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Vernacchio L, Hatoun J, Patane LB, O'Donnell H, Herigon JC. Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial. Pediatrics 2024; 153:e2023063691. [PMID: 38168832 DOI: 10.1542/peds.2023-063691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Short courses of antibiotic treatment are effective for pediatric community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). We compared the effectiveness of education with performance feedback, clinical decision support (CDS), and the combination in encouraging appropriately short treatment courses by primary care clinicians. METHODS We designed a site-randomized, quality improvement trial within a large pediatric primary care network. Each practice was randomly assigned to 1 of 4 groups: education and feedback; CDS; both interventions ("combined group"); and control. We performed difference-in-differences analysis to compare the proportion of cases with short course treatment before and after intervention among the 4 groups. RESULTS For all cases of CAP and SSTI, the proportion in the control group treated with the recommended duration did not change from the baseline period (26.1% [679 of 2603]) to the intervention period (25.8% [196 of 761]; P = .9). For the education and feedback group, the proportion rose from 22.3% (428 of 1925) to 45.0% (239 of 532; P < .001); for the CDS group, from 26.6% (485 of 1824) to 52.3% (228 of 436; P < .001); and for the combined group, from 26.2% (491 of 1875) to 67.8% (314 of 463; P < .001). A difference-in-differences analysis showed that all 3 intervention groups improved performance compared with the control group (P < .001); the combined group had greater improvement than the education and feedback group or the CDS group (P < .001). CONCLUSIONS In this quality improvement project to encourage shorter duration treatment of CAP and SSTI, both education with performance feedback and CDS were effective in modifying clinician behavior; however, the combination of the two was substantially more effective than either strategy alone.
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Affiliation(s)
- Louis Vernacchio
- Pediatric Physicians' Organization at Children's, Wellesley Hills, Massachusetts
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Hatoun
- Pediatric Physicians' Organization at Children's, Wellesley Hills, Massachusetts
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Heather O'Donnell
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Joshua C Herigon
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
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2
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Majety P, Ajayi A, Modest AM, Vamvini M, Freed JA. Novel interactive text-messaging curriculum for endocrinology board review. J Clin Transl Endocrinol 2023; 34:100326. [PMID: 37840693 PMCID: PMC10570572 DOI: 10.1016/j.jcte.2023.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023] Open
Abstract
Background The ABIM certification exam is one of the measures to ensure that physicians have the clinical skills for good care delivery. The 5-year average pass rate for ABIM Endocrinology exam is 82%. The pass rate significantly decreased to a nadir of 74% in 2021 and 2022, lowest of all medicine subspecialties. Objectives To assess the feasibility of text messaging curriculum for fellows and its utility in improving their test performance. Methods In 2021, endocrinology fellows from 51 programs across the country were invited to participate in our curriculum. They completed a pre-test, joined a texting group via Remind application and received 1 multiple choice question daily (total n = 78). After 15 weeks, they completed a post-test and survey. Paired results from pre- and post-test were compared. Results A total of 89 fellows from 27 programs responded. Of these, 82 fellows, predominantly females (n = 60; 73 %), filled out the pre-test. On an average, 42 fellows (SD = 12) responded to the questions daily and 57 % of them answered the questions within 24 h. Thirty fellows completed the post-test. The median number of correct responses on the pre-test was 5 (IQR 3-6), compared to 8 (IQR 6-9) in the post-test. There was a significant improvement (p-value < 0.0001) in fellows' performance in the post-test when compared with the pre-test following our intervention. Conclusions Text-messaging based curriculum for exam preparation is feasible and can improve test performance. Fellows find receiving a daily high yield multiple choice question via text-message as a useful tool for exam preparation.
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Affiliation(s)
- Priyanka Majety
- Department of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University Health, Richmond, VA, United States
| | - Ayodele Ajayi
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Anna M. Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Maria Vamvini
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jason A. Freed
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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3
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Steffey MA, Griffon DJ, Risselada M, Buote NJ, Scharf VF, Zamprogno H, Winter AL. A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors. Front Vet Sci 2023; 10:1184525. [PMID: 37465277 PMCID: PMC10351608 DOI: 10.3389/fvets.2023.1184525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.
