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Sonoda K, Hamilton M, Bump GM, Rosser B, Doughty B, Tripp R. Virtual Brunches to Enhance Recruitment of Residents and Fellows Who Self-Identify as Underrepresented in Medicine. J Grad Med Educ 2023; 15:171-174. [PMID: 37139213 PMCID: PMC10150808 DOI: 10.4300/jgme-d-22-00454.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/12/2022] [Accepted: 02/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background Our institution, along with many others, struggles to recruit residents and fellows who identify as underrepresented in medicine (UIM). There have been various program-level interventions implemented across the nation; however, little is known about graduate medical education (GME)-wide recruiting events for UIM trainees. Objective We describe the development, implementation, and evaluation of a GME-wide recruitment program, Virtual UIM Recruitment Diversity Brunches (VURDBs), to meet this need. Methods A virtual, 2-hour event was held 6 times on Sunday afternoons between September 2021 and January 2022. We surveyed participants on a rating of the VURDBs from excellent (4) to fair (1) and their likelihood of recommending the event to their colleagues from extremely (4) to not at all (1). We used institutional data to compare pre- and post-implementation groups using a 2-sample test of proportions. Results Across 6 sessions, 280 UIM applicants participated. The response rate of our survey was 48.9% (137 of 280). Fifty-eight percent (79 of 137) rated the event as excellent, and 94.2% (129 of 137) were extremely or very likely to recommend the event. The percentage of new resident and fellow hires who identify as UIM significantly increased from 10.9% (67 of 612) in academic year 2021-2022 to 15.4% (104 of 675) in academic year 2022-2023. The percentage of brunch attendees matriculating into our programs in academic year 2022-2023 was 7.9% (22 of 280). Conclusions VURDBs are a feasible intervention associated with increased rates of trainees identifying as UIM matriculating in our GME programs.
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Affiliation(s)
- Kento Sonoda
- Kento Sonoda, MD, AAHIVS, at the time of writing was a Fellow Physician, Division of General Internal Medicine, Department of Medicine, UPMC, and is now Assistant Professor, Department of Family and Community Medicine, Saint Louis University
| | - Melinda Hamilton
- Melinda Hamilton, MD, MS, is Professor, Department of Critical Care Medicine, Children's Hospital, UPMC
| | - Gregory M. Bump
- Gregory M. Bump, MD, is Professor, Division of General Internal Medicine, Department of Medicine, and Designated Institutional Official, Graduate Medical Education Department, UPMC
| | - Brittany Rosser
- Brittany Rosser, BA, is Project Manager, Graduate Medical Education Department, UPMC
| | - Brandon Doughty
- Brandon Doughty, BA, is Director of Operations, Graduate Medical Education Department, UPMC
| | - Rickquel Tripp
- Rickquel Tripp, MD, MPH, is Clinical Assistant Professor, Department of Emergency Medicine, and Vice Chair of Diversity, Equity, and Inclusion, Graduate Medical Education Department, UPMC
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Wang S, Denham Z, Ungerman EA, Stollings L, McCausland JB, Hamilton MF, Gonzaga AM, Bump GM, Metro DG, Adams PS. Do Lower Costs for Applicants Come at the Expense of Program Perception? A Cross-Sectional Survey Study of Virtual Residency Interviews. J Grad Med Educ 2022; 14:666-673. [PMID: 36591433 PMCID: PMC9765904 DOI: 10.4300/jgme-d-22-00332.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/03/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Travel costs and application fees make in-person residency interviews expensive, compounding existing financial burdens on medical students. We hypothesized virtual interviews (VI) would be associated with decreased costs for applicants compared to in-person interviews (IPI) but at the expense of gathering information with which to assess the program. OBJECTIVE To survey senior medical students and postgraduate year (PGY)-1 residents regarding their financial burden and program perception during virtual versus in-person interviews. METHODS The authors conducted a single center, multispecialty study comparing costs of IPI vs VI from 2020-2021. Fourth-year medical students and PGY-1 residents completed one-time surveys regarding interview costs and program perception. The authors compared responses between IPI and VI groups. Potential debt accrual was calculated for 3- and 7-year residencies. RESULTS Two hundred fifty-two (of 884, 29%) surveys were completed comprising 75 of 169 (44%) IPI and 177 of 715 (25%) VI respondents. The VI group had significantly lower interview costs compared to the IPI group (median $1,000 [$469-$2,050 IQR] $784-$1,216 99% CI vs $3,200 [$1,700-$5,500 IQR] $2,404-$3,996 99% CI, P<.001). The VI group scored lower for feeling the interview process was an accurate representation of the residency program (3.3 [0.5] vs 4.1 [0.7], P<.001). Assuming interview costs were completely loan-funded, the IPI group will have accumulated potential total loan amounts $2,334 higher than the VI group at 2% interest and $2,620 at 6% interest. These differences were magnified for a 7-year residency. CONCLUSIONS Virtual interviews save applicants thousands of dollars at the expense of their perception of the residency program.
