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Author: Brian S McGowan, PhD

ABSTRACT: A case study of healthcare providers’ goals during interprofessional rounds

Daily interprofessional rounds enhance collaboration among healthcare providers and improve hospital performance measures. However, it is unclear how healthcare providers’ goals influence the processes and outcomes of interprofessional rounds. The purpose of this case study was to explore the goals of healthcare providers attending interprofessional rounds in an internal medicine ward. The second purpose was to explore the challenges encountered by healthcare providers while pursuing these goals. Three focus groups were held with healthcare providers of diverse professional backgrounds. Focus group field notes and transcripts were analysed using thematic analysis. The data indicated that there was no consensus among healthcare providers regarding the goals of interprofessional rounds. Discharge planning and patient care delivery were perceived as competing priorities during rounds, which limited the participation of healthcare providers. Nevertheless, study participants identified goals of rounds that were relevant to most care providers: developing shared perspectives of patients through direct communication, promoting collaborative decision making, coordinating care, and strengthening interprofessional relationships. Challenges in achieving the goals of interprofessional rounds included inconsistent attendance, exchange of irrelevant information, variable participation by healthcare providers, and inconsistent leadership. The findings of this study underscore the importance of shared goals in the context of interprofessional rounding.

via A case study of healthcare providers’ goals during interprofessional rounds. – PubMed – NCBI.

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RESOURCE: How long is short-term memory? Shorter than you might think.

So, cognitive psychologists divide memory into the first 15-30 seconds, and they call this short-term memory, and alllllll the rest of memory that lasts beyond 30 seconds is long-term memory. Why would we make such a skewed split, and why aren’t there more categories (like medium-term memory)? And what good is this type of memory process, if it falls apart after much less than a minute?

You might wonder, what do we use short-term memory for? Even though short-term is very short, you are, in fact, constantly using it. You use it to remember the beginning of this sentence as you get to the end. You use it to sustain a conversation, which involves listening, formulating what you are going to say, and then saying it. You use short-term memory when you are baking, to remember the quantity of flour you need to weigh out. Your waitress will use her working memory to write down your order as you’re speaking it – but note that if she takes the whole table’s order and then goes to the machine to punch it in, she’s probably transferring your order to long-term memory!

The reason why cognitive psychologists believe that there is something truly special about the 15-30 second range that can be separated from all other memory beyond that timeframe is that patients who present with apparently total memory loss are still able to keep things in memory for 15-30 seconds.

via How long is short-term memory? Shorter than you might think. — The Learning Scientists.

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ABSTRACT: Selective Entrainment of Theta Oscillations in the Dorsal Stream Causally Enhances Auditory Working Memory Performance

The implication of the dorsal stream in manipulating auditory information in working memory has been recently established. However, the oscillatory dynamics within this network and its causal relationship with behavior remain undefined. Using simultaneous MEG/EEG, we show that theta oscillations in the dorsal stream predict participants’ manipulation abilities during memory retention in a task requiring the comparison of two patterns differing in temporal order. We investigated the causal relationship between brain oscillations and behavior by applying theta-rhythmic TMS combined with EEG over the MEG-identified target (left intraparietal sulcus) during the silent interval between the two stimuli. Rhythmic TMS entrained theta oscillation and boosted participants’ accuracy. TMS-induced oscillatory entrainment scaled with behavioral enhancement, and both gains varied with participants’ baseline abilities. These effects were not seen for a melody-comparison control task and were not observed for arrhythmic TMS. These data establish theta activity in the dorsal stream as causally related to memory manipulation.

via Selective Entrainment of Theta Oscillations in the Dorsal Stream Causally Enhances Auditory Working Memory Performance: Neuron.

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ABSTRACT: Externally induced frontoparietal synchronization modulates network dynamics and enhances working memory performance

Cognitive functions such as working memory (WM) are emergent properties of large-scale network interactions. Synchronisation of oscillatory activity might contribute to WM by enabling the coordination of long-range processes. However, causal evidence for the way oscillatory activity shapes network dynamics and behavior in humans is limited. Here we applied transcranial alternating current stimulation (tACS) to exogenously modulate oscillatory activity in a right frontoparietal network that supports WM. Externally induced synchronization improved performance when cognitive demands were high. Simultaneously collected fMRI data reveals tACS effects dependent on the relative phase of the stimulation and the internal cognitive processing state. Specifically, synchronous tACS during the verbal WM task increased parietal activity, which correlated with behavioral performance. Furthermore, functional connectivity results indicate that the relative phase of frontoparietal stimulation influences information flow within the WM network. Overall, our findings demonstrate a link between behavioral performance in a demanding WM task and large-scale brain synchronization.

via Externally induced frontoparietal synchronization modulates network dynamics and enhances working memory performance | eLife.

