Quality Improvement initiatives aim to improve care in Inflammatory Bowel Disease (IBD). These address a range of aspects of care including adherence to published guidelines. The objectives of this ...review were to document the scope and quality of published quality improvement initiatives in IBD, highlight successful interventions and the outcomes achieved.
We searched MEDLINE, EMBASE, CINAHL and Web of Science. Two reviewers independently screened and extracted data. We included peer reviewed articles or conference proceedings reporting initiatives intended to improve the quality of IBD care, with both baseline and prospectively collected follow-up data. Initiatives were categorised based on problems, interventions and outcomes. We used the Quality Improvement Minimum Quality Criteria Set instrument to appraise articles. We mapped the focus of the articles to the six domains of the IBD standards.
100 studies were identified (35 full text; 65 conference abstracts). Many focused on vaccination, medication, screening, or meeting multiple quality measures. Common interventions included provider education, the development of new service protocols, or enhancements to the electronic medical records. Studies principally focused on areas covered by the IBD standards 'ongoing care' and 'the IBD service', with less focus on standards 'pre-diagnosis', 'newly diagnosed', 'flare management', 'surgery' or 'inpatient care'.
Good quality evidence exists on approaches to improve the quality of a narrow range of IBD service functions, but there are many topic areas with little or no published quality improvement initiatives. We highlight successful quality improvement interventions and offer recommendations to improve reporting of future studies.
•Demonstrates how data science and open source software can be exploited to meet growing demand of data-driven decisions across organizational processes.•Application of the presented data science ...approach proved simpler and faster; reducing required sourcing assessment time from 30 to 90 days to less than an hour.•Demonstrates the efficacy of a theory driven data science method in a practical setting and then makes the tool available to other users via open source software.
Data science has emerged as a significant capability upon which firms compete. Although many data scientists and the high-performing companies that employ them seem to have developed robust methods to employ data sciences practices to achieve competitive advantages, there have been few attempts at defining and explaining how and why data science helps firms to achieve desired outcomes. In this paper, we describe how data science, which combines computer programming, domain knowledge, and analytic skillsets to scientifically extract insights from data, can be used to help meet the growing demand of analytic needs across an organization’s value chain. This is done through the illustration of an applied data science initiative to a strategic sourcing problem via the use of open-source technology. In doing so, we contribute to the growing data science literature by demonstrating the application of unique data science capabilities. Moreover, the paper provides a tutorial on how to use a specific R package along with an actual case in which that package use used.
Although research evaluating the impact of supply chain integration on performance has advanced substantially in the last decade, inconsistency and considerable variability of empirical findings ...leave unanswered questions for both research and practice. Using a meta‐analysis, we examine empirical studies to clarify the actual relationship, suggest new directions, and ultimately contribute toward the development of supply chain management theory. We focus on “strategic” supply chain integration rather than on functional or operational/tactical studies, which would weaken the practical value of the analysis and findings. To ascertain focus and homogeneity of the sample, we adopt a rigorous search protocol and sample construction. We find that integration–performance relationships are complex and nuanced such that integration should not be universally viewed as improving performance. We identify relationships that are more generalizable and also those that need additional scrutiny. Finally, we discuss the implications of our findings and provide directions for future research.
Objective
To identify the characteristics associated with high utilization of remote communications (RCs) in patients with headache.
Background
Patients with headache frequently communicate with ...their providers using secure portal messaging and telephone calls. However, clinical and demographic factors as well as visit patterns associated with RC utilization remain poorly characterized.
Methods
We retrospectively analyzed data from patients with headache who were evaluated in the ambulatory neurology faculty practice at the Icahn School of Medicine at Mount Sinai in New York between January 1 and June 30, 2019. We extracted clinical and demographic characteristics, total office visits, secure MyChart portal messages, and telephone encounters from our institutional data warehouse. We defined high RC and MyChart utilization as the top tertile of RC and MyChart message volume, respectively, and assessed the relationship between patient characteristics and high RC (primary outcome), as well as high MyChart utilization (secondary outcome). We characterized the relationship between clinicodemographic characteristics and the ratio of MyChart messages to total RCs (secondary outcome).
