Training in Informatics: Teaching Informatics in Surgical Pathology

This article presents an overview of the curriculum deemed essential for trainees in pathology, with mapping to the Milestones competency statements. The means by which these competencies desired for pathology graduates, and ultimately practitioners, can best be achieved is discussed. The value of case (problem)-based learning in this realm, in particular the kind of integrative experience associated with hands-on projects, to both cement knowledge gained in the lecture hall or online and to expand competency is emphasized.     

Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction

BackgroundCoronary artery bypass grafting (CABG) improves survival in patients with heart failure and severely reduced left ventricular systolic function (LVEF). Limited data exist regarding adverse cardiovascular event rates after CABG in patients with heart failure with midrange ejection fraction (HFmrEF; LVEF > 40% and < 55%).MethodsWe analyzed data on isolated CABG patients from the Veterans Affairs national database (2010-2019). We stratified patients into control (normal LVEF and no heart failure), HFmrEF, and heart failure with reduced LVEF (HFrEF) groups. We compared all-cause mortality and heart failure hospitalization rates between groups with a Cox model and recurrent events analysis, respectively.ResultsIn 6533 veterans, HFmrEF and HFrEF was present in 1715 (26.3%) and 566 (8.6%) respectively; the control group had 4252 (65.1%) patients. HFrEF patients were more likely to have diabetes mellitus (59%), insulin therapy (36%), and previous myocardial infarction (31%). Anemia was more prevalent in patients with HFrEF (49%) as was a lower serum albumin (mean, 3.6 mg/dL). Compared with the control group, a higher risk of death was observed in the HFmrEF (hazard ratio [HR], 1.3 [1.2-1.5)] and HFrEF (HR, 1.5 [1.2-1.7]) groups. HFmrEF patients had the higher risk of myocardial infarction (subdistribution HR, 1.2 [1-1.6]; P = .04). Risk of heart failure hospitalization was higher in patients with HFmrEF (HR, 4.1 [3.5-4.7]) and patients with HFrEF (HR, 7.2 [6.2-8.5]).ConclusionsHeart failure with midrange ejection fraction negatively affects survival after CABG. These patients also experience higher rates myocardial infarction and heart failure hospitalization.     

Medical informatics education by medical professors within their discipline

A system for medical informatics education for medical students has been developed in the medical school. This paper describes the concept underlying the development of this system and its progressive outcomes over 8 years. In order to stimulate students to acquire computer-related knowledge and skills, this subject has been integrated into the course works of various medical subjects such as physiology. In addition, acquired knowledge and skills are evaluated within each subject by the production of reports for example, using computers. This provides a concrete example for students of the relevance of the information sciences to the solving of medical problems. A well equipped computer facility for the study of medicine also plays a significant role in inspiring student incentive. A computer room equipped with Macintosh computers was opened adjacent to the main medical library and is used in the same manner as the library, with books replaced by computers. In addition, all new students acquire their own Macintosh PowerBook. These various initiations have facilitated concept that the computer may be applied to medical problem solving at any time or place and may become as commonplace as a pen in daily medical practice.     

Committing to genomic answers for all kids: Evaluating inequity in genomic research enrollment

PurposePersistent inequities in genomic medicine and research contribute to health disparities. This analysis uses a context-specific and equity-focused strategy to evaluate enrollment patterns for Genomic Answers for Kids (GA4K), a large, metropolitan-wide genomic study on children.MethodsElectronic health records for 2247 GA4K study participants were used to evaluate the distribution of individuals by demographics (race, ethnicity, and payor type) and location (residential address). Addresses were geocoded to produce point density and 3-digit zip code maps showing local and regional enrollment patterns. Health system reports and census data were used to compare participant characteristics with reference populations at different spatial scales.ResultsRacial and ethnic minoritized and populations with low-income were underrepresented in the GA4K study cohort. Geographic variation demonstrates inequity in enrollment and participation among children from historically segregated and socially disadvantaged communities.ConclusionOur findings illustrate inequity in enrollment related to both GA4K study design and structural inequalities, which we suspect may exist for similar US-based studies. Our methods provide a scalable framework for continually evaluating and improving study design to ensure equitable participation in and benefits from genomic research and medicine. The use of high-resolution, place-based data represents a novel and practical means of identifying and characterizing inequities and targeting community engagement.     

北美国际护理诊断定义与分类(2018-2020)修订解读

将北美国际护理诊断定义与分类(2018-2020)中护理诊断的名称、护理诊断的定义与护理诊断的指标与北美国际护理诊断定义与分类(2015-2017)进行了比较,从护理诊断的名称变更、定义与指标的修订,了解全球护理发展趋势.我国护士可参照北美国际护理诊断定义与分类(2018-2020),对临床病情判断精准性的提高、建立本土化的护理诊断分类系统及找到护理科研的选题素材,起到积极的意义.     

Deconstructing the Pharmacovigilance Hype Cycle

Data science is making increasing contributions to pharmacovigilance. Although the technical innovation of these works are indisputable, efficient progress in real-world pharmacovigilance signal detection may be hampered by corresponding technology life cycle effects, with a resulting tendency to conclude that, with large enough datasets and intricate algorithms, “the numbers speak for themselves,” discounting the importance of clinical and scientific judgment. A practical consequence is overzealous declarations regarding the safety or lack of safety of drugs. We describe these concerns through a critical discussion of key results and conclusions from case studies selected to illustrate these points.     

Data Representation,Coding, and Communication Standards

The immense volume of cases signed out by surgical pathologists on a daily basis gives little time to think about exactly how data are stored. An understanding of the basics of data representation has implications that affect a pathologist’s daily practice. This article covers the basics of data representation and its importance in the design of electronic medical record systems. Coding in surgical pathology is also discussed. Finally, a summary of communication standards in surgical pathology is presented, including suggested resources that establish standards for select aspects of pathology reporting.     

Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health

Objective

A technical expert panel convened by the Agency for Healthcare Research and Quality and the National Institute of Mental Health was charged with reviewing the state of research on behavioral intervention technologies (BITs) in mental health and identifying the top research priorities. BITs refers to behavioral and psychological interventions that use information and communication technology features to address behavioral and mental health outcomes.

Method

This study on the findings of the technical expert panel.

Results

Videoconferencing and standard telephone technologies to deliver psychotherapy have been well validated. Web-based interventions have shown efficacy across a broad range of mental health outcomes. Social media such as online support groups have produced disappointing outcomes when used alone. Mobile technologies have received limited attention for mental health outcomes. Virtual reality has shown good efficacy for anxiety and pediatric disorders. Serious gaming has received little work in mental health.

Conclusion

Research focused on understanding reach, adherence, barriers and cost is recommended. Improvements in the collection, storage, analysis and visualization of big data will be required. New theoretical models and evaluation strategies will be required. Finally, for BITs to have a public health impact, research on implementation and application to prevention is required.