum Disorder and determine the best practices that lead to improved outcomes and expedite the translation of findings to practice. To better achieve this mission, the ATN/AIR-P is engaging in a design process to transition to a Learning Network (LN), the Autism Learning Health Network. The purpose of this paper is to: (1) make the medical and patient communities aware of an Autism LN that is based on the Institute of Medicine’s definition of a Learning Health System; (2) describe how and why the ATN/AIR-P transformed to an LN; and (3) share lessons learned that might inform the transition of future existing networks surrounding other conditions.

Methods:
Design methods included: an in-person design session with various stakeholders, the development of a Key Driver Diagram and redesign of organizational processes, network governance, and data collection and analytics.

Results:
We realized many benefits in making the transition to an LN along with many lessons that can inform the design and implementation of the LN model when transforming existing networks to learning health systems.

Conclusions:
Transitioning a well-established research network requires a complex redesign of existing processes, data infrastructure, and cultural shifts compared with developing a new LN. We identified factors that may inform the transition of future established networks to expedite the process.
A Framework for Maintenance and Scaling of an Evidence-based Guideline Program
Authors: Seneski Annie , Stack Anne M. 
Published: June 2019

Introduction:
Use of Evidence-based Guidelines (EBGs) has been shown to improve and standardize care. After implementation and maturation of a guideline program, next steps include incorporating new evidence, sustaining adherence, minimizing measurement burden and fostering scaling of the program. We propose a framework for maintenance and dissemination of an EBG program.

Methods:
Using a program of 28 EBGs developed for use in a pediatric emergency department (ED) in 2010, we developed: a framework for iterative review and revision, a strategy to measure ongoing use in practice and an approach for minimizing repeated measurement sufficient to evaluate outcomes. Also, we created a process to spread the EBG program to the hospital's Department of Pediatrics.

Results:
The framework for maintenance and spread of a program of EBGs resulted in an annual review of individual guidelines with 14 revisions warranted by new evidence, some leading to decreased medication utilization and hospitalization rates. We demonstrated adherence to key quality measures, and decreased the number of measures from 89 to 43, retiring 46 measures with stable peformance. We spread the process for program development to the hospital pediatric department resulting in 36 new EBGs.

Conclusions:
We developed a framework for maintenance and scale of a program of EBGs. Our key learning points were that regular incorporation of new evidence, assessment and feedback on performance and leadership with administrative support are necessary to maintain improvement. This framework may assure sustainability and inform other guideline programs. We offer processes to promote guideline dissemination within an academic hospital.
Design and Development of Daily Morning Surgical Rounds in ICU by Quality Function Deployment
Authors: Tripathi Sandeep , Naevor Ann J. , Henrekin LaMonica L. , Welke Karl F. 
Published: June 2019

Objective:
Most healthcare quality improvement projects focus on change management rather than the design of the process. In this article, we describe the development of a new rounding model based on quality function deployment, a Design for Six Sigma tool.

Methods:
We used affinity diagram, focus groups, and Kano analysis to identify critical customer requirements. We also used Kano analysis to determine the design team’s ability to meet the requirements. We then completed a correlation matrix (House of Quality).

Results:
Fifteen quality characteristics were analyzed on a correlation matrix to meet 15 demanded qualities. Numerical values were calculated based on the interactions identified by the design team. We designed a new rounding model based on the House of Quality; this new rounding model resulted in higher provider satisfaction (median 76–80%, P = 0.06).

Conclusions:
We have described a sophisticated approach to the design of a new change strategy/intervention. This technique can be used as a starting point for other projects attempting to implement meaningful changes for complex processes of medical care.
Decreasing Time to Antibiotics for Patients with Sepsis in the Emergency Department
Authors: Emerson Beth L. , Ciaburri Rebecca , Brophy Cheryl , Kandil Sarah B. 
Published: June 2019

Background:
Sepsis is a significant cause of morbidity and mortality. Patients may present in a spectrum, from nonsevere sepsis through septic shock. Literature supports improvement in patient outcomes with timely care. This project describes an effort to improve delays in antibiotic administration in patients with sepsis spectrum disease presenting to a pediatric emergency department (PED).

Objective:
This project aimed to decrease time to antibiotics for patients with sepsis in the PED from 154 to <120 minutes within 2 years.

Methods:
Following the collection of baseline data, we assembled a multidisciplinary team. Specific interventions included staff education, the institution of a best practice alert with order set and standardized huddle response, and local stocking of antibiotics. We included all patients with orders for intravenous antibiotics and blood culture.