Results
We identified 1390 patients, of whom 477 (34.3%) were high RC utilizers and 321 (23.1%) were high MyChart utilizers. High RC utilizers generated 3306/3921 (84.3%) RCs. The presence of chronic headache (aOR 2.31, 95% CI 1.75–3.03, p < 0.0001), cluster headache (aOR 18.3, 95% CI 5.0–71.7, p = 0.001), and migraine (aOR 3.82, 95% CI 1.93–9.3, p = 0.011) was associated with high RC utilization. Patients ≥65 years of age were less likely to engage in MyChart messaging as a proportion of RC (191/680, 28.1%) compared with patients 18–30 years of age (243/620, 39.2%, p = 0.049) and 30–64 years of age (1172/2721, 43.1%, p < 0.0001).
Conclusions
A minority of patients with headache (477/1390; 34.3%) generated the majority (3306/3921; 84.3%) of RCs. Our findings should be validated in external patient cohorts with the objective of developing strategies to optimize RC utilization.
Scholars have observed the need to better understand the role of emotion in the issue of climate change, as well as to better convey the relationship between climate and other global crises. This ...article takes up these two positions, investigating the way social media facilitates affective connections between climate and other global risks. Using Twitter data from three global events - Covid, the 2020 U.S. presidential race, and the Russia-Ukraine war - the study examines how users connect climate change to each event. Placing these discussions in the context of online issue publics and ecocriticism, the paper examines the way users employ affect to connect these events to climate change. The paper uses a quantitatively driven qualitative approach, combining computational methods with a thematic analysis of affective expressions. Interestingly, sentiment was not universally negative, and the qualitative findings further suggest that users combine emotions in contradictory ways, expressed through the themes Weary Zealotry, The Hope-Disgust Dialectic, Climate as Proto-Disaster, Idiots and Enemies, and Global Solidarity. It is argued that a modified version of Beck's 'imagined communities of global risk' provides a framework for the role of affect in people's relationship to climate change.
Breast cancer is a heterogeneous disease and several distinct subtypes exist based on differential gene expression patterns. Molecular apocrine tumours were recently identified as an additional ...subgroup, characterised as oestrogen receptor negative and androgen receptor positive (ER− AR+), but with an expression profile resembling ER+ luminal breast cancer. One possible explanation for the apparent incongruity is that ER gene expression programmes could be recapitulated by AR. Using a cell line model of ER− AR+ molecular apocrine tumours (termed MDA‐MB‐453 cells), we map global AR binding events and find a binding profile that is similar to ER binding in breast cancer cells. We find that AR binding is a near‐perfect subset of FoxA1 binding regions, a level of concordance never previously seen with a nuclear receptor. AR functionality is dependent on FoxA1, since silencing of FoxA1 inhibits AR binding, expression of the majority of the molecular apocrine gene signature and growth cell growth. These findings show that AR binds and regulates ER cis‐regulatory elements in molecular apocrine tumours, resulting in a transcriptional programme reminiscent of ER‐mediated transcription in luminal breast cancers.
This paper explores genome‐wide and functional approaches to reveal that the subgroup of so‐called apocrine breast cancer utilise androgen receptor (AR) binding in the vicinity of oestrogen receptor (ER)‐binding sites to maintain an ER‐like gene expression signature. The results further reveal that FoxA1 is required for AR binding and function.
Hormonally regulated breast and prostate cancers are the most common cause of cancer in females and males respectively. FoxA1 acts as a pioneer factor for both androgen receptor (AR) and estrogen ...receptor-α (ER), dictating the binding location, and therefore function of these transcription factors. It is an essential protein for the transcriptional activity of both ER and AR, yet it has distinct roles with the two different nuclear receptors. In both malignancies, FoxA1 plays a pivotal role from early stage cancer through to drug resistant and metastatic disease. Due to this key role in mediating ER and AR function, FoxA1 is not only an attractive therapeutic target but could potentially function as a novel biomarker.