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ABSTRACT: Mnemonic Training Reshapes Brain Networks to Support Superior Memory

Memory skills strongly differ across the general population; however, little is known about the brain characteristics supporting superior memory performance. Here we assess functional brain network organization of 23 of the world’s most successful memory athletes and matched controls with fMRI during both task-free resting state baseline and active memory encoding. We demonstrate that, in a group of naive controls, functional connectivity changes induced by 6 weeks of mnemonic training were correlated with the network organization that distinguishes athletes from controls. During rest, this effect was mainly driven by connections between rather than within the visual, medial temporal lobe and default mode networks, whereas during task it was driven by connectivity within these networks. Similarity with memory athlete connectivity patterns predicted memory improvements up to 4 months after training. In conclusion, mnemonic training drives distributed rather than regional changes, reorganizing the brain’s functional network organization to enable superior memory performance.

via Mnemonic Training Reshapes Brain Networks to Support Superior Memory: Neuron.

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MANUSCRIPT: Beyond good intentions: Prompting people to make plans improves follow-through on important tasks

People fail to follow through on all types of important intentions, including staying fit, studying sufficiently, and voting. These failures cost individuals and society by escalating medical costs, shrinking lifetime earnings, and reducing citizen involvement in government. Evidence is mounting, however, that prompting people to make concrete and specific plans makes people more likely to act on their good intentions. Planning prompts seem to work because scheduling tasks makes people more likely to carry them out. They also help people recall in the right circumstances and in the right moment that they need to carry out a task. Prompts to make plans are simple, inexpensive, and powerful interventions that help people do what they intend to get done. They also avoid telling people what to do, allowing people to maintain autonomy over their own decisions.

Access the full article here!

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A rapid LEARNING healthcare system: Did we forget something?

The movement towards a rapid learning healthcare system has been gathering steam for just more than a decade. I was first introduced to the idea by its authors and early advocates in 2008:

“The objective of a rapid-learning health care system is simply to learn as fast as possible about what is the best treatment for each patient—and deliver it.”—Lynn Etheredge

As I began to familiarize myself with the framework I was both energized by its vision AND slightly concerned by what I saw as a critical flaw – the model largely ignored the actual science of learning.

Over time, as I engaged more and more with the leaders of the Rapid Learning Healthcare System movement, they acknowledged that in their initial view of the world (and I am paraphrasing here), “we assume that the individual clinicians already know ‘how to learn’ once they gain access to the most relevant information…” Unfortunately, as you hopefully understand by now, this is far from true!

Over the past five years the ArcheMedX team has been pioneering efforts to apply the science of learning to transform CME/CPD. In the past year alone we have successfully improved the learning experiences of thousands of healthcare providers and I have been fortunate enough to have lead nearly a dozen workshops helping healthcare educators leverage the science of learning within their own educational interventions. The impact of these efforts are game-changing:

  • Learners are three times more likely to complete an activity!
  • Changes in knowledge and competence are four to six times greater!
  • Learners dive far more deeply into structured curricula!
  • Educators are gaining access to invaluable new forms of learning data!

The Learning Actions Model – the central instructional design model that we use at ArcheMedX – enables educators to think beyond their content and to ensure that the actions that learners take while consuming content are effectively supported and structured. By doing so, the process of learning is made more efficient and learners learn better!

Looking back at our recent work, we have applied the Learning Actions Model to improve staff training and on-boarding; to support the transformation and evolution of patient-centered medical homes; and to scaffold the performance of front-line clinical trial staff. Each of these examples aligns perfectly with the recent efforts of the Rapid Learning Healthcare System movement.

In the end, there have been tremendous strides both nationally and internationally in supporting the emergence of a Rapid Learning Healthcare System. We are proud of the small part we are playing in ensuring that the science of learning is being added back into its necessary vision.

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MANUSCRIPT: An Analysis of 2.3 Million Participations in the Continuing Medical Education Program of a General Medical Journal

