Are smart pumps smart enough?

ObjectiveDoctoral and postdoctoral training in health services and policy research (HSPR) needs to evolve to address changing career trajectories, emerging health system challenges, and the advancement of learning health systems. This changing landscape necessitates examination of the core competencies that underpin training. This study presents a refreshed set of core competencies for HSPR to guide the modernization of training and considerations for implementation.MethodsQualitative methods and an iterative development process with extensive community engagement throughout were used. Data were obtained from multiple sources, including literature reviews, surveys, key informant interviews, focus groups, Task Force meetings, a consensus workshop, and a validation process (Fall 2022 to May 2024). The study setting is Canada.ResultsThe refreshed core competencies include nine essential domains that maintain an emphasis on rigorous scholarly preparation and prioritize leadership and other professional skills deemed essential to contribute to evidence‐informed system improvement and learning health systems. Additionally, the framework features two new transversal domains: Equity, Diversity, Inclusion, Accessibility, and Anti‐Oppression; and Indigenous Cultural Safety and Humility. These domains are considered fundamental principles to be embedded into all aspects of HSPR competencies and training, fostering more inclusive and equitable leaders and health systems.ConclusionsAs health systems continuously evolve, so too should the questions researchers address, the methods they use, and the skills needed to maximize contributions to evidence‐informed health system improvement and learning health systems. The refreshed core competencies for HSPR maintain important continuity with the inaugural competency framework while also including several important additions. The framework allows for flexibility in its implementation and us; it can be used to guide the enhancement of existing training programs, the development of new ones, and the growth and development of a HSPR workforce with the skills to lead and contribute within learning health systems.

As a group of Health System Impact (HSI) postdoctoral fellows, Sim and colleagues offer their reflections on ‘driving change’ within the health system and present a framework for understanding the HSI fellow as an embedded researcher. Our commentary offers a different perspective of the fellow’s role by highlighting the integrated knowledge translation (IKT) approach we consider to be foundational to the fellowship experience. Further, we provide several recommendations to enhance Sim and colleagues’ framework to ensure we capture the full value of the fellowship program to the HSI fellow, health system organization, and academic institution.

James N. Baron of Yale School of Management reviews, “Poker: The Parody of Capitalism” by Ole Bjerg. The EconLit Abstract of this book begins: “Explores the game of poker as a cultural expression with similar significance and resonance as art, literature, and film. Discusses the ontology of poker; anatomy of a poker hand; all you ever wanted to know about Texas Hold 'Em but were afraid to ask Slavoj Žižek; where the money comes from; styles of play in the poker economy; a tough way to make an easy living; why people play poker; losing it; what's in a game?; the history of poker; the poetry of money; and the uncanniness of poker. Berg is a postdoctoral fellow and research scientist at the Institute for Leadership, Politics and Philosophy at Copenhagen Business School. Index.”

In Memoriam Norman J. Siegel, MD

Editorial introductions

<div class="authors authors-lg"><div class="author"><div class="author-img"><img src="https://cdn.insights.bio/uploads/WF-ConfPhoto3.jpg copy.png" data-image="1"></div><div class="author-det"> <b>William Fodor</b> received his B.S. degree in Genetics and his Ph.D. degree in Molecular Genetics from The Ohio State University. He then completed his post-doctoral training in Immunobiology at the Yale School of Medicine (Mentor, R.A. Flavell). Dr. Fodor started his industrial career as a founding scientist of Alexion Pharmaceuticals, Inc. During his tenure at Alexion he directed the xenotransplantation, cell and tissue and organ engineering programs and advanced the program to include a pilot manufacturing facility for cell production. Dr. Fodor then moved to academia as an Associate Professor in the Center for Regenerative Biology at the University of Connecticut where he spent 3 years renovating his research to focus on stem cell biology for tissue repair. Dr. Fodor then returned to industry as Senior Director of Product Development at Viacell Inc., where he was responsible for various stem cell product development projects for hematologic indications as well as islet stem cell applications for diabetes. Following his tenure at Viacell, he continued his career in biotechnology as an independent consultant, serving many clients within the regenerative medicine field. Dr. Fodor’s relationship with Biostage was first as a consultant then as the Chief Scientific Officer, his current role. </div></div></div>