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Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
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4
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Gruss CL, Kappen TH, Fowler LC, Li G, Freundlich RE, McEvoy MD, Rothman BS, Sandberg WS, Wanderer JP. Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting. J Clin Anesth 2023; 86:111081. [PMID: 36812833 PMCID: PMC10148234 DOI: 10.1016/j.jclinane.2023.111081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
STUDY OBJECTIVE Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve PONV medication administration compliance and postoperative nausea and vomiting (PONV) outcomes. DESIGN Single center, prospective observational study between January 1, 2015, and June 30, 2017. SETTING Perioperative care at a university-affiliated tertiary care center. PATIENTS 57,401 adult patients who received general anesthesia in a non-emergency setting. INTERVENTION A multi-phased intervention that consisted of post-hoc reporting for individual providers by email about PONV occurrences in their patients, followed by directive CDS through preoperative daily case emails that provided therapeutic PONV prophylaxis recommendations based on patients' PONV risk scores. MEASUREMENT Compliance with PONV medication recommendations, as well as hospital rates of PONV were measured. MAIN RESULT Over the study period, there was a 5.5% (95% CI, 4.2% to 6.4%; p < 0.001) improvement in the compliance of PONV medication administration along with an 8.7% (95% CI, 7.1% to 10.2%, p < 0.001) reduction in PONV rescue medication administration in the PACU. However, there was no statistically or clinically significant reduction in the prevalence of PONV in the PACU. The prevalence of PONV rescue medication administration decreased during the Intervention Rollout Period (odds ratio 0.95 [per month]; 95% CI, 0.91 to 0.99; p = 0.017), and during the Feedback with CDS Recommendation Period (odds ratio, 0.96 [per month]; 95% CI, 0.94 to 0.99; p = 0.013). CONCLUSION PONV medication administration compliance modestly improves with CDS in conjunction with post-hoc reporting; however, no improvement in PACU rates of PONV occurred.
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Affiliation(s)
- Calvin L Gruss
- Department of Anesthesiology, Vanderbilt University Medical Center, United States of America.
| | - Teus H Kappen
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, the Netherlands
| | - Leslie C Fowler
- Department of Anesthesiology, Vanderbilt University Medical Center, United States of America
| | - Gen Li
- Department of Anesthesiology, Vanderbilt University Medical Center, United States of America
| | - Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, United States of America; Department of Biomedical Informatics, Vanderbilt University, United States of America
| | - Matthew D McEvoy
- Department of Anesthesiology, Vanderbilt University Medical Center, United States of America; Department of Surgery, Vanderbilt University Medical Center, United States of America
| | - Brian S Rothman
- Department of Anesthesiology, Vanderbilt University Medical Center, United States of America; Department of Biomedical Informatics, Vanderbilt University, United States of America; Department of Surgery, Vanderbilt University Medical Center, United States of America
| | - Warren S Sandberg
- Department of Anesthesiology, Vanderbilt University Medical Center, United States of America
| | - Jonathan P Wanderer
- Department of Anesthesiology, Vanderbilt University Medical Center, United States of America; Department of Biomedical Informatics, Vanderbilt University, United States of America
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5
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Roberts TJ, Bailey AS, Tahir N, Jacobson JO. Care Fragmentation, Faulty Communication, and Documentation Lapses Derail a Treatment Plan. JCO Oncol Pract 2023; 19:37-44. [PMID: 36375113 DOI: 10.1200/op.22.00471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This is the second Cancer Morbidity, Mortality, and Improvement Rounds, a series of articles intended to explore the unique safety risks experienced by oncology patients through the lens of quality improvement, systems and human factors engineering, and cognitive psychology. This case describes the care of a patient who was diagnosed with locally advanced lung cancer during the COVID-19 pandemic; it highlights how gaps in communication and care coordination caused the patient to receive care that did not reflect the consensus of his multidisciplinary team. The discussion highlights the importance of multidisciplinary care, particularly for patients with stage III non-small-cell lung cancer, discusses factors that led to communication gaps, and examines how we should assign accountability across dispersed health care systems.Cancer Morbidity, Mortality, and Improvement Rounds is a series of articles intended to explore the unique safety risks experienced by oncology patients through the lens of quality improvement, systems and human factors engineering, and cognitive psychology. For purposes of clarity, each case focuses on a single theme, although, as is true for all medical incidents, there are almost always multiple, overlapping, contributing factors. The quality improvement paradigm used here, which focuses on root cause analyses and opportunities to improve care delivery systems, was previously outlined in this journal.
