1
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Desai AN. The Other Side. Patient Educ Couns 2024; 125:108288. [PMID: 38653157 DOI: 10.1016/j.pec.2024.108288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/20/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Akshay Nilesh Desai
- Department of Internal Medicine at Cooper University Healthcare, Camden, NJ, United States.
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Booth A, Sommer I, Noyes J, Houghton C, Campbell F. Rapid reviews methods series: guidance on rapid qualitative evidence synthesis. BMJ Evid Based Med 2024:bmjebm-2023-112620. [PMID: 38355285 DOI: 10.1136/bmjebm-2023-112620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 12/22/2023] [Indexed: 02/16/2024]
Abstract
This paper forms part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group and addresses rapid qualitative evidence syntheses (QESs), which use modified systematic, transparent and reproducible methodsu to accelerate the synthesis of qualitative evidence when faced with resource constraints. This guidance covers the review process as it relates to synthesis of qualitative research. 'Rapid' or 'resource-constrained' QES require use of templates and targeted knowledge user involvement. Clear definition of perspectives and decisions on indirect evidence, sampling and use of existing QES help in targeting eligibility criteria. Involvement of an information specialist, especially in prioritising databases, targeting grey literature and planning supplemental searches, can prove invaluable. Use of templates and frameworks in study selection and data extraction can be accompanied by quality assurance procedures targeting areas of likely weakness. Current Cochrane guidance informs selection of tools for quality assessment and of synthesis method. Thematic and framework synthesis facilitate efficient synthesis of large numbers of studies or plentiful data. Finally, judicious use of Grading of Recommendations Assessment, Development and Evaluation approach for assessing the Confidence of Evidence from Reviews of Qualitative research assessments and of software as appropriate help to achieve a timely and useful review product.
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Affiliation(s)
- Andrew Booth
- EnSyGN Sheffield Evidence Synthesis Group, University of Sheffield, Sheffield, UK
- Cochrane Qualitative and Implementation Methods Group (CQIMG), London, UK
| | - Isolde Sommer
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Cochrane Rapid Reviews Group & Cochrane Austria, Krems, Austria
| | - Jane Noyes
- Cochrane Qualitative and Implementation Methods Group (CQIMG), London, UK
- Bangor University, Bangor, UK
| | - Catherine Houghton
- Cochrane Qualitative and Implementation Methods Group (CQIMG), London, UK
- University of Galway, Galway, Ireland
| | - Fiona Campbell
- EnSyGN Sheffield Evidence Synthesis Group, University of Sheffield, Sheffield, UK
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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3
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Koene S, Ropers FG, Wieland J, Rybak T, Wildschut F, Berghuis D, Morgan A, Trelles MP, Scheepe JR, Bökenkamp R, Peeters-Scholte CMPCD, Braden R, Santen GWE. Clinical phenotype of FOXP1 syndrome: parent-reported medical signs and symptoms in 40 individuals. J Med Genet 2024; 61:399-404. [PMID: 38123995 DOI: 10.1136/jmg-2023-109537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The first studies on patients with forkhead-box protein P1 (FOXP1) syndrome reported associated global neurodevelopmental delay, autism symptomatology, dysmorphic features and cardiac and urogenital malformations. The aim of this study was to assess the prevalence of congenital abnormalities in an unbiased cohort of patients with FOXP1 syndrome and to document rare complications. METHODS Patients with FOXP1 syndrome were included, mostly diagnosed via whole-exome sequencing for neurodevelopmental delay. A parent-report questionnaire was used to assess medical signs and symptoms, including questions about features rated as most burdensome by patients and their family. RESULTS Forty individuals were included, 20 females and 20 males. The mean age at assessment was 13.2 years (median 8.5 years; range 2-54 years; ≥18 years n = 7). Seven adults were included. All patients had developmental problems, including cognitive, communication, social-emotional and motor delays. The most prevalent medical signs and symptoms include delayed bladder control, sleeping problems, hypermetropia, strabismus, sacral dimple, undescended testes, abnormal muscle tone and airway infections. The most burdensome complaints for patients with FOXP1 syndrome, as perceived by parents, include intellectual disability, impaired communication, behaviour problems, lack of age-appropriate self-reliance, attention problems and anxiety. According to parents, patients have quite similar reported symptoms, although incontinence, obsessions and a complex sensory profile have a higher ranking. CONCLUSION The results of this study may be used to further guide medical management and identify patient priorities for future research targeted on those features of FOXP1 syndrome that most impair quality of life of patients and their families.
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Affiliation(s)
- Saskia Koene
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jannelien Wieland
- Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Tamara Rybak
- 's Heeren Loo Zorggroep, Amersfoort, Netherlands
| | - Floor Wildschut
- Clinical Neurodevelopmental Sciences, Leiden University Clinical and Adolescent Child Studies, Leiden, Netherlands
| | - Dagmar Berghuis
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Angela Morgan
- Victorian Clinical Genetics Service and Speech and Language, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Pilar Trelles
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry and Human Behaviour, Brown University, Providence, Rhode Island, USA
| | | | - Regina Bökenkamp
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Ruth Braden
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Gijs W E Santen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
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4
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Pan T, Zhang P. Dynamic intervention strategies await inclusion in clinical evidence synthesis. BMJ Evid Based Med 2024; 29:137-138. [PMID: 37857458 DOI: 10.1136/bmjebm-2023-112618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Ting Pan
- TCM Department, Foshan Fosun Chancheng Hospital, Foshan, Guangdong, China
| | - Peiming Zhang
- Department of Acupuncture and Moxibustion, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
- The Eighth Clinical School of Medicine, Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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5
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Walter G, Laddha R, Jetty A, Jabbarpour Y, Huffstetler A. Racial Inequities in Female Family Physicians Providing Women's Health Procedures. J Am Board Fam Med 2024; 37:134-136. [PMID: 38467430 DOI: 10.3122/jabfm.2023.230078r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 03/13/2024] Open
Abstract
Patient-physician race concordant dyads have been shown to improve patient outcomes; the race and ethnicity of family physicians providing women's health procedures has not been described. Using self-reported data, this analysis highlights the racial disparities in scope of practice; underrepresented in medicine (URiM) females are less likely to perform women's health procedures which may lead to disparities in care received by minority women.