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Affiliation(s)
- Sheri Wang
- All authors are with UPMC
- Sheri Wang, MD, is a PGY-2 Resident, Department of Anesthesiology and Perioperative Medicine
| | - Zachary Denham
- All authors are with UPMC
- Zachary Denham, MD, is a PGY-4 Resident, Department of Anesthesiology and Perioperative Medicine
| | - Elizabeth A. Ungerman
- All authors are with UPMC
- Elizabeth A. Ungerman, MD, MS, is Associate Residency Program Director, Department of Anesthesiology and Perioperative Medicine
| | - Lindsay Stollings
- All authors are with UPMC
- Lindsay Stollings, MD, is Chair, Resident Recruitment Committee, Department of Anesthesiology and Perioperative Medicine
| | - Julie B. McCausland
- All authors are with UPMC
- Julie B. McCausland, MD, MS, FACEP, is Program Director, Medical Education Transitional Year, and Co-Chair, Medical Education Professional Development Subcommittee, Department of Emergency Medicine
| | - Melinda Fiedor Hamilton
- All authors are with UPMC
- Melinda Fiedor Hamilton, MD, MS, is Co-Chair, ME Professional Development Committee, Department of Pediatrics
| | - Alda Maria Gonzaga
- All authors are with UPMC
- Alda Maria Gonzaga, MD, MS, is Associate Dean for Student Affairs, University of Pittsburgh School of Medicine, Department of Internal Medicine
| | - Gregory M. Bump
- All authors are with UPMC
- Gregory M. Bump, MD, is Associate Dean of Graduate Medical Education, Designated Institutional Official, and Chair, Graduate Medical Education Committee, Department of Internal Medicine
| | - David G. Metro
- All authors are with UPMC
- David G. Metro, MD, FASA, is Senior Vice Chair for Education and Faculty Affairs, Department of Anesthesiology and Perioperative Medicine
| | - Phillip S. Adams
- All authors are with UPMC
- Phillip S. Adams, DO, FASA, is Residency Program Director, Department of Anesthesiology and Perioperative Medicine
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Das AJ, Augustin RC, Corbelli JA, Bump GM. Residency and Fellowship Program Leaders' Perceptions of Virtual Recruitment and Interviewing. J Grad Med Educ 2022; 14:710-713. [PMID: 36591430 PMCID: PMC9765919 DOI: 10.4300/jgme-d-22-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/06/2022] [Accepted: 09/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Virtual recruitment is a new and more cost-effective alternative to traditional in-person recruitment in academic medicine. However, little is known about the perceived repercussions of the switch across a variety of training settings. OBJECTIVE To describe the perceptions of graduate medical education program leaders about virtual matching and preferred format for future recruitment within an integrated health care delivery system sponsoring residency and fellowship programs at both university- and community-based primary teaching sites. METHODS We surveyed program leadership of 136 Accreditation Council for Graduate Medical Education programs at a single sponsoring institution in April 2021, following residency match results but before matched applicants began programs. The 40-item survey pertained to various aspects of recruitment. Select questions were assessed using a 5-point Likert scale. Descriptive statistics, Student's t test, and ordinal linear regression models were used for analysis. RESULTS Out of 136 programs, 129 (94.8%) responded. Overall, preferred format for recruitment was neutral, although there was wide heterogeneity of responses. Programs felt that virtual recruitment marginally decreased their ability to describe strengths but did not affect the strength or diversity of their matched class. Community sites preferred in-person recruitment. CONCLUSIONS Programs did not perceive that virtual recruitment affected the strength or diversity of their 2021 matched class, although community programs were more likely to prefer in-person formats.
