Browsing by Author "Howenstine, Michelle S."

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    Diagnosis of Cystic Fibrosis in Screened Populations
    (Elsevier, 2017-02) Farrell, Philip M.; White, Terry B.; Howenstine, Michelle S.; Munck, Anne; Parad, Richard B.; Rosenfeld, Margaret; Sommerburg, Olaf; Accurso, Frank J.; Davies, Jane C.; Rock, Michael J.; Sanders, Don B.; Wilschanski, Michael; Sermet-Gaudelus, Isabelle; Blau, Hannah; Gartner, Silvia; McColley, Susanna A.; Pediatrics, School of Medicine
    Objective Cystic fibrosis (CF) can be difficult to diagnose, even when newborn screening (NBS) tests yield positive results. This challenge is exacerbated by the multitude of NBS protocols, misunderstandings about screening vs diagnostic tests, and the lack of guidelines for presumptive diagnoses. There is also confusion regarding the designation of age at diagnosis. Study design To improve diagnosis and achieve standardization in definitions worldwide, the CF Foundation convened a committee of 32 experts with a mission to develop clear and actionable consensus guidelines on diagnosis of CF with an emphasis on screened populations, especially the newborn population. A comprehensive literature review was performed with emphasis on relevant articles published during the past decade. Results After reviewing the common screening protocols and outcome scenarios, 14 of 27 consensus statements were drafted that apply to screened populations. These were approved by 80% or more of the participants. Conclusions It is recommended that all diagnoses be established by demonstrating dysfunction of the CF transmembrane conductance regulator (CFTR) channel, initially with a sweat chloride test and, when needed, potentially with newer methods assessing membrane transport directly, such as intestinal current measurements. Even in babies with 2 CF-causing mutations detected via NBS, diagnosis must be confirmed by demonstrating CFTR dysfunction. The committee also recommends that the latest classifications identified in the Clinical and Functional Translation of CFTR project [http://www.cftr2.org/index.php] should be used to aid with CF diagnosis. Finally, to avoid delays in treatment, we provide guidelines for presumptive diagnoses and recommend how to determine the age of diagnosis.
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    Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment
    (Taylor & Francis, 2022-09-15) Walvoord, Emily C.; Howenstine, Michelle S.; Allen, Bradley L.; Ribera, Amy K.; Nabhan, Zeina M.; Tori, Alvaro J.; Eichholtz, Rebekah D.; Dankoski, Mary E.; Family Medicine, School of Medicine
    Problem: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. Intervention: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. Context: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. Impact: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners’ awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. Lessons Learned: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.
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    Interprofessional Accredited Continuing Education for the Healthcare Team: A Review of 7 Cystic Fibrosis Courses
    (2023-04-28) Denny, Kim M.; Patel, Rima; Howenstine, Michelle S.
    INTRODUCTION: For accredited continuing education to be categorized as interprofessional, each activity must meet certain criteria as defined by the Joint Accreditation for Interprofessional Continuing Education (JA) including an integrated planning process that includes health care professionals from 2 or more professions who are reflective of the target audience members the activity is designed to address, an instructional design intent to achieve outcome(s) that reflect a change in skills, strategy, or performance of the health care team and/or patient outcomes; reflection of 1 or more of the interprofessional competencies; opportunities for learners to learn with, from, and about each other; and evaluation that seeks to determine changes in skills, strategy, performance of one's role or contribution as a member of the healthcare team; and/or impact on the healthcare team; and/or impact on patient outcomes. METHODS: Analysis of instructional design factors and learner data from 7 Courses (7 Enduring Activities each with 4-6 Modules); use data about what was accomplished to analyze the degree to which we met our goals of developing interprofessional accredited CE Courses. Data points to include: Diversity of Planning team members (healthcare professionals from 2 or more professions); An intent to achieve outcome(s) that reflect a change in skills, strategy, or performance of the health care team and/or patient outcomes; Addressing interprofessional competencies (to include): values/ ethics, roles/ responsibilities, interprofessional communication, and teams/teamwork; An opportunity for learners to learn with, from, and about each other (active learning); Post-activity evaluations that seek to determine: Changes in skills, strategy, performance of one's role or contribution as a member of the healthcare team; and/or Impact on the healthcare team; and/or Impact on patient outcomes. CONCLUSION: These Cystic Fibrosis 7 Courses are strong examples of Interprofessional accredited continuing education for the healthcare team. This model of CE Courses to address clinical practice gaps is a blueprint that can be utilized for other IU schools and departments.