Reducing emergency department (ED) computed tomography (CT) utilization in women treated for gynecologic cancers.

OBJECTIVES: The objective of this quality improvement (QI) project was to decrease the rate of low-value computed tomography (CT) imaging in established gynecologic oncology patients presenting to the emergency department (ED). METHODS: This was a cohort study with a before and after design that evaluated implementation of a QI project designed to decrease CT utilization in established gynecologic oncology patients in the ED. The pre-intervention cohort included patients admitted through the ED from 4/1/17 to 5/31/18, while the post-intervention cohort was from 6/1/18 to 5/31/19. The intervention included gynecologic oncology consultation before CT on patients who had imaging within the prior 3 weeks. Details regarding CT, ED length of stay (LOS), and oncologic history were abstracted. The value of CT was determined by consensus from 2 reviewers. Prospective data monitoring evaluated for patient safety. RESULTS: Prior to intervention, there were 129 unique ED encounters in gynecologic oncology patients leading to admission. CT scans were performed in 101 (78.3%) encounters, 57.7% of which were deemed to be of low-value. Following implementation, the CT utilization rate decreased significantly from median monthly rate of 75.2% to 49.1% (p < 0.00001), and the ED LOS decreased from 8.1 to 6.9 h (p = 0.0102). The number of CT scans deemed to be low-value in the post-intervention group decreased to 2 (3.8%). CONCLUSIONS: Implementation of an early consultation policy and imaging guidelines led to a significant decrease in unnecessary CT utilization and shorter ED LOS in gynecologic oncology patients presenting to the ED.

The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review.

Gilles de la Tourette syndrome (GTS) and other chronic tic disorders are neurodevelopmental conditions characterized by the presence of tics and associated behavioral problems. Whilst converging evidence indicates that these conditions can affect patients' quality of life (QoL), the extent of this impairment across the lifespan is not well understood. We conducted a systematic literature review of published QoL studies in GTS and other chronic tic disorders to comprehensively assess the effects of these conditions on QoL in different age groups. We found that QoL can be perceived differently by child and adult patients, especially with regard to the reciprocal contributions of tics and behavioral problems to the different domains of QoL. Specifically, QoL profiles in children often reflect the impact of co-morbid attention-deficit and hyperactivity symptoms, which tend to improve with age, whereas adults' perception of QoL seems to be more strongly affected by the presence of depression and anxiety. Management strategies should take into account differences in age-related QoL needs between children and adults with GTS or other chronic tic disorders.

Recommendations and guidelines of integrative medicine for COVID-19 care: The APEC project outcome.

This article - Recommendations and Guidelines of Integrative Medicine (IM) for COVID-19 Care - was one of the outcomes from an Asia-Pacific Economic Cooperation (APEC) Project (Integrative Medicine (IM) and COVID -19 Care) during the time between May 2022 and March 2023. With the efforts from care providers, researchers, health policy makers and healthcare administrative leaders among APEC economies, the purpose of this file was to provide comprehensive IM systems for COVID-19 care as recommendations and suggestive guidelines including care methods, tools, procedures, symptom conditions and targets selections, and points need to be considered during care applications. All cited COVID-19 care practices have confirmed their efficacy and usefulness either used alone or combined with conventional medicine. This article provides current useful medical information on IM for COVID-19 care which could benefit APEC economies and world health communities on their healthcare system.

Disaster medicine and pandemic response: A novel curriculum to improve understanding of complex care delivery during the COVID-19 pandemic.

Background: Despite a 2009 recommendation from the AMA that disaster medicine and public health response training should be implemented in medical schools, anywhere from 31% to 47% of medical education programs lack a formalized disaster medicine curriculum. A need for disaster medicine response training for University of Alabama medical students in an appropriately socially distanced format was identified during the COVID-19 pandemic. Methods: Our emergency medicine faculty in collaboration with the Federal Emergency Management Agency Center for Disaster Preparedness (FEMA CDP) created and implemented a novel virtual disaster medicine and pandemic response course for third-year medical students at the University of Alabama at Birmingham (UAB). The course was administered via a teleconferencing platform (Zoom, Zoom Video Communications, Inc.) in spring 2020 to more than 130 medical students. Results: Using pre- and postcourse surveys, we assessed a change in student confidence levels for their ability to explain topics covered in the course and their understanding of a chosen disaster. The students reported an average increase of 2.183 on a 5-point scale, with a score of 5 representing "completely confident" and a score of 1 representing "not at all confident." This course established the feasibility of a virtual instructor-led training (VILT) format for disaster medicine education and provided a template for the delivery of over 300 courses to more than 4,000 first responders and medical professionals through the FEMA CDP. Conclusions: Through collaboration with the FEMA CDP, our UAB faculty were able to successfully deliver a novel virtual disaster-preparedness and response course. The course resulted in subjective improvement of students' content understanding while also establishing the feasibility and effectiveness of a VILT format that could be readily applied to future courses in undergraduate medical education and beyond.

Unlocking the effects of gender faultlines on team creativity: is activation the key?

The purpose of this study was to use faultline theory to examine the effects of gender diversity on team creativity. Results from 80 teams working on an idea generation task indicated that the activation of gender faultlines negatively affected the number and overall creativity of ideas. However, gender faultlines that were not activated had no effect. Results also indicated that the relationship between activated gender faultlines and team creativity was partially mediated by the level of conflict within the team. Specifically, emotional conflict partially mediated the effects of activated gender faultlines on the number of ideas generated. Implications are discussed, as well as possible limitations and directions for future research.