Prognostic factors affecting ALS progression through disease tollgates.

Background And Objectives: Understanding factors affecting the timing of critical clinical events in ALS progression.

Methods: We captured ALS progression based on the timing of critical events (tollgates), by augmenting 6366 patients' data from the PRO-ACT database with tollgate-passed information using classification. Time trajectories of passing ALS tollgates after the first visit were derived using Kaplan-Meier analyses.

A Decision-Support System to Schedule Rotations for Trainees.

Background: Each training program has its own internal policies and restrictions, which must be considered while developing trainee schedules. Designing these schedules is complex and time consuming, and the final schedules often contain undesirable aspects for trainees.

Objective: We developed a decision-support system (DSS) to optimally schedule daily assignments and monthly rotations for trainees.

Non-invasive Hemoglobin Measurement Predictive Analytics with Missing Data and Accuracy Improvement Using Gaussian Process and Functional Regression Model.

Recent use of noninvasive and continuous hemoglobin (SpHb) concentration monitor has emerged as an alternative to invasive laboratory-based hematological analysis. Unlike delayed laboratory based measures of hemoglobin (HgB), SpHb monitors can provide real-time information about the HgB levels. Real-time SpHb measurements will offer healthcare providers with warnings and early detections of abnormal health status, e.

The difference between semi-continuum model and Richards' equation for unsaturated porous media flow.

Semi-continuum modelling of unsaturated porous media flow is based on representing the porous medium as a grid of non-infinitesimal blocks that retain the character of a porous medium. This approach is similar to the hybrid/multiscale modelling. Semi-continuum model is able to physically correctly describe diffusion-like flow, finger-like flow, and the transition between them.

Predicting Risk of Surgery in Patients With Small Bowel Crohn's Disease Strictures Using Computed Tomography and Magnetic Resonance Enterography.

Background: We aimed to determine if patient symptoms and computed tomography enterography (CTE) and magnetic resonance enterography (MRE) imaging findings can be used to predict near-term risk of surgery in patients with small bowel Crohn's disease (CD).

Methods: CD patients with small bowel strictures undergoing serial CTE or MRE were retrospectively identified. Strictures were defined by luminal narrowing, bowel wall thickening, and unequivocal proximal small bowel dilation.

Mapping of critical events in disease progression through binary classification: Application to amyotrophic lateral sclerosis.

Background: The progression of many degenerative diseases is tracked periodically using scales evaluating functionality in daily activities. Although estimating the timing of critical events (i.e.

A discrete event simulation to evaluate impact of radiology process changes on emergency department computed tomography access.

Background: Hospitals face the challenge of managing demand for limited computed tomography (CT) resources from multiple patient types while ensuring timely access.

Methods: A discrete event simulation model was created to evaluate CT access time for emergency department (ED) patients at a large academic medical center with six unique CT machines that serve unscheduled emergency, semi-scheduled inpatient, and scheduled outpatient demand. Three operational interventions were tested: adding additional patient transporters, using an alternative creatinine lab, and adding a registered nurse dedicated to monitoring CT patients in the ED.

Monitoring Diagnostic Safety Risks in Emergency Departments: Protocol for a Machine Learning Study.

Background: Diagnostic decision making, especially in emergency departments, is a highly complex cognitive process that involves uncertainty and susceptibility to errors. A combination of factors, including patient factors (eg, history, behaviors, complexity, and comorbidity), provider-care team factors (eg, cognitive load and information gathering and synthesis), and system factors (eg, health information technology, crowding, shift-based work, and interruptions) may contribute to diagnostic errors. Using electronic triggers to identify records of patients with certain patterns of care, such as escalation of care, has been useful to screen for diagnostic errors.

A two dimensional semi-continuum model to explain wetting front instability in porous media.

Modelling fluid flow in an unsaturated porous medium is a complex problem with many practical applications. There is enough experimental and theoretical evidence that the standard continuum mechanics based modelling approach is unable to capture many important features of porous media flow. In this paper, a two-dimensional semi-continuum model is presented that combines ideas from continuum mechanics with invasion percolation models.

Measuring Sensitivity and Precision of Real-Time Location Systems (RTLS): Definition, Protocol and Demonstration for Clinical Relevance.

The ability of a Real Time Location System (RTLS) to provide correct information in a clinical environment is an important consideration in evaluating the effectiveness of the technology. While past efforts describe how well the technology performed in a lab environment, the performance of such technology has not been specifically defined or evaluated in a practice setting involving workflow and movement. Clinical environments pose complexity owing to various layouts and various movements.

Using operative features to identify surgical complexity: a case in breast surgery practice.

Increasing workload is one of the main problems that surgical practices face. This increase is not only due to the increasing demand volume but also due to increasing case complexity. This raises the question on how to measure and predict the complexity to address this issue.

A new optimization algorithm for HDR brachytherapy that improves DVH-based planning: Truncated Conditional Value-at-Risk (TCVaR).

To introduce a new optimization algorithm that improves DVH results and is designed for the type of heterogeneous dose distributions that occur in brachytherapy.The new optimization algorithm is based on a prior mathematical approach that uses mean doses of the DVH metric tails. The prior mean dose approach is referred to as conditional value-at-risk (CVaR), and unfortunately produces noticeably worse DVH metric results than gradient-based approaches.

Comparing bowel and urinary domains of patient-reported quality of life at the end of and 3 months post radiotherapy between intensity-modulated radiotherapy and proton beam therapy for clinically localized prostate cancer.

Purpose: To prospectively assess acute differences in patient-reported outcomes in bowel and urinary domains between intensity-modulated radiotherapy (IMRT) and proton beam therapy (PBT) for prostate cancer.

