Implementation and Analysis of an Institution-Wide EHR-Integrated Handoff Note.

EHR-Integrated Handoff Notes are becoming increasingly prevalent, especially among inpatient clinical service teams composed of physicians in training (resident physicians). We describe the implementation of such a tool at our institution, and then describe the usage of the tool, as well as changes made to its content, structure, and format, years after original implementation. We also describe frequency and temporal distribution of updates made to free text elements of the Handoff Note.

Applying Machine Learning Across Sites: External Validation of a Surgical Site Infection Detection Algorithm.

Background: Surgical complications have tremendous consequences and costs. Complication detection is important for quality improvement, but traditional manual chart review is burdensome. Automated mechanisms are needed to make this more efficient.

Accelerating Surgical Site Infection Abstraction With a Semi-automated Machine-learning Approach.

Objective: To demonstrate that a semi-automated approach to health data abstraction provides significant efficiencies and high accuracy.

Background: Surgical outcome abstraction remains laborious and a barrier to the sustainment of quality improvement registries like ACS-NSQIP. A supervised machine learning algorithm developed for detecting SSi using structured and unstructured electronic health record data was tested to perform semi-automated SSI abstraction.

Outcomes and influences of rural-focused integrated clerkship programs in general surgery.

Background: A shortage of general surgeons is predicted in the future, with particular impact on rural surgery. This is an exploratory analysis on a rural-focused longitudinal integrated clerkship to determine if such clerkships can be used to increase interest and recruitment in rural general surgery.

Methods: An institutional database was reviewed to identify students who became general surgeons after completing a rural-focused longitudinal integrated clerkship.

Resident-Physician Preferences for Electronic Handoff Note Content: Implications for Implementation of a System-Wide Electronic Health Record-Integrated Handoff Tool.

Increasing attention is paid to the Handoff Process and EHR- integrated tools to enhance the Handoff Process and aid in creating Handoff Notes are becoming more prevalent. In this study, we attempted to determine the ideal content of the Handoff Note based on the preferences of the resident physicians for whom the tool was being constructed. This commenced with an initial semi-structured interview and culminated in a large-scale survey.

Colorectal Lymphoma: A Contemporary Case Series.

Background: Colon and rectal lymphomas are rare and can occur in the context of posttransplant lymphoproliferative disorder. Evidence-based management guidelines are lacking.

Objective: The purpose of this study was to characterize the presentation, diagnosis, and management of colorectal lymphoma and to identify differences within the transplant population.

Penetrating Colon Trauma Outcomes in Black and White Males.

Introduction: Racial disparities have been both published and disputed in trauma patient mortality, outcomes, and rehabilitation. In this study, the objective was to assess racial disparities in patients with penetrating colon trauma.

Methods: The National Trauma Data Bank was searched for males aged ≥14years from 2010 through 2014 who underwent operative intervention for penetrating colon trauma.

Using Implementation Science to Adapt a Training Program to Assist Surgeons with High-Stakes Communication.

Objective: Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity.

Creating a Rural Surgery Track and a Review of Rural Surgery Training Programs.

Objective: The objective of this study was to present the process of developing a rural surgery training track within an established residency program and review the current rural surgery training programs in the nation.

Design: This study reviews current rural surgery training opportunities at Accreditation Council for Graduate Medical Education accredited surgical residencies in the United States and presents the process of creating the University of Minnesota's rural surgery training track.

Setting: This study was performed at the University of Minnesota, in Minneapolis, Minnesota, and at Essentia Health-Saint Mary's Medical Center, in Duluth, Minnesota.

Medical Student Perceptions of 24-Hour Call.

Objective: To assess the medical student perception and experience of a 24-hour call requirement, and to learn if improvements can be made to improve the 24-hour call requirement.

Design: Medical students completing their required surgical clerkship over 1 academic year at our institution were surveyed prior to their clerkship and on the last week of clerkship regarding their perceptions and experience with 24-hour call.

Setting: This study was performed at the University of Minnesota, in Minneapolis, Minnesota, a medical school and tertiary medical center.

Characterizing Functional Health Status of Surgical Patients in Clinical Notes.

Functional health status is an important factor not only for determining overall health, but also for measuring risks of adverse events. Our hypothesis is that important functional status data is contained in clinical notes. We found that several categories of phrases related to functional status including diagnoses, activity and care assessments, physical exam, functional scores, assistive equipment, symptoms, and surgical history were important factors.

Usability Evaluation of an Unstructured Clinical Document Query Tool for Researchers.

Natural Language Processing - Patient Information Extraction for Researchers (NLP-PIER) was developed for clinical researchers for self-service Natural Language Processing (NLP) queries with clinical notes. This study was to conduct a user-centered analysis with clinical researchers to gain insight into NLP-PIER's usability and to gain an understanding of the needs of clinical researchers when using an application for searching clinical notes. Clinical researcher participants (n=11) completed tasks using the system's two existing search interfaces and completed a set of surveys and an exit interview.