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Affiliation(s)
- Grace Walter
- From the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington DC (GW, RL, AJ, YJ, AH); Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, VA (AH)
| | - Radhika Laddha
- From the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington DC (GW, RL, AJ, YJ, AH); Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, VA (AH)
| | - Anuradha Jetty
- From the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington DC (GW, RL, AJ, YJ, AH); Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, VA (AH)
| | - Yalda Jabbarpour
- From the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington DC (GW, RL, AJ, YJ, AH); Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, VA (AH)
| | - Alison Huffstetler
- From the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington DC (GW, RL, AJ, YJ, AH); Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, VA (AH)
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6
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Hancock K. Lack of Diversity in Female Family Physicians Performing Women's Health Procedures. J Am Board Fam Med 2024; 37:21. [PMID: 38448241 DOI: 10.3122/jabfm.2023.230477r0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
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7
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Equity of access to healthcare for a patient with a severe intellectual disability. BMJ Evid Based Med 2024:bmjebm-2024-112866. [PMID: 38360046 DOI: 10.1136/bmjebm-2024-112866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024]
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8
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Kohut K, Speight B, Young J, Way R, Wiggins J, Monje-Garcia L, Eccles DM, Foster C, Turner L, Snape K, Hanson H. Co-design of patient information leaflets for germline predisposition to cancer: recommendations for clinical practice from the UK Cancer Genetics Group (UKCGG), Cancer Research UK (CRUK) funded CanGene-CanVar Programme and the Association of Genetic Nurse Counsellors (AGNC). J Med Genet 2024; 61:142-149. [PMID: 38050080 DOI: 10.1136/jmg-2023-109440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/27/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Testing for germline pathogenic variants (GPVs) in cancer predisposition genes is increasingly offered as part of routine care for patients with cancer. This is often urgent in oncology clinics due to potential implications on treatment and surgical decisions. This also allows identification of family members who should be offered predictive genetic testing. In the UK, it is common practice for healthcare professionals to provide a patient information leaflet (PIL) at point of care for diagnostic genetic testing in patients with cancer, after results disclosure when a GPV is identified, and for predictive testing of at-risk relatives. Services usually create their own PIL, resulting in duplication of effort and wide variability regarding format, content, signposting and patient input in co-design and evaluation. METHODS Representatives from UK Cancer Genetics Group (UKCGG), Cancer Research UK (CRUK) funded CanGene-CanVar programme and Association of Genetic Nurse Counsellors (AGNC) held a 2-day meeting with the aim of making recommendations for clinical practice regarding co-design of PIL for germline cancer susceptibility genetic testing. Lynch syndrome and haematological malignancies were chosen as exemplar conditions. RESULTS Meeting participants included patient representatives including as co-chair, multidisciplinary clinicians and other experts from across the UK. High-level consensus for UK recommendations for clinical practice was reached on several aspects of PIL using digital polling, including that PIL should be offered, accessible, co-designed and evaluated with patients. CONCLUSIONS Recommendations from the meeting are likely to be applicable for PIL co-design for a wide range of germline genetic testing scenarios.
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Affiliation(s)
- Kelly Kohut
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Beverley Speight
- Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Rosalind Way
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Jennifer Wiggins
- Cancer Genetics, The Royal Marsden NHS Foundation Trust, London, UK
| | - Laura Monje-Garcia
- The St Mark's Centre for Familial Intestinal Cancer, London North West University Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Diana M Eccles
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | | | - Katie Snape
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - Helen Hanson
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
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9
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Davies E. Informed by research, transformed by research. BMJ Evid Based Med 2024; 29:62-63. [PMID: 37857459 PMCID: PMC10850663 DOI: 10.1136/bmjebm-2023-112646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Elspeth Davies
- Social Anthropology, University of Cambridge, Cambridge, UK
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10
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Riganti P, Kopitowski KS, McCaffery K, van Bodegom-Vos L. The paradox of using SDM for de-implementation of low-value care in the clinical encounter. BMJ Evid Based Med 2024; 29:14-16. [PMID: 37080738 DOI: 10.1136/bmjebm-2022-112201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Paula Riganti
- Family and Community Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Karin Silvana Kopitowski
- Family and Community Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Kirsten McCaffery
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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11
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Mitchell EC, Ott M, Ross D, Grant A. Development of a Tool to Assess Surgical Resident Competence On-Call: The Western University Call Assessment Tool (WUCAT). Journal of Surgical Education 2024; 81:106-114. [PMID: 38008642 DOI: 10.1016/j.jsurg.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND A central tenet of competency-based medical education is the formative assessment of trainees. There are currently no assessments designed to examine resident competence on-call, despite the on-call period being a significant component of residency, characterized by less direct supervision compared to daytime. The purpose of this study was to design a formative on-call assessment tool and collect valid evidence on its application. METHODS Nominal group technique was used to identify critical elements of surgical resident competence on-call to inform tool development. The tool was piloted over six months in the Division of Plastic & Reconstructive Surgery at our institution. Quantitative and qualitative evidence was collected to examine tool validity. RESULTS A ten-item tool was developed based on the consensus group results. Sixty-three assessments were completed by seven staff members on ten residents during the pilot. The tool had a reliability coefficient of 0.67 based on a generalizability study and internal item consistency was 0.92. Scores were significantly associated with years of training. We found the tool improved the quantity and structure of feedback given and that the tool was considered feasible and acceptable by both residents and staff members. CONCLUSIONS The Western University Call Assessment Tool (WUCAT) has multiple sources of evidence supporting its use in assessing resident competence on-call.
