Journal of the National Medical Association最新文献_第9页

Digital Transformation in Healthcare: Optimizing Operations for Sustainable Growth 医疗保健领域的数字化转型：优化运营，实现可持续增长

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.063

M. Rami Bailony M.D., M.S

{"title":"Digital Transformation in Healthcare: Optimizing Operations for Sustainable Growth","authors":"M. Rami Bailony M.D., M.S","doi":"10.1016/j.jnma.2024.07.063","DOIUrl":"10.1016/j.jnma.2024.07.063","url":null,"abstract":"<div><p>In the dynamic healthcare landscape, digital tools play a pivotal role in elevating medical practices. This talk delves into the integration of Remote Patient Monitoring (RPM), Telehealth, Customer Relationship Management (CRM) systems, ChatGPT and Virtual ancillary staff, therapists, and medical assistants as key components in digitally transforming healthcare operations.</p><p>Illustrating Enara health's digital strategy, the talk also highlights the impact of other leading RPM platforms like Optimize Health, Cadence Solutions, HealthSnap, Athelas, Health Recovery Solutions, Accuhealth, and TimeDoc Health in improving healthcare accessibility. These platforms allow clinics to digitally extend themselves, eliminating geographically associated costs with real-time data tracking and streamlined communication. The shift to digital platforms represents a strategic, cost-saving initiative. Leveraging these tools streamlines operations, automates tasks, and enhances productivity, resulting in substantial operational cost reductions.</p><p>Telehealth emerges as a pivotal solution, providing patients with convenient access to healthcare services from home while reducing providers' physical office space costs. Simultaneously, Virtual Assistant staffing contributes significantly to cost savings for physician business owners by eliminating the need for a physical office presence. Adding therapists to our virtual startup also means patients can receive comprehensive care in one place, minimizing the need for external consultations. Lastly, using ChatGPT can assist physicians by handling tasks suitable for AI solutions, making their workload more manageable.</p><p>The paper advocates for the strategic adoption of these digital solutions to optimize healthcare operations, improve customer satisfaction, and foster sustainable business growth in the evolving healthcare landscape.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 438-439"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inflammatory Arthritis in a Patient with Common Variable Immunodeficiency (CVID) 常见变异性免疫缺陷病（CVID）患者的炎症性关节炎

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.013

Dan Trung Nguyen MS, Dominic Dizon MD

{"title":"Inflammatory Arthritis in a Patient with Common Variable Immunodeficiency (CVID)","authors":"Dan Trung Nguyen MS, Dominic Dizon MD","doi":"10.1016/j.jnma.2024.07.013","DOIUrl":"10.1016/j.jnma.2024.07.013","url":null,"abstract":"<div><h3>Introduction</h3><p>CVID is the most common primary immunodeficiency in adults. It is defined as poor response to vaccines and low immunoglobulins, excluding other causes. Paradoxically, one of the most common complications of CVID is autoimmunity involving many systems. However, these usually resolve or improve with immunoglobulin injection. Here, we present a rare case of a patient with inflammatory arthritis that progressively worsened despite treatments.</p></div><div><h3>Method</h3><p>Case report with literature review</p></div><div><h3>Result</h3><p>A 55-year-old male with history of hypothyroidism, granuloma annulare, common variable immunodeficiency, and osteoporosis presented with arthralgia. The pain and swelling involved most of the hand joints, bilateral wrists, elbows, and knees. He has been receiving weekly subcutaneous immunoglobulin G without complications. The treatment regimen involved hydroxychloroquine, methotrexate that was replaced with leflunomide, and chronic use of low-dose oral prednisone that led to osteoporosis. Physical exam revealed mild synovitis and tenderness at all joints of the hand and wrists. Autoimmune markers are all negative except for positive ANA. Recent hand radiogram showed mild erosion of the right fifth proximal phalanx. The patient did not show improvement with the regimen, and discussion would be made with immunologists and rheumatologists to consider additional treatments.</p></div><div><h3>Discussion</h3><p>Autoimmunity in CVID can involve inflammatory arthritis symptoms mostly resolved with immunoglobulin injection and treatment regimen. The case report showed a rare scenario and emphasized the unpredictable response to standard arthritis treatments. More clinical trials on the effect of medication on CVID complications are needed, and these patients require more careful monitoring with multiple specialty professionals.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 415"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

α-1AG is a Useful Urinary Biomarker In Proliferative Lupus Nephritis α-1AG是增殖性狼疮性肾炎的有用尿液生物标记物

