Medical Information Delivering Improved Customer Experience: A Guide.

Customer experience (CX) is essential in any business. In the pharmaceutical industry, the Medical Information Contact Center is a customer-facing unit that provides evidence-based, scientifically balanced information to healthcare professionals and patients in response to unsolicited inquiries. The purpose of this paper is to provide analysis and guidance for designing and measuring interactions in the Medical Information Contact Center to facilitate the delivery of a superior and continuously improving CX. Surveys were conducted to establish current trends in CX among a diverse group of CX professionals and members of phactMI, a non-profit collaboration of Medical Information leaders from the pharmaceutical industry. The top three observations from the CX professionals survey centered on establishing a clear CX strategy, use of technology, and frequency of sharing results. Three potential areas for improvement focus on CX strategy, measurements of CX, and sharing of results. An analysis of quality monitoring results of customer interactions in the pharmaceutical industry from Centerfirst, a contact center quality monitoring service provider, was also reviewed. This analysis found a positive correlation between CX and three agent skills: taking the lead, empathy, and strong compliance skills. Based on these results, a CX guide was developed and specifically tailored for the pharmaceutical industry. This tool may be used to help identify, assess, and possibly improve CX.

Making Space to Save Lives: A Critical Role for the Hospitalist During Mass Casualty Incidents.

OBJECTIVE: An effective hospital response to mass casualty incidents (MCIs) requires rapid mobilization of personnel capable of caring for critically ill trauma patients and availability of resuscitation resources. METHODS: Hospitals facing an MCI wrestle with the challenge of immediately adjusting their overextended clinical operations to resuscitate a large number of rapidly arriving patients without compromising the care of existing patients. RESULTS: Hospitalists are well positioned to add significant value by off-loading the emergency department (ED) given their broad clinical expertise. We describe our institution's protocol to generate immediate and sustained surge capacity by integrating our hospitalist service into MCI response. CONCLUSIONS: Our protocol details the safe and rapid transfer of care of existing ED patients to hospitalist teams to make ED staff and space available to care for incoming MCI patients.

The Health and Social Needs of Patients Discharged From the Emergency Department With Suspected COVID-19.

Health-related social needs (HRSNs), such as food or housing insecurity, are important drivers of disparities in outcomes during public health emergencies. We describe the development of a telehealth follow-up program in Boston, Massachusetts, for patients discharged from the emergency department after coronavirus disease 2019 (COVID-19) testing to identify patients with worsening clinical symptoms, to screen for unmet HRSNs, and to deliver self-isolation counseling and risk-reduction strategies for socially vulnerable people. We prioritized telephone calls to patients with public health insurance and patients without primary care physicians. In the first 43 days of operation, March 30-May 12, 2020, our intervention reached 509 patients, with 209 (41.1%) patients reporting an HRSN, most commonly related to food, housing, or utilities. Thirty-one (6.1%) patients required assessment by a clinician for clinical worsening. This public health intervention may be useful for other institutions developing programs to address the social and health needs of patients discharged with suspected COVID-19.

Five Decades of Global Chemical Terror Attacks: Data Analysis to Inform Training and Preparedness.

BACKGROUND: Chemical weapons attacks during the recent conflict in Syria and Iraq highlight the need to better understand the changing epidemiology of chemical weapons use, especially among non-state actors. Public health professionals and policy-makers require this data to prioritize funding, training, chemical weapons preparedness, disaster response, and recovery. The purpose of this investigation is to provide descriptive data that can be used by policy-makers and public safety officials to better prepare for these potential attacks. METHODS: A five-decade descriptive retrospective review of The Global Terrorism Database, maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism, was conducted to understand trends in chemical agents, targets, and routes of exposure. We reviewed and analyzed data specific to these documented chemical attacks between 1970 and 2017. RESULTS: 383 terror attacks involved chemical weapons over the study period. A specific agent was named in 154 incidents, while 124 incidents could be classified into traditional chemical weapons categories (eg, vesicant, choking agents). A route of exposure was identified in 242 attacks, with the most common routes of exposure being dermal-mucosal and inhalational. Caustic agents were used in the highest portion of attacks (25%) where the route of exposure was known. Explosive devices were used in 21% of attacks to deliver these chemical agents. Of particular note, private citizens and educational facilities were targeted in 25% and 12% of attacks, respectively. The average number of attacks increased from 6 per year between 1970 and 2011 to 24.9 per year between 2011 and 2017 (coinciding with the start of the Syria conflict). The most commonly utilized chemicals were chlorine (26.0%), tear gas (20.8%), and cyanide (15.6%). Blood agent incidents declined from 32.6% before the September 11, 2001 attacks to 13.6% after 2001, while nerve agent attacks fell from 9.3% to 1.2%. In contrast, choking (namely chlorine) and vesicant (mustard) agent use increased from 7% to 48.1% and from 2.3% to 6.2% of attacks, respectively. CONCLUSIONS: Chemical weapon use in global terrorism remains an increasingly common occurrence that requires better characterization. The average number of chemical terrorist attacks per year is increasing, with a large proportion resulting from the conflicts in Iraq and Syria. Choking (chlorine) and vesicant (mustard) agents have become the predominant chemical terror agent since 2001, with a decreased incidence of blood (cyanogenic) and nerve (sarin) agents. Future preparedness initiatives should focus on vulnerable targets such as private citizens and educational institutions. Improving blast injury response is essential, along with prioritizing disaster training focused on choking agents, vesicants, and caustics.