Background: Physicians frequently use continuing medical education (CME) in journals. However, little is known of the evaluation of journal CME by readers and also user and participation characteristics. Deutsches Ärzteblatt, the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. Therefore, it provides a unique opportunity to analyze a journal CME program directed at an entire population of physicians.
Objective: The aim is to show key sociodemographic characteristics of participants, frequency and temporal distributions of participations, and to analyze whether the articles are suitable for a general medical audience, how physicians rate the CME articles, how successful they were in answering simple multiple-choice questions, and to detect distinct clusters of participants.
Methods: Using obligatory online evaluation forms and multiple-choice questions, we analyzed all participations of the entire 142 CME articles published between September 2004 and February 2014. We compared demographic characteristics of participants with official figures on those characteristics as provided by the German Medical Association.
Results: A total of 128,398 physicians and therapists (male: 54.64%, 70,155/128,393; median age class 40 to 49 years) participated 2,339,802 times (mean 16,478, SD 6436 participations/article). Depending on the year, between 12.33% (44,064/357,252) and 16.15% (50,259/311,230) of all physicians in the country participated at least once. The CME program was disproportionally popular with physicians in private practice, and many participations took place in the early mornings and evenings (4544.53%, 1,041,931/2,339,802) as well as over the weekend (28.70%, 671,563/2,339,802). Participation by specialty (ranked in descending order) was internal medicine (18.25%, 23,434/128,392), general medicine (16.38%, 21,033/128,392), anesthesiology (10.00%, 12,840/128,392), and surgery (7.06%, 9059/128,392). Participants rated the CME articles as intelligible to a wider medical audience and filling clinically relevant knowledge gaps; 78.57% (1,838,358/2,339,781) of the sample gave the CME articles very good or good marks. Cluster analysis revealed three groups, one comprised of only women, with two-thirds working in private practice.
Conclusions: The CME article series of Deutsches Ärzteblatt is used on a regular basis by a considerable proportion of all physicians in Germany; its multidisciplinary articles are suitable to a broad spectrum of medical specialties. The program seems to be particularly attractive for physicians in private practice and those who want to participate from their homes and on weekends. Although many physicians emphasize that the articles address gaps in knowledge, it remains to be investigated how this impacts professional performance and patient outcomes.

via JMIR-An Analysis of 2.3 Million Participations in the Continuing Medical Education Program of a General Medical Journal: Suitability, User Characteristics, and Evaluation by Readers | Christ | Journal of Medical Internet Research.

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AMPEL BioSolutions and ArcheMedX Form Partnership Aimed at Improving Success Rate of Clinical Trials

CHARLOTTESVILLE – AMPEL BioSolutions, a leading translational medicine and clinical operations company and ArcheMedX, a digital platform for effective online health care education and training programs, today announced a new collaboration to transform clinical trial recruitment and retention by enabling research sites to more effectively educate and continually engage clinical staff and patients.

The partnership will address the challenges with patient recruitment and retention for clinical trials by developing a new model for improving communication and education across study sites. By combining AMPEL’s extensive clinical expertise with the award-winning ArcheMedX e-learning and analytics platform, AMPEL and ArcheMedX will ensure that principal investigators, trial coordinators, clinical staff, and patients are well informed and continually engaged throughout the trial.

Dr. Peter Lipsky, MD, CEO and chief medical officer of AMPEL BioSolutions said, “This collaboration directly addresses the major challenge in clinical trials in the United States, namely patient recruitment, by engaging sites directly and providing the education and team building foundation that is essential for success.”

This partnership is the culmination of years of independent efforts by both organizations to improve clinical outcomes through distinctly unique solutions.

“Clinical trials are essential to advancing the quality of care, and we have already seen the impact more effective education, communication, and engagement can have on study sites,” said Joel Selzer, co-founder and CEO of ArcheMedx. “Through this collaboration, we can dramatically lower operational costs and improve the probability for a successful trial.”

In recent years, patient recruitment and retention for clinical trials has become increasingly difficult as 15 to 20 percent of trial sites never enroll a single patient, and 90 percent of study sites often fail to meet their enrollment goals. Since patient enrollment has a heavy cost and is critical to the success of a trial, there have been numerous attempts to identify the underlying challenges and offer potential solutions.

Study sites face obstacles in identifying, recruiting, and retaining patients. In addition, the overwhelming majority of patients are unaware a trial may be an option and/or have not been provided with sufficient education about the potential value and benefit the trial may provide. Patient involvement and clinical site engagement are essential for clinical trial success and both will be the focus of this new initiative.

—

About AMPEL BioSolutions

AMPEL is a recognized leader in translational and precision medicine and has designed, organized and analyzed a number of successful proof of concept clinical trials.

About ArcheMedX

ArcheMedX powers hundreds of more engaging and effective online education and training programs for the nation’s leading healthcare organizations.

New Partnership

Both headquartered in Charlottesville, VA, a thriving biosciences, technology, and startup ecosystem, AMPEL Biosciences and ArcheMedX are well positioned to combine forces and dramatically improve the success rate of clinical trials across the country.

Contacts: Kate Vega, Communications Dir of AMPEL BioSolutions (434-326-8272) or Joel Selzer, CEO ArcheMedX (434-260-1850)

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RESOURCE: Patient Recruitment and Enrollment in Clinical Trials

Have you ever had trouble enrolling patients for a study? If you answered “yes” then you’re not alone. Most trials end up having to double their original timelines to meet enrollment goals, and 48% of sites under-enroll study volunteers. These delays in drug development cost a lot of money, but when it comes to finding the right participants, patient recruitment is easier said than done.

via Patient Recruitment and Enrollment in Clinical Trials Infographic.

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