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1. Water Management Considerations for a Self-Sustaining Moonbase

Author

Lee, Jeffrey S., Yelderman, Joe, and Cleaver, Gerald B.

Subjects
Physics - Physics and Society, Astrophysics - Earth and Planetary Astrophysics, Astrophysics - Instrumentation and Methods for Astrophysics, Physics - Popular Physics
Abstract

The most pragmatic first step in the all-but-inevitable 3rd-millennium V\"olkerwanderung of humanity throughout the Solar System is the establishment of a permanent human presence on the Moon. This research examines: 1. the human, agricultural, and technical water needs of a 100-person, 500 m x 100 m x 6 m self-sustaining lunar colony; 2. choosing a strategic location for the moonbase; 3. a heat drill model by which the needed lunar water ice could be sublimated; and 4. the robust water treatment and recovery infrastructure and water management personnel that would be needed for a self-sustaining moonbase., Comment: 36 pages, 12 Figues, 3 Tables

Published
2024

2. Validation of Quality Assessment Measures for Inpatient Gastroenterology Consults on Oncologic Patients in Non-teaching Services at a Cancer Center: A Cross-Sectional Study

Author

Kidambi, Trilokesh D., Qadri, Rateeba, Varughese, Jay, Seto, Tyler, Idos, Gregory, Lin, James, Hirsch, Peter, Trieu, Harry, Ma, Huiyan, Hein, Marjorie, Ahn, Alice, Hy-Hincy, Claire, Lew, Michael W., Kessler, Jonathan, Perumpail, Ryan B., Terdiman, Jonathan P., Lee, Jeffrey K., Day, Lukejohn, Manesh, Reza Sedighi, Taplitz, Randy, and Banciu-Odell, Cornelia

Published
2024
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4. Outcomes of Planetary Collisions: Importance of Gravity and Material Properties

Author

Smallwood, Jeremy L., Lee, Jeffrey S., Matthews, Lorin S., and Wyatt, Bryant M.

Subjects
Astrophysics - Earth and Planetary Astrophysics
Abstract

The final sizes, composition, and angular momenta of solid planetary bodies depend on the outcomes of collisions between planetary embryos. The most common numerical method for simulating embryo collisions is to combine a gravity solver with a hydrodynamic solver, allowing pressure gradients, shock waves, and gravitational torques to loft material into orbit. Here, we perform the first direct comparison between hydrodynamic methods and a simplified method employing only gravity and a quadratic repulsive force. The formation of Earth's Moon, perhaps the most heavily simulated planetary collision, is used as a test case. Many of the main features of a collision between two planetary embryos, including collisions in which an orbiting disc of material and/or intact moons are formed, are controlled solely by gravitational forces. Comparison of the methods shows that the mass and orbit of the satellite, as well as the extent of physical mixing between the protoearth and impactor, are similar regardless of the inclusion of the inclusion of hydrodynamic effects or the equation of state employed. The study of thermal and chemical effects of the impact, and determining the time scale for lunar accretion, still require a full hydrodynamic calculation. The simplified gravity plus quadratic repulsive force approach allows rapid testing of various initial conditions to identify cases for further detailed study., Comment: 10 pages, 4 figures, submitted to MNRAS

Published
2023

10. The Real Number n-Degree Pythagorean Theorem

Author

Lee, Jeffrey S. and Cleaver, Gerald B.

Subjects
Mathematics - General Mathematics
Abstract

This paper extends the Pythagorean Theorem to positive and negative real exponents to take the form a^n + b^n = c^n and makes use of the definition gamma = b/a >= 1. For the case of n in the set of positive real numbers, n greater than or equal to 1 is necessary for the vertex angle to be real, and there are no restrictions on gamma beyond its definition. However, for n in the set of negative reals, two significant restrictions that are necessary for a^n + b^n = c^n to yield real vertex angles have been discovered by this work: 1 <= gamma < 2, and n cannot exceed a critical value which is gamma-dependent. Additionally, the areas of the associated triangles have been determined as well as the conditions for those areas to be maxima or minima., Comment: 24 pages, 20 figures

Published
2022

21. Combining Asian and European genome-wide association studies of colorectal cancer improves risk prediction across racial and ethnic populations