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Affiliation(s)
- Eric C Mitchell
- Department of Surgery, Western University, London, Ontario, Canada
| | - Michael Ott
- Department of Surgery, Western University, London, Ontario, Canada
| | - Douglas Ross
- Department of Surgery, Western University, London, Ontario, Canada
| | - Aaron Grant
- Department of Surgery, Western University, London, Ontario, Canada.
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12
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Peluso F, Caraffi SG, Contrò G, Valeri L, Napoli M, Carboni G, Seth A, Zuntini R, Coccia E, Astrea G, Bisgaard AM, Ivanovski I, Maitz S, Brischoux-Boucher E, Carter MT, Dentici ML, Devriendt K, Bellini M, Digilio MC, Doja A, Dyment DA, Farholt S, Ferreira CR, Wolfe LA, Gahl WA, Gnazzo M, Goel H, Grønborg SW, Hammer T, Iughetti L, Kleefstra T, Koolen DA, Lepri FR, Lemire G, Louro P, McCullagh G, Madeo SF, Milone A, Milone R, Nielsen JEK, Novelli A, Ockeloen CW, Pascarella R, Pippucci T, Ricca I, Robertson SP, Sawyer S, Falkenberg Smeland M, Stegmann S, Stumpel CT, Goel A, Taylor JM, Barbuti D, Soresina A, Bedeschi MF, Battini R, Cavalli A, Fusco C, Iascone M, Van Maldergem L, Venkateswaran S, Zuffardi O, Vergano S, Garavelli L, Bayat A. Deep phenotyping of the neuroimaging and skeletal features in KBG syndrome: a study of 53 patients and review of the literature. J Med Genet 2023; 60:1224-1234. [PMID: 37586838 DOI: 10.1136/jmg-2023-109141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND KBG syndrome is caused by haploinsufficiency of ANKRD11 and is characterised by macrodontia of upper central incisors, distinctive facial features, short stature, skeletal anomalies, developmental delay, brain malformations and seizures. The central nervous system (CNS) and skeletal features remain poorly defined. METHODS CNS and/or skeletal imaging were collected from molecularly confirmed individuals with KBG syndrome through an international network. We evaluated the original imaging and compared our results with data in the literature. RESULTS We identified 53 individuals, 44 with CNS and 40 with skeletal imaging. Common CNS findings included incomplete hippocampal inversion and posterior fossa malformations; these were significantly more common than previously reported (63.4% and 65.9% vs 1.1% and 24.7%, respectively). Additional features included patulous internal auditory canal, never described before in KBG syndrome, and the recurrence of ventriculomegaly, encephalic cysts, empty sella and low-lying conus medullaris. We found no correlation between these structural anomalies and epilepsy or intellectual disability. Prevalent skeletal findings comprised abnormalities of the spine including scoliosis, coccygeal anomalies and cervical ribs. Hand X-rays revealed frequent abnormalities of carpal bone morphology and maturation, including a greater delay in ossification compared with metacarpal/phalanx bones. CONCLUSION This cohort enabled us to describe the prevalence of very heterogeneous neuroradiological and skeletal anomalies in KBG syndrome. Knowledge of the spectrum of such anomalies will aid diagnostic accuracy, improve patient care and provide a reference for future research on the effects of ANKRD11 variants in skeletal and brain development.
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Affiliation(s)
- Francesca Peluso
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Stefano G Caraffi
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Gianluca Contrò
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Lara Valeri
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
- Department of Pediatrics, University of Modena and Reggio Emilia Faculty of Medicine and Surgery, Modena, Emilia-Romagna, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Giorgia Carboni
- Radiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Alka Seth
- Radiology, Rigshospitalet, Kobenhavn, Denmark
| | - Roberta Zuntini
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Emanuele Coccia
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Guja Astrea
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
| | - Anne-Marie Bisgaard
- Center for Rare Diseases, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Ivan Ivanovski
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Silvia Maitz
- Service of Medical Genetics, IOSI, EOC, Lugano, Switzerland
| | | | - Melissa T Carter
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Maria Lisa Dentici
- Department of Clinical Genetics, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Koenraad Devriendt
- Department for Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
| | - Melissa Bellini
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Cristina Digilio
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Asif Doja
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - David A Dyment
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Stense Farholt
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Carlos R Ferreira
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Lynne A Wolfe
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - William A Gahl
- National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Maria Gnazzo
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Himanshu Goel
- Hunter Genetics, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sabine Weller Grønborg
- Center for Rare Diseases, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
- Department of Clinical Genetics, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Trine Hammer
- Department of Clinical Genetics, Copenhagen University Hospital, Kobenhavn, Denmark
- Department for Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
| | - Lorenzo Iughetti
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Tjitske Kleefstra
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - David A Koolen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Francesca Romana Lepri
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Gabrielle Lemire
- Department of Genetics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Pedro Louro
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Gary McCullagh
- Royal Manchester Children's Hospital and University of Manchester, Royal Manchester Children's Hospital, Manchester, Manchester, UK
| | - Simona F Madeo
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Annarita Milone
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
| | - Roberta Milone
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
| | - Jens Erik Klint Nielsen
- Department of Pediatrics, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Charlotte W Ockeloen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Tommaso Pippucci
