Mayo Clinic's Pulse Check: Health Opinions & Behaviors in America

One of the most pressing health issues of our time, the opioid epidemic is devastating communities — and driving health care professionals to examine and evaluate prescribing practices. The fifth Mayo Clinic National Health Checkup focuses on awareness and behaviors related to opioid use in pain management.

The full pdf can be downloaded below.  

The Digital Scribe

Current generation electronic health records suffer a number of problems that make them inefficient and associated with poor clinical satisfaction. Digital scribes or intelligent documentation support systems, take advantage of advances in speech recognition, natural language processing and artificial intelligence, to automate the clinical documentation task currently conducted by humans. Whilst in their infancy, digital scribes are likely to evolve through three broad stages. Human led systems task clinicians with creating documentation, but provide tools to make the task simpler and more effective, for example with dictation support, semantic checking and templates. Mixed-initiative systems are delegated part of the documentation task, converting the conversations in a clinical encounter into summaries suitable for the electronic record. Computer-led systems are delegated full control of documentation and only request human interaction when exceptions are encountered. Intelligent clinical environments permit such augmented clinical encounters to occur in a fully digitised space where the environment becomes the computer. Data from clinical instruments can be automatically transmitted, interpreted using AI and entered directly into the record. Digital scribes raise many issues for clinical practice, including new patient safety risks. Automation bias may see clinicians automatically accept scribe documents without checking. The electronic record also shifts from a human created summary of events to potentially a full audio, video and sensor record of the clinical encounter. Digital scribes promisingly offer a gateway into the clinical workflow for more advanced support for diagnostic, prognostic and therapeutic tasks.

The full article can be downloaded below.  

Developmental roadmap for antimicrobial susceptibility testing systems

Antimicrobial susceptibility testing (AST) technologies help to accelerate the initiation of targeted antimicrobial therapy for patients with infections and could potentially extend the lifespan of current narrow-spectrum antimicrobials. Although conceptually new and rapid AST technologies have been described, including new phenotyping methods, digital imaging and genomic approaches, there is no single major, or broadly accepted, technological breakthrough that leads the field of rapid AST platform development. This might be owing to several barriers that prevent the timely development and implementation of novel and rapid AST platforms in health-care settings. In this Consensus Statement, we explore such barriers, which include the utility of new methods, the complex process of validating new technology against reference methods beyond the proof-of-concept phase, the legal and regulatory landscapes, costs, the uptake of new tools, reagent stability, optimization of target product profiles, difficulties conducting clinical trials and issues relating to quality and quality control, and present possible solutions.

The full article can be downloaded below.  

Looking to the future of patient-centered cancer research and treatment

Over the past 40 years, cancer research has seen revolutionary discoveries — about genes, targeted drugs, and immune therapies — that have already had dramatic effects for some patients.

But to speed progress toward better therapies, we need another kind of revolution: We need to enable cancer patients to become active partners in research.

The full article from Reed Jobs and Eric S. Lander can be found at this link.  

The development of a clinical policy ethics assessment tool

Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals’ etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups.

The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and guidelines.

The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols’ ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity.

The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee.

Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test–retest reliability coefficient = 0.86, = 0.84, a1 = 0.817, a2 = 0.824 and interclass correlation coefficient = 0.874.

Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses’ education, values and quality of care.

Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice.

The full article can be downloaded below.  

New dimensions in smart wearable technology

The field of wearable technologies is a novel and promising emerging area that offers a number of benefits to users and healthcare professionals alike, enabling realtime monitoring of diseases, convenience and ease of use. Professor Shuenn-Yuh Lee of the Department of Electrical Engineering at National Cheng Kung University (NCKU), Taiwan, is immersed in this field and working on a project called ‘Guard Patch: An intelligent wearable wireless system with IoT and biosignal acquisition’.

This area of research is becoming increasingly important given the context of a rapidly ageing population and associated considerations of the prolificacy of chronic diseases, growing awareness of cost and emphasis on the importance of health monitoring. ‘Prevention is better than cure is an important concept in healthcare,’ highlights Lee. ‘To economise on the social cost and improve the quality of medical treatment, a platform capable of examination anywhere and anytime by itself should be developed, which can transmit personal examination data to the healthcare centre or hospital via the Internet or wireless communication systems.’

This led Lee to set up a research laboratory – the Communication and Biologic Integrated Circuit (CBIC) Lab – to develop the interactive intelligent healthcare and monitoring system (IIHMS). This system includes a body sensor network (BSN) and a local sensor network (LSN), with the BSN acting as the medium of communication between the wearable devices and the portable facility, and the LSN being the intermediate medium between the portable facility and the healthcare centre.

The full report can be downloaded below.  

