Rhode Island medical journal (2013)最新文献

Background: Triage, the process of organizing and prioritizing patient interventions, is a fundamental aspect of emergency departments. This study focuses on the implementation of the recently developed triage tool for resource-limited settings - the Interagency Integrated Triage Tool (IITT) at the Bayalpata Hospital (BH) Emergency Department located in rural Nepal.

Methods: The study involved training healthcare workers and implementing the IITT. Pre- and post- implementation surveys of these healthcare workers were completed. Patient surveys gauged satisfaction and wait times.

Results: Pre-implementation surveys revealed limited prior training, subjective triage methods, and identified barriers to appropriate triage. Post-implementation surveys showed improved staff comfort and understanding of triage and demonstrated a shift in reported barriers.

Conclusions: The study highlights the challenges faced by a low-resource rural emergency department. The IITT implementation addressed staff concerns, particularly regarding training, but ongoing education and addressing spatial limitations were persisting barriers.

Improving the well-being of healthcare workers (HCWs) requires embedding well-being into healthcare operations. However, limitations of current well-being metrics serve as barriers for healthcare systems to address well-being in the same manner as other operational challenges, such as patient access and safety. Identification and measurement of Work Determinants of Well-Being (WDOW), organizationally attributable characteristics that are related to HCW health and well-being, are necessary first steps for healthcare institutions to take a systems approach to well-being. By leveraging existing data within healthcare systems, we describe how we built a well-being analytics team and database to identify WDOW. We use a case example of Paid Time Off (PTO) utilization to illustrate the potential of this approach to reduce burnout and improve well-being among HCWs.

Background: The evolution from the Triple Aim to the Quintuple Aim has highlighted physician well-being as crucial for healthcare delivery. While evidence- based interventions exist, implementing sustainable well- being initiatives remains challenging for healthcare organizations.

Design: This report demonstrates how three established business frameworks - McKinsey 7S Framework, Kotter's 8-Step Change Model, and PESTEL analysis - can be adapted to implement physician well-being initiatives in healthcare settings.

Results: These frameworks analyzed three initiatives: promoting break-taking behaviors (McKinsey 7S), transitioning from a sick-call to a back-up call system (Kotter's model), and updating Work-Family-Career Guidelines (PESTEL). Each framework provided unique insights: 7S enabled systematic organizational alignment, Kotter's model facilitated change management, and PESTEL assessed external factors influencing implementation.

Conclusion: Adapting business frameworks to healthcare settings provides structured approaches for implementing physician well-being initiatives, demonstrating how cross-sector tools can advance the Quintuple Aim while addressing systemic drivers of burnout.

Cardiac magnetic resonance imaging (CMR) is an exciting noninvasive imaging modality with increasing utilization in the field of cardiovascular medicine. In conjunction with echocardiogram, computed tomography, and invasive therapies, CMR has provided exceptional capability to further evaluate complex clinical cardiac conditions. CMR provides both anatomical and physiological information of a variety of tissue types, without the need for ionizing radiation. This article aims to first review basic principles of CMR and later discuss MRI's role in diagnosis of cardiomyopathy and treatment implications.

Background: Orthopedic trauma patients are at high risk for venous thromboembolic (VTE) complications. Despite this, VTE prophylaxis is often held peri-operatively out of concern for increased bleeding and associated complications. This review's purpose is to examine guidelines and studies on withholding prophylactic anticoagulation peri-operatively.

Methods: A narrative review was created using a PubMed systematic literature search with a Boolean approach and these terms: venous thromboembolism, trauma, orthopedic surgery, prophylaxis.

Results: The Western Trauma Association recommends uninterrupted VTE prophylaxis throughout all planned operations, except in very select cases. Most other major trauma and orthopedic societies give no specific recommendations. No current high-quality, randomized control trials investigating this exist; however, emerging studies demonstrate no increased risk of clinically significant hemorrhage when VTE prophylaxis was continued.

Conclusions: There is not compelling evidence or major societal consensus supporting VTE prophylaxis interruption for orthopedic trauma surgery. Therefore, continuation may be safe, potentially reducing patient morbidity.

Objectives: Knee Osteoarthritis (OA) is one of the most frequently encountered conditions in orthopedic practice. This study aimed to validate the Knee Intake Patient Survey (KIPS), a short-form questionnaire designed to assist in the initial diagnosis and treatment stratification for knee OA.

Methods: Patient intake survey results from a single adult reconstruction clinic were retrospectively analyzed alongside clinical diagnoses and treatment recommendations. The KIPS total score and individual question responses were assessed for their correlation with a diagnosis of knee OA versus other knee pathologies, as well as treatment decisions.