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Affiliation(s)
- Thomas J Roberts
- Dana-Farber Cancer Institute, Boston, MA.,Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | - Joseph O Jacobson
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
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Saab MM, O'Driscoll M, FitzGerald S, Sahm LJ, Leahy-Warren P, Noonan B, Kilty C, O'Malley M, Lyons N, Burns HE, Kennedy U, Lyng Á, Hegarty J. Referring patients with suspected lung cancer: a qualitative study with primary healthcare professionals in Ireland. Health Promot Int 2022; 37:6639404. [PMID: 35810412 PMCID: PMC9271233 DOI: 10.1093/heapro/daac088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is the leading cause of cancer death globally. Most cases are diagnosed late. Primary healthcare professionals are often the first point of contact for symptoms of concern. This study explored primary healthcare professionals’ experience of referring individuals with signs and symptoms suggestive of lung cancer along the appropriate healthcare pathway and explored strategies to help primary healthcare professionals detect lung cancer early. Focus groups and individual interviews were conducted with 36 general practitioners, community pharmacists, practice nurses, and public health nurses. Data were analysed thematically. Participants identified typical lung cancer signs and symptoms such as cough and coughing up blood (i.e., haemoptysis) as triggers for referral. Atypical/non-specific signs and symptoms such as back pain, pallor, and abnormal blood tests were perceived as difficult to interpret. Participants often refrained from using the word ‘cancer’ during conversations with patients. Ireland’s Rapid Access Lung Clinics were perceived as underused, with some general practitioners referring patients to these clinics only when clear and definitive lung cancer signs and symptoms are noted. Lack of communication and the resulting disruption in continuity of care for patients with suspected lung cancer were highlighted as healthcare system flaws. Education on early referral can be in the form of communications from professional organizations, webinars, interdisciplinary meetings, education by lung specialists, and patient testimonials. Lung cancer referral checklists and algorithms should be simple, clear, and visually appealing, either developed as standalone tools or embedded into existing primary care software/programmes.
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Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Michelle O'Driscoll
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland.,School of Pharmacy, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Patricia Leahy-Warren
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Maria O'Malley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Noreen Lyons
- Rapid Access Lung Clinic, Cork University Hospital, T12 DC4A, Cork, Ireland
| | - Heather E Burns
- National Cancer Control Programme, Health Service Executive, DO1 A3Y8, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, DO1 A3Y8, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, DO1 A3Y8, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
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Williams C, Rao A, Ziemba JB, Myers JS, Patel N. Text Messaging Real-Time COVID-19 Clinical Guidance to Hospital Employees. Appl Clin Inform 2021; 12:259-265. [PMID: 33792010 DOI: 10.1055/s-0041-1726117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND During the initial days of the coronavirus disease 2019 (COVID-19) pandemic, hospital-wide practices rapidly evolved, and hospital employees became a critical population for receiving consistent and timely communication about these changes. OBJECTIVES We aimed to rapidly implement enterprise text messaging as a crisis communication intervention to deliver key COVID-related safety and practice information directly to hospital employees. METHODS Utilizing a secure text-messaging platform already routinely used in direct patient care, we sent 140-character messages containing targeted pandemic-related updates to on-duty hospital employees three times per week for 13 weeks. This innovation was evaluated through the analysis of aggregate "read" receipts from each message. Effectiveness was assessed by rates of occupational exposures to COVID-19 and by two cross-sectional attitudinal surveys administered to all text-message recipients. RESULTS On average, each enterprise text message was sent to 1,997 on-duty employees. Analysis of "read" receipts revealed that on average, 60% of messages were consistently read within 24 hours of delivery, 34% were read in 2 hours, and 16% were read in 10 minutes. Readership peaked and fell in the first week of messaging but remained consistent throughout the remainder of the intervention. A survey administered after 2 weeks revealed that 163 (79%) users found enterprise texts "valuable," 152 (73%) users would recommend these texts to their colleagues, and 114 (55%) users preferred texts to email. A second survey at 9 weeks revealed that 109 (80%) users continued to find texts "valuable." Enterprise messaging, in conjunction with the system's larger communication strategy, was associated with a decrease in median daily occupational exposure events (nine events per day premessaging versus one event per day during messaging). CONCLUSION Enterprise text messages sent to hospital-employee smartphones are an efficient and effective strategy for urgent communications. Hospitals may wish to leverage this technology during times of routine operations and crisis management.