Clinician opioid prescribing practices and patient utilization of prescribed opioids in pediatrics

Little is known regarding clinician prescribing of opioid medications and of patient use of prescribed opioid medications in pediatrics. The authors sought to learn more about pediatric clinician opioid prescribing practices and patient utilization and disposal of prescribed opioids. This was a cross-sectional, observational study that took place in a tertiary care pediatric healthcare center. Participants were pediatric clinicians who prescribe opioid medications and parents of children prescribed an opioid medication. Clinicians were surveyed about opioid prescribing practices for acute pain management in children, and parents were asked about utilization and disposal of prescribed opioids. Most clinician respondents (64 percent) reported prescribing opioid medications to manage acute pain. The typical length of opioid prescriptions was limited to 7 days (93 percent). Parents reported a high prevalence of leftover opioid medications (86 percent). Most (59 percent) did not dispose of the remaining medication. Ultimately, targets for intervention to reduce unnecessary opioid exposure in youth are identified.

The full article can be downloaded below.  

Shedding light on conditions for the successful passive dissemination of recommendations in primary care: a mixed methods study

Passive dissemination of information in healthcare refers to the publication or mailing of newly established guidelines or recommendations. It is one of the least costly knowledge translation activities. This approach is generally considered to be ineffective or to result in only small changes in practice. Recent research, however, suggests that passive dissemination could, under certain conditions, result in modifications of practice, similar to more active dissemination approaches. The objective of our study was to uncover the conditions associated with the change in primary care practice, namely Family Medicine Groups (FMGs) in Quebec (Canada), following the passive dissemination of recommendations for the diagnosis and management of Alzheimer’s disease and related dementia (AD).

We used a three-step, innovative, convergent mixed methods design based on a multiple case study in eight FMGs. Two studies were conducted in parallel: (1) a before and after retrospective chart review and a cluster analysis of FMGs performed on two clinical performance indicators—the rate of AD diagnosis and the quality of follow-up care; (2) a qualitative descriptive study using interviews and focus groups with FMG clinicians and healthcare managers. The results were integrated using joint displays. 

After the passive dissemination of the recommendations, some FMGs started to implement the recommendations while other FMGs did not change their practice with respect to the AD diagnosis rate and quality of follow-up care. Three interrelated conditions were identified for the successful passive dissemination of clinical recommendations: (1) FMG clinicians with a moderate to high baseline expertise and confidence, which was linked to their existing collaboration with hospital-based specialists in dementia and their motivation; (2) the presence of a self-identified champion (individual champion or collective championship) in the FMGs taking the lead, motivating the clinical staff or organizing training; (3) the availability of sufficient clinical staff enabled these two conditions to have an impact on the implementation of recommendations through passive dissemination.

Passive dissemination of clinical recommendations, a low-cost knowledge translation approach, may lead to practice change under some specific conditions. More active dissemination efforts may only be needed in sites where these conditions are absent.

The full article can be downloaded below.  

Lessons from Mayo Clinic’s Redesign of Stroke Care

Facing escalating costs of medications and technology, health care patients and providers in the United States continue to search for opportunities to reduce overall costs while maintaining and improving health care outcomes. At the Mayo Clinic Comprehensive Stroke Center Practice, we conducted a project to design and deliver care more customized to the needs of individual patients while reducing cost and resource constraints. It is a risk-stratified approach that could be applied to treating many medical conditions.

The team saw an opportunity to reduce costs based upon how and where patients received care, while still meeting Joint Commission requirements for post-TPA care, by treating low-risk patients in a NSPCU-level bed with a specialized hybrid level of nursing care (see the table below) for the first 12 hours. This risk-stratified care model improved value by delivering equivalent care quality with a lower-cost mix of resources. In addition, the stratification process allowed for better “demand elasticity” of ICU bed utilization.

The full article can be viewed at this link.  

Negotiating Relation Work with Telehealth Home Care Companionship Technologies that Support Aging in Place

In response to a perceived caregiver shortage and need to support aging in place, telehealth home care systems are being developed to provide remote care and monitoring to older people. Tough research has examined the experiences of teleoperators delivering care through these systems, we know less about the experiences of older adults receiving this care. We report findings from a three-month study of a tablet-based telehealth home care system that provides support for aging in place. We find that there is a mismatch between the designer’s conception of how care should be delivered and the ways that participants were interested in using the system. Tis mismatch exists in four areas: participants’ interest in geting to know the human teleoperators and rejecting the virtual avatar, interrogating the interface to figure out the inner workings of the platform, pushing for a more symmetrical relationship, and negotiating the relation work that they were willing to perform in the “sacred space” of their homes. We draw on the concept of heteromation to understand the political dimensions of telehealth aging in place technologies. We also provide implications and future directions for technologies requiring relation work as well as the design of avatar-based remote companionship.

The full paper can be downloaded below.