Strategic Planning: Moving From Plan to Implementation.

Successful organizations depend on strategic thinkers who understand strategic planning and strategic management. These strategic leaders can proactively manage the constant environmental changes to position their organizations for a competitive advantage and avoid acting in a reactive and defensive manner. However, while organizations are often adept at developing extensive strategic plans, implementation of the plan is often poor or without a definitive strategy. This article addresses key strategies for successful implementation of changes to bring about sustainable cultural change in an organization to meet the organization's overall strategic goals, specifically through the use of implementation science.

Virtual reality surgical planning for endoscopic endonasal approaches to the craniovertebral junction.

PURPOSE: To demonstrate the utility of virtual reality (VR) for preoperative surgical planning of endoscopic endonasal craniovertebral junction (CVJ) surgery. MATERIALS AND METHODS: Five patients who had undergone endoscopic endonasal surgery of the craniovertebral junction with preoperative virtual reality surgical planning were identified and described. RESULTS: The anterior approach to the CVJ has been traditionally accomplished transorally. However, recently the transnasal endoscopic approach to this location has been described. Multiple anatomical studies have been conducted using the nasopalatine, nasoaxial, and rhinopalatine lines (NPL, NAxL, RPL) in an attempt to preoperatively delineate the inferior limits of endoscopic dissection. The use of advanced surgical simulation using immersive virtual reality is an innovative approach for analyzing CVJ anatomy and developing a surgical plan. VR simulation through the use of interactive and highly accurate patient specific models allows for the creation of three-dimensional (3D) digital reconstructions via the fusion of CT and MRI studies. Incorporation of simulation technology has been shown to increase surgeon proficiency while simultaneously decreasing complication rates. The described case series demonstrates the novel utility of VR planning for designing the endoscopic surgical approach to the CVJ. CONCLUSIONS: VR technology allows for the creation of anatomically accurate 3D models that can be used for preoperative planning of endoscopic endonasal surgery. Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.

A Novel Approach to Virtual Surgical Planning for Mandibular and Midfacial Reconstruction With a Fibula Free Flap.

BACKGROUND: The fibula free flap is a major workhorse in facial reconstruction. To decrease operative times, virtual surgical planning (VSP) has been implemented. Traditional VSP is costly and may delay operative planning. in this study, the authors present a novel algorithm using readily accessible software packages to perform VSP in a manner that is quick and cost-effective. METHODS: A 6-part survey was administered to physicians with prior training in facial reconstruction. Fourteen physicians participated regarding outcomes on 10 patients who underwent mandibular or midfacial fibula free flap reconstruction. Participants were asked to match the true postoperative and VSP models and rate the similarity of the models using the Likert scale (0-10). The goal was to determine whether the VSP models accurately depicted the actual reconstruction, and whether they would use VSP in future clinical practice. RESULTS: The physicians surveyed were able to match the models correctly 93.6% of the time. The mean score for the similarity between virtual and actual models ranged between 7.60 and 8.80. Most participants (90.9%) who answered stated they would use our VSP algorithm if they were trained in the protocol. CONCLUSIONS AND RELEVANCE: Virtual surgical planning models were created utilizing our novel algorithm. Participants matched the preoperative VSP plan with the postoperative model most of the time and rated the similarity well. Participants in our study are interested in learning more about physician performed VSP. The authors believe this model may be financially and clinically relevant and serve as an excellent educational tool.

Tackling communication and analytical problems in environmental planning: Expert assessment of key definitions and their relationships.

Inadequate definition of key terms and their relationships generates significant communication and analytical problems in environmental planning. In this work, we evaluate an ontological framework for environmental planning designed to combat these problems. After outlining the framework and issues addressed, we describe its evaluation by a group of experts representing a range of expertise and institutions. Experts rated their level of agreement with 12 propositions concerning the definitions and models underpinning the framework. These propositions, in turn, were used to assess three assumptions regarding the expected effectiveness of the framework and its contribution to addressing the abovementioned planning problems. In addition to point-based best estimates of their agreement with propositions, expert ratings were also captured on a continuous interval-valued scale. The use of intervals addresses the challenge of measuring and modelling uncertainty associated with complex assessments such as those provided by experts. Combined with written anonymous expert comments, these data provide multiple perspectives on the level of support for the approach. We conclude that the framework can complement existing planning approaches and strengthen key definitions and related models, thus helping avoid communication and analytical problems in environmental planning. Finally, experts highlighted areas that require further development, and we provide recommendations for improving the framework.