- U.O. Genetica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Emilia-Romagna, Italy
| | - Ivana Ricca
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
| | - Stephen P Robertson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Sawyer
- Department of Genetics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | | | - Sander Stegmann
- Department of Clinical Genetics and School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Constanze T Stumpel
- Department of Clinical Genetics and School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Amy Goel
- University of Newcastle, Callaghan, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Juliet M Taylor
- Genetic Health Service - Northern Hub, Genetic Health Service - Northern Hub, Aukland, New Zealand
| | - Domenico Barbuti
- Radiology and Bioimaging Unit, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Annarosa Soresina
- Paediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Ex-perimental Sciences, ASST Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | | | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Toscana, Italy
| | - Anna Cavalli
- Child Neurology and Psychiatry Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Carlo Fusco
- Child Neurology and Psychiatry Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Maria Iascone
- Laboratory of Medical Genetics, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Lionel Van Maldergem
- Centre de génétique humaine, Université de Franche-Comté, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | | | - Orsetta Zuffardi
- Department of Molecular Medicine, University of Pavia, Pavia, Lombardia, Italy
| | - Samantha Vergano
- Division of Medical Genetics and Metabolism, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Livia Garavelli
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Allan Bayat
- Department for Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
- Institute for Regional Health Services Research, University of Southern Denmark, Odense, Syddanmark, Denmark
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13
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Trivedi S, Hall S, Inglis F, Chaudhry A. Proof-of-concept solution to create an interoperable timeline of healthcare data. BMJ Health Care Inform 2023; 30:e100754. [PMID: 37940189 PMCID: PMC10693683 DOI: 10.1136/bmjhci-2023-100754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES To overcome the barriers of interoperability by sharing simulated patient data from different electronic health records systems and presenting them in an intuitive timeline of events. METHODS The 'Patient Story' software comprising database and blockchain, PS Timeline Windows interface, PS Timeline Web interface and network relays on Azure cloud was customised for Epic and Lorenzo electonic patient record (EPR) systems used at different hospitals, using site-specific adapters. RESULTS Each site could view their own clinical documents and view each other's site specific, fully coded test sets of (Care Connect) medications, conditions and allergies, in an aggregated single view. DISCUSSION This work has shown that clinical data from different EPR systems can be successfully integrated and visualised on a single timeline, accessible by clinicians and patients. CONCLUSION The Patient Story system combined the timeline visualisation with successful interoperability across healthcare settings, as well giving patients the ability to directly interact with their timeline.
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Affiliation(s)
- Sapna Trivedi
- Clinical Informatics (eHospital), Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stephen Hall
- Clinical Informatics (eHospital), Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fiona Inglis
- Clinical Informatics (eHospital), Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Afzal Chaudhry
- Epic Systems Corporation, (previously eHospital), Epic Systems, The Core, St Thomas St, Bristol, UK
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14
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Riganti P, McKinnon AM. Plain language summaries: enhancing patient-centred care and improving accessibility of health research. BMJ Evid Based Med 2023; 28:299-302. [PMID: 37258093 DOI: 10.1136/bmjebm-2022-112200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Paula Riganti
- The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Family Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, Argentina
| | - Annette Marie McKinnon
- Patient Advisors Network, Toronto, Ontario, Canada
- Centre for Advancing Collaborative Healthcare & Education, University Health Network, Toronto, Ontario, Canada
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15
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Tatebe LC, Golisch KB, Janczewski LM, Krueger M, Halverson A. Autonomy Maps: Building a Shared Mental Model for Progressive Resident Operative Autonomy on the Road to Entrustable Professional Activities (EPAs). J Surg Educ 2023; 80:1351-1354. [PMID: 37537103 DOI: 10.1016/j.jsurg.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/12/2023] [Accepted: 07/08/2023] [Indexed: 08/05/2023]
Abstract
Our residents expressed dissatisfaction with operative autonomy and faculty feedback regarding technical skills. They reported variability among faculty regarding allowed operative autonomy. Our goals were to establish a shared mental model among residents and faculty regarding intraoperative performance expectations. We asked faculty to assign a level of expected autonomy (Zwisch scale) for various steps of common procedures according to the resident post-graduate year. Through an iterative process, the maps were standardized across service lines. The resulting "Autonomy Maps" were distributed to the faculty and residents. We held educational sessions and set expectations for use. Selected benchmarks were incorporated into resident end-of-rotation assessment forms. Initial operative case mapping identified variability in faculty expectations for a given post-graduate year and procedure. Residents reported improved satisfaction with understanding expectations regarding operative performance. Establishing autonomy benchmarks facilitated more specific feedback regarding residents' technical skills. Faculty expectations for resident operative autonomy are variable. Autonomy Maps provide structure for a shared mental model between faculty and residents for progressive operative autonomy and serve as a framework for expectations that improve resident satisfaction. Case-specific technical benchmarks are useful tools for assessing residents' technical milestones.