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.018

Leshaia Davis-Johnson BS, Rebecca Lightman BS, Conner Lynn BS, Dawn Caster BS, David Powell PhD, Nicholas Short PhD

{"title":"α-1AG is a Useful Urinary Biomarker In Proliferative Lupus Nephritis","authors":"Leshaia Davis-Johnson BS, Rebecca Lightman BS, Conner Lynn BS, Dawn Caster BS, David Powell PhD, Nicholas Short PhD","doi":"10.1016/j.jnma.2024.07.018","DOIUrl":"10.1016/j.jnma.2024.07.018","url":null,"abstract":"<div><h3>Purpose</h3><p>Lupus nephritis (LN) is kidney inflammation and injury that commonly results from systemic lupus erythematosus (SLE). Neutrophils contribute to LN is by releasing contents from preformed granules that damage the kidney. Neutrophils release α-1 acid glycoprotein (α-1AG) in secondary and tertiary granules. The purpose of this study was to investigate α-1AG as a candidate biomarker in proliferative lupus nephritis.</p></div><div><h3>Methods</h3><p>ELISAs were used to measure α-1AG in urine from patients with proliferative lupus nephritis, membranous lupus nephritis, minimal change disease (MCD), membranous glomerulonephritis (MGN), and healthy donor (HD) controls. α-1AG was also measured in neutrophil supernatants. Logistic regression was used to generate a receiver operating characteristic (ROC) curve, which provided an optimal cutoff concentration. Comparisons of all groups were analyzed using a Kruskal-Wallis test with post-hoc corrected Dunn's tests. Paired LN patient samples (active LN dates to inactive LN) were compared using a two-tailed Wilcoxon matched pairs signed rank test with Bonferroni correction for multiple comparisons.</p></div><div><h3>Results</h3><p>A-1AG are significantly more abundant in urine of Active proliferative LN patients’ more α-1AG than HD, patients with membranous LN, MCD, or MGN. An optimal cutoff concentration was determined using ROC curves at 89,230.77 ng/mL.</p></div><div><h3>Conclusion</h3><p>⍺-1AG appears to be a promising diagnostic marker for proliferative LN. Moreover, it also appears to be a marker for disease activity in proliferative LN. Neutrophils may release some of the ⍺-1AG that appears in LN patients’ urine. The role of neutrophil-derived ⍺-1AG on renal injury remains to be determined.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 418"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Increasing naloxone distribution in Black Communities: A case study 增加黑人社区的纳洛酮分发量：案例研究

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.032

T.J. Winhusen Ph.D., Patricia L. Brown MBA, MSSA, LISW-S, LICDC-CS, Tina I. Ernst JD, BA, Timothy I. Ingram MS, RS, Kamaria A. Tyehimba PhD, LISW-S, LICDC-CS

{"title":"Increasing naloxone distribution in Black Communities: A case study","authors":"T.J. Winhusen Ph.D., Patricia L. Brown MBA, MSSA, LISW-S, LICDC-CS, Tina I. Ernst JD, BA, Timothy I. Ingram MS, RS, Kamaria A. Tyehimba PhD, LISW-S, LICDC-CS","doi":"10.1016/j.jnma.2024.07.032","DOIUrl":"10.1016/j.jnma.2024.07.032","url":null,"abstract":"<div><h3>Purpose</h3><p>Recent years have seen a dramatic increase in opioid-related overdose deaths in Black individuals. Naloxone is an opioid overdose antidote that works by blocking and displacing opioid agonists at the mu opioid receptor within seconds after administration. However, stigma has been a barrier to achieving wide-spread naloxone distribution in Black communities. We provide a case study from the HCS in which a partnership in Hamilton County, Ohio facilitated overdose education and naloxone distribution (OEND) in the Black community.</p></div><div><h3>Methods</h3><p>HCS researchers partnered with the African American Engagement Workgroup (AAEW) to facilitate OEND. The team focused OEND-related efforts at faith-based community events, large churches with significant Black membership, and Black-owned businesses. Stigma reduction was a significant component of the initial plan, followed by overdose education, instructions on how to administer naloxone, and why it was so important to keep kits available within businesses and in individual residences.</p></div><div><h3>Results</h3><p>Strong AAEW leadership with meaningful connections among the Ministers in the Cincinnati Area Baptist Association and Black business owners allowed the strategy to be implemented successfully. Church, and other community, members led efforts and provided trainings and distribution events at larger Black urban churches and community events. During services, church leadership supported stigma reduction and encouraged training attendance. Approximately 640 naloxone kits were distributed in five months. The initial OEND project grew into a larger-scale effort to provide expedited assessments, access, and linkage to medication for opioid use disorder.</p></div><div><h3>Conclusion</h3><p>Effective partnerships in the Black community facilitated OEND and other evidence-based practices.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 424"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Race/Ethnicity Accuracy in Electronic Medical Records at Pediatric Hospitals 儿科医院电子病历中的种族/族裔准确性