Author

Thomas, Minta, Su, Yu-Ru, Rosenthal, Elisabeth A., Sakoda, Lori C., Schmit, Stephanie L., Timofeeva, Maria N., Chen, Zhishan, Fernandez-Rozadilla, Ceres, Law, Philip J., Murphy, Neil, Carreras-Torres, Robert, Diez-Obrero, Virginia, van Duijnhoven, Franzel J. B., Jiang, Shangqing, Shin, Aesun, Wolk, Alicja, Phipps, Amanda I., Burnett-Hartman, Andrea, Gsur, Andrea, Chan, Andrew T., Zauber, Ann G., Wu, Anna H., Lindblom, Annika, Um, Caroline Y., Tangen, Catherine M., Gignoux, Chris, Newton, Christina, Haiman, Christopher A., Qu, Conghui, Bishop, D. Timothy, Buchanan, Daniel D., Crosslin, David R., Conti, David V., Kim, Dong-Hyun, Hauser, Elizabeth, White, Emily, Siegel, Erin, Schumacher, Fredrick R., Rennert, Gad, Giles, Graham G., Hampel, Heather, Brenner, Hermann, Oze, Isao, Oh, Jae Hwan, Lee, Jeffrey K., Schneider, Jennifer L., Chang-Claude, Jenny, Kim, Jeongseon, Huyghe, Jeroen R., Zheng, Jiayin, Hampe, Jochen, Greenson, Joel, Hopper, John L., Palmer, Julie R., Visvanathan, Kala, Matsuo, Keitaro, Matsuda, Koichi, Jung, Keum Ji, Li, Li, Le Marchand, Loic, Vodickova, Ludmila, Bujanda, Luis, Gunter, Marc J., Matejcic, Marco, Jenkins, Mark A., Slattery, Martha L., D’Amato, Mauro, Wang, Meilin, Hoffmeister, Michael, Woods, Michael O., Kim, Michelle, Song, Mingyang, Iwasaki, Motoki, Du, Mulong, Udaltsova, Natalia, Sawada, Norie, Vodicka, Pavel, Campbell, Peter T., Newcomb, Polly A., Cai, Qiuyin, Pearlman, Rachel, Pai, Rish K., Schoen, Robert E., Steinfelder, Robert S., Haile, Robert W., Vandenputtelaar, Rosita, Prentice, Ross L., Küry, Sébastien, Castellví-Bel, Sergi, Tsugane, Shoichiro, Berndt, Sonja I., Lee, Soo Chin, Brezina, Stefanie, Weinstein, Stephanie J., Chanock, Stephen J., Jee, Sun Ha, Kweon, Sun-Seog, Vadaparampil, Susan, Harrison, Tabitha A., Yamaji, Taiki, Keku, Temitope O., Vymetalkova, Veronika, Arndt, Volker, Jia, Wei-Hua, Shu, Xiao-Ou, Lin, Yi, Ahn, Yoon-Ok, Stadler, Zsofia K., Van Guelpen, Bethany, Ulrich, Cornelia M., Platz, Elizabeth A., Potter, John D., Li, Christopher I., Meester, Reinier, Moreno, Victor, Figueiredo, Jane C., Casey, Graham, Lansdorp Vogelaar, Iris, Dunlop, Malcolm G., Gruber, Stephen B., Hayes, Richard B., Pharoah, Paul D. P., Houlston, Richard S., Jarvik, Gail P., Tomlinson, Ian P., Zheng, Wei, Corley, Douglas A., Peters, Ulrike, and Hsu, Li

Published
2023
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25. GRP78 expression and prognostic significance in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant therapy versus surgery first

Author

Tong, Yi Tat, Wang, Hua, Wei, Dongguang, Prakash, Laura R, Kim, Michael, Tzeng, Ching-Wei D, Lee, Jeffrey E, Rashid, Asif, Koay, Eugene J, Wolff, Robert A, Maitra, Anirban, Katz, Matthew Hg, and Wang, Huamin

Subjects
Rare Diseases, Pancreatic Cancer, Digestive Diseases, Cancer, Carcinoma, Pancreatic Ductal, Endoplasmic Reticulum Chaperone BiP, Glucose, Humans, Neoadjuvant Therapy, Neoplasm Recurrence, Local, Pancreatic Neoplasms, Prognosis, Retrospective Studies, GRP78, Neoadjuvant therapy, Pancreatic cancer, Survival, Tumor response grading, Clinical Sciences, Gastroenterology & Hepatology
Abstract