Digital smile planning technique applied to prosthetic rehabilitation of dental esthetic area: a case report.

Nowadays, the objective of esthetic rehabilitation is not only to guarantee the results to the patients in terms of esthetic parameters but also the possibility to show the pre-visualization of possible results and therapy planning. OBJECTIVE: The aim of this study is to apply the 3D-DPS digital planning technique, in the prosthetic treatment of a patient, to produces digitally the mockup for the digital previewing and esthetic crown and veneer for the final prosthetic treatment. MATERIALS AND METHODS: A case report participant is a young patient, a female, 26 years old, with no oral, periodontal, or systemic diseases. After a sign of an informed consent and an explication of a plan of treatment, technical intraoral and extraoral pictures and intraoral digital impressions were taken. The digital images improved from the 2D Smile Lynx Software and the scanner stereolithographic (STL) file was matched into the CAD Lynx to obtain a virtual previsualization of teeth and smile design. Then, the mockup was milled using a CAM system. Minimally invasive preparation was carried out on the enamel surface with the mockup as position guides. Finally, the esthetic CAD-CAM veneer and crown were produced digitally using the CAD Wax as a guide. RESULTS: The use of the digital project and the pre-operative mockup allowed a perfect initial evaluation and a better understanding of the patient's treatment plan. CONCLUSIONS: The 3D digital planning technique is a new, predictably and minimally invasive technique. It allows diagnosis and a better communication with the patient. It helps to reduce the working time and the possible errors usually associated with the classical prosthodontic manual step.

COVID-19 and the flu: data simulations and computational modelling to guide public health strategies.

BACKGROUND: Pandemics threaten lives and economies. This article addresses the global threat of the anticipated overlap of COVID-19 with seasonal-influenza. OBJECTIVES: Scientific evidence based on simulation methodology is presented to reveal the impact of a dual outbreak, with scenarios intended for propagation analysis. This article aims at researchers, clinicians of family medicine, general practice and policy-makers worldwide. The implications for the clinical practice of primary health care are discussed. Current research is an effort to explore new directions in epidemiology and health services delivery. METHODS: Projections consisted of machine learning, dynamic modelling algorithms and whole simulations. Input data consisted of global indicators of infectious diseases. Four simulations were run for '20% versus 60% flu-vaccinated populations' and '10 versus 20 personal contacts'. Outputs consisted of numerical values and mathematical graphs. Outputs consisted of numbers for 'never infected', 'vaccinated', 'infected/recovered', 'symptomatic/asymptomatic' and 'deceased' individuals. Peaks, percentages, R0, durations are reported. RESULTS: The best-case scenario was one with a higher flu-vaccination rate and fewer contacts. The reverse generated the worst outcomes, likely to disrupt the provision of vital community services. Both measures were proven effective; however, results demonstrated that 'increasing flu-vaccination rates' is a more powerful strategy than 'limiting social contacts'. CONCLUSIONS: Results support two affordable preventive measures: (i) to globally increase influenza-vaccination rates, (ii) to limit the number of personal contacts during outbreaks. The authors endorse changing practices and research incentives towards multidisciplinary collaborations. The urgency of the situation is a call for international health policy to promote interdisciplinary modern technologies in public health engineering.

Management of Vascular Complications during Anterior Lumbar Spinal Surgery Using Mini-Open Retroperitoneal Approach.

