Time is a terrible thing to waste: optimising use of intraoperative monitoring practitioner time towards maximising in-house IOM service provision and reducing spend on external provision.

Intraoperative monitoring (IOM) during orthopaedic and neurosurgical operations informs surgeons about the integrity of patients' central and peripheral nervous systems. It is provided by IOM practitioners (IOMPs), who are usually neurophysiology healthcare scientists. Increasing awareness of the benefits for patient safety and surgical outcomes, along with post-COVID-19 service recovery, has resulted in a material increase in demand for IOM provision nationally, and particularly at Salford Royal Hospital (SRH), which is a regional specialist neurosciences centre.There is a shortage of IOMPs in the UK National Health Service (NHS). At SRH, this is exacerbated by staff capacity shortage, requiring £202 800 of supplementary private provision in 2022.At SRH, IOMPs work in pairs. Our productive time is wasted by delays to surgical starts beyond our control and by paired working for much of a surgery session. This quality improvement (QI) project set out to release productive time by: calling the second IOMP to theatre only shortly before start time, the other IOMP returning to the office during significant delays, releasing an IOMP from theatre when appropriate and providing a laptop in theatre for other work.We tested and refined these change ideas over two plan-do-study-act improvement cycles. Compared with complete paired working, we increased the time available for additional productive work and breaks from an average of 102 to 314 min per operating day, not quite achieving our project target of 360 min.The new ways of working we developed are a step towards ability (when staff capacity increases) to test supporting two (simultaneous) operations with three IOMPs (rather than two pairs of IOMPs). Having significantly improved the use of staff time, we then also used our QI project data to make a successful business case for investment in two further IOMP posts with a predicted net saving of £20 000 per year along with other associated benefits.

Health care system efficiency in otolaryngological surgeries during COVID-19 pandemic in years 2020-2021 compared to years 2018-2019: data from the Military Institute of Medicine in Warsaw.

<b>Introduction:</b> Coronavirus disease 19 (COVID-19) pandemic had a great impact on the health care system. This resulted not only from changes in the way medical facilities operated but also from the need to treat a huge number of patients. On the other hand, uninfected people feared visiting the doctor.</br></br> <b>Aim:</b> The aim of the study was to assess the impact of the COVID-19 pandemic on the diagnostics and treatment of patients with head and neck cancer.</br></br> <b>Materials and methods:</b> This retrospective study involved analysis of data of patients from a single hospital unit who underwent surgical procedures due to head and neck cancer during the COVID-19 pandemic in years 2020-2021 (pandemic group) compared to years 2018-2019 (pre-pandemic group).</br></br> <b>Results:</b> Patients in the pandemic group (n = 123) were older and were more likely to have grade 3 cancer than patients in the pre-pandemic group (n = 116). Cancer stages were similar in both groups. During the pandemic, time from the first outpatient visit to surgery was longer (median 1.6 vs. 0.8 months), while time to radiotherapy was shorter (median 50.5 vs. 63 days) than in the pre-pandemic period.</br></br> <b>Conclusion:</b> During the pandemic, patients had to wait slightly longer for surgery but not for radiotherapy when compared with the pre-pandemic period. Despite this, they did not have more advanced disease.

Persistent Inpatient Harm: the Unremitting Challenge of Patient Safety.

The sobering realization that little has changed in the scope of inpatient harm makes it plain that efforts intent on improving patient safety must be redoubled if the status quo is to be reversed. Living up to the recommendations of the iconic Institute of Medicine (IOM) Report (To Err Is Human: Building a Safer Health System) must remain top of mind. Much can and must be done to assure to the degree possible the safety of the inpatient population.

Perception of Medical Students Regarding TU-IOM MBBS Curriculum and Teaching Learning Methods in Nepal.

