Browsing by Subject "Delivery of Health Care"
Now showing 1 - 20 of 54
- Results Per Page
- Sort Options
Item The Adult Spina Bifida Patient: Does a Delay in Referral Impact Urodynamic Findings and Clinical Outcomes? Recommendations for Transition of Care(2017-01-17) Eastman, Jessica; Lemack, Gary; Harris, Catherine; Howard, CatherineINTRODUCTION: Improvements in the management of children with myelomeningocele have resulted in an influx of such patients, many of whom have complex neurogenic bladder conditions, to adult urologists. We reviewed the presenting symptoms, urodynamic findings, and changes in clinical management of adults with spina bifida, specifically focusing on the relationship between the delay in urological follow-up and clinical outcomes. METHODS: All patients with neurological conditions that presented for urologic evaluation at a tertiary referral center have been prospectively entered into a database since 2000. Data from patients with spina bifida including, bladder management, chief complaint, urodynamic findings (UDS), surgical interventions and upper tract imaging were analyzed. RESULTS: Of the 1110 patients in the database, 60 patients with spina bifida were identified (51.7% male, 48.3% female). Median age at presentation was 33 (16-64). The majority of patients presented for symptom evaluation (75%) vs. establishing care (25%). The most common presenting symptoms were incontinence (n=18, 30%) and urinary tract infection (UTI) (n=15, 25%). Patients who had documented prior urologic evaluation were assessed for the interval to presentation (n=53). Patients were classified as having their last evaluation within the preceding 12 months (n=23, 43.3%), between 12 and 24 months (n=17, 32%), between 2 and 5 years (n=11, 20.8%) or greater than 5 years prior (n=2, 3.8%). Patients were significantly more likely to present within 12 months of their last evaluation if they were symptomatic (p=0.022). Patients presenting more than one year from their last evaluation were more likely to have DO (p=0.0215), though neither altered compliance nor DESD were associated with delay in diagnosis. As seen with children, the UDS diagnosis of impaired compliance was significantly associated with abnormal imaging findings (p=0.0328). Overall, 42% of this cohort required intervention following referral, and urologic workup including urodynamics altered clinical management in 58.9% of patients. CONCLUSION: Spina Bifida patients continue to require close surveillance into adulthood, and this evaluation must include urodynamic testing. Additionally, there is indication that patients who delay care are more likely to have UDS abnormalities that might necessitate changes in management strategies. We advocate follow-up of less than 12 months between adult urology clinics or within one year after pediatric surveillance has terminated.Item The approaching singularity in medicine: when computers exceed physician performance(2014-01-31) Amarasingham, RubenItem Bias and equity teaching rounds: an educational exercise to minimize bias in patient care(2022-05-06) Capers, Quinn, IV; Ahmad, Zahid; Estelle, Carolee; Hegde, Anita; Nadamuni, Mridula; Racial Equity, Diversity & Inclusion (REDI) CommitteeItem Bioethics and COVID-19: lessons for a post-pandemic future(2024-03-12) Brendel, Rebecca Weintraub[Note: The slide presentation is not available from this event.] The COVID-19 pandemic presented a critical need for bioethics engagement as the U.S. (and the world) faced the stark reality that the demand for critical care resources would exceed supply. This session begins by reviewing general approaches to bioethical challenges through an overview of major philosophical approaches with attention to Beauchamp and Childress' (Four) Principles of Biomedical Ethics. Using the COVID-19 pandemic as a paradigm, it will explore the successes and lessons learned from the work of bioethics in the pandemic context. The experience of COVID-19 and the disparities laid bare will serve as an introduction to a variety of lenses, strategies, and opportunities through which bioethics can strive to chart a path forward to achieve health care justice in its broadest forms. The presentation concludes with practical guidance regarding both identifying ethical challenges and approaches in health care generally and candidate opportunities for progress in the future.Item Case studies in bias in medicine: audience participation required(2021-10-08) Capers, Quinn, IV; Jamshed, Namirah; Estelle, Carolee; Shoultz, Thomas; Islam, AnaItem Cultivating a culture of safety in academic medical centers(2021-10-15) Wootton, TaylorItem Cultivating biomedical innovation(2018-07-20) Agusala, KartikItem Cultural competence in the care of Muslim patients and their families(2023-03-10) Rashdan, SawsanItem Decentralizing outpatient diabetes care: a collaborative approach(2020-09-18) Gunasekaran, UmaItem Development of the Liang Handover Assessment Tool for Simulation (L-HATS)(2020-05-01T05:00:00.000Z) Liang, Tyler; Greilich, Philip; Phelps, Eleanor; Reed, W. GaryINTRODUCTION: Clinical handovers are critical to patient safety and outcomes. Handover simulation prepares healthcare students for handoffs in the clinical setting upon graduation. UT Southwestern has developed a longitudinal handover educational curriculum in which student handovers will be assessed. Although valid and reliable tools exist for assessing clinical handovers, assessment tools adapted for the undergraduate simulation environment currently do not exist. Our objective was to develop a reliable and valid assessment tool that could be used by scholarly healthcare students to assess undergraduate simulated handovers throughout the longitudinal handover education curriculum. METHODS: A literature review was conducted to identify critical elements of high-quality, effective handovers. Following the tool's creation, we underwent several PDSA cycles to optimize the tool for medical student evaluation and ease of grading. Grader inclusion criteria were students who had completed the transition to clerkship (T2C) handover activity. A training curriculum was developed to train graders on proper use of the tool and to promote reliable grading with the tool. 62 pre-clinical student handovers were conducted in the simulation