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Affiliation(s)
- Leah C Tatebe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | | | | | - Mackenzie Krueger
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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16
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Stiggelbout A, Griffioen I, Brands J, Melles M, Rietjens J, Kunneman M, van der Kolk M, van Eijck C, Snelders D. Metro Mapping: development of an innovative methodology to co-design care paths to support shared decision making in oncology. BMJ Evid Based Med 2023; 28:291-294. [PMID: 37236775 PMCID: PMC10579511 DOI: 10.1136/bmjebm-2022-112168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Anne Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Erasmus School Of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ingeborg Griffioen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Design Studio Panton, Deventer, The Netherlands
| | | | - Marijke Melles
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Judith Rietjens
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Marion van der Kolk
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Casper van Eijck
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk Snelders
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
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Affiliation(s)
- Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Merel M Ruissen
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
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18
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Whiwon L, Salma S, Daniel A, Stephanie L, Marc C, Cherith S, Abby T, Angela S, Robin H, Yvonne B. Patient-facing digital tools for delivering genetic services: a systematic review. J Med Genet 2023; 60:1-10. [PMID: 36137613 DOI: 10.1136/jmg-2022-108653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
This study systematically reviewed the literature on the impact of digital genetics tools on patient care and system efficiencies. MEDLINE and Embase were searched for articles published between January 2010 and March 2021. Studies evaluating the use of patient-facing digital tools in the context of genetic service delivery were included. Two reviewers screened and extracted patient-reported and system-focused outcomes from each study. Data were synthesised using a descriptive approach. Of 3226 unique studies identified, 87 were included. A total of 70 unique digital tools were identified. As a result of using digital tools, 84% of studies reported a positive outcome in at least one of the following patient outcomes: knowledge, psychosocial well-being, behavioural/management changes, family communication, decision-making or level of engagement. Digital tools improved workflow and efficiency for providers and reduced the amount of time they needed to spend with patients. However, we identified a misalignment between study purpose and patient-reported outcomes measured and a lack of tools that encompass the entire genetic counselling and testing trajectory. Given increased demand for genetic services and the shift towards virtual care, this review provides evidence that digital tools can be used to efficiently deliver patient-centred care. Future research should prioritise development, evaluation and implementation of digital tools that can support the entire patient trajectory across a range of clinical settings. PROSPERO registration numberCRD42020202862.
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Affiliation(s)
- Lee Whiwon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shickh Salma
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Assamad Daniel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Luca Stephanie
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Clausen Marc
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Somerville Cherith
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tafler Abby
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shaw Angela
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Hayeems Robin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Bombard Yvonne
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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19
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Whiwon L, Salma S, Daniel A, Stephanie L, Marc C, Cherith S, Abby T, Angela S, Robin H, Yvonne B. Patient-facing digital tools for delivering genetic services: a systematic review. J Med Genet 2023; 60:1-10. [PMID: 36137613 DOI: 10.1136/jmg-2022-109085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/19/2022] [Indexed: 01/24/2023]
Abstract
This study systematically reviewed the literature on the impact of digital genetics tools on patient care and system efficiencies. MEDLINE and Embase were searched for articles published between January 2010 and March 2021. Studies evaluating the use of patient-facing digital tools in the context of genetic service delivery were included. Two reviewers screened and extracted patient-reported and system-focused outcomes from each study. Data were synthesised using a descriptive approach. Of 3226 unique studies identified, 87 were included. A total of 70 unique digital tools were identified. As a result of using digital tools, 84% of studies reported a positive outcome in at least one of the following patient outcomes: knowledge, psychosocial well-being, behavioural/management changes, family communication, decision-making or level of engagement. Digital tools improved workflow and efficiency for providers and reduced the amount of time they needed to spend with patients. However, we identified a misalignment between study purpose and patient-reported outcomes measured and a lack of tools that encompass the entire genetic counselling and testing trajectory. Given increased demand for genetic services and the shift towards virtual care, this review provides evidence that digital tools can be used to efficiently deliver patient-centred care. Future research should prioritise development, evaluation and implementation of digital tools that can support the entire patient trajectory across a range of clinical settings. PROSPERO registration numberCRD42020202862.
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Affiliation(s)
- Lee Whiwon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shickh Salma
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Assamad Daniel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Luca Stephanie
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Clausen Marc
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Somerville Cherith
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tafler Abby
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shaw Angela
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Hayeems Robin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Bombard Yvonne
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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20
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Marcotte KM, Holmstrom AL, Thelen AE, Gates R, George BC, Krumm AE. Opportunities to Increase Workplace Feedback: A Multi-institutional Examination. J Surg Educ 2022; 79:e124-e129. [PMID: 36207256 DOI: 10.1016/j.jsurg.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/20/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE While feedback is an essential component of resident education, there are few large-scale studies examining when and under what conditions formative feedback is provided. Workplace-based assessment systems offer an opportunity to identify factors influencing when faculty provides feedback to trainees. Influential factors affecting feedback may provide targets for increasing and improving feedback in resident education. DESIGN Data on whether dictated feedback was provided were obtained from the Society for Improving Medical Professional Learning (SIMPL) mobile application. We used generalized linear mixed effects models to identify the degree to which faculty members, procedures, surgical case characteristics, and trainee performance were associated with whether narrative feedback was provided using SIMPL. SETTING This study was conducted using data from members of the SIMPL collaborative. PARTICIPANTS 67,434 evaluations from 70 general surgery programs were included from 2015 to 2021. Of these, 25,355 evaluations included dictated feedback. RESULTS Approximately 61% of the variation in whether dictated feedback was provided was attributable to the individual faculty member. Compared to residents who achieved autonomy ratings of "Active Help," residents who achieved ratings of "Supervision Only" (odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.72, 0.88) had a lower likelihood of receiving dictated feedback. Residents who achieved ratings of "Intermediate" (OR = 0.81, CI = 0.74, 0.89), "Practice-Ready" (OR = 0.50, CI = 0.45, 0.57), or "Exceptional (OR = 0.64, CI = 0.54, 0.76) showed a lower likelihood of receiving dictated feedback compared to those rated as "Inexperienced." Cases rated as "High" in terms of complexity were associated with an increased likelihood of having dictation (OR = 1.35, CI = 1.26, 1.44). CONCLUSIONS The largest contributing factor for whether dictated feedback is included in a SIMPL evaluation are factors specific to the attending surgeon. Resident performance, resident autonomy, and case complexity had only modest associations with feedback decisions. Efforts to improve the amount of formative feedback for trainees should be directed towards reducing the variation in which attending surgeons elect to provide feedback.