Substance use is a major global public health challenge. A well-trained health care workforce is needed to prevent, address, and treat substance use disorders (SUD) internationally. In September 2021, the Yale Schools of Medicine (YSM) and Public Health (YSPH) and the University of Jordan (UJ) collaborated to establish the Yale-UJ Joint Training Program in Addiction Medicine. The curriculum was developed using the six-step Kern Model. The program aimed to create opportunities for cross-cultural, interprofessional education in addiction medicine to address education and treatment gaps. The two-year program led to novel learning, training, and research opportunities in addiction medicine for faculty, staff, and students at YSM, YSPH, and UJ. The program implemented 16 lectures, a live in-person training workshop, three student-led discussion events, a student-led exchange network, a novel elective course, two cross-institutional research projects, and resulted in three published peer reviewed articles, two international conference presentations, three elective training opportunities, and one postdoctoral training. The program was well received by students and faculty and resulted in SUD treatment stakeholder collaboration in both countries. Establishment of a cross-national, interprofessional joint training program creates opportunities to implement novel education, research, and mentorship to prepare a culturally informed workforce.

BackgroundWorkface projections indicate an increasing shortfall in neurologists and other medical specialists to treat persons with Alzheimer’s disease and other causes of dementia (Dall et al. Neurology 2013). This problem will be further magnified by available disease modifying therapies aimed at earlier stages of illness, markedly expanding the patient pool (Anderson et al. J Prev Alzheimers 2022; Hlavka et al. Rand 2019). With the Alzheimer’s disease treatment landscape approaching these turning points the University of Alabama at Birmingham Brain Aging and Memory (BAM) Clinic undertook a multidisciplinary expansion to improve access and increase the role of nonphysician professionals to optimize care. Onboarding this interdisciplinary team was complicated by separation of staff members mandated by the COVID‐19 pandemic. These factors, along with emerging use of “team‐based learning” educational models led to the creation of the BAM Learning Club (BAM LC).MethodsBAM LC is a weekly synchronous online series of didactics, lectures, case discussions, journal reviews, and team‐building wellness activities. Participants include Neurologists, Psychiatrists, Psychologists, RN Case managers, RN Clinical Care Coordinators, Social Workers, Nurse Practitioners, Pharmacists, Caregiver Counselors, Research Scientists, Clinical Trial Coordinators, Postdoctoral Fellows, Residents, and Medical Students. Sessions are recorded for future onboarding and educational needs. Content is generated by the BAM LC members with support from its director.ResultsBAM LC began in June 2021 and has continued weekly with increasing interest and attendance. Shared learning has led to practice improvements, a collaborative environment, and a cohesive multidisciplinary team. Recorded sessions have been used to provide education outside of our cohort and will be maintained for future use.ConclusionTeam‐based learning has resulted in better academic, clinical, and communication outcomes among health care professionals (Joshi et al. Cureus 2022). Multidisciplinary team‐led learning opportunities focused on dementia care could serve as a tool to promote further practice improvement, collaboration, and cohesion within healthcare organizations. Normalization of synchronous remote learning during the pandemic facilitated acceptance, uptake, and participation across disciplines. This process also has the potential to provide further system‐wide education in health systems to diversify the workforce and improve readiness to treat a rapidly expanding patient population.

Ethnocultural Variations in Mental Illness Discourse: Some Implications for Building Therapeutic Alliances