Methods And Materials: Bowel function (BF), urinary irritative/obstructive symptoms (UO), and urinary incontinence (UI) domains of EPIC-26 were collected in patients with T1-T2 prostate cancer receiving IMRT or PBT at a tertiary cancer center (2015-2018). Mean changes in domain scores were analyzed from pretreatment to the end of and 3 months post-radiotherapy for each modality.

Quantifying the Impact of Resuscitation-Team Activation in Hospital Emergency Departments.

Hospital emergency department (ED) operations are affected when critically ill or injured patients arrive. Such events often lead to the initiation of specific protocols, referred to as Resuscitation-team Activation (RA), in the ED of Mayo Clinic, Rochester, MN where this study was conducted. RA events lead to the diversion of resources from other patients in the ED to provide care to critically ill patients; therefore, it has an impact on the entire ED system.

Unnecessary wait hours: a novel ED system-level metric.

Background: Emergency department (ED) operations leaders are under increasing pressure to make care delivery more efficient. Publicly reported ED efficiency metrics are traditionally patient centred and do not show situational or facility-based improvement opportunities. We propose the consideration of a novel metric, the 'Number of Unnecessary Waits (NUW)' and the corresponding 'Unnecessary Wait Hours (UWH)', to measure space efficiency, and we describe how we used NUW to evaluate operational changes in our ED.

PNaV: A tool for generating a high-dose-rate brachytherapy treatment plan by navigating the Pareto surface guided by the visualization of multidimensional trade-offs.

Purpose: A Pareto Navigation and Visualization (PNaV) tool is presented for interactively constructing a high-dose-rate (HDR) brachytherapy treatment plan by navigating and visualizing the multidimensional Pareto surface. PNaV aims to improve treatment planning time and quality and is generalizable to any number of dose-volume histogram (DVH) and convex dose metrics.

Methods And Materials: Pareto surface visualization and navigation were demonstrated for prostate, breast, and cervix HDR brachytherapy sites.

Attitudes and Behavior of Health Care Workers Before, During, and After Implementation of Real-Time Location System Technology.

Objective: To assess how staff attitudes before, during, and after implementation of a real-time location system (RTLS) that uses radio-frequency identification tags on staff and patient identification badges and on equipment affected staff's intention to use and actual use of an RTLS.

Participants And Methods: A series of 3 online surveys were sent to staff at an emergency department with plans to implement an RTLS between June 1, 2015, and November 29, 2016. Each survey corresponded with a different phase of implementation: preimplementation, midimplementation, and postimplementation.

Getting to the Heart of the Matter: A Triage Model to Improve Utilization of Cardiology Consultative Services.

Objective: To assess the impact of a triage system of emergency department (ED) referrals for outpatient cardiology appointments.

Patient And Methods: We implemented a triage system of ED referrals for outpatient cardiology appointments among patients with a cardiovascular chief complaint deemed safe to leave the ED but needing outpatient follow-up. There were 303 and 267 unique patients in the pre-triage implementation and post-triage implementation cohorts, respectively.

Patient-Care Team Contact Patterns Impact Treatment Length of Stay in the Emergency Department.

Real-time location systems (RTLS) has found extensive application in the healthcare setting, that is shown to improve safety, save cost, and increase patient satisfaction. More specifically, some studies have shown the efficacy of RTLS leading to an improved workflow in the emergency department. However, due to substantial implementation costs of such technologies, hospital administrators show reluctance in RTLS adoption.

CCMapper: An adaptive NLP-based free-text chief complaint mapping algorithm.

Objective: Chief complaint (CC) is among the earliest health information recorded at the beginning of a patient's visit to an emergency department (ED). We propose a heuristic methodology for automatically mapping the free-text data into a structured list of CCs.

Methods: A comprehensive structured list categorizing CCs was developed by experienced Emergency Medicine (EM) physicians.

Characterization of emergency department abandonment using a real-time location system.

Background: Patients who present to emergency departments (EDs) for evaluation but are noted to have left without being seen (LWBS) are potentially at great risk. Governmental agencies, such as the Centers for Medicare and Medicaid, as well as hospitals and health organizations, are examining the factors which drive LWBS, including accurately quantifying patient tolerance to wait times and targeting interventions to improve patient tolerance to waiting.

Objective: Compare traditional methods of estimating time to LWBS with an objective method using a real-time location tracking system (RTLS); examine temporal factors associated with greater LWBS rates.

A semi-continuum model of saturation overshoot in one dimensional unsaturated porous media flow.

A semi-continuum model for fluid flow in saturated-unsaturated porous medium in one spatial dimension is presented. The model is based on well-established physics, measurable parameters and material characteristics. The porous material is characterized by porosity, intrinsic permeability, main wetting and draining branches of the retention curve, and the saturation dependence of the relative permeability.

Pattern-based strategic surgical capacity allocation.

Strategic allocation of limited operating room (OR) capacity to surgeons is crucial for the coordination of surgical work flow, including planning of consultation and surgery days, and staff assignment to perioperative teams. However, it is a challenging problem in practice, since the capacity allocation needs to be cyclic for schedule predictability and surgical team coordination, and also needs to satisfy surgeons' preferences. It is further complicated by the practice of surgeons sharing ORs.

A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes.

Objective: To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes.

Methods: This was a prospective observation cohort study in a large academic emergency department. Two research assistants with experience in physician-scribe interactions and ED workflow shadowed attending physicians for a total of 64 hours in the adult emergency department.

Development of data integration and visualization tools for the Department of Radiology to display operational and strategic metrics.

Visualizing process metrics can help identify targets for improvement initiatives. Dashboards and scorecards are tools to visualize important metrics in an easily interpretable manner. We describe the development of two visualization systems: a dashboard to provide real-time situational awareness to frontline coordinators, and a scorecard to display aggregate monthly performance metrics for strategic process improvement efforts.