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Affiliation(s)
- Kayla M Marcotte
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan.
| | - Amy L Holmstrom
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinois
| | - Angela E Thelen
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Rebecca Gates
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Andrew E Krumm
- Center for Surgical Training and Research, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
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21
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White EM, Esposito AC, Kurbatov V, Wang X, Caty MG, Laurans M, Yoo PS. How I Learned is How I Teach - Perspectives on How Faculty Surgeons Approach Informed Consent Education. J Surg Educ 2022; 79:e181-e193. [PMID: 36253332 DOI: 10.1016/j.jsurg.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/24/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To understand the variability of surgical attending experience and perspectives regarding informed consent and how it impacts resident education DESIGN: A novel survey was distributed electronically to explore faculty surgeon's personal learning experience, knowledge, clinical practice, teaching preferences and beliefs regarding informed consent. Chi-square and Kruskal-Wallis testing was performed to look for associations and a cluster analysis was performed to elucidate additional patterns among. SETTING Single, tertiary, university-affiliated health care system (Yale New Haven Health in Connecticut), including 6 teaching hospitals. PARTICIPANTS Clinical faculty within the Department of Surgery. RESULTS A total of 85 surgeons responded (49% response rate), representing 17 specialties, both private practice and university and/or hospital-employed, with a range of years in practice. Across all ages, specialties, the most common method for both learning (86%) and teaching (82%) informed consent was observation of the attending. Respondents who stated they learned by observing attendings were more likely to report that they teach by having trainees observe them (OR 8.5, 95% CI 1.3-56.5) and participants who recalled learning by having attendings observe them were more likely to observe their trainees (OR 4.1, 95% CI 1.5-11.2).Cluster analysis revealed 5 different attending phenotypes with significant heterogeneity between groups. A cluster of younger attendings reported the least diverse learning experience and high levels of concern for legal liability and resident competency. They engaged in few strategies for teaching residents. By comparison, the cluster that reported the most diverse learning experience also reported the richest diversity of teaching strategies to residents but rarely allowed residents to perform consent with their patients. Meanwhile, 2 other cluster provided a more balanced experience with some opportunities for practice with patients and some diversity of teaching- these clusters, respectively, consist of older, experienced general surgeons and surgeons in trauma and/or critical care. CONCLUSIONS Surgeon's demographics, personal experiences, and specialty appear to significantly influence their teaching styles and the educational experience residents receive regarding informed consent.
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Affiliation(s)
- Erin M White
- Yale University School of Medicine, Department of Surgery, New Haven, Connecticut
| | - Andrew C Esposito
- Yale University School of Medicine, Department of Surgery, New Haven, Connecticut
| | - Vadim Kurbatov
- Yale University School of Medicine, Department of Surgery, Department of Genetics, New Haven, Connecticut
| | - Xujun Wang
- Yale University School of Medicine, Department of Genetics, New Haven, Connecticut
| | - Michael G Caty
- Yale University School of Medicine, Department of Surgery, New Haven, Connecticut
| | - Maxwell Laurans
- Yale University School of Medicine, Department of Neurosurgery, New Haven, Connecticut
| | - Peter S Yoo
- Yale University School of Medicine, Department of Surgery, New Haven, Connecticut.
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22
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Wang Y, Feng W. Cancer-related psychosocial challenges. Gen Psychiatr 2022; 35:e100871. [PMID: 36311374 PMCID: PMC9540834 DOI: 10.1136/gpsych-2022-100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/18/2022] [Indexed: 12/03/2022] Open
Abstract
Over the past decade, cancer incidence has increased globally while its mortality has decreased. Accordingly, healthcare practitioners aim to provide comprehensive care to cancer patients. The biopsychosocial model suggests medical professionals' understanding of how psychosocial factors influence the entire course of cancer is critical. However, until now, an integrative review summarising the full scope of these psychosocial domains has been lacking. This review substantiates that cancer patients, survivors, their caregivers, and oncology professionals face substantial psychosocial challenges. Cancer patients and survivors may experience deterioration of self-concept, disturbance of body image, sexual problems and difficulties in social relationships while attempting to cope with casual issues. The burdens of care provision and the impact on the health of caregivers of cancer patients are also noteworthy. Improving the quality of patient-doctor communication and overcoming burnout are significant challenges for oncology healthcare professionals.
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Affiliation(s)
- Youyang Wang
- Department of Psychological Medicine, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Wei Feng
- Department of Psychological Medicine, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
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Weill SR, Layden AJ, Nabozny MJ, Leahy J, Claxton R, Zelenski AB, Zimmermann C, Childers J, Arnold R, Hall DE. Applying VitalTalk TM Techniques to Best Case/Worst Case Training to Increase Scalability and Improve Surgeon Confidence in Shared Decision-making. J Surg Educ 2022; 79:983-992. [PMID: 35246401 DOI: 10.1016/j.jsurg.2022.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/03/2022] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Best Case/Worst Case (BC/WC) is a communication tool designed to promote shared decision-making for high-risk procedures near the end of life. This study aimed to increase scalability of a BC/WC training program and measure its impact on surgeon confidence in and perceived importance of the methodology. DESIGN A prospective cohort pre-post study; December 2018 to January 2019. SETTING Multi-center tertiary care teaching hospital. PARTICIPANTS Forty-eight resident surgeons from general surgery and otolaryngology. RESULTS Learners were 24 to 37 years old with 52% in post graduate year 1 to 2. Although learners encountered high-stakes communication (HSC) frequently (3.6 [0.7] on 5-point Likert scale), most reported no HSC training in medical school (74.5%) or residency (87.5%). BC/WC training was accomplished with an instructor to learner ratio of 1-to-5.3. After training, learner confidence improved on all measured communication skills on a 5-point scale (e.g., exploring patient's values increased from 3.6 [0.8] to 4.1 [0.6], p = <0.0001); average within-person improvement was 0.72 (0.6) points across all skills. Perceived importance improved across all skills (e.g., basing a recommendation on patient's values increased from 4.4 [0.8] to 4.8 [0.5], p = 0.0009); average within-person improvement was 0.46 (0.5) points across all skills. Learners reported this training would likely help them in future interactions (4.4 [0.73] on 5-point scale) and 95.2% recommended it be offered to resident physicians in other residency programs and to attending surgeons. CONCLUSIONS Formal training in BC/WC increases learners' perception of both the importance of HSC skills and their confidence in exercising those skills in clinical practice. VitalTalkTM methodology permitted scaling training to 5.3 learners per instructor and was highly recommended for other surgeons. Ongoing training, such as this, may support more patient-centered decision-making and care.