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Affiliation(s)
- Anjali J. Das
- Anjali J. Das, MD, is Clinical Instructor of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center (UPMC), and Advanced Women's Health Fellow, VA Pittsburgh Medical Center
| | - Ryan C. Augustin
- Ryan C. Augustin, MD, is Chief Resident, Department of Medicine, UPMC
| | - Jennifer A. Corbelli
- Jennifer A. Corbelli, MD, MS, is Associate Professor of Medicine, University of Pittsburgh School of Medicine, Program Director, Internal Medicine Residency, and Vice Chair of Education, Department of Medicine, UPMC
| | - Gregory M. Bump
- Gregory M. Bump, MD, is Professor of Medicine, University of Pittsburgh School of Medicine, and Associate Dean for Graduate Medical Education and Designated Institutional Official, UPMC
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Bump GM, Deans V, Berliner JI, Nguyen VT, Jacobson SL. CuRBside (Confidential Referrals for Behavioral Health): an Innovative Approach to Enhance Physician Well-being. Acad Psychiatry 2022; 46:791-792. [PMID: 35578096 DOI: 10.1007/s40596-022-01650-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Gregory M Bump
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Victoria Deans
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Vu T Nguyen
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
OBJECTIVES Reporting medical errors is a focus of the patient safety movement. As frontline physicians, residents are optimally positioned to recognize errors and flaws in systems of care. Previous work highlights the difficulty of engaging residents in identification and/or reduction of medical errors and in integrating these trainees into their institutions' cultures of safety. METHODS The authors describe the implementation of a longitudinal, discipline-based, multifaceted curriculum to enhance the reporting of errors by pediatric residents at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center. The key elements of this curriculum included providing the necessary education to identify medical errors with an emphasis on systems-based causes, modeling of error reporting by faculty, and integrating error reporting and discussion into the residents' daily activities. The authors tracked monthly error reporting rates by residents and other health care professionals, in addition to serious harm event rates at the institution. RESULTS The interventions resulted in significant increases in error reports filed by residents, from 3.6 to 37.8 per month over 4 years (P < 0.0001). This increase in resident error reporting correlated with a decline in serious harm events, from 15.0 to 8.1 per month over 4 years (P = 0.01). CONCLUSIONS Integrating patient safety into the everyday resident responsibilities encourages frequent reporting and discussion of medical errors and leads to improvements in patient care. Multiple simultaneous interventions are essential to making residents part of the safety culture of their training hospitals.
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Affiliation(s)
| | - Gregory M Bump
- Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center
| | - Gabriella A Butler
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center
| | | | - Andrew R Buchert
- Department of Pediatrics, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Szymusiak J, Walk TJ, Benson M, Hamm M, Zickmund S, Gonzaga AM, Bump GM. A Qualitative Analysis of Resident Adverse Event Reporting: What's Holding Us Back. Am J Med Qual 2019; 35:155-162. [PMID: 31185725 DOI: 10.1177/1062860619853878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study utilized focus groups of residents, who report adverse events at differing rates depending on their hospital site, to better understand barriers to residents' reporting and identify modifiable aspects of an institution's culture that could encourage resident event reporting. Focus groups included residents who rotated at 3 hospitals and represented 4 training programs. Focus groups were audio recorded and analyzed using qualitative methods. A total of 64 residents participated in 8 focus groups. Reporting behavior varied by hospital culture. Residents worried about damage to their professional relationships and lacked insight into the benefits of multiple reports of the same event or how human factors engineering can prevent errors. Residents did not understand how reporting affects litigation. Residents at other academic institutions likely experience similar barriers. This study illustrates that resident reporting is modifiable by changing hospital culture, but hospitals have only a few opportunities to mishandle reporting before resident reporting attitudes solidify.
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Affiliation(s)
- John Szymusiak
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas J Walk
- University of Pittsburgh School of Medicine, Pittsburgh, PA.,VA Pittsburgh Healthcare System, Pittsburgh PA
| | - Maggie Benson
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Megan Hamm
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan Zickmund
- VA Salt Lake City Health Services Research and Development IDEAS 2.0 Center of Innovation, Salt Lake City, UT.,University of Utah School of Medicine, Salt Lake City, UT
| | | | - Gregory M Bump
- University of Pittsburgh School of Medicine, Pittsburgh, PA
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Szymusiak J, Walk TJ, Benson M, Hamm M, Zickmund S, Gonzaga AM, Bump GM. Encouraging Resident Adverse Event Reporting: A Qualitative Study of Suggestions from the Front Lines. Pediatr Qual Saf 2019; 4:e167. [PMID: 31579867 PMCID: PMC6594779 DOI: 10.1097/pq9.0000000000000167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/25/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Little is known about what motivates residents to report adverse events. The goals of the qualitative study were to: (1) better understand facilitators to residents' event reporting and (2) identify effective interventions that encourage residents to report. METHODS The authors conducted focus groups of upper-level residents from 4 training programs (2 internal medicine, a pediatric, and a combined medicine-pediatric) who rotated at 3 institutions within a large healthcare system in 2016. Quantitative data on reporting experience were gathered. Focus groups were audio recorded and transcribed. Two coders reviewed transcripts using the editing approach and organized codes into themes. RESULTS Sixty-four residents participated in 8 focus groups. Residents were universally exposed to reportable events and knew how to report. Residents' reporting behavior varied by site according to local culture, with residents filing more reports at the pediatric hospital compared to other sites, but all groups expressed similar general views about facilitators to reporting. Facilitators included familiarity with the investigation process, reporting via telephone, and routine safety educational sessions with safety administrators. Residents identified specific interventions that encouraged reporting at the pediatric hospital, including incorporating an attending physician review of events into sign-out and training on error disclosure. CONCLUSIONS This study provides insight into what motivates resident event reporting and describes concrete interventions to increase reporting. Our findings are consistent with the Theoretical Domains Framework of behavioral change. These strategies could prove successful at other pediatric hospitals to build a culture that values reporting and prepares residents as patient safety champions.