Results:
From April 2015 to April 2017, the PED demonstrated reduction in time to antibiotics from 154 to 114 minutes. The time from emergency department (ED) arrival to antibiotic order also improved, from 87 to 59 minutes.

Conclusions:
This initiative improved prioritization and efficiency of care of sepsis, and overall time to antibiotics in this population. The results of this project demonstrate the effectiveness of a multidisciplinary team working to improve an essential time-driven process.
Hemisphere-Specific Properties of the Ventriloquism Aftereffect in Humans and Monkeys
Authors: Kopčo Norbert , Lokša Peter , Lin I-fan , Groh Jennifer , Shinn-Cunningham Barbara 
Published: June 2019

ABSTRACTVisual calibration of auditory space requires re-alignment of representations differing in 1) format (auditory hemispheric channels vs. visual maps) and 2) reference frames (head-centered vs. eye-centered). Here, a ventriloquism paradigm from Kopčo et al. (J Neurosci, 29, 13809-13814) was used to examine these processes in humans and monkeys for ventriloquism induced within one spatial hemifield. Results show that 1) the auditory representation is adapted even by aligned audio-visual stimuli, and 2) the spatial reference frame is primarily head-centered in humans but mixed in monkeys. These results support the view that the ventriloquism aftereffect is driven by multiple spatially non-uniform processes.PACS numbers: 43.66.Pn, 43.66.Qp, 43.66.Mk
Human subsystems of medial temporal lobes extend locally to amygdala nuclei and globally to an allostatic-interoceptive system
Authors: Ruiz-Rizzo Adriana L. , Beissner Florian , Finke Kathrin , Müller Hermann J. , Zimmer Claus , Pasquini Lorenzo , Sorg Christian 
Published: June 2019

AbstractIn mammals, the hippocampus, entorhinal, perirhinal, and parahippocampal cortices (i.e., core regions of the human medial temporal lobes, MTL) are locally interlaced with the adjacent amygdala nuclei at the structural and functional levels. At the global brain level, the human MTL has been described as part of the default mode network whereas amygdala nuclei as parts of the salience network, with both networks forming collectively a large-scale brain system supporting allostatic-interoceptive functions. We hypothesized (i) that intrinsic functional connectivity of slow activity fluctuations would reveal human MTL subsystems locally extending to the amygdala; and (ii) that these extended local subsystems would be globally embedded in large-scale brain systems supporting allostatic-interoceptive functions. From the resting-state fMRI data of three independent samples of cognitively healthy adults (one main and two replication samples: Ns = 101, 61, and 29, respectively), we analyzed the functional connectivity of fluctuating ongoing BOLD-activity within and outside the amygdala-MTL in a data-driven way using masked independent component and dual-regression analyses. We found that at the local level MTL subsystems extend to the amygdala and are functionally organized along the longitudinal amygdala-MTL axis. These subsystems were characterized by a consistent involvement of amygdala, hippocampus, and entorhinal cortex, but a variable participation of perirhinal and parahippocampal regions. At the global level, amygdala-MTL subsystems selectively connected to salience, thalamic-brainstem, and default mode networks – the major cortical and subcortical parts of the allostatic-interoceptive system. These results provide evidence for integrated amygdala-MTL subsystems in humans, which are embedded within a larger allostatic-interoceptive system.
Skill acquisition increases myelination and strengthens functional connectivity in the sensorimotor circuit of the adult rat
Authors: Sampaio-Baptista Cassandra , de Weijer Antoin , van der Toorn Annette , Otte Willem M. , Winkler Anderson M. , Lazari Alberto , Salvan Piergiorgio , Bannerman David M. , Dijkhuizen Rick M. , Johansen-Berg Heidi 
Published: June 2019

ABSTRACTThe effects of skill acquisition on whole-brain structure and functional networks have been extensively investigated in humans but have yet to be explored in rodents. Forelimb reaching training in rodents results in well-established focal functional and structural reorganization within the motor cortex (M1) and cerebellum, indicating distributed alterations in both structure and function. However, it is unclear how local alterations in structure and function relate to distributed learning-related changes across motor networks. Here we trained adult rats in skilled reaching and used multimodal whole-brain in vivo MRI to assess both structural and functional plasticity over time.We detected increases in a myelin-related MRI metric in white matter, cortical areas, and to a lesser extent in the cerebellum, paralleled by strengthened functional connectivity between M1 and cerebellum, possibly reflecting a decrease in cerebellum inhibition over M1. Skill learning therefore leads to myelin increases in pathways that connect sensorimotor regions, and in functional connectivity increases between areas involved in motor learning, all of which correlate with performance. These findings closely mirror previous reports of network-level changes following motor learning in humans and underlines the correspondence between human and rodent brain circuits for motor learning, despite important differences in the anatomy of physiology of movement circuits between species.
In vitro and in vivo efficacy of the combination of colistin and endolysins against clinical strains of Multi-Drug Resistant (MDR) pathogens
Authors: Blasco L. , Ambroa A. , Trastoy R. , Perez-Nadales E. , Fernández-Cuenca F. , Torre-Cisneros J. , Oteo J. , Oliver A. , Canton R. , Kidd T. , Navarro F. , Miró E. , Pascual A. , Bou G. , Martínez-Martínez L. , Tomas M. ,   GEMARA SEIMC/REIPI Bacterial Clinical Adaptation Study Group
Published: June 2019