BACKGROUND: Anterior retroperitoneal spine exposure has become increasingly performed for the surgical treatment of various spinal disorders. Despite its advantages, the procedure is not riskless and can expose to potentially life-threatening vascular lesions. The aim of this review is to report the vascular lesions that can happen during anterior lumbar spinal surgery using mini-open retroperitoneal approach and to describe their management. METHODS: A systematic literature search was performed according to PRISMA to identify studies published in English between January 1980 and December 2019 reporting vascular complications during anterior lumbar spinal surgery with mini-open retroperitoneal approach. Three authors independently conducted the literature search on PubMed/Medline database using a combination of the following terms: "spinal surgery", "anterior lumbar surgery (ALS)", "anterior lumbar interbody fusion (ALIF)", "lumbar total disc replacement", "artificial disc replacement", "vascular complications", "vascular injuries". Vascular complications were defined as any peri-operative or post-operative lesions related to an arterial or venous vessel. The management of the vascular injury was extracted. RESULTS: Fifteen studies fulfilled the inclusion criteria. Venous injuries were observed in 13 studies. Lacerations and deep venous thrombosis ranged from 0.8% to 4.3% of cases. Arterial lesions were observed in 4 studies and ranged from 0.4% to 4.3% of cases. It included arterial thrombosis, lacerations or vasospasms. The estimated blood loss was reported in 10 studies and ranged from 50 mL up to 3000 mL. Vascular complications were identified as a cause of abortion of the procedure in 2 studies, representing respectively 0.3% of patients who underwent ALS and 0.5% of patients who underwent ALIF. CONCLUSION: Imaging pre-operative planning is of utmost importance to evaluate risk factors and the presence of anatomic variations in order to prevent and limit vascular complications. Cautions should be taken during the intervention when manipulating major vessels and routine monitoring of the limb oxygen saturation should be systematically performed for an early detection of arterial thrombosis. The training of the surgeon access remains a key-point to prevent and manage vascular complications during anterior lumbar spinal surgery with mini-open retroperitoneal.

A novel CRT-IMRT-combined (Co-CRIM) planning technique for peripheral lung stereotactic body radiotherapy in pinnacle treatment planning system.

OBJECTIVES: This study attempts to explore a novel peripheral lung stereotactic body radiotherapy (SBRT) planning technique that can balance the pros and cons of three-dimensional conformal radiotherapy (CRT) and intensity-modulated radiation therapy (IMRT) / volumetric modulated arc therapy (VMAT). METHODS: Treatment plans were retrospectively designed based on CRT, IMRT, VMAT, and the proposed CRT-IMRT-combined (Co-CRIM) techniques using Pinnacle treatment planning system (TPS) for 20 peripheral lung cancer patients. Co-CRIM used an inverse optimization algorithm available in Pinnacle TPS. To develop a Co-CRIM plan, the number of segments in each field was limited to one, the minimum segment area was set to the internal target volume (ITV), and the minimum monitor units (MU) of the segment was the quotient of fractional dose divided by twice the number of total fields. The performance of Co-CRIM was then compared with other techniques. RESULTS: For conformity index (CI), Co-CRIM performed comparably to IMRT/VMAT but better than CRT. For gradient index (GI), Co-CRIM was similar to IMRT/VMAT or CRT. For heterogeneity index (HI), Co-CRIM was comparable to IMRT/VMAT, higher than CRT. The dosimetric results of spinal cord and lung with Co-CRIM were better than CRT, comparable to IMRT, but inferior to VMAT. The MU resulted from Co-CRIM was lower than IMRT/VMAT but higher than CRT. For plan verification γ passing rate, Co-CRIM was higher than IMRT/VMAT, comparable to CRT. For planning time, Co-CRIM was shorter than CRT or VMAT but similar to IMRT. CONCLUSIONS: The proposed Co-CRIM technique on Pinnacle TPS is an effective planning technique for peripheral lung SBRT.

Optimizing forest road planning in a sustainable forest management area in the Brazilian Amazon.