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Affiliation(s)
- John Szymusiak
- From the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas J. Walk
- From the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Maggie Benson
- From the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Megan Hamm
- From the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan Zickmund
- VA Salt Lake City Health Services Research and Development IDEAS 2.0 Center of Innovation, Salt Lake City, UT
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Alda Maria Gonzaga
- From the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Gregory M. Bump
- From the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Agarwal V, Bump GM, Heller MT, Chen LW, Branstetter BF, Amesur NB, Hughes MA. Resident Case Volume Correlates with Clinical Performance: Finding the Sweet Spot. Acad Radiol 2019; 26:136-140. [PMID: 30087064 DOI: 10.1016/j.acra.2018.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES To determine whether the total number of studies interpreted during radiology residency correlates with clinical performance as measured by objective criteria. MATERIALS AND METHODS We performed a retrospective cohort study of three graduating classes of radiology residents from a single residency program between the years 2015-2017. The total number of studies interpreted by each resident during residency was tracked. Clinical performance was determined by tracking an individual resident's major discordance rate. A major discordance was recorded when there was a difference between the preliminary resident interpretation and final attending interpretation that could immediately impact patient care. Accreditation council for graduate medical education milestones at the completion of residency, Diagnostic radiology in-training scores in the third year, and score from the American board of radiology core exam were also tabulated. Pearson correlation coefficients and polynomial regression analysis were used to identify correlations between the total number of interpreted films and clinical, test, and milestone performance. RESULTS Thirty-seven residents interpreted a mean of 12,709 studies (range 8898-19,818; standard deviation [SD] 2351.9) in residency with a mean major discordance rate of 1.1% (range 0.34%-2.54%; stand dev 0.49%). There was a nonlinear correlation between total number of interpreted films and performance. As the number of interpreted films increased to approximately 16,000, clinical performance (p = 0.004) and test performance (p = 0.01) improved, but volumes over 16,000 correlated with worse performance. CONCLUSION The total number of studies interpreted during radiology training correlates with performance. Residencies should endeavor to find the "sweet spot": the amount of work that maximizes clinical exposure and knowledge without overburdening trainees.
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Agarwal V, Bump GM, Heller MT, Chen LW, Branstetter BF, Amesur NB, Hughes MA. Do Residency Selection Factors Predict Radiology Resident Performance? Acad Radiol 2018; 25:397-402. [PMID: 29239834 DOI: 10.1016/j.acra.2017.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/12/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of our study is to determine what information in medical student residency applications predicts radiology residency success as defined by objective clinical performance data. MATERIALS AND METHODS We performed a retrospective cohort study of residents who entered our institution's residency program through the National Resident Matching Program as postgraduate year 2 residents and completed the program over the past 2 years. Medical school grades, selection to Alpha Omega Alpha (AOA) Honor Society, United States Medical Licensing Examination (USMLE) scores, publication in peer-reviewed journals, and whether the applicant was from a peer institution were the variables examined. Clinical performance was determined by calculating each resident's cumulative major discordance rate for on-call cases the resident read and gave a preliminary interpretation. A major discordance was defined as a difference between the preliminary resident and the final attending interpretations that could immediately impact the care of the patient. A multivariate logistic regression was performed to determine significant variables. RESULTS Twenty-seven residents provided preliminary reports on call for 67,145 studies. The mean major discordance rate was 1.08% (range 0.34%-2.54%). Higher USMLE Step 1 scores, publication before residency, and election to AOA Honor Society were all statistically significant predictors of lower major discordance rates (P values 0.01, 0.01, and <0.001, respectively). CONCLUSIONS Overall resident performance was excellent. There are predictors that help select the better performing residents, namely higher USMLE Step 1 scores, one to two publications during medical school, and election to AOA in the junior year of medical school.
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Abstract
BACKGROUND Rapid response teams (RRTs) help in delivering safe, timely care. Typically they are activated by clinicians using specific parameters. Allowing patients and families to activate RRTs is a novel intervention. The University of Pittsburgh Medical Center developed and implemented a patient- and family-initiated rapid response system called Condition Help (CH). METHODS When the CH system is activated, a patient care liaison or an on-duty administrator meets bedside with the unit charge nurse to address the patient's concerns. In this study, we collected demographic data, call reasons, call designations (safety or nonsafety), and outcome information for all CH calls made during the period January 2012 through June 2015. RESULTS Two hundred forty patients/family members made 367 CH calls during the study period. Most calls were made by patients (76.8%) rather than family members (21.8%). Of the 240 patients, 43 (18%) made multiple calls; their calls accounted for 46.3% of all calls (170/367). Inadequate pain control was the reason for the call in most cases (48.2%), followed by dissatisfaction with staff (12.5%). The majority of calls involved nonsafety issues (83.4%) rather than safety issues (11.4%). In 41.4% of cases, a change in care was made. CONCLUSIONS Patient- and family-initiated RRTs are designed to engage patients and families in providing safer care. In the CH system, safety issues are identified, but the majority of calls involve nonsafety issues. Journal of Hospital Medicine 2017;12:157-161.