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Affiliation(s)
- Cheyenne Williams
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Aditi Rao
- Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Justin B Ziemba
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Clinical Effectiveness and Quality Improvement, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Jennifer S Myers
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Clinical Effectiveness and Quality Improvement, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.,Division of General Internal Medicine, Department of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Neha Patel
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Clinical Effectiveness and Quality Improvement, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.,Division of General Internal Medicine, Department of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States
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8
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Montrief T, Haas MRC, Alvarez A, Gottlieb M, Siegal D, Chan T. Thinking Outside the Inbox: Use of Slack in Clinical Groups as a Collaborative Team Communication Platform. AEM EDUCATION AND TRAINING 2021; 5:121-129. [PMID: 33521500 PMCID: PMC7821068 DOI: 10.1002/aet2.10497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/19/2020] [Accepted: 06/17/2020] [Indexed: 05/10/2023]
Affiliation(s)
- Tim Montrief
- Department of Critical Care MedicineUniversity of Pittsburgh Medical CenterPittsburghPAUSA
| | - Mary R. C. Haas
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMIUSA
| | - Al'ai Alvarez
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCAUSA
| | - Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoILUSA
| | - Deborah Siegal
- Department of MedicinePopulation Health Research InstituteMcMaster UniversityHamiltonOntarioCanada
| | - Teresa Chan
- Department of MedicineDivision of Emergency MedicineMcMaster UniversityHamiltonOntarioCanada
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Wood KE, Krasowski MD. Academic E-Mail Overload and the Burden of "Academic Spam". Acad Pathol 2020; 7:2374289519898858. [PMID: 32010761 PMCID: PMC6974753 DOI: 10.1177/2374289519898858] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 01/14/2023] Open
Abstract
This article presents an editorial perspective on the challenges associated with e-mail
management for academic physicians. We include 2-week analysis of our own e-mails as
illustrations of the e-mail volume and content. We discuss the contributors to high e-mail
volumes, focusing especially on unsolicited e-mails from medical/scientific conferences
and open-access journals (sometimes termed “academic spam emails”), as these e-mails
comprise a significant volume and are targeted to physicians and scientists. Our 2-person
sample is consistent with studies showing that journals that use mass e-mail advertising
have low rates of inclusion in recognized journal databases/resources. Strategies for
managing e-mail are discussed and include unsubscribing, blocking senders or domains,
filtering e-mails, managing one’s inbox, limiting e-mail access, and e-mail etiquette.
Academic institutions should focus on decreasing the volume of unsolicited e-mails,
fostering tools to manage e-mail overload, and educating physicians including trainees
about e-mail practices, predatory journals, and scholarly database/resources.
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Affiliation(s)
- Kelly E Wood
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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10
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Biggin A. A 21st century plague of biblical proportions. J Paediatr Child Health 2018; 54:1292-1293. [PMID: 30198119 DOI: 10.1111/jpc.14218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022]
Abstract
Modern medicine has eradicated smallpox, contained polio and is making significant advances in personalised/genetic medicine. However, we are facing a pandemic of apocalyptic proportions, and there is currently no vaccine or United Nations Charter to help address this issue. Following its insidious spread in the 1980s, the full impact of this phenomenon on civilisation has not been fully appreciated. It has slipped under the radar of the International Classification of Diseases (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classification systems. We all know someone who is affected by this condition, and society is struggling to cope with the acute and chronic morbidity that has ensued. I am, of course, referring to the problem of the workplace email. This article examines the problems associated with workplace email and aims to offer some strategies to help contain it.