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.092

Gary L. Freed MD, MPH, Susan J. Woolford MD, MPH, Brittany Bogan MHSA, Adam Nicholson MD, Deborah Niedbala MSN

{"title":"Race/Ethnicity Accuracy in Electronic Medical Records at Pediatric Hospitals","authors":"Gary L. Freed MD, MPH, Susan J. Woolford MD, MPH, Brittany Bogan MHSA, Adam Nicholson MD, Deborah Niedbala MSN","doi":"10.1016/j.jnma.2024.07.092","DOIUrl":"10.1016/j.jnma.2024.07.092","url":null,"abstract":"<div><h3>Introduction</h3><p>Numerous studies have examined health inequities. Inherent to the validity of these studies is accuracy of racial and/or ethnic designations. Without knowledge of the degree of misattribution, studies risk missing disparities that exist and finding some that do not. This study examined the accuracy of electronic medical record (EHR) racial/ethnic attribution across the three largest pediatric hospitals in Michigan.</p></div><div><h3>Methods</h3><p>For each hospital the specific options for the classification of race/ethnicity available in their EHR were identified (ranging from 6 to 47 for race and 2 to 9 for ethnicity). Parents were approached in outpatient clinics and asked to select from a list of the options at their hospital, the race and ethnicity of their child. This was used as the gold standard for comparison with the information in the EHR.</p><p>Analysis for matching occurred in three stages. 1) Exact match; 2) “Prioritizing” of non-white component of combinations (e.g., any combination with Black designated as Black); 3) “Prioritizing” plus consolidation (e.g., putting all Asian groups together).</p></div><div><h3>Results</h3><p>Approximately 1500 parents participated from each hospital. Across the 3 hospitals, exact matching for race ranged from approximately 50% to 78%. Lower matching occurred for hospitals using more categories. After consolidation and grouping of categories, match rates improved markedly.</p></div><div><h3>Conclusions</h3><p>Accuracy in race and ethnicity data is essential for valid assessment of inequities. Hospitals with expanded categories may need to consolidate/group race/ethnicity data for accurate analyses. Efforts to improve EHR accuracy and to statistically account for current error rates are urgently needed.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 451-452"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anxiety sensitivity among Black youth: A cross-sectional analysis of the direct and indirect effects of community violence exposure, neighborhood risk, parenting practices, and peer effects 黑人青少年的焦虑敏感性：对社区暴力暴露、邻里风险、养育方式和同伴影响的直接和间接影响的横断面分析。

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.005

Andrew Foell , Kyle A. Pitzer , Von Nebbitt , Margaret Lombe , Mansoo Yu , Melissa L. Villodas , Ngozi Enelamah , Husain Lateef

{"title":"Anxiety sensitivity among Black youth: A cross-sectional analysis of the direct and indirect effects of community violence exposure, neighborhood risk, parenting practices, and peer effects","authors":"Andrew Foell , Kyle A. Pitzer , Von Nebbitt , Margaret Lombe , Mansoo Yu , Melissa L. Villodas , Ngozi Enelamah , Husain Lateef","doi":"10.1016/j.jnma.2024.07.005","DOIUrl":"10.1016/j.jnma.2024.07.005","url":null,"abstract":"<div><p>Youth exposed to community violence and neighborhood stressors report devastating mental health consequences. Black youth are at greater risk and experience community violence at rates higher than other youth populations. An underexplored mental health consequence is anxiety sensitivity, the fear of experiencing anxiety-related symptoms, which contributes to maladaptive coping strategies and the development and severity of other mental health problems. This study utilized structural equation modeling (SEM) to examine socio-ecological risk and protective factors associated with community violence exposure and anxiety sensitivity among low-income Black youth. Survey data are from a sample of 320 Black youth residing in public and subsidized housing in a Northeastern city in the United States. Results indicated that neighborhood risk, parenting behaviors, and exposure to delinquent peers were indirectly associated with anxiety sensitivity, which occurred through community violence exposure. Additionally, neighborhood risks had direct effects on anxiety sensitivity. Results point to the need to incorporate social and environmental factors in interventions addressing anxiety sensitivity among Black youth in urban communities.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 390-402"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0027968424000865/pdfft?md5=b5fc5ceb3b0a6ef3361f9d8cef37fac1&pid=1-s2.0-S0027968424000865-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Modern Systemic therapies with Radiosurgery for Brain Metastases from Breast Cancer 放射外科治疗乳腺癌脑转移瘤的现代全身疗法

