Browsing by Subject "clinical practice"

Now showing 1 - 9 of 9
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    The 2016 Model of the Clinical Practice of Emergency Medicine
    (Elsevier, 2017-06) Counselman, Francis L.; Babu, Kavita; Edens, Mary Ann; Gorgas, Diane L.; Hobgood, Cherri; Marco, Catherine A.; Katz, Eric; Rodgers, Kevin; Stallings, Leonard A.; Wadman, Michael C.; Beeson, Michael S.; Keehbauch, Julia N.; Emergency Medicine, School of Medicine
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    Current Clinical Applications of Artificial Intelligence in Radiology and Their Best Supporting Evidence
    (Elsevier, 2020-11) Tariq, Amara; Purkayastha, Saptarshi; Padmanaban, Geetha Priya; Krupinski, Elizabeth; Trivedi, Hari; Banerjee, Imon; Gichoya, Judy W.; BioHealth Informatics, School of Informatics and Computing
    Purpose Despite tremendous gains from deep learning and the promise of artificial intelligence (AI) in medicine to improve diagnosis and save costs, there exists a large translational gap to implement and use AI products in real-world clinical situations. Adoption of standards such as Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis, Consolidated Standards of Reporting Trials, and the Checklist for Artificial Intelligence in Medical Imaging is increasing to improve the peer-review process and reporting of AI tools. However, no such standards exist for product-level review. Methods A review of clinical trials showed a paucity of evidence for radiology AI products; thus, the authors developed a 10-question assessment tool for reviewing AI products with an emphasis on their validation and result dissemination. The assessment tool was applied to commercial and open-source algorithms used for diagnosis to extract evidence on the clinical utility of the tools. Results There is limited technical information on methodologies for FDA-approved algorithms compared with open-source products, likely because of intellectual property concerns. Furthermore, FDA-approved products use much smaller data sets compared with open-source AI tools, because the terms of use of public data sets are limited to academic and noncommercial entities, which precludes their use in commercial products. Conclusions Overall, this study reveals a broad spectrum of maturity and clinical use of AI products, but a large gap exists in exploring actual performance of AI tools in clinical practice.
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    Developing the Agile Implementation Playbook for Integrating Evidence-Based Health Care Services into Clinical Practice
    (Wolters Kluwer, 2018-10) Boustani, Malaz A.; van der Marck, Marjolein A.; Adams, Nadia; Azar, Jose M.; Holden, Richard J.; Vollmar, Horst C.; Wang, Sophia; Williams, Christopher; Alder, Catherine; Suarez, Shelley; Khan, Babar; Zarzaur, Ben; Fowler, Nicole R.; Overley, Ashley; Solid, Craig A.; Gatmaitan, Alfonso; Medicine, School of Medicine
    Problem: Despite the more than $32 billion the National Institutes of Health has invested annually, evidence-based health care services are not reliably implemented, sustained, or distributed in health care delivery organizations, resulting in suboptimal care and patient harm. New organizational approaches and frameworks that reflect the complex nature of health care systems are needed to achieve this goal. Approach: To guide the implementation of evidence-based health care services at their institution, the authors used a number of behavioral theories and frameworks to develop the Agile Implementation (AI) Playbook, which was finalized in 2015. The AI Playbook leverages these theories in an integrated approach to selecting an evidence-based health care service to meet a specific opportunity, rapidly implementing the service, evaluating its fidelity and impact, and sustaining and scaling up the service across health care delivery organizations. The AI Playbook includes an interconnected eight-step cycle: (1) identify opportunities; (2) identify evidence-based health care services; (3) develop evaluation and termination plans; (4) assemble a team to develop a minimally viable service; (5) perform implementation sprints; (6) monitor implementation performance; (7) monitor whole system performance; and (8) develop a minimally standardized operating procedure. Outcomes: The AI Playbook has helped to improve care and clinical outcomes for intensive care unit survivors and is being used to train clinicians and scientists in AI to be quality improvement advisors. Next Steps: The authors plan to continue disseminating the details of the AI Playbook and illustrating how health care delivery organizations can successfully leverage it.
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    Hospitalists and the Decline of Comprehensive Care
    (2016-09) Gunderman, Richard; Department of Radiology and Imaging Sciences, IU School of Medicine
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    Long-Acting Reversible Contraception
    (2017-02) Curtis, Kathryn M.; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of Medicine
    This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. A 17-year-old high school student who has never been pregnant presents for advice regarding contraception. She has an unremarkable medical history and is planning to become sexually active with her boyfriend in the near future. Her primary concern is an unintended pregnancy, and she inquires about methods of contraception that are highly effective. How would you counsel her about options for contraception?