Causal Phenotyping for Susceptibility to Cardiotoxicity from Antineoplastic Breast Cancer Medications.

Cardiotoxicity is a relatively common and particularly important adverse event caused by chemotherapy for breast cancer patients. Typical associative phenotypes, such as risk factors associated with diabetes, can often be detected solely based on the data elements existing in electronic health records; however, causal phenotypes, such as risk factors causing cardiotoxicity, require establishing causation between chemotherapy and determining new heart disease, and cannot be directly observedfrom EHR. We propose three phenotyping algorithms to assess breast cancer patients' susceptibility to cardiotoxicity caused by five first-line antineoplastic drugs: (1) causal phenotype model to predict the patients' risk of cardiotoxicity as the difference between the heart disease risks with exposure and nonexposure to the drugs; (2) regular predictive model; (3) combined predictive model of the above two models.

Representation of Social History Factors Across Age Groups: A Topic Analysis of Free-Text Social Documentation.

As individuals age, there is potential for dramatic changes in the social and behavioral determinants that affect health status and outcomes. The importance of these determinants has been increasingly recognized in clinical decision-making. We sought to characterize how social and behavioral health determinants vary in different demographic groups using a previously established schema of 28 social history types through both manual analysis and automated topic analysis of social documentation in the electronic health record across the population of an entire integrated healthcare system.

Acute Kidney Injury and Sepsis.

Background: Worldwide, both acute kidney injury (AKI) and sepsis are significant clinical complications, particularly in critical care patients. Sepsis is an important cause of AKI, and AKI is a common complication of sepsis.

Methods: We reviewed the literature, including current practice guidelines, on sepsis-associated AKI.

Usability Evaluation of NLP-PIER: A Clinical Document Search Engine for Researchers.

NLP-PIER (Natural Language Processing - Patient Information Extraction for Research) is a self-service platform with a search engine for clinical researchers to perform natural language processing (NLP) queries using clinical notes. We conducted user-centered testing of NLP-PIER's usability to inform future design decisions. Quantitative and qualitative data were analyzed.

Assessing Provider-Generated Free-Text Quality in EHR-Integrated Handoff Notes.

Handoff notes are increasingly integrated within electronic health record (EHR) systems and often contain data automatically generated from the EHR and free-text narratives. We examined the quality of data entered by providers in the free-text portion of our institutional EHR handoff tool. Overall, 65% of handoff notes contained at least one error (average 1.

Characterizing Surgical Site Infection Signals in Clinical Notes.

Surgical site infections (SSIs) are the most common and costly of hospital acquired infections. An important step in reducing SSIs is accurate SSI detection, which enables measurement quality improvement, but currently remains expensive through manual chart review. Building off of previous work for automated and semi-automated SSI detection using expert-derived "strong features" from clinical notes, we hypothesized that additional SSI phrases may be contained in clinical notes.

Phenotyping and Visualizing Infusion-Related Reactions for Breast Cancer Patients.

Infusion-related reactions (IRRs) are typical adverse events for breast cancer patients. Detecting IRRs and visualizing their occurance associated with the drug treatment would potentially assist clinicians to improve patient safety and help researchers model IRRs and analyze their risk factors. We developed and evaluated a phenotyping algorithm to detect IRRs for breast cancer patients.

Triptolide abrogates growth of colon cancer and induces cell cycle arrest by inhibiting transcriptional activation of E2F.

Despite significant progress in diagnostics and therapeutics, over 50 thousand patients die from colorectal cancer annually. Hence, there is urgent need for new lines of treatment. Triptolide, a natural compound isolated from the Chinese herb Tripterygium wilfordii, is effective against multiple cancers.

Prosurvival role of heat shock factor 1 in the pathogenesis of pancreatobiliary tumors.

Several mechanisms have evolved to ensure the survival of cells under adverse conditions. The heat shock response is one such evolutionarily conserved survival mechanism. Heat shock factor-1 (HSF1) is a transcriptional regulator of the heat shock response.

Role of Hsp-70 in triptolide-mediated cell death of neuroblastoma.

Background: Our recent work demonstrated that treatment of neuroblastoma with triptolide causes apoptotic cell death in vitro and decreases tumor size in vivo. Triptolide therapy has been associated with reduced expression of Hsp-70, suggesting a mechanism of cell killing involving Hsp-70 inhibition. The principal objective of this study was to investigate the role of Hsp-70 in triptolide-mediated cell death in neuroblastoma.

Triptolide therapy for neuroblastoma decreases cell viability in vitro and inhibits tumor growth in vivo.

Background: Heat shock protein (Hsp)-70 is overexpressed in several human malignancies, and its inhibition has been shown to kill cancer cells. Our objectives were to assess the effectiveness of triptolide, an Hsp-70 inhibitor, in treating neuroblastoma in vitro and in vivo, and to measure the associated effects on Hsp-70 levels and apoptosis markers.

Methods: After exposing N2a and SKNSH cell lines to triptolide, cell viability was assessed.