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Affiliation(s)
- Sydney R Weill
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Alexander J Layden
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Janet Leahy
- Department of General Medicine, Section of Palliative Care and Medical Ethics, UPMC, Pittsburgh, Pennsylvania
| | - Rene Claxton
- Department of General Medicine, Section of Palliative Care and Medical Ethics, UPMC, Pittsburgh, Pennsylvania
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Chris Zimmermann
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Julie Childers
- Department of General Medicine, Section of Palliative Care and Medical Ethics, UPMC, Pittsburgh, Pennsylvania
| | - Robert Arnold
- Department of General Medicine, Section of Palliative Care and Medical Ethics, UPMC, Pittsburgh, Pennsylvania
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania; The Wolff Center at UPMC, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Geriatric Research Educational and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Anis HK, Rothfusz CA, Eskildsen SM, Klika AK, Piuzzi NS, Higuera CA, Molloy RM. Does Surgical Trainee Participation Affect Infection Outcomes in Primary Total Knee Arthroplasty? J Surg Educ 2022; 79:993-999. [PMID: 35300952 DOI: 10.1016/j.jsurg.2022.02.006] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/10/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate whether the involvement of surgeons-in-training was associated with increased infection rates, including both prosthetic joint infection (PJI) and surgical site infection (SSI), following primary total knee arthroplasty (TKA). DESIGN This was a retrospective review of outcomes following primary total knee arthroplasty. Surgeries were divided into two groups: (a) attending-only and (b) trainee-involved. Association with PJI and SSI were evaluated with univariate analysis and multivariate analysis to adjust for sex, age, body mass index (BMI), Charlson Comorbidity Index (CCI), year of surgery, operative time, and hospital/surgeon volume. SETTING A single, large North-American integrated healthcare system between January 1, 2014 and December 31, 2017. PARTICIPANTS A total of 12,664 primary TKAs with a minimum of one-year (mean of 2-years, range 1-4.5) follow-up were evaluated. RESULTS Residents and fellows were more likely to participate in cases with longer operative times (p<0.001) than the attending-only group. A significant difference existed on univariate analysis between the trainee-involved group and attending-only group for PJI incidence (p=0.015) but not for SSI (p=0.840). After adjusting for patient- and procedure-related features, however, neither PJI nor SSI were independently associated with trainee involvement (PJI: p=0.089; SSI: p=0.998). CONCLUSIONS Trainee participation did not directly correlate with increased infection risk, despite their association with longer-operative times and increased medical complexity. Further approaches to mitigating the risk of SSI and PJI for patients with increased comorbidities and in complex TKA cases, which demand longer operative times, are still required.
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Affiliation(s)
- Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | - Christopher A Rothfusz
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | | | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio.
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation Florida, Weston Hospital, Weston, Florida
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
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Orovec A, Bishop A, Scott SA, Wilson D, Richardson CG, Oxner W, Glennie RA. Validation of a Surgical Objective Structured Clinical Examination (S-OSCE) Using Convergent, Divergent, And Trainee-Based Assessments of Fidelity. J Surg Educ 2022; 79:1000-1008. [PMID: 35232691 DOI: 10.1016/j.jsurg.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Describe the validation of a surgical objective structured clinical examination (S-OSCE) for the purpose of competency assessment based on the Royal College of Canada's Can-MEDS framework. DESIGN A surgical OSCE was developed to evaluate the management of common orthopedic surgical problems. The scores derived from this S-OSCE were compared to Ottawa Surgical Competency Operating Room Evaluation (O-SCORE), a validated entrustability assessment, to establish convergent validity. The S-OSCE scores were compared to Orthopedic In-Training Examination (OITE) scores to evaluate divergent validity. Resident evaluations of the clinical encounter with a standardized patient and the operative procedure were scored on a 10-point Likert scale for fidelity. SETTING A tertiary level academic teaching hospital. PARTICIPANTS 21 postgraduate year 2 to 5 trainees of a 5-year Canadian orthopedic residency program creating 160 operative case performances for review. RESULTS There were 5 S-OSCE days, over a 4-year period (2016-2019) encompassing a variety of surgical procedures. Performance on the S-OSCE correlated strongly with the O-SCORE (Pearson correlation coefficient 0.88), and a linear regression analysis correlated moderately with year of training (R² = 0.5345). The Pearson correlation coefficient between the S-OSCE and OITE scores was 0.57. There was a significant increase in the average OITE score after the introduction of the surgical OSCE. Resident fidelity ratings were available from 16 residents encompassing 8 different surgical cases. The average score for the overall simulation (8.0±1.6) was significantly higher than the cadaveric surgical simulation (6.5 ± 0.8) (p < 0.001) CONCLUSIONS: The S-OSCE scores correlate strongly with an established form of assessment demonstrating convergent validity. The correlation between the S-OSCE and OITE scores was less, demonstrating divergent validity. Although residents rank the overall simulation highly, the fidelity of the cadaveric simulation may need improvement. Administration of a surgical OSCE can be used to evaluate preoperative and intraoperative decision making and complement other forms of assessment.
