‘OB Nest’: Just the name may bring warm feelings to parents and prospective parents. However, at Mayo Clinic, it’s much more than a name. It’s a new way that Mayo Clinic is providing prenatal care. And, families say they are thrilled with the process.
Current prenatal care for a pregnancy consists of 12-14 visits with an obstetrician. However, often these visits are just brief check-ins to make sure a pregnancy is progressing well. Previous research has looked at ways to give providers more time for high-risk patients, and save time and office visits for women with low-risk pregnancies. While these studies have shown that fewer visits are safe, patients reported less satisfaction overall.
Seeking to identify ways to improve patient experience and perceived value, Mayo Clinic researchers decided to test a new way of providing prenatal care, dubbed ‘OB Nest.’
With the changes to the care experience provided within OB Nest, the researchers found that not only did patient satisfaction improve, but also this improved satisfaction came with fewer office visits.
‘Traditionally, pregnancy is treated as a sickness,’ says Yvonne Butler Tobah, M.D., a Mayo Clinic obstetrician and lead author of this study. ‘We wanted our care to reflect the normal, life-bringing event that it is, and [we] looked for a way to transform prenatal care into a wellness, patient-oriented experience.’
The Department of Obstetrics and Gynecology, in collaboration with the Center for Innovation, worked with patients and staff to collect and prioritize ideas to improve the way pregnant women and their families experience prenatal care. Along with the department, the Care Experience Program, which is part of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, took this information and these ideas and designed evidence-based practice improvements for prenatal care.
OB Nest study participants – all of whom were experiencing low-risk pregnancies – entered the programme with a specific nurse identified as their lead contact. They received eight scheduled office visits (More were optional.) and home monitoring equipment for fetal heart rate and maternal blood pressure. In addition, they could take part in an online care community with other OB Nest participants and nurses from the OB Nest care team.
‘My schedule is very hectic,’ says Seri Carney, M.D., a mom who participated in the OB Nest study during pregnancy with her second child. ‘It was really nice to only have to go in for my appointments every other month. My husband and I didn’t have to worry as often about arranging our work schedules for the appointments.’
‘We could listen to the heartbeat whenever we wanted,’ says Dr. Carney. ‘Our daughter was 4 at the time, and doing it at home meant that she could get involved, too. That was really fun. It also felt like it made me more aware of the movements and heartbeat of my baby.’
In her third trimester, when Dr. Carney noticed her baby’s heartbeat was a little low, she was able to email her care team. They reacted right away and got Carney in for a stress test. All was fine, and within a few weeks, she and her family welcomed baby Luisa Jane.
The OB Nest research project is part of Mayo Clinic’s healthcare delivery research efforts, and aligns with the Institute for Healthcare Improvement Triple Aim.
‘This fulfills the holy grail of what patients expect today,’ says Abimbola Famuyide, M.B.B.S., chair of the Department of Obstetrics and Gynecology, and study principal investigator. ‘How can we continue to improve patient experience and clinical outcomes, while, at the same time, keep costs down?’
‘Improving the patient experience, in the case of OB Nest, includes empowering expectant women to truly engage in, and take control of, their care,’ says Dr. Famuyide. He and his team learned that having one nurse as the centre point for each woman’s care and concerns provided them the comfort of easy connection. Concurrently, fewer office visits saved healthcare provider resources, while reducing patient burden.
This practice transforming research is leading to permanent changes in the way women receive prenatal care across Mayo Clinic. It is part of the goal of the Mayo Model of Community Care, to deliver wellness-focused, high-value healthcare – improving access, convenience and patient satisfaction, while lowering costs.

Mayo Clinichttp://tinyurl.com/jsjgz2t

A team of researchers have discovered a new way for early detection of a potentially deadly fungal infection in patients with suppressed immune systems such as those being treated for leukemia or who have had an organ transplant.
A multidisciplinary research group led by Allan Brasier of The University of Texas Medical Branch at Galveston.
Patients receiving leukemia chemotherapy treatments, bone marrow stem cell transplants or lung transplants are some of those at risk for serious infection by the disease-causing Aspergillus fungus, a common mould in the environment that easily becomes airborne. When inhaled, the mould colonizes the respiratory tract. In patients with immune suppression from their chemotherapy treatment, the mould invades into the bloodstream where it spreads and infects several organs including the liver, lungs and brain. People with normal immune systems are able to destroy the inhaled mould without becoming infected.
Despite close monitoring for infection and aggressive anti-fungal therapy in vulnerable people, the fatality rates are as high as 50 to 90 percent depending on a patient’s underlying disease and site of infection. While early diagnosis can improve the patient’s outcome, timely detection of the infection is difficult.
Currently, the infection is diagnosed with X-rays and tests that measure levels of fungal molecules that produce an immune reaction in a patient’s blood. These tests are not very accurate and often can lead to a wrong diagnosis.
The study describes how the team studied patients undergoing chemotherapy for leukemia, bone marrow transplants and lung transplants from several of the collaborating institutions and identified, confirmed and evaluated a new method of detecting the infectious mould in patients with leukemia. Similar people with no health conditions participated in the study as a comparison group.
The test results for the mould were different for each group of patients, so future commercial diagnostic tests using this technology should be tailored for different medical conditions commonly linked with this infection.
Brasier, director of UTMB’s Institute for Translational Sciences, said the breakthrough was ‘an example of successful collaboration that brought together experts in several different scientific fields to approach a difficult problem.’ The team’s discovery could translate to refined diagnostics, earlier treatment and improved survival for patients affected by this infection. More studies will be needed to confirm and validate this panel as a diagnostic test in independent patients.