BackgroundGlucose-regulated protein 78 (GRP78) plays an essential role in protein folding, transportation, and degradation, thus regulates ER homeostasis and promotes cell survival, proliferation and invasion. GRP78 expression in PDAC patients who received neoadjuvant therapy has not been reported.MethodsThis retrospective study of resected PDAC patients included 125 patients treated with neoadjuvant therapy (NAT) and 140 patients treated with surgery first (SF). The expression of GRP78 was evaluated by immunohistochemistry on tissue microarrays and the results were correlated with clinicopathologic parameters and survival.ResultsGRP78 expression was higher in SF patients compared to NAT patients (P

Published
2021

35. An Update on the Epidemiology, Molecular Characterization, Diagnosis, and Screening Strategies for Early-Onset Colorectal Cancer

Author

Burnett-Hartman, Andrea N, Lee, Jeffrey K, Demb, Joshua, and Gupta, Samir

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Nutrition and Dietetics, Cancer, Digestive Diseases, Prevention, Colo-Rectal Cancer, 4.4 Population screening, Detection, screening and diagnosis, Good Health and Well Being, Age of Onset, Biomarkers, Tumor, Colorectal Neoplasms, Early Detection of Cancer, Humans, Mass Screening, Microsatellite Instability, Practice Guidelines as Topic, Precision Medicine, Risk Factors, Triage, Early-Onset Colorectal Cancer, Epidemiology, Red Flags, Neurosciences, Paediatrics and Reproductive Medicine, Gastroenterology & Hepatology, Clinical sciences, Nutrition and dietetics
Abstract

Rising trends in the incidence and mortality of early-onset colorectal cancer (CRC) in those who are younger than 50 years have been well established. These trends have spurred intense investigation focused on elucidating the epidemiology and characteristics of early-onset CRC, as well as on identifying strategies for early detection and prevention. In this review, we provide a contemporary update on early-onset CRC with a particular focus on epidemiology, molecular characterization, red flag signs and symptoms, and screening for early-onset CRC.

Published
2021

37. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: summary and recommendations

Author

Fujii-Lau, Larissa L., Thosani, Nirav C., Al-Haddad, Mohammad, Acoba, Jared, Wray, Curtis J., Zvavanjanja, Rodrick, Amateau, Stuart K., Buxbaum, James L., Calderwood, Audrey H., Chalhoub, Jean M., Coelho-Prabhu, Nayantara, Desai, Madhav, Elhanafi, Sherif E., Fishman, Douglas S., Forbes, Nauzer, Jamil, Laith H., Jue, Terry L., Kohli, Divyanshoo R., Kwon, Richard S., Law, Joanna K., Lee, Jeffrey K., Machicado, Jorge D., Marya, Neil B., Pawa, Swati, Ruan, Wenly, Sawhney, Mandeep S., Sheth, Sunil G., Storm, Andrew, Thiruvengadam, Nikhil R., and Qumseya, Bashar J.

Published
2023
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38. American Society for Gastrointestinal Endoscopy guideline on role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: methodology and review of evidence

Author

Fujii-Lau, Larissa L., Thosani, Nirav C., Al-Haddad, Mohammad, Acoba, Jared, Wray, Curtis J., Zvavanjanja, Rodrick, Amateau, Stuart K., Buxbaum, James L., Wani, Sachin, Calderwood, Audrey H., Chalhoub, Jean M., Coelho-Prabhu, Nayantara, Desai, Madhav, Elhanafi, Sherif E., Fishman, Douglas S., Forbes, Nauzer, Jamil, Laith H., Jue, Terry L., Kohli, Divyanshoo R., Kwon, Richard S., Law, Joanna K., Lee, Jeffrey K., Machicado, Jorge D., Marya, Neil B., Pawa, Swati, Ruan, Wenly, Sawhney, Mandeep S., Sheth, Sunil G., Storm, Andrew, Thiruvengadam, Nikhil R., and Qumseya, Bashar J.

Published
2023
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40. Evaluating Different Approaches for Calculating Adenoma Detection Rate: Is Screening Colonoscopy the Gold Standard?