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Affiliation(s)
- Elizabeth L Eden
- Internal Medicine Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laurie L Rack
- Medicine Services, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ling-Wan Chen
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gregory M Bump
- University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Bump GM, Coots N, Liberi CA, Minnier TE, Phrampus PE, Gosman G, Metro DG, McCausland JB, Buchert A. Comparing Trainee and Staff Perceptions of Patient Safety Culture. Acad Med 2017; 92:116-122. [PMID: 27276009 DOI: 10.1097/acm.0000000000001255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The Accreditation Council for Graduate Medical Education implemented the Clinical Learning Environment Review (CLER) program to evaluate and improve the learning environment in teaching hospitals. Hospitals receive a report after a CLER visit with observations about patient safety, among other domains, the accuracy of which is unknown. Thus, the authors set out to identify complementary measures of trainees' patient safety experience. METHOD In 2014, they administered the Hospital Survey on Patient Safety Culture to residents and fellows and general staff at 10 hospitals in an integrated health system. The survey measured perceptions of patient safety in 12 domains and incorporated two outcome measures (number of medical errors reported and overall patient safety). Domain scores were calculated and compared between trainees and staff. RESULTS Of 1,426 trainees, 926 responded (65% response rate). Of 18,815 staff, 12,015 responded (64% response rate). Trainees and staff scored five domains similarly-communication openness, facility management support for patient safety, organizational learning/continuous improvement, teamwork across units, and handoffs/transitions of care. Trainees scored four domains higher than staff-nonpunitive response to error, staffing, supervisor/manager expectations and actions promoting patient safety, and teamwork within units. Trainees scored three domains lower than staff-feedback and communication about error, frequency of event reporting, and overall perceptions of patient safety. CONCLUSIONS Generally, trainees had comparable to more favorable perceptions of patient safety culture compared with staff. They did identify opportunities for improvement though. Hospitals can use perceptions of patient safety culture to complement CLER visit reports to improve patient safety.
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Affiliation(s)
- Gregory M Bump
- G.M. Bump is associate professor of medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. N. Coots is administrative fellow, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. C.A. Liberi is director of patient safety, Wolff Center for Quality, Safety, and Innovation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. T.E. Minnier is chief quality officer, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. P.E. Phrampus is associate professor of emergency medicine and anesthesiology, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. G. Gosman is associate professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. D.G. Metro is professor of anesthesiology, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. J.B. McCausland is associate professor, Departments of Medicine and Emergency Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. A. Buchert is assistant professor of pediatrics, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Kulkarni HS, Chey WD, Mookherjee S, Saint S, Bump GM. Taking the detour. J Hosp Med 2015; 10:686-90. [PMID: 26178589 DOI: 10.1002/jhm.2424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Hrishikesh S Kulkarni
- Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - William D Chey
- Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Sanjay Saint
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Department of Veterans Affairs, Ann Arbor Healthcare System and Health Services Research and Development Center of Excellence, Ann Arbor, Michigan
| | - Gregory M Bump
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Bump GM, Calabria J, Gosman G, Eckart C, Metro DG, Jasti H, McCausland JB, Itri JN, Patel RM, Buchert A. Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture. J Grad Med Educ 2015. [PMID: 26217435 PMCID: PMC4507899 DOI: 10.4300/jgme-d-14-00280.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. OBJECTIVE We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. METHODS Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. RESULTS Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year. CONCLUSIONS Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time.
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Affiliation(s)
- Gregory M Bump
- University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Montefiore, 9 South, 200 Lothrop Street, Pittsburgh, PA, 15213-2582, USA,
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Michaelsen K, Sanders JL, Zimmer SM, Bump GM. Overcoming Patient Barriers to Discussing Physician Hand Hygiene: Do Patients Prefer Electronic Reminders to Other Methods? Infect Control Hosp Epidemiol 2015; 34:929-34. [DOI: 10.1086/671727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Despite agreement that handwashing decreases hospital-acquired infections (HAIs), physician hand hygiene remains suboptimal. Interventions to empower patients to discuss handwashing have had variable success.Objective.To understand patient perceived barriers to discussing physician hand hygiene and to determine whether patients prefer electronic alerts over printed information as an intervention to discuss physician handwashing.Design.Cross-sectional study of 250 medical/surgical patients at an academic medical center.Results.Ninety-six percent of patients had heard of HAIs. Ninety-six percent of patients thought it was important for physicians to clean their hands before touching anything in a patient's room. The majority of patients (78%) believed patients should remind physicians to clean their hands. Thirty-two percent of patients observed physician hand hygiene noncompliance. In multivariate analysis, predictors of not speaking up regarding physician hand hygiene included never having worked in health care (odds ratio [OR], 2.8 [95% confidence interval (CI), 1.5-5.1]), not observing a physician clean hands before touching the patient (OR, 2.4 [95% CI, 1.3-4.4]), and not thinking patients should have to remind physicians to clean hands (OR, 5.5 [95% CI, 2.4-12.7]). Ninety-three percent of patients favored electronic device reminders over printed information as an intervention to encourage patients to discuss hand hygiene with their doctors.Conclusions.The strongest predictor of not challenging a doctor to clean their hands was not believing it was the patient's role to do so. Patients prefer electronic device reminders to printed information as an aid in overcoming barriers to discussing hand hygiene with physicians.