setting and recorded. The handovers were stratified into three levels (low, intermediate, and high quality), and 10 handovers were selected from each of the three levels for grading (30 handovers total). Each handover was scored by four clerkship medical students "graders". Two-way random effects intra-class correlation coefficients (ICC) were used to establish inter-rater reliability and inter-rater agreement among graders using the tool. Three external handover experts were used to establish the tool's validity using face validity. RESULTS: The product of this project is Liang Handover Assessment Tool for Simulation (L-HATS) which evaluated three domains: handover content, handover process, and language with a maximum score of 28. Two-way random effects ICC for agreement was 0.804, 95% CI [0.601, 0.906]. Two-way random effects ICC for reliability was 0.866, 95% CI [0.765, 0.930]. Three external handover experts have sufficiently validated the tool. CONCLUSIONS: The L-HATS had good to excellent inter-rater reliability and agreement. The L-HATS is the first reliable and valid handover assessment tool used for undergraduate simulation education. By using a two-way random effects model, the results suggest that the tool can be used in settings outside of the T2C handover simulation activity. Having good to excellent absolute agreement suggests that the tool is suitable for assigning grades. Future studies include comparing faculty vs student grading of handovers as well as evaluating the tool in the clinical setting.Item The disclosure dilemma: when adverse events affect multiple patients(2015-01-13) Dudzinski, Denise M.Imagine that endoscopes had not been properly processed for a period of several months. Once discovered, the problem is immediately corrected, but patients scoped during those months are more likely to even though the majority are unlikely to have been harmed? This presentation will explore the ethical and practical dimensions of this question by examining several cases.Item Donald W. Seldin, M.D., Research Symposium finalist presentations(2023-05-05) Eleazu, Ijeoma; Ramos, Lisandro Maya; Salcedo Betancourt, Juan; Singh, Sumitabh; Smith, AaronThis edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Eighth Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 28, 2023. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2023 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation includes additional award presentations recognizing Clinical Vignettes, as well as the Award for Research in Quality of Care and Education at Parkland Hospital, the Social Impact Award, and the Award for Basic Science (non-GME).Item Economics in medicine: a physician's perspective(2017-11-10) Chen, CatherineItem Ethics of smart pills and the dawn of surveillance medicine(2019-10-08) Klugman, Craig M.This presentation will explore the ethics of digital medicine--technology represented by pills that alter our bodily functions alongside sensors that not only collect data about our bodies, but share it with our physicians, family and friends. With FDA approval of the Abilify MyCite system in November 2017, pills now interact with cell phones to track medication adherence, but at what cost? Surveillance medicine stands to redefine the physician patient relationships and raises a host of new ethical issues such as redefining notions of privacy, confidentiality, vulnerability, trust, autonomy, consent, data and device management, dependability, physician autonomy, and equity in access to treatment. This presentation introduces attendees to these technologies and explores the ethical and professional challenges raised as they become more ubiquitous.Item Item Exploring the untapped nexus of ethics and health facility design(2023-01-10) Anderson, Diana C.; Hercules, William J.; Teti, Stowe Locke; Deemer, David A.Architecture inherently reflects the normative preferences of its time. This certainly applies to healthcare architecture, where design concepts have intentional and decades-long effects on patients, families, and staff. Employing healthcare architecture to alter behaviors, mediate interpersonal interactions, and affect patient outcomes make it an ethical matter. We propose that advances in design science and our understanding of its powerful effects warrant a shift in how we think about space, and that the built environment in healthcare is analogous to a medical intervention. As such, all responsible stakeholders should openly discuss and thoroughly scrutinize the intentional use of the built environment to affect perceptions and change behaviors of patients, residents to a similar standard as conventional medical therapies. We highlight prominent examples of such architectural interventions, analyze their implementation, and offer perspective on how medicine and architecture can create ethically responsible spaces.Item Health and digital technology partnerships: too close for comfort?(2021-02-09) Sullivan, Laura SpeckerDigital technology companies are seeking out partnerships with medical institutions at an astounding rate. Those involved tout these partnerships as empowering consumers, driving innovation, and increasing efficiency. At the same time, ethical red flags have gone up over potential violations of patient privacy and unsanctioned use of data for non-medical purposes. While contract transparency is a core ethical concern when personal health data is involved, a broader question is whether these contracts are different in kind than more established healthcare partnerships. Big data partnerships are relatively unique; these companies neither specialize in the healthcare industry nor provide healthcare institutions with an identifiable medical product. The ethical dimensions of these partnerships extend to broader questions about the appropriate role of digital technology corporations in an arena that, at least in theory, is oriented toward the physical, mental, and social well-being of everyone within our society.Item Health care for the uninsured(2004-08-12) Kirk, Lynne M.Item Health care systems around the world, socialized, private.....What can we learn?(2010-07-30) Gruntmanis, UgisItem Health Information technology: has its adoption been worth it?(2016-01-29) Kazi, Salahuddin
- «
- 1 (current)
- 2
- 3
- »