Author

Kamineni, Aruna, Sugg-Skinner, Celette, Zhao, Wei K., Ziebell, Rebecca A., Contreras, Richard, Kim, Eric J., Lee, Jeffrey K., Levin, Theodore R., Ghai, Nirupa R., Fireman, Bruce H., Quesenberry, Charles P., Corley, Douglas A., Jensen, Christopher D., Chubak, Jessica, Schottinger, Joanne E., Halm, Ethan A., and Udaltsova, Natalia

Published
2023
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41. Clinicopathological correlation of radiologic measurement of post-therapy tumor size and tumor volume for pancreatic ductal adenocarcinoma

Author

Wei, Dongguang, Zaid, Mohamed M, Katz, Matthew H, Prakash, Laura R, Kim, Michael, Tzeng, Ching-Wei D, Lee, Jeffrey E, Agrawal, Anshuman, Rashid, Asif, Wang, Hua, Varadhachary, Gauri, Wolff, Robert A, Tamm, Eric P, Bhosale, Priya R, Maitra, Anirban, Koay, Eugene J, and Wang, Huamin

Subjects
Cancer, Biomedical Imaging, Clinical Research, Rare Diseases, Digestive Diseases, Clinical Trials and Supportive Activities, Pancreatic Cancer, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Adult, Aged, Aged, 80 and over, Carcinoma, Pancreatic Ductal, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Lymphatic Metastasis, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Pancreatic Neoplasms, Pancreaticoduodenectomy, Retrospective Studies, Survival Analysis, Tomography, X-Ray Computed, Treatment Outcome, Pancreatic cancer, Radiologic tumor size, Radiologic tumor volume, Tumor response grade, Tumor stage, Clinical Sciences, Gastroenterology & Hepatology
Abstract

ObjectivesTumor size measurement is critical for accurate tumor staging in patients with pancreatic ductal adenocarcinoma (PDAC). However, accurate tumor size measurement is challenging in patients who received neoadjuvant therapy before resection, due to treatment-induced fibrosis and tumor invasion beyond the grossly identified tumor area. In this study, we evaluated the correlation between the tumor size and tumor volume measured on post-therapy computed tomography (CT) scans and the pathological measurement. Also, we investigated the correlation between these measurements and clinicopathological parameters and survival.Materials and methodsRetrospectively, we evaluated 343 patients with PDAC who received neoadjuvant therapy, followed by pancreaticoduodenectomy and had pre-operative pancreatic protocol CT imaging. We measured the longest tumor diameter (RadL) and the radiological tumor volume (RadV) on the post-therapy CT scan, then we categorized RadL into four radiologic tumor stages (RTS) based on the current AJCC staging (8th edition) protocol and RadV based on the median. Pearson correlation or Spearman's coefficient (δ), T-test and ANOVA was used to test the correlation between the radiological and pathological measurement. Chi-square analysis was used to test the correlation with the tumor pathological response, lymph-node metastasis and margin status and Kaplan-Meier and Cox-proportional hazard for survival analysis. P-value < 0.05 was considered significant.ResultsAs a continuous variable, RadL showed a positive linear correlation with the post-therapy pathologic tumor size in the overall patient population (Pearson correlation coefficient: 0.72, P

Published
2021

45. Satellites reveal Earth's seasonally shifting dust emission sources

Author

Chappell, Adrian, Webb, Nicholas P., Hennen, Mark, Schepanski, Kerstin, Ciais, Philippe, Balkanski, Yves, Zender, Charles S., Tegen, Ina, Zeng, Zhenzhong, Tong, Daniel, Baker, Barry, Ekström, Marie, Baddock, Matthew, Eckardt, Frank D., Kandakji, Tarek, Lee, Jeffrey A., Nobakht, Mohamad, von Holdt, Johanna, and Leys, John F.

Published
2023
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46. Electronic Health Record Use among Ophthalmology Residents while on Call.

Author

Long, Christopher, Tai-Seale, Ming, Lee, Jeffrey, Baxter, Sally, and El-Kareh, Robert

Subjects
EHR tasks, audit logs, call burden, clinical activity, education policy, electronic health records, ophthalmology residents
Abstract

BACKGROUND: As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours. METHODS: In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks. RESULTS: Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents on-call EHR activities. CONCLUSION: In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.