Online networks have blurred the lines between national and global news, and have given users a more active role in how information flows. This opens up the opportunity for individuals to engage with ...foreign events in new ways, curating information and offering their own interpretations. In this article, we investigate how national elections are taken up in the global Twittersphere, using a set of 198,635 English-language tweets about the 2018 Swedish parliamentary election. Based on a network analysis and a content analysis of themes in the tweets, we demonstrate that national media events can become “deterritorialised” by globally networked publics. A second key finding is that the Swedish election is leveraged to discuss anti-globalist themes such as immigration and nationalism in, paradoxically, a global and deterritorialised context.
The autonomic nervous system (ANS), hypothalamic–pituitary–adrenal (HPA) axis, and immune system are connected anatomically and functionally. These three systems coordinate the central and peripheral ...response to perceived and systemic stress signals. Both the parasympathetic and sympathetic components of the autonomic nervous system rapidly respond to stress signals, while the hypothalamic–pituitary–adrenal axis and immune system have delayed but prolonged actions. In vitro, animal, and human studies have demonstrated consistent anti-inflammatory effects of parasympathetic activity. In contrast, sympathetic activity exerts context-dependent effects on immune signaling and has been associated with both increased and decreased inflammation. The location of sympathetic action, adrenergic receptor subtype, and timing of activity in relation to disease progression all influence the ultimate impact on immune signaling. This article reviews the brain circuitry, peripheral connections, and chemical messengers that enable communication between the ANS, HPA axis, and immune system. We describe findings of in vitro and animal studies that challenge the immune system with lipopolysaccharide. Next, neuroimmune connections in animal models of chronic inflammatory disease are reviewed. Finally, we discuss how a greater understanding of the ANS-HPA-immune network may lead to the development of novel therapeutic strategies that are focused on modulation of the sympathetic and parasympathetic nervous system.
OBJECTIVES
To evaluate the effects of a community pharmacy‐based fall prevention intervention (STEADI‐Rx) on the risk of falling and use of medications associated with an increased risk of falling.
...DESIGN
Randomized controlled trial.
SETTING
A total of 65 community pharmacies in North Carolina (NC).
PARTICIPANTS
Adults (age ≥65 years) using either four or more chronic medications or one or more medications associated with an increased risk of falling (n = 10,565).
INTERVENTION
Pharmacy staff screened patients for fall risk using questions from the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. Patients who screened positive were eligible to receive a pharmacist‐conducted medication review, with recommendations sent to patients' healthcare providers following the review.
MEASUREMENTS
At intervention pharmacies, pharmacy staff used standardized forms to record participant responses to screening questions and information concerning the medication reviews. For participants with continuous Medicare Part D/NC Medicaid coverage (n = 3,212), the Drug Burden Index (DBI) was used to assess exposure to high‐risk medications, and insurance claims records for emergency department visits and hospitalizations were used to assess falls.
RESULTS
Among intervention group participants (n = 4,719), 73% (n = 3,437) were screened for fall risk. Among those who screened positive (n = 1,901), 72% (n = 1,373) received a medication review; and 27% (n = 521) had at least one medication‐related recommendation communicated to their healthcare provider(s) following the review. A total of 716 specific medication recommendations were made. DBI scores decreased from the pre‐ to postintervention period in both the control and the intervention group. However, the amount of change over time did not differ between these two groups (P = .66). Risk of falling did not change between the pre‐ to postintervention period or differ between groups (P = .58).
CONCLUSION
We successfully implemented STEADI‐Rx in the community pharmacy setting. However, we found no differences in fall risk or the use of medications associated with increased risk of falling between the intervention and control groups. J Am Geriatr Soc 68:1778‐1786, 2020.
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