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Owlia M, Bump GM. The reply. Am J Med 2014; 127:e43. [PMID: 25205278 DOI: 10.1016/j.amjmed.2014.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Mina Owlia
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Gregory M Bump
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Owlia M, Yu L, Deible C, Hughes MA, Jovin F, Bump GM. Head CT scan overuse in frequently admitted medical patients. Am J Med 2014; 127:406-10. [PMID: 24508413 DOI: 10.1016/j.amjmed.2014.01.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/30/2014] [Accepted: 01/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients frequently admitted to medical services undergo extensive computed tomography (CT) imaging. Some of this imaging may be unnecessary, and in particular, head CT scans may be over-used in this patient population. We describe the frequency of abnormal head CT scans in patients with multiple medical hospitalizations. METHODS We retrospectively reviewed all CT scans done in 130 patients with 7 or more admissions to medical services between January 1 and December 31, 2011 within an integrated health care system. We calculated the number of CT scans, anatomic site of imaging, and source of ordering (emergency department, inpatient floor). We scored all head CT scans on a 0-4 scale based on the severity of radiographic findings. Higher scores signified more clinically important findings. RESULTS There were 795 CT scans performed in total, with a mean of 6.7 (± SD 5.8) CT scans per patient. Abdominal/pelvis (39%), chest (30%), and head (22%) CT scans were the most frequently obtained. The mean number of head CT scans performed was 2.9 (SD ± 4.2). Inpatient floors were the major site of CT scan ordering (53.7%). Of 172 head CT scans, only 4% had clinically significant findings (scores of 3 or 4). CONCLUSIONS Patients with frequent medical admissions are medically complex and undergo multiple CT scans in a year. The vast majority of head CT scans lack clinically significant findings and should be ordered less frequently. Interdisciplinary measures should be advocated by hospitalists, emergency departments, and radiologists to decrease unnecessary imaging in this population.
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Affiliation(s)
- Mina Owlia
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Lan Yu
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pa
| | - Christopher Deible
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Marion A Hughes
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Franziska Jovin
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Gregory M Bump
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Gonzalo JD, Bump GM, Huang GC, Herzig SJ. Implementation and evaluation of a multidisciplinary systems-focused internal medicine morbidity and mortality conference. J Grad Med Educ 2014; 6:139-46. [PMID: 24701325 PMCID: PMC3963772 DOI: 10.4300/jgme-d-13-00162.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/17/2013] [Accepted: 10/02/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Morbidity and mortality (M&M) conferences provide a forum for discussing adverse events and systems-based practice (SBP) issues; however, few models for implementing multidisciplinary, systems-focused M&M conferences exist. OBJECTIVE To implement a new systems-focused M&M conference and evaluate success in focusing on adverse events and systems issues in a nonpunitive, multidisciplinary manner. METHODS We implemented a new M&M conference into our large university-based internal medicine residency program. Using content analysis, we qualitatively analyzed audio recordings of M&M conferences from the first year of implementation (2010-2011) to determine the frequency of adverse events (injury resulting from medical care), SBP discussion, and allocation of blame. Multidisciplinary attendance was evaluated by attendance logs. Surveys assessed change in interns' perceptions of M&M conferences before and after the conference series (measured by median Likert-scale response) and trainee/faculty attitudes regarding the goal of M&M conferences. RESULTS There were 226 attendees (66 faculty, 160 residents/fellows) at 9 M&M conferences. Average attendance per conference was 71, with representation from 16 disciplines. All M&M conferences (100%) included adverse events, SBP discussion, and lacked explicit individual blame. Interns' perceptions improved, including their belief that the M&M conference's purpose is systems improvement (4.35 versus 4.71, P = .02) and complications are discussed without blame (3.81 versus 4.34, P = .01). After experiencing M&M conferences, trainees/faculty reported favorable ratings, including beliefs that the M&M conference is important for education (97%) and the purpose is systems improvement (95%). CONCLUSIONS The implementation of a new systems-focused M&M conference resulted in a conference series focusing on adverse events and associated system issues in a nonpunitive, multidisciplinary context.