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.102

Andjie Jeudy BS, David J. Crompton, Danushka S. Seneviratne, Pooja Advani, Jennifer Peterson, William C. Fox, Sanjeet Grewal, Laura Vallow, Daniel M. Trifiletti

{"title":"Modern Systemic therapies with Radiosurgery for Brain Metastases from Breast Cancer","authors":"Andjie Jeudy BS, David J. Crompton, Danushka S. Seneviratne, Pooja Advani, Jennifer Peterson, William C. Fox, Sanjeet Grewal, Laura Vallow, Daniel M. Trifiletti","doi":"10.1016/j.jnma.2024.07.102","DOIUrl":"10.1016/j.jnma.2024.07.102","url":null,"abstract":"<div><h3>Objective</h3><p>Stereotactic radiosurgery is an established treatment for breast cancer brain metastases. However, there is limited data regarding the clinical outcomes of SRS when delivered with targeted systemic therapies. Our aim was to assess the clinical outcomes and toxicities of patients receiving modern systemic therapy concurrently with SRS in comparison to patients undergoing traditional cytotoxic chemotherapy and SRS.</p></div><div><h3>Methods</h3><p>Through this IRB-approved retrospective analysis, we collected the clinical outcomes of 43 patients with brain metastases from breast cancer treated with SRS in combination with modern targeted systemic therapies (delivered within 4 weeks of SRS).</p></div><div><h3>Results</h3><p>A total of 235 brain metastases were treated with single fraction SRS in combination with systemic therapy. Of the 235 tumors, 49 were treated with concurrent cytotoxic systemic therapy, 60 with antibody or endocrine, 41 with immunotherapy combination, 56 were not treated with concurrent systemic therapy, and 56 received other systemic therapy. In comparison to patients receiving concurrent cytotoxic chemotherapy and SRS, those receiving antibody/endocrine therapy with SRS and those receiving no systemic therapy had significantly higher rates of local treatment failure (p=0.005). Patients receiving immunotherapy concurrently with SRS had similar rates of local treatment failure compared to those undergoing cytotoxic chemotherapy (p=0.47). We found no association between the type of systemic therapy delivered with SRS and elsewhere brain failure, or radionecrosis (all p>0.2).</p></div><div><h3>Conclusion</h3><p>Delivery of no therapy with SRS or the delivery of antibody/endocrine therapy concurrently with SRS were both associated with significantly higher rates of local treatment failure.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 456"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Integrated Management of Malignant Head and Neck Paragangliomas: A Case Report and Review of Literature 恶性头颈部副神经节瘤的综合治疗：病例报告和文献综述

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.082

Samip Patel M.D., Estephania Candelo-Gomez MD, Christina Presmy B.S

{"title":"Integrated Management of Malignant Head and Neck Paragangliomas: A Case Report and Review of Literature","authors":"Samip Patel M.D., Estephania Candelo-Gomez MD, Christina Presmy B.S","doi":"10.1016/j.jnma.2024.07.082","DOIUrl":"10.1016/j.jnma.2024.07.082","url":null,"abstract":"<div><h3>Introduction</h3><p>Paragangliomas are infrequent neuroendocrine neoplasms that typically arise from autonomic ganglia, predominantly presenting in the head and neck regions, with the potential for benign or malignant progression. The transformation into a malignant state poses significant diagnostic and therapeutic dilemmas, underscoring the intricacies of intervention protocols. Given the paucity of standardized treatments for advanced metastatic presentations, this case report aims to augment the comprehension of integrated treatment modalities in the management of intricate cases.</p></div><div><h3>Methods</h3><p>A comprehensive literature review was undertaken to evaluate the epidemiology, demographic characteristics, functional attributes, tumor localization, and genomic correlations of malignant head and neck paragangliomas, including the incidence of gene mutations associated with metastatic progression, in contrast with the parameters of the presented case.</p></div><div><h3>Results</h3><p>A 32-year-old man diagnosed with a paraganglioma affecting the carotid artery and showing distant metastases underwent high-risk surgery and radionuclide therapy, with a positive outcome of no cranial nerve deficits post-treatment. A review of the literature on similar cases revealed a higher occurrence in females and a general pattern of low functional capacity associated with these tumors. The dominating primary therapy for these tumors based on the literature review was surgical excision.</p></div><div><h3>Conclusions</h3><p>Malignant paragangliomas of the head and neck present diagnostic and treatment challenges especially given the context of advanced and distant metastasis. A multimodal approach may be required in the management of complex cases including surgery, chemotherapy, and or/radiotherapy.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 447"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Telehealth Transformation: A Mixed-Methods Study on Organizational Change Processes and Outcomes in Private Medical Practices 远程医疗转型：私立医疗机构组织变革过程与结果的混合方法研究