Published
2020

47. Impact of observational training on endoscopic mucosal resection outcomes and competency for large colorectal polyps: single endoscopist experience

Author

Lee, Jeffrey K, Kidambi, Trilokesh D, Kaltenbach, Tonya, Bhat, Yasser M, Shergill, Amandeep, McQuaid, Kenneth R, Terdiman, Jonathan P, and Soetikno, Roy M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Colo-Rectal Cancer, Prevention, Clinical Research, Cancer, Clinical sciences
Abstract

Background and study aims  Endoscopic mucosal resection (EMR) is standard treatment for large colorectal polyps. However, it is a specialized technique with limited data on the effectiveness of training methods to acquire this skill. The aim of this study was to evaluate the impact of observational training on EMR outcomes and competency in an early-stage endoscopist. Patients and methods  A single endoscopist completed comprehensive EMR training, which included knowledge acquisition and direct observation of EMR cases, and proctored supervision, during the third year of gastroenterology fellowship. After training, EMR was independently attempted on 142 consecutive, large (i. e., ≥ 20 mm), non-pedunculated colorectal polyps between July 2014 and December 2017 (mean age 61.7 years; mean polyp size 30.4 mm; en-bloc resection 55 %). Surveillance colonoscopy for evaluation of residual neoplasia was available for 86 % of the cases. Three primary outcomes were evaluated: endoscopic assessment of complete resection, rate of adverse events (AEs), and rate of residual neoplasia on surveillance colonoscopy. Results  Complete endoscopic resection was achieved in 93 % of cases, the rates of AEs and residual neoplasia were 7.8 % and 7.3 %, respectively. The rate of complete resection remained stable (at 85 % or greater) with increasing experience while rates of AEs and residual neoplasia peaked and decreased after 60 cases. Conclusions  An early-stage endoscopist can acquire the skills to perform effective EMR after completing observational training. At least 60 independent EMRs for large colorectal polyps were required to achieve a plateau for clinically meaningful outcomes.

Published
2020

48. B cells and tertiary lymphoid structures promote immunotherapy response

Author

Helmink, Beth A, Reddy, Sangeetha M, Gao, Jianjun, Zhang, Shaojun, Basar, Rafet, Thakur, Rohit, Yizhak, Keren, Sade-Feldman, Moshe, Blando, Jorge, Han, Guangchun, Gopalakrishnan, Vancheswaran, Xi, Yuanxin, Zhao, Hao, Amaria, Rodabe N, Tawbi, Hussein A, Cogdill, Alex P, Liu, Wenbin, LeBleu, Valerie S, Kugeratski, Fernanda G, Patel, Sapna, Davies, Michael A, Hwu, Patrick, Lee, Jeffrey E, Gershenwald, Jeffrey E, Lucci, Anthony, Arora, Reetakshi, Woodman, Scott, Keung, Emily Z, Gaudreau, Pierre-Olivier, Reuben, Alexandre, Spencer, Christine N, Burton, Elizabeth M, Haydu, Lauren E, Lazar, Alexander J, Zapassodi, Roberta, Hudgens, Courtney W, Ledesma, Deborah A, Ong, SuFey, Bailey, Michael, Warren, Sarah, Rao, Disha, Krijgsman, Oscar, Rozeman, Elisa A, Peeper, Daniel, Blank, Christian U, Schumacher, Ton N, Butterfield, Lisa H, Zelazowska, Monika A, McBride, Kevin M, Kalluri, Raghu, Allison, James, Petitprez, Florent, Fridman, Wolf Herman, Sautès-Fridman, Catherine, Hacohen, Nir, Rezvani, Katayoun, Sharma, Padmanee, Tetzlaff, Michael T, Wang, Linghua, and Wargo, Jennifer A

Subjects
Biomedical and Clinical Sciences, Oncology and Carcinogenesis, Immunology, Immunization, Cancer, Vaccine Related, Genetics, B-Lymphocytes, Biomarkers, Tumor, Carcinoma, Renal Cell, Cell Cycle Checkpoints, Clone Cells, Dendritic Cells, Follicular, Gene Expression Regulation, Neoplastic, Humans, Immunologic Memory, Immunotherapy, Mass Spectrometry, Melanoma, Neoplasm Metastasis, Phenotype, Prognosis, RNA-Seq, Receptors, Immunologic, Single-Cell Analysis, T-Lymphocytes, Tertiary Lymphoid Structures, Transcriptome, General Science & Technology
Abstract