The University of Texas Medical Branch at Galveston http://tinyurl.com/hezj57l

For children with autism and a class of genetic disorders, exposure to diagnostic ultrasound in the first trimester of pregnancy is linked to increased autism severity, according to a study conducted by researchers at UW Medicine, University of Washington Bothell and Seattle Children’s Research Institute.
The study looked at the variability of symptoms among kids with autism, not what causes autism. The researchers found that exposure to diagnostic ultrasound in the first trimester is linked to increased autism symptom severity. The greatest link is among kids with certain genetic variations associated with autism; 7 percent of the children in the study had those variations.
Food and Drug Administration (FDA) guidelines recommend that diagnostic ultrasound be used only for medical necessity.
‘I believe the implications of our results are to bolster the FDA guidelines,’ said corresponding author Pierre D. Mourad, a UW professor of neurological surgery in Seattle. He is also a professor of engineering and mathematics at UW Bothell. As a UW Medicine scientist, he specializes in translational research on ultrasound and the brain.
Mourad said their results are related to the first trimester of pregnancy. Data from looking at the effect of ultrasound on the second and third trimester showed no link, he said.
Mourad said he and his colleagues now intend to look more closely into links between ultrasound and autism severity, as well as the possibility – thus far not shown – that ultrasound exposure could contribute to autism incidence.

UW Medicine http://tinyurl.com/hupd4oq

SpiroCall enables patients to measure lung function over a phone call. It is designed to work with any type of phone around the world, not just smartphones.
Most people in the developing world who have asthma, cystic fibrosis or other chronic lung diseases have no way to measure how well their lungs are functioning outside of a clinic or doctor visit. But many do have access to a phone, though it may be a 10-year-old flip phone or a communal village landline instead of the latest app-driven smartphone.
That’s why University of Washington computer science and engineering and electrical engineering researchers have developed SpiroCall, a new health sensing tool that can accurately measure lung function over a simple phone call.
A paper to be presented shows that SpiroCall’s results came within 6.2 percent of results from clinical spirometers used in hospitals and doctor’s offices, meaning it meets the medical community’s standards for accuracy.
‘We wanted to be able to measure lung function on any type of phone you might encounter around the world – smartphones, dumb phones, landlines, pay phones,’ said Shwetak Patel, Washington Research Foundation endowed professor of computer science & engineering and electrical engineering at the UW. ‘With SpiroCall, you can call a 1-800 number, blow into the phone and use the telephone network to test your lung function.’
In 2012, researchers from the UW’s UbiComp Lab introduced SpiroSmart – which lets people monitor their lung function by blowing into their smartphones.
The patients take a deep breath in and exhale as hard and fast as they can until they can’t exhale any more. The phone’s microphone senses sound and pressure from that exhalation and sends the data to a central server, which uses machine learning algorithms to convert the data into standard measurements of lung function.

University of Washington http://tinyurl.com/hgpmr2u

About a quarter of healthcare providers said their virtual care programmes – telemedicine and telehealth – are financially sustainable and are improving efficiency, patient volumes and loyalty by filling gaps in medical specialties or helping chronically ill patients, according to a poll conducted by KPMG LLP, the U.S. audit, tax and advisory firm.
Telehealth, which uses technology to connect clinicians with patients, is gaining credence in urgent care settings from mobile devices, ‘primary care plus’ from retail clinics or for psychiatric assessments in an emergency department. Telemedicine – clinician-to-clinician consults – has a long history in radiology and for remote, underserved patient populations where specialists are needed for their clinical expertise, but it is gaining greater use. For example, telemedicine is used for neurology consults for stroke patients and also for referring nursing home patients to hospitals if they need more acute care.
‘Healthcare providers need to think of virtual care as a means to improve patient access and provider efficiency, especially as value-based contracts and other reimbursement incentives gain a greater share of revenue, while meeting patient care needs by filling gaps for key medical specialties,’ said Dr. Richard Bakalar, managing director at KPMG and a member of the firm’s Global Healthcare Center of Excellence. ‘Telehealth is rapidly evolving beyond urgent care and is increasingly used for follow up visits and helping chronically ill patients connect with their doctor online. Health plans and government payers are seeing the value from the technology and enhancing reimbursement for virtual care.’
Yet, approximately 35 percent of respondents in the poll said they have not yet started a programme incorporating virtual care, and the remaining 40 percent are in early stages.

• KPMG’s poll found that the biggest drivers for expediting adoption of virtual care were:
• Increase patient volumes and loyalty (29 percent)
• Care coordination of high risk patients (17 percent)
• Reduce costs for access to medical specialists (17 percent)
• Meaningful use and payer incentives for adoption (13 percent)
• Patient requests/consumer demand (13 percent).

Implementing a virtual care programme is not without challenges, however. Healthcare providers cited several, including:

• Too many other technological priorities (19 percent)
• Maintaining a sustainable business model (18 percent)
• Organizational readiness to implement new services/technology (18 percent)
• Regulatory compliance and risk concerns (15 percent).

KPMG LLPhttp://tinyurl.com/hlgwoyk