Collaboration leads to enhanced curriculum.

BACKGROUND: In 2007, we initiated a health information management (HIM) track of our biomedical informatics graduate program, and subsequent ongoing program assessment revealed a confluence of topics and courses within HIM and clinical informatics (CI) tracks. We completed a thorough comparative analysis of competencies derived from AMIA, AHIMA, and CAHIIM. Coupled with the need to streamline course offerings, the process, described in this paper allowed new opportunities for faculty collaboration, resulted in the creation of a model assessment for best practice in courses, and led to new avenues of growth within the program. OBJECTIVE: The objective of the case study is to provide others in the informatics educational community with a model for analysis of curriculum in order to improve quality of student learning. METHODS: We describe a case study where an academic informatics program realigned its course offerings to better reflect the HIM of today, and prepare for challenges of the future. Visionary leadership, intra-departmental self-analysis and alignment of the curriculum through defined mapping process reduced overlap within the CI and HIM tracks. Teaching within courses was optimized through the work of core faculty collaboration. RESULTS: The analysis of curriculum resulted in reduction of overlap within course curriculum. This allowed for additional and new course content to be added to existing courses. CONCLUSIONS: Leadership fostered an environment where top-down as well as bottom-up collaborative assessment activities resulted in a model to consolidate learning and reduce unnecessary duplication within courses. A focus on curriculum integration, emphasis on course alignment and strategic consolidation of course content raised the quality of informatics education provided to students. Faculty synergy was an essential component of this redesign process. Continuous quality improvement strategy included an ongoing alignment of curriculum and competencies through a comparative analysis approach. Through these efforts, new innovation was possible.

Development and implementation of a clinical pathway for patients undergoing total laryngectomy: impact on cost and quality of care.

BACKGROUND: The current health care climate demands the provision of quality patient care in a cost-effective manner. Clinical pathways define the essential components of care that are provided to patients with a specific diagnosis to achieve a desired outcome within a predetermined period. Development and implementation of clinical pathways streamline the provision of quality care in the most cost-effective manner. OBJECTIVES: To develop a clinical pathway for patients undergoing total laryngectomy and to evaluate its impact on the cost and quality of care provided to these patients. SETTING: A tertiary care academic medical center. PATIENTS AND METHODS: A total of 45 patients were included in the study. The clinical pathway was implemented for 15 patients, while the other 30 patients were treated without the implementation of the pathway guidelines. MAIN OUTCOME MEASURES: Length of hospital stay, readmission rate, and hospital variable costs. RESULTS: The clinical pathway affected all cost outcome measures. Length of stay decreased by 2.4 days (29%; P=.001), and the average hospital variable cost decreased from $3992 to $3419 per case. This represents a 14.4% reduction in cost associated with pathway implementation (P=.02). The standardization of care eliminated unnecessary variation and repetition in resource usage, resulting in overall cost reduction. Pathway implementation resulted in a lower readmission rate (7% [1/15]) than that of patients treated prior to protocol implementation (23% [7/30]). CONCLUSION: Implementing a carefully developed clinical pathway may reduce cost without compromising the quality of care for patients undergoing total laryngectomy.

Tissue fixation security in transosseous rotator cuff repairs: a mechanical comparison of simple versus mattress sutures.

The primary purpose of this investigation was to compare tissue fixation security by simple sutures versus mattress sutures in transosseous rotator cuff repair. These two repair techniques were each performed in 17 human cadaver shoulders, with two bone tunnels being used for the repair by two simple sutures and two other bone tunnels being used for the repair by one mattress suture. The repairs were loaded to failure in a servohydraulic materials test system. Rotator cuff repair by simple sutures was found to be significantly stronger than repair by mattress sutures (P = .0007). The average ultimate load to failure for the simple suture construct (189.62 N) was 39.72% greater than that for the mattress suture construct (135.71 N). Most of the failures occurred by suture breakage at the knot. Load-sharing by multiple suture tails and multiple knots in the simple suture configuration likely contributed to its superior strength characteristics compared with the mattress suture configuration.

The utility of technetium-99m DTPA inhalational scans in artificially ventilated patients.

Technetium-99m diethylenetriaminepentaacetic acid ([99mTc]DTPA) radioaerosol scans performed on 21 consecutive artificially ventilated patients were compared to 50 similar scans performed on patients breathing without mechanical assistance. All patients were referred for evaluation of suspected pulmonary embolism. The comparison revealed increased extrathoracic tracheal and mediastinal tracheal deposition but less central bronchial deposition in the artificially ventilated patients. Peripheral penetration in both groups of patients was excellent. Within the artificially ventilated group, peripheral penetration of activity seemed equally good in patients receiving positive-end expiratory pressure ventilation (n = 14) and those ventilated with normal pressures (n = 7). The frequency of regions in which aerosol activity (A) was present in the same zone as a perfusion (P) defect was the same in the controls and artificially ventilated patients (12% against 14%) but the frequency of the reverse type of mismatch (i.e., P greater than A) was significantly higher in the artificially ventilated group (42% against 14%, p less than 0.001). The results suggest that [99mTc]DTPA aerosol scans in artificially ventilated patients are associated with good peripheral penetration of activity and frequently yield valuable clinical information.

Potassium transport in Chlamydomonas reinhardtii: isolation and characterization of transport-deficient mutant strains.

Putative potassium-transport-deficient mutant strains of Chlamydomonas reinhardtii Dang. were induced by ultra-violet mutagenesis and were identified by their dependence on abnormally high concentrations of potassium for growth. Potassium transport studies employing (86)Rb as a tracer were carried out with wild-type cells and with three independently isolated KDP (potassium-dependent phenotype) clones. Wildtype cells exhibit two transport activities. Transport activity A was expressed when cells were grown in medium supplemented with 10 mM KCl. The transporter with type-A activity does not discriminate between either Rb(+) or K(+) as a substrate and has a Km for Rb(+) equal to 1 mM and a Vmax equal to 31 nmol Rb(+) h(-1) 10(-6) cells. Transport activity B was expressed when cells were starved of potassium for 24 h. The transporter with type-B activity prefers K(+) to Rb(+) as a substrate; it has a Km for Rb(+) equal to 2.5 mM and a Vmax equal to 210 nmol Rb(+) h(-1) 10(-6) cells. All three mutant clones exhibit transport activity comparable to type-A when grown in 10 mM KCl. When starved of potassium for 24 h, two KDP clones demonstrate no transport activity and the third clone continues to exhibit only type-A activity.