Real-time prediction of intradialytic relative blood volume: a proof-of-concept for integrated cloud computing infrastructure.

BACKGROUND: Inadequate refilling from extravascular compartments during hemodialysis can lead to intradialytic symptoms, such as hypotension, nausea, vomiting, and cramping/myalgia. Relative blood volume (RBV) plays an important role in adapting the ultrafiltration rate which in turn has a positive effect on intradialytic symptoms. It has been clinically challenging to identify changes RBV in real time to proactively intervene and reduce potential negative consequences of volume depletion. Leveraging advanced technologies to process large volumes of dialysis and machine data in real time and developing prediction models using machine learning (ML) is critical in identifying these signals. METHOD: We conducted a proof-of-concept analysis to retrospectively assess near real-time dialysis treatment data from in-center patients in six clinics using Optical Sensing Device (OSD), during December 2018 to August 2019. The goal of this analysis was to use real-time OSD data to predict if a patient's relative blood volume (RBV) decreases at a rate of at least - 6.5 % per hour within the next 15 min during a dialysis treatment, based on 10-second windows of data in the previous 15 min. A dashboard application was constructed to demonstrate how reporting structures may be developed to alert clinicians in real time of at-risk cases. Data was derived from three sources: (1) OSDs, (2) hemodialysis machines, and (3) patient electronic health records. RESULTS: Treatment data from 616 in-center dialysis patients in the six clinics was curated into a big data store and fed into a Machine Learning (ML) model developed and deployed within the cloud. The threshold for classifying observations as positive or negative was set at 0.08. Precision for the model at this threshold was 0.33 and recall was 0.94. The area under the receiver operating curve (AUROC) for the ML model was 0.89 using test data. CONCLUSIONS: The findings from our proof-of concept analysis demonstrate the design of a cloud-based framework that can be used for making real-time predictions of events during dialysis treatments. Making real-time predictions has the potential to assist clinicians at the point of care during hemodialysis.

A Structured Immersion Approach to Approaching Interprofessional Education.

BACKGROUND: Interprofessional education (IPE) must explore the interdependency between healthcare professionals and ensure that IPE learning experiences are rooted in sound teaching and learning theories. Embedding IPE experiences into curricula using an incremental progression rather than "add-on" or "one-and-done" experience provides for continuous development of interprofessional competence by students as part of the learning process. Employing a school-wide structured immersion approach, over a 2-year period, incorporating five core IPE experiences designed to incrementally engage students in deeper, community-rich, person-centered learning experiences that are meaningful and sustainable. METHODS: An exploratory mixed-methods approach to collected data during the 2018-2019 academic year of the Core Signature IPE Experiences was employed (I-V). As part of the program review process, students were asked to voluntarily provide anonymous feedback after completion of each Core. Quantitative data was collected using Interdisciplinary Education Perception Scale (IEPS). Qualitative data were obtained from responses to open-ended questions added to the demographic component of the survey. The open-ended questions were designed to support, explain, and provide depth to the quantitative section. An elemental coding method was used to preliminarily review the corpus and generate descriptive codes and themes. Descriptive codes summarize in a word or short phrase the basic topic of a qualitative passage. RESULTS: Quantitative data of IEPS scores demonstrated students' mean scores in high range for each subscale at Core II (5.15) and slightly positive trend observed across three remaining Cores with Core V displaying highest mean score (5.44). From the qualitative survey, descriptive codes were agreed upon by two reviewers as providing the essence of response topic. Qualitative themes support and provide insight into quantitative data. CONCLUSIONS: Recognizing the interdependency which exits between professionals and developing trust and mutual respect among disciplines is paramount to ensuring evidence-based, person-centered healthcare. Infusing IPE learning experiences in the academy can play an important role in student development; however, IPE experiences must be rooted in learning theory. Program review findings from the Core Signature structured immersion experiences used across six health professions offers insight and a sound direction for health profession programs seeking to design IPE experiences that will aid in elevating the standard of healthcare and improving patient outcomes, by creating a collaborative ready workforce.

The Future of Pediatric Speech-Language Pathology in a More Collaborative World.

Examining interprofessional practice through the lens of speech-language pathology identifies a number of challenges to and opportunities for interprofessional practice. While practitioners believe they practice interprofessionally, health services are often distributed across a network within which collaboration can falter. Certain professions, like speech-language pathology, are well-positioned to work across this network and improve care. Barriers to collaboration are interpersonal, structural, regulatory, and governmental. To enhance interprofessional practice, students should receive interprofessional education; practitioners should engage in interprofessional continuing education based on their practice environment; and leaders and researchers should identify frameworks to support better interprofessional practice.

Perceptions of an international interprofessional education experience: Findings from students based in Europe and North America.

The globalisation of healthcare is changing the demands placed on health professionals. It requires different skills and thought processes across national borders. Thinking in an innovative manner may provide healthcare workers with some of the necessary tools to facilitate international change by increasing students' mental flexibility and ability to apply solutions in multiple contexts. We created the International Innovation Program for health profession education students to learn about and implement the innovation process. The programme provides students the opportunity to learn in interprofessional, international teams and apply didactic knowledge to community problems using the innovation process. The purpose of this article is to describe student perceptions across 4 years of programme implementation. Through analysis of closed-ended survey data, we found that students who participated in the programme reported improvements in collaboration and teamwork, project management, interprofessional teamwork, professional growth and development, thinking in an innovative manner, research and development skills, information seeking, and willingness to work on international projects. Analysis of the open-ended questions revealed five themes: language, teamwork and collaboration, cultural awareness, innovation process, and personal growth and self-improvement. The long-term, follow-up data indicate that these attributes can be transferred into a clinical context which have implications for improved collaboration and patient care.