Treatment with immune checkpoint blockade (ICB) has revolutionized cancer therapy. Until now, predictive biomarkers1-10 and strategies to augment clinical response have largely focused on the T cell compartment. However, other immune subsets may also contribute to anti-tumour immunity11-15, although these have been less well-studied in ICB treatment16. A previously conducted neoadjuvant ICB trial in patients with melanoma showed via targeted expression profiling17 that B cell signatures were enriched in the tumours of patients who respond to treatment versus non-responding patients. To build on this, here we performed bulk RNA sequencing and found that B cell markers were the most differentially expressed genes in the tumours of responders versus non-responders. Our findings were corroborated using a computational method (MCP-counter18) to estimate the immune and stromal composition in this and two other ICB-treated cohorts (patients with melanoma and renal cell carcinoma). Histological evaluation highlighted the localization of B cells within tertiary lymphoid structures. We assessed the potential functional contributions of B cells via bulk and single-cell RNA sequencing, which demonstrate clonal expansion and unique functional states of B cells in responders. Mass cytometry showed that switched memory B cells were enriched in the tumours of responders. Together, these data provide insights into the potential role of B cells and tertiary lymphoid structures in the response to ICB treatment, with implications for the development of biomarkers and therapeutic targets.

Published
2020

49. The North American Neuroendocrine Tumor Society Consensus Paper on the Surgical Management of Pancreatic Neuroendocrine Tumors.

Author

Howe, James R, Merchant, Nipun B, Conrad, Claudius, Keutgen, Xavier M, Hallet, Julie, Drebin, Jeffrey A, Minter, Rebecca M, Lairmore, Terry C, Tseng, Jennifer F, Zeh, Herbert J, Libutti, Steven K, Singh, Gagandeep, Lee, Jeffrey E, Hope, Thomas A, Kim, Michelle K, Menda, Yusuf, Halfdanarson, Thorvardur R, Chan, Jennifer A, and Pommier, Rodney F

Subjects
Humans, Neuroendocrine Tumors, Pancreatic Neoplasms, Societies, Medical, North America, Consensus Development Conferences as Topic, Review Literature as Topic, Practice Guidelines as Topic, Surgeons, Rare Diseases, Cancer, Neurosciences, Pancreatic Cancer, Digestive Diseases, pancreas, neuroendocrine, pancreatic neuroendocrine tumor, metastases, neuroendocrine tumor liver metastases, pancreatectomy, Clinical Sciences, Gastroenterology & Hepatology
Abstract

This manuscript is the result of the North American Neuroendocrine Tumor Society consensus conference on the surgical management of pancreatic neuroendocrine tumors from July 19 to 20, 2018. The group reviewed a series of questions of specific interest to surgeons taking care of patients with pancreatic neuroendocrine tumors, and for each, the available literature was reviewed. What follows are these reviews for each question followed by recommendations of the panel.

Published
2020

50. Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

Author

Baxter, Sally L, Gali, Helena E, Chiang, Michael F, Hribar, Michelle R, Ohno-Machado, Lucila, El-Kareh, Robert, Huang, Abigail E, Chen, Heather E, Camp, Andrew S, Kikkawa, Don O, Korn, Bobby S, Lee, Jeffrey E, Longhurst, Christopher A, and Millen, Marlene

Subjects
Health Services and Systems, Health Sciences, Patient Safety, Clinical Research, Good Health and Well Being, Adult, Cell Phone, Cohort Studies, Communication, Documentation, Electronic Health Records, Humans, Ophthalmology, Outcome Assessment, Health Care, Outpatients, Patient Satisfaction, Time Factors, electronic health records, ophthalmology, quality improvement, informatics, communication, Information Systems, Clinical Sciences, Health services and systems
Abstract

ObjectiveTo evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients.MethodsThis prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR.ResultsTime spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use.ConclusionInformatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician-patient interactions, these strategies may help alleviate risk of physician burnout.

Published
2020

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