"A friendly reminder" - Improving workflow and efficiency in a pulmonary fellows' outpatient continuity clinic.

BACKGROUND: Seeing patients in an ambulatory clinic generates electronic medical record (EMR) inbox tasks. Little is known about the standard baseline message turnaround time to EMR inbox task completion and whether electronic reminders improve turnaround time. OBJECTIVE: 1) Obtain baseline message type and mean message turnaround time (MTT) to EMR inbox task completion data, 2) Standardize EMR workflow education, 3) Disseminate bi-weekly electronic reminders to fellows in their continuity clinic and measure MTT. METHODS: Prospective, non-randomized, unblinded, cross-over pre- and post-intervention pilot study in an ambulatory pulmonary clinic at a large, urban, academic referral health system. Sixteen pulmonary and critical care fellows affiliated with the Indiana University School of Medicine Pulmonary and Critical Care Fellowship were divided equally into two groups, with the study period from October of 2021 to May of 2022, and were given bi-weekly calendar reminders in Microsoft Outlook with measurement of EMR messages and MTT. RESULTS: 2554 messages were acknowledged with result notes (n = 1676, 59.16 %) being the most common. There was a 40 % decrease in overall MTT from the pre- to the post-intervention period (MTT = 33 days in pre-intervention period for whole cohort, MTT = 19 days in post-intervention period). CONCLUSIONS: MTT for EMR inbox tasks at a large, academic center with fellowship trainees is roughly 2.5 weeks. These findings should prompt other institutions to investigate their own trainees' inbox handling habits and validates the benefit of EMR training and reminders on fellowship trainee's in-basket task turnaround time.

Spontaneous pneumothoraces during pregnancy in patients with lymphangioleiomyomatosis.

Patients with lymphangioleiomyomatosis (LAM) are prone to developing spontaneous pneumothoraces (SPs). We aimed to characterize the burden of SPs during pregnancy in LAM, using a web-based survey. Among the 50 respondents, 12 (24%) had never been pregnant and 38 (76%) were pregnant at least once, resulting in a total of 80 pregnancies. Respiratory symptoms during pregnancy led to the diagnosis of LAM in 34% of (13/38) patients, with SPs being the presenting manifestation in most of these patients (10/13, 77%). Eleven of the 38 pregnant patients (29%) experienced at least one SP during pregnancy. The majority of the SPs (∼60%) occurred during the second trimester. Our study provides valuable insights regarding the risk, burden, and timing of pregnancy-related SPs in patients with LAM that would be useful for the LAM community.

A unique histone deacetylase inhibitor alters microRNA expression and signal transduction in chemoresistant ovarian cancer cells.

Previously, we demonstrated potent antineoplastic activity of a distinctive histone deacetylase inhibitor (HDACI), AR42, against chemoresistant CP70 ovarian cancer cells in vitro and in vivo. Here, in follow-up to that work, we explored AR42 global mechanisms-of-action by examining drug-associated, genome-wide microRNA and mRNA expression profiles, which differed from those of the well-studied HDACI vorinostat. Expression of microRNA genes in negative correlation with their "target" coding gene (mRNA) transcripts, and transcription factor genes with expression positively correlated with coding genes having their cognate binding sites, were identified and subjected to gene ontology analyses. Those evaluations showed AR42 gene expression patterns to negatively correlate with Wnt signaling (> 18-fold induction of SFRP1), the epithelial-to-mesenchymal transition (40% decreased ATF1), and cell cycle progression (33-fold increased 14-3-3σ). By contrast, AR42 transcriptome alterations correlated positively with extrinsic ("death receptor") apoptosis (> 2.3-fold upregulated DAPK) and favorable ovarian cancer histopathology and prognosis. Inhibition of Wnt signaling was experimentally validated by: (1) > 2.6-fold reduced Wnt reporter activity; and (2) 36% reduction in nuclear, activated ß-catenin. Likely AR42 induction of multiple (type I or type II autophagic) cell death cascades was further supported by 57% decreased reliance upon reactive oxygen, increased mitochondrial membrane disruption, and caspase independence, as compared with vorinostat. Taken together, we demonstrate distinct antineoplastic pathway alterations, in aggressive ovarian cancer cells, following treatment with a promising HDACI, AR42. These combined computational and experimental approaches may also represent a straightforward means for mechanistic studies of other promising antineoplastics, and/or the identification of agents that may complement epigenetic therapies.

Integrating clinical information in NHS Scotland: the role of Scottish Care Information Store.

A key plank in NHS Scotland's information management and technology (IM&T) eHealth Strategy is the web-based system known as Scottish Care Information (SCI) Store, which gives primary and secondary care clinicians access to core clinical information. There is one SCI Store in each of the 15 NHS Board areas. At present all GP practices in 11 of these areas have access to SCI Stores for test results. Work is underway to augment the Stores with clinical letters and GP summary data. Strategically, SCI Store is seen as the ubiquitous element in our eHealth Strategy which will allow information to be shared across Scotland in a secure and reliable way.