Background The present Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum under Tribhuvan University - Institute of Medicine (TU-IOM) was last revised twelve-years back. Though the curriculum was built upon internationally approved recommendations on curriculum design, it is ineffectively practiced in most medical schools of Nepal with major focus on didactic teaching-learning. The curriculum, hence, needs effective implementation and revision. Objective To identify the strengths, weaknesses, and areas of improvement in the medical curriculum through student-based feedback and outline the possibility of incorporating newer evidence-based teaching-learning methodologies in Nepal. Method This is a descriptive and cross-sectional study. With appropriate ethical approval, a questionnaire was developed and disseminated virtually to all medical students of Nepal under TU from MBBS fourth year onwards. The questionnaire comprised of Likert and close-ended questions. The data analysis was followed after receiving the filled questionnaire through Google forms. Result A total of 337 respondents participated in the study. The most effectively implemented components out of the SPICES model were Integrated learning (I) and Communitybased learning (C), with 73.89% and 68.84% responses. There were 94.7% (319) students who favored the incorporation of research in the core curriculum. Only 34.2% (115) students found PowerPoint lectures, the most utilized form of teachinglearning in Nepal, as engaging. The respondents (84.6%) showed a high degree of readiness to incorporate newer evidence-based teaching-learning tools such as flipped learning, blended learning, and peer-to-peer learning. Conclusion This study shows that effective interventions must be rethought on various aspects of the curriculum, taking students' feedback on the table while considering curricular revision.

One Hospital's Response to the Institute of Medicine Report, "Dying in America".

BACKGROUND: In response to the Institute of Medicine (IOM) report, Dying in America, we undertook an institution wide effort to improve the experience of patients and families facing serious illness by engaging leadership and developing a program to promote the practice of generalist palliative care. MEASURES: The impact of the program was measured with process measures related to its' three parts. INTERVENTION: We developed a three-part generalist palliative care program that focuses on 1) instructional design, 2) advance care planning, and 3) engagement. OUTCOMES: Over four years, the program trained 51 interprofessional clinicians in a two-week intensive palliative care course and 1,541 interprofessional clinicians in a 90-150 min skills-based training. Clinicians documented 15,791 serious illness conversations. Zoom community engagement sessions were attended by 411 live viewers, and subsequently, 1918 YouTube views. Additionally, we report on the impact of the COIVD-19 crisis on our efforts. Early in the pandemic, over two months, 464 interprofessional clinicians documented 5,168 conversations with patients. CONCLUSION/LESSONS LEARNED: A broad based strategy resulted wide institutional engagement with serious illness care.

Implementation of the Institute of Medicine Treatment Plan in Oncology Practice.

Participation in the Centers for Medicare & Medicaid Services (CMS) value-based payment reform, the Oncology Care Model (OCM), requires that every beneficiary has a documented 13-point Institute of Medicine treatment plan (TP) when commencing antineoplastic therapy. The intent is to enhance shared decision-making between the patient and care team by providing transparent treatment recommendations and engaging patients and caregivers in meaningful discussion. There is limited discussion in the literature about how to adapt the CMS recommendations to diverse practice settings while maintaining fidelity to the intent of the TP. Here, the authors compare how 3 clinically and geographically unique OCM participating institutions implemented the TP in their respective institutions within the domains of the Consolidated Framework for Implementation Research. Similar themes in implementation are identified, including engaging stakeholders, leveraging information technology, and considering scalability. Adaptations that are unique to the culture and setting of each site are also described.

Development of an Actionable Framework to Address Cancer Care Disparities in Medically Underserved Populations in the United States: Expert Roundtable Recommendations.

PURPOSE: Cancer disparities persist among medically underserved populations despite widespread efforts to address them. We describe the development of a framework for addressing cancer care disparities across the cancer care continuum (CCC), guided by the CCC domains established by the Institute of Medicine/National Academies of Sciences, Engineering, and Medicine (IOM/NAS). MATERIALS AND METHODS: An environmental scan was conducted to identify strategies and associated experts who are providing or have successfully provided community- and/or patient-centric IOM/NAS-defined domain standards to our target populations. A multistakeholder expert roundtable working group was convened for framework development. A premeeting survey informed agenda development, documented expert practices for target populations, and identified priority areas for meeting focus. RESULTS: The environmental scan identified 84 unique experts across 8 stakeholder groups and 44 patient organizations; 50 were invited to the roundtable and 33 participated. They broadly represented disease sites, geography, and experience with target populations and all CCC domains. The premeeting survey (16 responses) identified coordination of care or patient navigation (66.7%), community engagement (60.0%), and healthcare system changes (53.3%) as priority focus areas. The experts identified access and treatment barriers or gaps within and between CCC domains, specified key notable practices to address these, and developed an actionable framework and recommendations for each priority focus area. CONCLUSION: The framework and recommendations are intended to guide researchers, healthcare leaders, advocates, community- and patient-focused service organizations, and policy leaders to address and promote health equity in cancer care access and treatment outcomes.