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Affiliation(s)
- Andrew Biggin
- Faculty of Medicine and Health, University of Sydney Children's Hospital Westmead Clinical School, Sydney, New South Wales, Australia
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11
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Armstrong MJ. Improving email strategies to target stress and productivity in clinical practice. Neurol Clin Pract 2017; 7:512-517. [PMID: 29431178 DOI: 10.1212/cpj.0000000000000395] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physician burnout is gaining increased attention in medicine and neurology and often relates to hours worked and insufficient time. One component of this is administrative burden, which relates to regulatory requirements and electronic health record tasks but may also involve increased time spent processing emails. Research in academic medical centers demonstrates that physicians face increasing inbox sizes related to mass distribution emails from various sources on top of emails required for patient care, research, and teaching. This commentary highlights the contribution of administrative tasks to physician burnout, research to date on email in medical contexts, and corporate strategies for reducing email burden that are applicable to neurology clinical practice. Increased productivity and decreased stress can be achieved by limiting the amount one accesses email, managing inbox size, and utilizing good email etiquette. Department and practice physician leaders have roles in decreasing email volume and modeling good practice.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville
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12
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Lewis MA, Dicker AP. Social Media and Oncology: The Past, Present, and Future of Electronic Communication Between Physician and Patient. Semin Oncol 2015; 42:764-71. [PMID: 26433557 DOI: 10.1053/j.seminoncol.2015.07.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The relationship between patient and physician is in flux with the advent of electronic media that are advancing and enhancing communication. We perform a retrospective, current, and forward-looking examination of the technologies by which information is exchanged within the healthcare community. The evolution from e-mail and listservs to blogs and the modern social networks is described, with emphasis on the advantages and pitfalls of each medium, especially in regard to maintaining the standards of privacy and professionalism to which doctors are held accountable. We support the use of contemporary platforms like Twitter and Facebook for physicians to establish themselves as trustworthy online sources of medical knowledge, and anticipate ongoing collaboration between researchers, patients, and their advocates in trial design and accrual.
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Affiliation(s)
- Mark A Lewis
- Gastrointestinal Medical Oncology and General Oncology, MD Anderson Cancer Center, Houston, TX.
| | - Adam P Dicker
- Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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13
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Chiu H, Steele D, McAlister C, Lam WC. Delivery recommendations for pregnant females with risk factors for rhegmatogenous retinal detachment. Can J Ophthalmol 2014; 50:11-8. [PMID: 25677277 DOI: 10.1016/j.jcjo.2014.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 10/08/2014] [Accepted: 10/28/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE High-risk pathologies for rhegmatogenous retinal detachment (RRD) in otherwise healthy pregnant females are not contraindications for spontaneous vaginal delivery. However, 74% of European obstetrician-gynecologist (OBGYN) respondents in 2008 recommended operative delivery for females at risk for RRD. This discrepancy is likely due to an older study suggesting a causal relation between Valsalva-like manoeuvres and RRD. The purpose of this study is to determine current delivery recommendations for healthy pregnant females with high-risk pathologies for RRD among Canadian ophthalmologists and OBGYNs. METHODS Anonymous prospective cross-sectional survey sent via electronic link in 2013. χ(2) test of proportions was used to compare delivery recommendations between the 2 specialties. Multinomial logistic regression was used to identify predictors for recommendations. RESULTS A total of 356 participants responded including 92 ophthalmologists and 27 trainees, and 185 OBGYNs and 52 trainees. For healthy pregnant females with previously treated retinal hole/tear or treated RRD, significantly more OBGYNs recommended cesarean section and significantly more ophthalmologists recommended spontaneous vaginal delivery. Length of practice and type of practice setting were significant predictors among obstetricians in their delivery recommendations. CONCLUSIONS This study is the first to include obstetricians, ophthalmologists, and their trainees in a survey of the recommended mode of delivery for pregnant females with risk factors of RRD. Our results suggest that obstetricians concerned about potential RRD in pregnant patients may be unnecessarily recommending operative management. Educational sessions on the risk for RRD with spontaneous vaginal delivery may reconcile the current differences in recommendations between ophthalmologists and obstetricians.
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Affiliation(s)
- Hannah Chiu
- Department of Ophthalmology and Vision Sciences
| | - Donna Steele
- Department of Obstetrics and Gynecology, University of Toronto; Department of Obstetrics and Gynecology, St. Michael's Hospital
| | | | - Wai-Ching Lam
- Department of Ophthalmology and Vision Sciences; Department of Ophthalmology, University Health Network, Toronto Western Hospital, Toronto, Ont..
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