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Affiliation(s)
- Siyang Leng
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Bump GM, Bost JE, Buranosky R, Elnicki M. Faculty member review and feedback using a sign-out checklist: improving intern written sign-out. Acad Med 2012; 87:1125-1131. [PMID: 22722359 DOI: 10.1097/acm.0b013e31825d1215] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Although residents commonly perform patient care sign-out during training, faculty do not frequently supervise or evaluate sign-out. The authors designed a sign-out checklist, and they investigated whether use of the checklist, paired with faculty member review and feedback, would improve interns' written sign-out. METHOD In a randomized, controlled design in 2011, the authors compared the sign-out content and the overall sign-out summary scores of interns who received twice-monthly faculty member sign-out evaluation with those of interns who received the standard sign-out instruction. A sign-out checklist, which the authors developed on the basis of internal needs assessment and published sign-out recommendations, guided the evaluation of written sign-out content and sign-out organization as well as the twice-monthly, face-to-face evaluation that the interns in the intervention group received. RESULTS Using the sign-out checklist and receiving feedback from a faculty member led to statistically significant improvements in interns' sign-out. Through regression analysis, the authors calculated a 23% difference in the sign-out content (P = .005) and a 2.2-point difference in the overall summary score (on a 9-point scale, P = .009) between the interns who received sign-out feedback and those who did not. The content and quality of the intervention group's sign-outs improved, whereas the content and quality of the control group's worsened. CONCLUSIONS A sign-out checklist paired with twice-monthly, face-to-face feedback from a faculty member led to improvements in the content and quality of interns' written sign-out.
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Affiliation(s)
- Gregory M Bump
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582, USA.
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Abstract
PURPOSE Recently the Accreditation Council for Graduate Medical Education mandated decreased shift duration for intern physicians to no more than 16 hours. Such work-hour restrictions are likely to increase patient care hand-offs. It is well accepted that sign-out (i.e., hand-off) processes are error prone and lack standardization. Moreover, many residency programs do not evaluate sign-out. We designed and tested whether a sign-out evaluation process could be implemented to improve written sign-out. METHOD Based on observed sign-out deficiencies at our institution we adapted a simple curriculum incorporating the SIGNOUT mnemonic, which we paired with weekly faculty member evaluation and feedback on sign-out using a structured sign-out evaluation tool. Later in the week, written sign-out was independently scored by 2-blinded senior resident reviewers who compared the inclusion of sign-out content, organization, and readability. RESULTS Compared to baseline data in 128 written sign-outs, the pairing of a 1-page curriculum with weekly faculty member evaluation of written sign-out improved the inclusion of advanced directives from 38% to 69% (p < .001) and anticipatory guidance from a mean score of 1.8 (SD = 1.2) to 2.3 (SD = 1.5) on a 5-point scale (p = .01) in 177 written sign-outs. Readability and organization were unchanged. CONCLUSIONS A simple curriculum paired with structured faculty evaluation and feedback can improve some parameters of sign-out. Structured evaluative sign-out tools may be useful to improve and teach sign-out skills.
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Affiliation(s)
- Gregory M Bump
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA.
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Bump GM, Jovin F, Destefano L, Kirlin A, Moul A, Murray K, Simak D, Elnicki DM. Resident sign-out and patient hand-offs: opportunities for improvement. Teach Learn Med 2011; 23:105-111. [PMID: 21516595 DOI: 10.1080/10401334.2011.561190] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Inpatient care is characterized by multiple transitions of patient care responsibilities. In most residency programs trainees manage transitions via verbal, written, or combined methods of communication termed "sign-out." Often sign-out occurs without standardization or supervision. PURPOSE The purpose was to assess daily sign-out with a goal of identifying aspects of this process most in need of improvement. METHODS This was a prospective, observational cohort study of interns' sign-out conducted by industrial engineering students. Daily sign-out was analyzed for inclusion of multiple criteria and scored on organization (on a scale of 0-4) based on how effectively written information was conveyed. RESULTS We observed 124 unique verbal and written sign-outs. We found that 99% of sign-outs included a general hospital course. Sign-outs were well organized with a mean of 3.1, though substantial variation was noted (SD = 0.8). Directions for anticipated patient events were included in only 42% of sign-outs. Do Not Resuscitate (DNR) or advanced directive discussions were reported in only 11% of sign-outs. Only 50% of successive daily sign-outs were updated. CONCLUSIONS We found variability in the content and organization of interns' sign-out, possibly reflecting a lack of instruction and supervision. Standardization of sign-out content, and education on good sign-out skills are increasingly important as patient hand-offs become more frequent.
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Affiliation(s)
- Gregory M Bump
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA.