Changing perceptions of obesity—recollections of a paediatrician

Introduction Spine surgery is a growing and challenging subspecialty in most health systems in Latin America and Peru, where the extent of its possibilities must attend an overflowing spine pathologies demand, such as traumatic and degenerative; considering that budgetary resources with almost immediate availability and trained medical specialists are imperative needed. Continuing medical education and subspecialization with competency-based curricula responds to the rapid expansion of technology and knowledge in this field, a fact which promotes better patient care, a greater sense of responsibility and dedication, a trend of critical analysis and research, and certainly the possibility to get more attractive job opportunities. This study examines the gaps in knowledge of the author who developed a 3 months' Postdoctoral Training AOSpine Fellowship Program, focused on traumatic and degenerative spine pathology, at the Department of Spine Diseases of the Instituto de Ortopedia e Traumatologia (IOT) FMUSP, Sao Paulo, Brazil. Material and Methods AOSpine Fellow Neurosurgeon activities in the scope of spine diseases were evaluated over a first period of 6 months before training ( n = 12 patients) and a second period of 6 months after training ( n = 18 patients) at the Neurosurgical Unit, Department of Surgical Specialties of the Hospital Antonio Lorena del Cusco, Peru; with emphasis in the fields of clinical and surgical practice (clinical, radiographic, and operative records from the whole 30 consecutive operative patients group with traumatic and degenerative diseases), academic performance, and research tasks. Multivariable linear regression was used to evaluate the relationship between experience level of the surgeon and surgical performance; as well as mentioning differences in the other two practice fields. Results Real differences between two periods were identified with the greatest difference in better performance seen on completing the fellowship (vs. nonfellowship): cervical trauma (80 vs. 62%), cervical stabilization (71 vs. 54%), thoracolumbar trauma (92 vs. 59%). and degenerative spine diseases (65 vs. 47%) and its complications (36 vs. 31%). In the second period, surgical correction and level of complications were significantly better; meanwhile, operative time and length of patients stay were significantly longer. No group differences were founded with respect to estimated blood loose (EBL), transfusion rates, and postoperative infections. Other advantages of the posttraining period were review log cases, surgical technique discussion, analysis of biomechanics, classification system, surgical approach and planning, number of screws placed, and stronger constructs. Finally, two spinal research projects were developed in the posttraining surgery. Conclusion To provide an efficient and safe service covering the broad spectrum of spinal pathology, a formal AOSpine fellowship, ideally with a formal curriculum, should be considered and recommended. Advantages include optimization of the diagnostic process, therapeutic classification, biomechanical analysis, neuroimaging study, selection of material, and user satisfaction. Research activities and academic industry support must be enhanced.

Recent natural disasters and events of terrorism and war have heightened society's recognition of the need for emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, several additional issues related to terrorism preparedness must be considered, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if not monitored carefully. The challenge of dealing with the threat of terrorism, natural disasters, and public health emergencies in the United States is daunting not only for disaster planners but also for our medical system and health professionals of all types, including pediatricians. As part of the network of health responders, pediatricians need to be able to answer concerns of patients and families, recognize signs of possible exposure to a weapon of terror, understand first-line response to such attacks, and sufficiently participate in disaster planning to ensure that the unique needs of children are addressed satisfactorily in the overall process. Pediatricians play a central role in disaster and terrorism preparedness with families, children, and their communities. This applies not only to the general pediatrician but also to the pediatric medical subspecialist and pediatric surgical specialist. Families view pediatricians as their expert resource, and most of them expect the pediatrician to be knowledgeable in areas of concern. Providing expert guidance entails educating families in anticipation of events and responding to questions during and after actual events. It is essential that pediatricians educate themselves regarding these issues of emergency preparedness. For pediatricians, some information is currently available on virtually all of these issues in recently produced printed materials, at special conferences, in broadcasts of various types, and on the Internet. However, selecting appropriate, accurate sources of information and determining how much information is sufficient remain difficult challenges. Similarly, guidance is needed with respect to developing relevant curricula for medical students and postdoctoral clinical trainees.

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

The pharmacist-led implementation of a smart pump-electronic medical record (EMR) interoperability program at a hospital within a regional health system is described. Smart pump-EMR interoperability involves a wireless, bidirectional connection by which infusion information transmitted by the EMR prepopulates infusion devices, reducing keystokes and opportunities for manual programming errors. The smart pumps transmit time-stamped infusion data to the EMR for nurse documentation. Use of interoperability technology forces the use of dose-error reduction software so that 100% of prepopulated infusions and dosage adjustments are protected. To improve i.v. medication safety and documentation at a 286-bed hospital within an 8-hospital health system, pharmacists led an initiative to implement smart pump-EMR interoperability as a first step toward systemwide implementation. The hospital's smart pump-EMR interoperability initiative resulted in patient safety and revenue-generation gains in the first 8 months after implementation. The mean number of keystrokes needed to program an infusion was reduced from 15 to 2 (an 86% decrease). Pump alerts, alert overrides, and reprogrammed or cancelled infusions were decreased. In addition, the program improved outpatient charge capture, resulting in $370,000 in incremental revenue. A pharmacist-led implementation of smart pump-EMR interoperability led to measurable, data-based improvements in i.v. medication safety and improved accuracy, timeliness, and efficiency of i.v. infusion documentation. Revenue was increased due to improved charge capture for outpatient i.v. infusions.

Background: Intravenous (IV) medication errors are a common type of error identified in hospitals and can lead to considerable harm. Over the past 20 years there have been several hundred...