The construction of forest roads in Brazilian Amazon is costly and has a significant environmental impact. Several practices and principles must be observed to comply with legislation, to preserve the remaining forest, and to ensure sustainable exploitation. Road planning is complex in this context, based on the number of aspects and variables that must be considered. This research aimed to evaluate computational methods' effectiveness in planning forest roads, optimizing resources to reduce damage to the remaining forest, compared to traditional planning methods. The study area was a native forest under a sustainable forest management regime located in municipalities of Terra Santa and Oriximiná, in Pará, in Brazilian Amazon. Data obtained from area made it possible formulate six instances of different sizes. A binary integer linear programming model was used, solved using CPLEX software, and Dijkstra, Bellman-Ford, Dial, and D'Esopo-Pape shortest path algorithm, implemented in C programming language. During processing of instances, the time taken to obtain the solution increased according to size of instance, however, time difference was not significant. Among the evaluated algorithms, the D'Esopo-Pape algorithm showed the best performance. The evaluated methods were effective in obtaining an optimal solution for proposed forest road planning. The solutions obtained using computational methods more effectively considered the restrictions associated with sustainable forest management, in contrast to those derived from the traditional planning by forestry company.

Balancing Workload in the PACU by Using an Integrated OR Planning Methodology.

PURPOSE: The individual scheduling of the operating rooms (ORs) has a significant influence on postoperative care at hospital facilities. We studied the effect of incorporating postoperative departments in the decision process with regard to scheduling ORs and developed an integrated OR planning methodology that determines an optimal surgery sequence and postanesthesia care unit (PACU) nursing staff level, with the objective to level the variability in inflow of patients in the PACU. DESIGN: We developed an integrated OR planning methodology that investigates the sequencing of a surgical suite process with multiple ORs and postoperative hospital facilities. METHODS: This research was performed by representing a discrete-time two-stage flow shop problem. A retrospective study was performed in which the derived model was validated using discrete-event simulation. FINDINGS: Simulation results show that applying the integrated planning methodology decreased the variability in bed demand and smoothed the workload for the nursing staff in the PACU. Moreover, applying the algorithm led to a decrease in PACU completion time and a reduced amount of overtime hours for the surgical suite. Based on our results, we derived simple scheduling guidelines. CONCLUSIONS: Our simulation results confirmed the hypothesis that prospectively sequencing ORs' cases can effectively decrease the variability in bed demand and smoothen the workload for the staff personnel. Moreover, applying the algorithm leads to a decrease in PACU completion time and less overtime hours for the surgical suite. As such, an integrated OR planning methodology facilitates hospitals in improving OR efficiency.

Optimizing the depth and the direction of prospective planning using information values.

Evaluating the future consequences of actions is achievable by simulating a mental search tree into the future. Expanding deep trees, however, is computationally taxing. Therefore, machines and humans use a plan-until-habit scheme that simulates the environment up to a limited depth and then exploits habitual values as proxies for consequences that may arise in the future. Two outstanding questions in this scheme are "in which directions the search tree should be expanded?", and "when should the expansion stop?". Here we propose a principled solution to these questions based on a speed/accuracy tradeoff: deeper expansion in the appropriate directions leads to more accurate planning, but at the cost of slower decision-making. Our simulation results show how this algorithm expands the search tree effectively and efficiently in a grid-world environment. We further show that our algorithm can explain several behavioral patterns in animals and humans, namely the effect of time-pressure on the depth of planning, the effect of reward magnitudes on the direction of planning, and the gradual shift from goal-directed to habitual behavior over the course of training. The algorithm also provides several predictions testable in animal/human experiments.

The effects of early schema acquisition on mathematical problem solving.

The current paper explores the effects of providing people with schema training at the outset of learning (compared to at later stages) on mathematical word problems modeled after problems from the Graduate Record Examination. Additionally, the ratio of worked examples to problem-solving practice was manipulated. Participants were randomly assigned to one of four conditions and were tested on near and far transfer problems. Participants provided schema training at the outset of learning outperformed those provided schema training after problem-solving practice, particularly on far transfer problems. Likewise, participants provided with a higher ratio of worked examples to problem-solving practice demonstrated better performance during testing than those provided with more problem-solving practice and fewer worked examples. These findings extend the worked example effect to far transfer problems and suggest that providing schema training prior to learning solution strategies may be effective in improving mathematical problem solving.

Introduction of a specialized consultation prior to insertion of totally implantable access venous devices: Impact on cancellation rate and patient satisfaction.