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    Pathways to a Lung Cancer Diagnosis
    (Wiley, 2015-03) Carter-Harris, Lisa; Hermann, Carla P.; Burke Draucker, Claire; School of Nursing
    Purpose The purpose of this qualitative descriptive study was to identify and describe pathways to a lung cancer diagnosis based on narratives of persons diagnosed with the disease. Data sources Eleven adults with lung cancer were recruited from an academic thoracic oncology clinic in a large city in the southeastern United States. Moderately structured interviews were conducted by an experienced nurse practitioner (NP) to obtain information regarding the participants’ experiences leading to their diagnosis. Qualitative content analysis was used to develop a typology of pathways. Conclusions Findings revealed four distinct pathways: missing opportunities, waiting and seeing, being alarmed, and being blindsided. Implications for practice The Pathways to a Lung Cancer Diagnosis Typology has important implications for clinical practice and can be used to inform NPs and other healthcare providers who provide care for patients at risk for or diagnosed with lung cancer.
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    Physician self-reported use of empathy during clinical practice
    (Sage, 2022) Comer, Amber; Fettig, Lyle; Bartlett, Stephanie; D'Cruz, Lynn; Umythachuk, Nina; Health Sciences, School of Health and Human Sciences
    Objectives The use of empathy during clinical practice is paramount to delivering quality patient care and is important for understanding patient concerns at both the cognitive and affective levels. This study sought to determine how and when physicians self-report the use of empathy when interacting with their patients. Methods A cross-sectional survey of 76 physicians working in a large urban hospital was conducted in August of 2017. Physicians were asked a series of questions with Likert scale responses as well as asked to respond to open-ended questions. Results All physicians self-report that they always (69%) or usually (29.3%) use empathic statements when engaging with patients. 93.1% of physicians believe that their colleagues always (20.7%) or usually (69%) use empathic statements when communicating with patients. Nearly one-third of physicians (33%) indicated that using the words “I understand” denotes an empathic statement. Although 36% of physicians reported that they would like to receive more training or assistance about how and when to use empathy during clinical practice. Significance of Results Despite the self-reported prevalent use of empathic statements, one-third of physicians indicate a desire for more training in what empathy means and when it should be used in a clinical setting. Additionally, nearly one-third of physicians in this study reported using responses that patients may not perceive as being empathic, even when intended to be empathic. This suggests that many physicians feel uncertain about a clinical skill they believe should be used in most, if not all, encounters.
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    Understanding High-Dose, Ultra-High Dose-Rate and , Spatially Fractionated Radiotherapy
    (Elsevier, 2020) Griffin, Robert J.; Ahmed, Mansoor M.; Amendola, Beatriz; Belyakov, Oleg; Bentzen, Søren M.; Butterworth, Karl T.; Chang, Sha; Coleman, C. Norman; Djonov, Valentin; Formenti, Sylvia C.; Glatstein, Eli; Guha, Chandan; Kalnicki, Shalom; Le, Quynh-Thu; Loo, Billy W., Jr.; Mahadevan, Anand; Massaccesi, Mariangela; Maxim, Peter G.; Mohiuddin, Majid; Mohiuddin, Mohammed; Mayr, Nina A.; Obcemea, Ceferino; Petersson, Kristoffer; Regine, William; Roach, Mack; Romanelli, Pantaleo; Simone, Charles B., II; Snider, James W.; Spitz, Douglas; Vikram, Bhadrasain; Vozenin, Marie-Catherine; Abdel-Wahab, May; Welsh, James; Wu, Xiaodong; Limoli, Charles L.; Radiation Oncology, School of Medicine
    The National Cancer Institute’s Radiation Research Program in collaboration with the Radiosurgery Society hosted a workshop on Understanding High-Dose, Ultra-High Dose rate and Spatially Fractionated Radiotherapy on August 20-21, 2018 to bring together experts in experimental and clinical experience in these and related fields. Critically, the overall aims were to understand the biological underpinning of these emerging techniques and the technical/physical parameters that must be further defined to drive clinical practice through innovative biologically-based clinical trials.
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    Understanding the Current Anatomical Competence Landscape: Comparing Perceptions of Program Directors, Residents, and Fourth Year Medical Students
    (Wiley-Blackwell, 2016-07) Fillmore, Erin P.; Brokaw, James J.; Kochhar, Komal; Nalin, Peter M.
    A mixed methods survey of fourth year medical students, resident physicians, and residency program directors at the Indiana University School of Medicine gathered perceptions of anatomical competence—defined as the anatomical education necessary for effective clinical practice. The survey items explored numerous aspects of anatomical competence, including the most effective modes of instruction, perceptions of readiness for clinical practice, and specific suggestions for improving anatomical education during medical school and residency. The response rate was 46% for fourth year medical students, 47% for residents (as graduates from 137 medical schools), and 71% for program directors. A majority of students and residents reported the following: that their course in Gross Anatomy prepared them well for clinical practice; that cadaveric dissection was important in the early development of their anatomical competence; and that placing a greater emphasis on clinical relevance in medical school would have improved their anatomical competence even further. However, in terms of anatomical preparedness upon entering residency, the program directors rated their residents less prepared than the residents rated themselves. All three groups agreed there is need for additional opportunities for anatomical educational during medical school and residency. Suggestions for improving anatomical education included: provide more opportunities for cadaveric dissection during medical school and residency; more consistent teaching of anatomy for clinical practice; more workshops that review anatomy; and better integration of anatomy with the teaching of other subjects during medical school.