Results: Higher total KIPS scores were significantly associated with a diagnosis of knee OA and increased likelihood of surgical recommendation, while lower scores correlated with alternative diagnoses (e.g., patellofemoral arthritis or knee internal derangement) and physical therapy recommendations. A KIPS threshold score of ≥10 maximized the specificity (94.4%) for diagnosing knee OA.

Conclusions: The KIPS questionnaire effectively differentiates knee OA from other pathologies and stratifies patients for treatment recommendations. Incorporating validated tools like KIPS may enhance clinical efficiency and support future AI-driven diagnostic models in orthopedic care.

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, necessitating advancements in diagnostic techniques. Coronary CT angiography (CCTA) has emerged as a pivotal non-invasive tool for evaluating coronary artery anatomy and detecting atherosclerotic plaque burden with high spatial resolution. This review explores the evolution of CCTA, highlighting its technological advancements, clinical applications, and challenges. Key innovations such as multidetector CT, photon-counting CT, and functional assessment tools like FFR-CT have enhanced CCTA's diagnostic and prognostic capabilities. Despite these advancements, issues related to radiation exposure, iodinated contrast, and patient-specific limitations persist. Future directions include the development of novel imaging biomarkers and strategies to minimize radiation exposure. By synthesizing existing literature and recent developments, this paper provides a comprehensive understanding of CCTA's role in contemporary CAD management.

Cardiac Positron Emission Tomography (PET) is a power- ful imaging tool with diverse applications in the detection and diagnosis of various cardiac conditions, including inflammatory, infectious, and neoplastic processes. Using the radiotracer 18F-fluorodeoxyglucose (18F-FDG), cardiac PET enables the identification of cardiac involvement in diseases such as sarcoidosis and severe infections affecting the heart tissue. Additionally, 18F-FDG PET is valuable in the evaluation of cardiac masses, helping to assess their metabolic activity and potential malignancy. As a non-invasive imaging modality, 18F-FDG PET provides crucial insights into the pathophysiology of cardiac diseases, aiding in early diagnosis, therapeutic decision-making, and monitoring of treatment response.

Cardiac amyloidosis (CA) is an infiltrative disease that results from the deposition of amyloid fibrils in the myocardium, resulting in restrictive cardiomyopathy. The amyloid fibrils are predominantly derived from two parent proteins, immunoglobulin light chain (AL) and transthyretin (ATTR), and ATTR is further classified into hereditary (ATTRv) and wild-type (ATTRwt) based on the presence or absence, respectively, of a mutation in the transthyretin gene. Once thought to be a rare entity, CA is increasingly recognized as a significant cause of heart failure due to improved clinical awareness and better diagnostic imaging. Advances in multimodality imaging, including echocardiography, cardiac magnetic resonance imaging, and CA radionuclide imaging, have markedly enhanced the non-invasive detection of this condition. While ATTR can often be diagnosed with CA radionuclide imaging in conjunction with the absence of paraproteinemia, the diagnosis of AL typically requires histological confirmation. This review, with the help of a case presentation, highlights the critical role of noninvasive imaging modalities in early detection and quantification of disease burden, which are crucial for timely treatment and improvement in patient outcomes.

Chest pain is one of the most common chief complaints seen in both the emergency department (ED) and primary care settings.1,2 It is estimated that 20-40% of the general population will suffer from chest pain at some point throughout their lives.3 Interestingly although obstructive coronary artery disease (CAD) prevalence has declined, chest pain as a presenting symptom has become increasingly common over the last decade.4 Chest pain can stem from different organ systems including cardiac, pulmonary, gastrointestinal, musculoskeletal, or psychiatric.5,6 However, only about 18% of chest pain is diagnosed as cardiac in nature.7 Cardiac chest pain, in itself, has a broad differential including ischemic CAD, but can also be a result of non-ischemic causes such as valvopathies, myocarditis, pericarditis, aortic dissection, or heart failure.8 Ischemic chest pain can be broken into life-threatening acute coronary syndrome (ACS), unstable angina, or stable angina. Discerning the etiology of chest pain based on history and physical exam alone is challenging as symptomatology can overlap with multiple organ systems.9 Therefore, physicians often rely on testing to reach a diagnosis, a practice which costs the United States healthcare system billions of dollars per year.4 In this review, we aim to identify the cardiac-testing modalities available to clinicians to accurately diagnose a cause of chest pain and consider which test might be most appropriate for patients evaluated in the ambulatory or ED setting.