OBJECTIVES: Preoperative consultation is usually not performed before insertion of a totally implantable venous access device (TIVAD). In our experience, an incomplete preoperative assessment, a predictable medical condition contraindicating surgery, or no-show patients the day of surgery led to several surgery cancellations. Therefore, we introduced a specific preoperative surgical consultation for TIVAD that took place shortly before surgery. The aim of the present study is to evaluate the patients' satisfaction and to establish the rate of cancellation after the adoption of this strategy. METHODS: Two-hundred and four patients who benefited from the preoperative consultation before TIVAD insertion from August 2014 to August 2016 were included. Satisfaction of patients and cancellation rate were documented. RESULTS: With that strategy, no TIVAD insertion was either delayed or cancelled. The overall level of satisfaction was high (91.8%); 184 patients (90.2%) judged the consultation useful in preparation for the surgery. The surgical procedure met their expectations in 92.2% of cases. Patients known for a psychiatric comorbidity were more likely to express dissatisfaction. CONCLUSIONS: The introduction of a specific preoperative surgical consultation for TIVAD insertion led to a high level of patients' satisfaction. After the preoperative consultation, no cancellation was recorded. Special approaches have to be considered for patients with a psychiatric comorbidity.

Passing the Chief Nursing Officer Baton: The Importance of Succession Planning and Transformational Leadership.

In today's dynamic healthcare environment, it is more important than ever that the chief nursing officer (CNO) possesses transformational leadership skills. This includes the cultivation of leaders whom the CNO can partner with to advance strategic priorities that benefit patients, families, clinical nurses, and others within a strong, supportive practice environment. A collaborative partnership not only ensures the advancement of an agenda for change but also enhances communication and visibility and provides an opportunity for development of key individuals on the executive team. By supporting partnerships, the CNO has the opportunity to keep talented leaders in the pipeline and to identify those who should be a part of the succession planning process. This is a critically important concept that can lead to a smooth leadership transition.

A novel and clinically useful dynamic conformal arc (DCA)-based VMAT planning technique for lung SBRT.

PURPOSE: Volumetric modulated arc therapy (VMAT) is gaining popularity for stereotactic treatment of lung lesions for medically inoperable patients. Due to multiple beamlets in delivery of highly modulated VMAT plans, there are dose delivery uncertainties associated with small-field dosimetry error and interplay effects with small lesions. We describe and compare a clinically useful dynamic conformal arc (DCA)-based VMAT (d-VMAT) technique for lung SBRT using flattening filter free (FFF) beams to minimize these effects. MATERIALS AND METHODS: Ten solitary early-stage I-II non-small-cell lung cancer (NSCLC) patients were treated with a single dose of 30 Gy using 3-6 non-coplanar VMAT arcs (clinical VMAT) with 6X-FFF beams in our clinic. These clinically treated plans were re-optimized using a novel d-VMAT planning technique. For comparison, d-VMAT plans were recalculated using DCA with user-controlled field aperture shape before VMAT optimization. Identical beam geometry, dose calculation algorithm, grid size, and planning objectives were used. The clinical VMAT and d-VMAT plans were compared via RTOG-0915 protocol compliances for conformity, gradient indices, and dose to organs at risk (OAR). Additionally, treatment delivery efficiency and accuracy were recorded. RESULTS: All plans met RTOG-0915 requirements. Comparing with clinical VMAT, d-VMAT plans gave similar target coverage with better target conformity, tighter radiosurgical dose distribution with lower gradient indices, and dose to OAR. Lower total number of monitor units and small beam modulation factor reduced beam-on time by 1.75 min (P < 0.001), on average (maximum up to 2.52 min). Beam delivery accuracy was improved by 2%, on average (P < 0.05) and maximum up to 6% in some cases for d-VMAT plans. CONCLUSION: This simple d-VMAT technique provided excellent plan quality, reduced intermediate dose-spillage, and dose to OAR while providing faster treatment delivery by significantly reducing beam-on time. This novel treatment planning approach will improve patient compliance along with potentially reducing intrafraction motion error. Moreover, with less MLC modulation through the target, d-VMAT could potentially minimize small-field dosimetry errors and MLC interplay effects. If available, d-VMAT planning approach is recommended for future clinical lung SBRT plan optimization.

Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study.

INTRODUCTION: A voluntary State Government-led programme in Victoria, Australia 'Defibrillators for Sporting Clubs and Facilities Program' ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme. METHODS: This was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results. RESULTS: Key issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised. CONCLUSIONS: This study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices.

Mass casualty incidents-are you ready? A major incident planning template for diagnostic radiology.

Mass casualty incidents (MCIs) create a large number of casualties in a short period of time. Diagnostic radiology plays an important role in major incident responses but is often underrepresented during major incident planning (MIP) and simulation. Surveys suggest radiologists are unfamiliar with their role during an MCI. We aimed to identify key topics for radiology MIP, familiarize radiologists with their role during an MCI and identify areas for future research. The terms "radiology" and "mass casualty incident" were entered into the advanced search builder on PubMed. Abstracts from this primary search were reviewed and papers selected for inclusion. Additional studies of interest were identified upon review of reference sections of relevant articles and from the related article tab on PubMed. MCI and trauma guidelines were reviewed. Key factors that caused issues during prior MCIs were identified including staff alert mechanisms, patient identification strategies, patient tracking, scan ordering and result communication. Limitations of local imaging resources and capacity should be identified and inform plans for the utilization of diagnostic radiology in the MCI setting. Simulation can help identify areas for improvement and familiarize staff with their roles. Further development of reliable MCI alert technology and patient identification strategies are needed as well as prospective validation of trauma CT selection criteria to identify patients who will benefit most from CT. Radiology should take part in MIP to address key issues encountered during prior MCIs and in MCI simulation to optimize major incident response.

Lack of Strategic Funding and Long-Term Job Security Threaten to Have Profound Effects on Cardiovascular Researcher Retention in Australia.

BACKGROUND: Cardiovascular disease is the leading cause of death in Australia. Investment in research solutions has been demonstrated to yield health and a 9.8-fold return economic benefit. The sector, however, is severely challenged with success rates of traditional peer-reviewed funding in decline. Here, we aimed to understand the perceived challenges faced by the cardiovascular workforce in Australia prior to the COVID-19 pandemic. METHODS: We used an online survey distributed across Australian cardiovascular societies/councils, universities and research institutes over a period of 6 months during 2019, with 548 completed responses. Inclusion criteria included being an Australian resident or an Australian citizen who lived overseas, and a current or past student or employee in the field of cardiovascular research. RESULTS: The mean age of respondents was 42±13 years, 47% were male, 85% had a full-time position, and 40% were a group leader or laboratory head. Twenty-three per cent (23%) had permanent employment, and 82% of full-time workers regularly worked >40 hours/week. Sixty-eight per cent (68%) said they had previously considered leaving the cardiovascular research sector. If their position could not be funded in the next few years, a staggering 91% of respondents would leave the sector. Compared to PhD- and age-matched men, women were less likely to be a laboratory head and to feel they had a long-term career path as a cardiovascular researcher, while more women were unsure about future employment and had considered leaving the sector (all p<0.05). Greater job security (76%) and government and philanthropic investment in cardiovascular research (72%) were highlighted by responders as the main changes to current practices that would encourage them to stay. CONCLUSION: Strategic solutions, such as diversification of career pathways and funding sources, and moving from a competitive to a collaborative culture, need to be a priority to decrease reliance on government funding and allow cardiovascular researchers to thrive.

Improving Shared Decision-making and Treatment Planning Through Predictive Modeling: Clinical Insights on Ventral Hernia Repair.

Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions.

The Medical Library as a Component of a Medical School Outreach Experience.

The United States is facing a shortage of physicians for minorities and patients in disadvantaged areas. Many medical schools have pipeline programs to promote the interest of minority students in medicine. The Brody School of Medicine at East Carolina University established the Brody RISE program. Recruitment efforts targeted schools within Pitt County, NC. Students participate in interactive STEM activities and campus tours. Laupus Health Sciences Librarians developed interactive activities that engage critical thinking and teach anatomy and medical history. The organizers of the Brody RISE program continually evaluate and expand the program. Laupus Library continues to partner in these activities.