Maternal Metabolic Biomarkers are Associated with Obesity and Excess Gestational Weight Gain.

OBJECTIVE: The purpose of this study was to evaluate the independent contribution of maternal obesity and gestational weight gain (GWG) in excess of the Institute of Medicine's guidelines on levels of maternal serum inflammatory and metabolic measures. STUDY DESIGN: Banked maternal serum samples from 120 subjects with documented prepregnancy or first trimester body mass index (BMI) were utilized for analyte analyses. Validated, BMI-specific formulas were utilized to categorize GWG as either insufficient, at goal or excess based on the Institute of Medicine guidelines with gestational age adjustments. Serum was analyzed for known inflammatory or metabolic pathway intermediates using the Luminex xMap system with the MILLIPLEX Human Metabolic Hormone Magnetic Bead Panel. Measured analytes included interleukin-6, monocyte chemoattractant protein-1, and tumor necrosis factor-α and metabolic markers amylin, c-peptide, ghrelin, gastric inhibitory polypeptide, glucagon-like peptide-1, glucagon, insulin, leptin, pancreatic polypeptide, and peptide YY. Kruskal-Wallis ANOVA and Pearson's correlation coefficients were calculated for each marker. RESULTS: C-peptide, insulin, and leptin all varied significantly with both obesity and GWG while glucagon-like peptide-1 varied by BMI but not GWG. These analytes covaried with other metabolic analytes, but not with inflammatory analytes. CONCLUSION: Maternal metabolic biomarkers at delivery vary significantly with both obesity and GWG. Taken together, these findings suggest that GWG (with and without comorbid obesity) is an important mediator of measurable metabolites in pregnancy but is not necessarily accompanied by inflammatory measures in serum. These findings are consistent with GWG being an independent risk factor for metabolic disturbances during pregnancy.

What happened to the US cancer cooperative groups? A status update ten years after the Institute of Medicine report.

The US cancer cooperative groups (cooperative groups) were founded in the 1950s to establish a standing infrastructure to conduct multi-institutional cancer clinical trials. Initially funded almost entirely by the US National Cancer Institute (NCI), over the years, the research conducted by the Cooperative Groups has evolved to meet the demands of cancer clinical research, with a scope now encompassing trials to advance cancer treatment, cancer control, biomarker development and validation, and health services research, with a corresponding broadening of their funding sources. The cooperative groups are also a critical mechanism for educating the next generation of cancer clinical trialists from many different disciplines. This review outlines the overall mission, structure, and funding of the cooperative groups, beginning in 1955 when they were first established by the NCI, and describes the considerable progress against cancer achieved over the past decade.

Idiopathic Pulmonary Fibrosis Guideline Recommendations. Need for Adherence to Institute of Medicine Methodology?

Rationale: The 2018 idiopathic pulmonary fibrosis (IPF) guidelines were developed using an approach that adhered to the Institute of Medicine (IOM) standards, in which each recommendation was informed by a systematic review. The convergence of opinion on recommendations and evidence (CORE) process is a modified Delphi process that does not require a systematic review but yields similar recommendations. Objectives: To determine the importance of systematic reviews to the recommendations made by the IPF guidelines. Methods: IPF experts who were not on the IPF guideline panel and had no knowledge of the guideline's evidence synthesis or recommendations were recruited to answer the same questions as the guidelines but using a modified CORE process. Recommendations derived from the modified CORE process and IOM-adherent process were then compared. Concordance of the course of action, strength of recommendation, and quality of evidence was measured. Results: Ten questions were addressed. The modified CORE process and IOM-adherent process yielded concordant recommendations for 9 of 10 (90%) questions (ĸ-agreement, 0.84; 95% confidence interval, 0.55-1.00). The strength of the recommendations was the same for seven of eight (88%) graded recommendations (ĸ-agreement, 0.75; 95% confidence interval, 0.31-1.00), but ratings of the quality of evidence were discordant. The modified CORE process was less expensive and required less time and effort than the IOM-adherent process. Conclusions: The modified CORE process developed recommendations that were concordant with those developed by an experienced guideline panel using the robust standards of the IOM; however, it was less expensive and less burdensome.

Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: Are the Institute of Medicine guidelines associated with better outcomes?

OBJECTIVE: The Institute of Medicine (IOM) recommended a gestational weight gain for full-term twin pregnancies of 17-25 kg for normal Body mass Index patients', and characterize its guidelines on during twin pregnancies as "provisional". Indeed, they are exclusively based on observational epidemiological data. The objective of this study was to investigate whether the IOM's gestational weight gain guidelines are optimal for maternal and neonatal. OUTCOMES STUDY DESIGN: We included all consecutive twin pregnancies delivering two live births retrospectively. Monoamniotic pregnancies, major congenital abnormalities, twin-to-twin transfusion syndrome, patients with missing gestational weight gain data in the last month before delivery, and patients with a body mass index (BMI) ≤18.5 were excluded. To control for gestational length, we divided the total weight gain by the gestational age in weeks at the last weight measurement to obtain the weight gain per week. Patients were classified as having low gestational weight gain, adequate gestational weight gain, or excessive gestational weight gain, with the results adjusted for BMI and tobacco use. RESULTS: There were 878 patients in our level-III university hospital maternity ward who met the inclusion criteria in 1997-2013. Excessive gestational weight gain women had greater rates of preeclampsia than adequate gestational weight gain women did. Low gestational weight gain women showed a lower rate of gestational hypertension than AGWG women did. Delivery before 37 weeks of gestation (26.9% vs. 17.3%, p = 0.009), birth weight <2500 g, respiratory distress syndrome, and transfer to the neonatal intensive care unit were more frequent in the LGWG group compared with the AGWG group. Apgar score <7 at 5 min were more frequent in the EGWG group. CONCLUSION: Adequate gestational weight gain was associated with better outcomes. Our results suggest that the IOM guidelines for twin pregnancy are appropriate and therefore should be routinely used.

Long-Term Survivorship Care After Cancer Treatment: A New Emphasis on the Role of Rehabilitation Services.

In May 2018, the National Cancer Policy Forum (NCPF) of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) released a report, Long-Term Survivorship Care After Cancer Treatment: Proceedings of Workshop. NCPF-published reports have historically played a significant role in driving policy and payment model changes in oncology care, in addition to raising awareness about the needs of individuals with cancer. This 2018 report provides a specific set of recommendations for improving symptom management and rehabilitation that suggest the integration of rehabilitation services at the point of cancer diagnosis and throughout the continuum of cancer care to effectively screen for and manage the anticipated functional morbidity associated with cancer treatment. The specificity of these recommendations is of significant relevance to the physical therapy profession and should encourage bold steps to effectively increase the presence of physical therapists as members of interdisciplinary cancer care teams. The profession must act to implement models of prospective care, develop targeted education and training initiatives to assure the knowledge and skills of our workforce for this complex population, and augment the current evidence base with greater attention to health services research aiming to understand the effectiveness of rehabilitation services in improving costs, utilization, and meaningful functional outcomes.

Keep Them From Harm and Injustice?

Fear remains a major barrier to transparency of hospital errors.

Review and application of the National Academies of Sciences, Engineering, and Medicine bullying or cyberbullying recommendations for screening and lesbian, gay, bisexual, and transgender youth.

Bullying has been long seen as a natural part of childhood and adolescence. However, a growing body of evidence suggests bullying and now cyberbullying may inflict harm or distress on targeted youth including physical, psychological, social, or educational harm. The purpose of this paper is to endorse the National Academies of Sciences, Engineering, and Medicine statement, summarize the report, and apply the recommendations to screening lesbian, gay, bisexual and transgender youth related to bullying and cyberbullying; line 11 change exemplified to discussed. Screening for bullying against youth; lesbian, gay, bisexual, and transgender youth as a high-risk group for bullying victimization; and implications to address bullying against youth are exemplified. Nurses need to promote policies that foster inclusive, supportive, safe, and healthy schools and environments for youth.