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Bump GM, Dandu M, Kaufman SR, Shojania KG, Flanders SA. How complete is the evidence for thromboembolism prophylaxis in general medicine patients? A meta-analysis of randomized controlled trials. J Hosp Med 2009; 4:289-97. [PMID: 19504490 DOI: 10.1002/jhm.450] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Guidelines recommend pharmacologic prophylaxis for hospitalized medical patients at increased risk of thromboembolism. Despite recommendations, multiple studies demonstrate underutilization. Factors contributing to underutilization include uncertainty that prophylaxis reduces clinically relevant events, as well as questions about the best form of prophylaxis. We sought to determine whether prophylaxis decreases clinically significant events and to answer whether unfractionated heparin (UFH) or low molecular weight heparin (LMWH) is either more effective or safer. DATA SOURCES The MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched through June 2008. Relevant bibliographies and conference proceedings were reviewed and LMWH manufacturers were contacted. STUDY SELECTION Randomized trials comparing UFH or LMWH to control, as well as head-to-head comparisons of UFH to LMWH in general medicine patients. DATA EXTRACTION AND ANALYSIS End points of deep venous thrombosis (DVT), proximal or symptomatic DVT, pulmonary embolism, mortality, bleeding, and thrombocytopenia were extracted from individual trials. Pooled relative risks were calculated using random effects modeling. RESULTS We identified 8 trials comparing prophylaxis to control, and 6 trials comparing UFH to LMWH. Prophylaxis reduced DVT (relative risk [RR] = 0.55; 95% confidence interval [CI]: 0.36-0.92), proximal DVT (RR = 0.46; 95% CI: 0.31-0.69), and pulmonary embolism (RR = 0.70; 95% CI: 0.53-0.93). Prophylaxis increased the risk of any bleeding (RR = 1.54; 95% CI: 1.15-2.06) but not major bleeding. Across trials comparing LMWH to UFH, there were no differences for any outcome. CONCLUSIONS Among medical patients, pharmacologic prophylaxis reduced the risk of thromboembolism without increasing risk of major bleeding. The current literature does not demonstrate superior efficacy of UFH or LMWH.
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Affiliation(s)
- Gregory M Bump
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA.
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Affiliation(s)
- Gregory M Bump
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-0376, USA.
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Abstract
Elderly depressed patients are vulnerable to recurrence of depression and benefit from long-term antidepressant therapy. Physicians increasingly use selective serotonin re-uptake inhibitors (SSRIs) as maintenance therapy, although in the absence of data showing that SSRIs are as efficacious as tricyclic antidepressants (TCAs) in the prevention of depression relapse and recurrence. Our objective was to evaluate, in an open trial, the efficacy of paroxetine versus nortriptyline for preventing recurrence of depression in the elderly. Elderly patients with major depression were randomly assigned in a double-blinded fashion to receive either paroxetine or nortriptyline for the acute treatment of depression. Patients who did not respond or tolerate their assigned medications were crossed over openly to the comparator agent. Patients whose depression remitted continued antidepressant medication (paroxetine n = 38; nortriptyline n = 21) during an open 18-month follow-up study. We examined the rates of and times to relapse and to termination of treatment for any reason. Paroxetine (PX) and nortriptyline (NT) patients had similar rates of relapse (16% vs. 10%, respectively) and time to relapse (60.3 weeks vs. 58.8 weeks, respectively) over 18 months. A lower burden of residual depressive symptoms and side effects during continuation and maintenance treatment was evident in nortriptyline-treated patients. Paroxetine and nortriptyline demonstrated similar efficacy in relapse and recurrence prevention in elderly depressed patients over an 18-month period.
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Affiliation(s)
- G M Bump
- Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Bump GM, Reynolds CF, Smith G, Pollock BG, Dew MA, Mazumdar S, Geary M, Houck PR, Kupfer DJ. Accelerating response in geriatric depression: a pilot study combining sleep deprivation and paroxetine. Depress Anxiety 2000; 6:113-8. [PMID: 9442985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Elderly depressed patients often require an average of 12 weeks of pharmacotherapy before attaining remission. The delay between treatment initiation and remission may decrease compliance and prolongs suffering; hence, interventions that decrease the time to onset of antidepressant activity are needed. Our objective was to evaluate, in an open trial, the use of one night of total sleep deprivation combined with paroxetine to accelerate antidepressant response in elderly patients. Thirteen elderly patients with major depression were sleep-deprived for one night and started paroxetine on the night of recovery sleep. Patients were followed for twelve weeks, and clinical improvement was rated using the 17-item Hamilton Depression Rating Scale and a version of the Hamilton modified for sleep deprivation studies. 8/13 (62%) patients experienced significant improvement of depressive symptoms by 2 weeks. Within 12 weeks 11/13 (85%) patients responded to the combination of sleep deprivation and paroxetine. Median response time was 2 weeks. Clinical response at 12 weeks was correlated with changes in Sleep Deprivation Depression Rating Scale Scores between baseline and recovery sleep. In an open trial, the combined use of total sleep deprivation and paroxetine appears to be an effective method for speeding the onset of clinical antidepressant activity in geriatric depression and for improving early recognition of non-response.
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Affiliation(s)
- G M Bump
- Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, University of Pittsburgh, PA 15213, USA
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