ABSTRACTThe multidrug resistance (MDR) among pathogenic bacteria is jeopardizing the worth of antimicrobials, which had previously changed medical sciences. In this study, we used bioinformatic tools to identify the endolysins ElyA1 and ElyA2 (GH108-PG3 family) present in the genome of bacteriophages Ab1051Φ and Ab1052Φ, respectively. The muralytic activity of these endolysins over MDR clinical isolates (Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae) was tested using the turbidity reduction assay. The minimal inhibitory concentrations (MICs) of endolysin, colistin and their combination were determined using the microdilution checkerboard method. The antimicrobial activity of the combinations was confirmed by time kill curves and in vivo assays in larvae of Galleria mellonella. Our results showed that ElyA1 displayed activity against all 25 strains of A. baumannii and P. aeruginosa tested and against 13 out of 17 strains of K. pneumoniae. No activity was detected when assays were done with endolysin ElyA2. The combined antimicrobial activity of colistin and endolysin ElyA1 yielded a reduction in the colistin MIC for all strains studied, except K. pneumoniae. These results were confirmed in vivo in G. mellonella survival assays. In conclusion, the combination of colistin with new endolysins such as ElyA1 could increase the bactericidal activity and reduce the MIC of the antibiotic, thus also reducing the associated toxicity.IMPORTANCEThe development of multiresistance by pathogen bacteria increases the necessity of the development of new antimicrobial strategies. In this work, we combined the effect of the colistin with a new endolysin, ElyA1, from a bacteriophage present in the clinical strain of Acinetobacter baumannii Ab105. ElyA1 is a lysozyme-like family (GH108-GP3), whose antimicrobial activity was described for first time in this work. Also, another endolysin, ElyA2, with the same origin and family, was characterized but in this case no activity was detected. ElyA1 presented lytic activity over a broad spectrum of strains from A. baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. When colistin was combined with ElyA1 an increase of the antimicrobial activity was observed with a reduced concentration of colistin, and this observation was also confirmed in vivo in Galleria mellonella larvae. The combination of colistin with new endolysins as ElyA1 could increase the bactericidal activity and lowering the MIC of the antibiotic, thus also reducing the associated toxicity.
iNetModels 2.0: an interactive visualization and database of multi-omics data
Authors: Arif Muhammad , Zhang Cheng , Li Xiangyu , Güngör Cem , Çakmak Buğra , Arslantürk Metin , Tebani Abdellah , Özcan Berkay , Subaş Oğuzhan , Zhou Wenyu , Piening Brian , Turkez Hasan , Fagerberg Linn , Price Nathan , Hood Leroy , Snyder Michael , Nielsen Jens , Uhlen Mathias , Mardinoglu Adil 
Published: June 2019

ABSTRACTIt is essential to reveal the associations between different omics data for a comprehensive understanding of the altered biological process in human wellness and disease. To date, very few studies have focused on collecting and exhibiting multi-omics associations in a single database. Here, we present iNetModels, an interactive database and visualization platform of Multi-Omics Biological Networks (MOBNs). This platform describes the associations between the clinical chemistry, anthropometric parameters, plasma proteomics and metabolomics as well as metagenomics for oral and gut microbiome obtained from the same individuals. Moreover, iNetModels includes tissue- and cancer-specific Gene Co-expression Networks (GCNs) for exploring the connections between the specific genes. This platform allows the user to interactively explore a single feature's association with other omics data and customize its particular context (e.g. male/female specific). The users can also register their own data for sharing and visualization of the MOBNs and GCNs. Moreover, iNetModels allows users who do not have a bioinformatics background to facilitate human wellness and diseases research. iNetModels can be accessed freely athttps://inetmodels.comwithout any limitation.