Disaster Training in 24 Hours: Evaluation of a Novel Medical Student Curriculum in Disaster Medicine.

BACKGROUND: Over a decade ago, the Association of American Medical Colleges called for incorporation of disaster medicine training into the education of medical students in the United States. Despite this recommendation, similar suggestions by other professional organizations, and significant interest from medical students and educators, few medical schools explicitly include robust disaster training in their curricula. OBJECTIVES: This study describes the results of the implementation of a novel medical student curriculum in disaster response at an allopathic U.S. medical school. Specifically, this study evaluates the effectiveness of a voluntary training program in increasing the knowledge of medical students to respond to disasters. METHODS: Over 2 years, 24 hours of training consisting of didactics and hands-on exercises was delivered to medical students by volunteers from the Department of Emergency Medicine. Student knowledge was tested prior to and after each training session through a multiple-choice questionnaire and evaluated using a paired t-test. RESULTS: Consistent with previous studies, this voluntary disaster curriculum improved students' knowledge of emergency preparedness. The mean test score for all students participating in the training increased from 5.30 ± 1.05 (with a maximum score of 10), to 7.98±0.96 post course. CONCLUSION: This intervention represents a low-cost, high-impact mechanism for improving the capacity of an underutilized segment of the health care team to respond to public health emergencies.

Experimental setup for the laboratory investigation of micrometeoroid ablation using a dust accelerator.

A facility has been developed to simulate the ablation of micrometeoroids in laboratory conditions. An electrostatic dust accelerator is used to generate iron particles with velocities of 10-70 km/s. The particles are then introduced into a chamber pressurized with a target gas, where the pressure is adjustable between 0.01 and 0.5 Torr, and the particle partially or completely ablates over a short distance. An array of biased electrodes above and below the ablation path is used to collect the generated ions/electrons with a spatial resolution of 2.6 cm along the ablating particles' path, thus allowing the study of the spatiotemporal evolution of the process. For completely ablated particles, the total collected charge directly yields the ionization coefficient of a given dust material-target gas combination. The first results of this facility measured the ionization coefficient of iron atoms with N2, air, CO2, and He target gases for impact velocities >20 km/s, and are reported by Thomas et al. [Geophys. Res. Lett. 43, 3645 (2016)]. The ablation chamber is also equipped with four optical ports that allow for the detection of the light emitted by the ablating particle. A multichannel photomultiplier tube system is used to observe the ablation process with a spatial and temporal resolution of 0.64 cm and 90 ns. The preliminary results indicate that it is possible to calculate the velocity of the ablating particle from the optical observations, and in conjunction with the spatially resolved charge measurements allow for experimental validation of ablation models in future studies.

Building a world-class A/P function: how UPMC went paperless.

UPMC engaged people, processes, and technology to move its A/P function from a highly manual, paper-based operation to a completely automated process. UPMC's CFO hired a chief supply chain officer to develop a strategic plan, and UPMC named a value analysis team to gain clinician buy-in. UPMC automated A/P by enabling receipt of electronic invoices. UPMC streamlined its processes for invoices.

Sources and temporal dynamics of arsenic in a New Jersey watershed, USA.

We examined potential sources and the temporal dynamics of arsenic (As) in the slightly alkaline waters of the Wallkill River, northwestern New Jersey, where violations of water-quality standards have occurred. The study design included synoptic sampling of stream water and bed sediments in tributaries and the mainstem, hyporheic-zone/ground water on the mainstem, and seasonal and diurnal sampling of water at selected mainstem sites. The river valley is bordered by gneiss and granite highlands and shale lowlands and underlain by glacial deposits over faulted dolomites and the Franklin Marble. Ore bodies in the Marble, which have been mined for rare Zn ore minerals, also contain As minerals. Tributaries, which drain predominantly forested and agricultural land, contributed relatively little As to the river. The highest concentrations of As (up to 34 mug/L) emanated from the outlet of man-made Lake Mohawk at the river's headwaters; these inputs varied substantially with season--high during warm months, low during cold months, apparently because of biological activity in the lake. Dissolved As concentrations were lower (3.3 microg/L) in river water than those in ground water discharging into the riverbed (22 microg/L) near the now-closed Franklin Mine. High total As concentrations (100-190 mg/kg) on the <0.63 microm fraction of bed sediments near the mine apparently result from sorption of the As in the ground-water discharge as well as from the As minerals in the streambed. As concentrations in river water were diluted during high stream flow in fall, winter and spring, and concentrated during low flow in summer. In unfiltered samples from a wetlands site, diurnal cycles in trace-element concentrations occurred; As concentrations appeared to peak during late afternoon as pH increased, but Fe, Mn, and Zn concentrations peaked shortly after midnight. The temporal variability of As and its presence at elevated concentrations in ground water and sediments as well as streamwater demonstrate the importance of (1) sampling a variety of media and (2) determining the time scales of As variability to fully characterize its passage through a river system.