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.087

Masab A Mansoor DBA, MBA, ¸BS

{"title":"Telehealth Transformation: A Mixed-Methods Study on Organizational Change Processes and Outcomes in Private Medical Practices","authors":"Masab A Mansoor DBA, MBA, ¸BS","doi":"10.1016/j.jnma.2024.07.087","DOIUrl":"10.1016/j.jnma.2024.07.087","url":null,"abstract":"<div><h3>Purpose</h3><p>This mixed-methods case study investigated the impacts, costs, barriers, and facilitators associated with implementing telehealth services across two private pediatric clinic systems. The research examined the effects of telehealth on provider engagement and financial performance.</p></div><div><h3>Methods</h3><p>Thirty-four clinicians, administrators, and staff across the pediatric and cardiology clinics were interviewed before and after enterprise-level telehealth adoption to examine change processes amid this innovation. Twelve months of pre- and post-implementation financial records underwent statistical analysis to assess revenue and cost dynamics. Quantitative outcome measures encompassed expenses, revenues, and telehealth visit utilization rates, while qualitative analysis of interviews and focus groups revealed key implementation themes through rigorous inductive coding of participant narratives.</p></div><div><h3>Results</h3><p>Results showed significantly increased costs (44-75%) and revenues (21-47%) at both clinics following virtual care expansion. Monthly telehealth visits per provider exponentially rose over 450% across sites. Qualitatively, 83% of providers appreciated scheduling flexibility benefits, but 68% of staff cited workflow disruptions. Interpretatively, findings demonstrated catalyzed financial and productivity transformations and nuanced perceived disruption amid pronounced appointment capacity expansions.</p></div><div><h3>Conclusions</h3><p>Interpretatively, findings demonstrated catalyzed financial and productivity transformations and nuanced perceived disruption amid pronounced appointment capacity expansions. Recommendations encompass updated care coordination protocols, enhanced training and support resources, incentivizing provider usage, and modulating implementation pacing responding to user feedback during large-scale organizational innovation.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 449"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Antibiotic Usage for Hidradenitis Suppurativa: Risk for Infection and Death 使用抗生素治疗化脓性扁桃体炎：感染和死亡风险

IF 2.5 4区医学

Journal of the National Medical Association Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.038

A Hill Marc BS, MA, S Jeremy Bordeaux, MD

{"title":"Antibiotic Usage for Hidradenitis Suppurativa: Risk for Infection and Death","authors":"A Hill Marc BS, MA, S Jeremy Bordeaux, MD","doi":"10.1016/j.jnma.2024.07.038","DOIUrl":"10.1016/j.jnma.2024.07.038","url":null,"abstract":"<div><h3>Introduction</h3><p>Hidradenitis Suppurativa (HS) is an inflammatory skin condition that disproportionately affects young Black adult females. Antibiotics are commonly used for disease management, making it important to consider the potential complications such as infection and death. The literature has started to examine the relationship between patients with HS and Clostridium Difficile (C.diff), but only with smaller studies, and no studies have examined the death rate. This study investigates the risk for infection of C. diff and death for patients with HS.</p></div><div><h3>Methods</h3><p>A retrospective cohort study was performed utilizing the global database TriNetX. Two cohorts were assembled that were compared in their development of C.diff or death. The first cohort included patients who used various antibiotics after their HS diagnosis (n = 86,251). The second cohort served as the control and included patients with HS that did not use these antibiotics (n = 60,157). For the statistical analysis, the risk ratio was calculated. The antibiotics examined included Clindamycin, Rifampin, Tetracycline, Minocycline, and Doxycycline.</p></div><div><h3>Results</h3><p>The risk ratio and associated 95% confidence intervals for contracting C.diff or death is 2.265 (1.971, 2.604) and 1.357 (1.284, 1.434), respectively.</p></div><div><h3>Conclusion</h3><p>The results show a statistically significant increased risk of developing a C.diff infection and of dying when utilizing these antibiotics. Antibiotic usage has shown to improve HS symptoms, however, clinicians must be wary about the complications that could occur when prescribing antibiotics, such as increased risk of C.diff infection and death.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 427"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0