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Affiliation(s)
- Adele Orovec
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alex Bishop
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie A Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dave Wilson
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - C Glen Richardson
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Oxner
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Andrew Glennie
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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Mustaffa KH, Shafie AA, Ngu LH. A comparison of self-evaluated survey and work sampling approach for estimating patient-care unit cost multiplier in genetic nursing activities. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:170-179. [PMID: 35714898 DOI: 10.1016/j.anr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/03/2021] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare patient care multipliers estimated from subjective evaluation against work sampling techniques in genetic nursing activities. METHODS An observational work sampling technique was conducted from November to December 2019 with nine genetic nurses in a tertiary referral centre in Malaysia. The work sampling activity instrument was devised, validated, and pilot tested. All care and noncare-related activities were sampled at 10-minute intervals within 8 hours of working over 14 days, followed by a subjective evaluation of activities survey over the same period. Bonferroni correction was undertaken for multiple testing with a p value of 0.0025. RESULTS The two techniques produced significant differences in genetic nurses' activities categorization. The work sampling showed that compared with subjective evaluation, direct care (19.3% versus 45.0%; p < .001) was estimated to be significantly lower, and indirect care (40.4% versus 25.6%; p < .001) and unit-related care (28.5% versus 16.9%; p < .001) were higher. Both techniques produced a similar proportion of time spent in other noncare activities (12.0%) but differed in genetic meetings and information-gathering activities. While the multipliers for patient face-to-face contact were significantly larger between work sampling (4.57) and the survey (1.94), the multipliers for patient care time were smaller between work sampling (1.47) and the survey (1.24), indicating that caution should be taken when multiplying for patient contact time compared to patient care activity to determine the cost of care provision. CONCLUSION A considerable proportion of time spent away from the patient needs to be allocated to patient-related care time. Thus, estimating the paid cost solely based on direct time with patients considerably underestimates the cost per hour of nurses' care. It is recommended to employ 'patient-related activity' instead of the 'face-to-face contact' multiplier because the former did not significantly differ from the one estimated using work sampling.
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Affiliation(s)
- Khairu Hazwan Mustaffa
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Penang, Malaysia; Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Penang, Malaysia.
| | - Lock-Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Benson R, Clough A, Nelder C, Pitt E, Portner R, Vassiliou M, McDaid L, Choudhury A, Rembielak A, Eccles C. Evaluation of the palliative radiotherapy pathway in a single institute: Can an MR Linac improve efficiency? J Med Imaging Radiat Sci 2022; 53:S44-S50. [PMID: 34922879 PMCID: PMC9716003 DOI: 10.1016/j.jmir.2021.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/27/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Palliative radiotherapy (RT) is effectively used to relieve cancer related symptoms. The demand for these services is increasing worldwide. Rapid response clinics have been developed as a means to streamline the palliative RT radiotherapy process and increase efficiency and improve patient experiences. Key components to successful rapid response palliative RT are access to care, streamlined services and innovation. To successfully implement a rapid response RT programme, it is essential to identify gaps between currently provided care and ideal or enhanced care. The aims of this work are to audit the current palliative RT workflow at our institution both prior to and during the coronavirus pandemic. This work reports the impact of covid-19 on rate of palliative RT referrals and proposes a radiographer led, MR guided rapid response workflow to reduce wait times METHODS: A retrospective audit of palliative radiotherapy booking forms was completed over a two yearperiod (2019-2020) to assess the current pathway both prior to and during the covid-19 pandemic. This audit identified patients who had received urgent/emergency spinal RT in the specified timeframe. Further data on these patients was collected using departmental oncology information systems to form a detailed analysis of the pathway and wait times. Data was recorded and analysed using Microsoft Excel. RESULTS A total of 813 patients met the inclusion criteria for this audit. Data was reported for 2019 and 2020 separately to determine any significant impact caused by the covid-19 pandemic. In 2020 there was an 11.5% increase in referrals for palliative radiotherapy with an equal portion (81%) of total referrals in each year being for single fractions. Timelines from referral to treatment delivery were reported, with those patients receiving same day single fraction RT palliative radiotherapy undergoing further analysis to determine the amount of time spent in the department. Mean wait time for these patients was 5 hours and 20 minutes in 2019 but increased by 20.9% in 2020. CONCLUSIONS The increasing demand for palliative RT due to rising global cancer rates and extended life expectancy due to advanced systemic treatments may lead to increased wait times. An increase in both referrals and mean wait time was seen during the covid-19 pandemic. Improving efficiency and access to care is essential for this population. The MR Linac could play a role in streamlining palliative RT workflows due to its ability to employ a scan, plan and treat model in a single session. This work forms preliminary support for the development of a trial one stop palliative program on the MR Linac.
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Affiliation(s)
- Rebecca Benson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Abigael Clough
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Claire Nelder
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Eleanor Pitt
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Robin Portner
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Maria Vassiliou
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lisa McDaid
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Agata Rembielak
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Cynthia Eccles
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
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McGahan BG, Hatef J, Shaikhouni A, Leonard J, Grossbach AJ, Lonser RR, Powers CJ. Resident Night Float or 24-hour Call Hospital Coverage: Impact on Training, Patient Outcome, and Length of Stay. J Surg Educ 2022; 79:732-739. [PMID: 34866033 DOI: 10.1016/j.jsurg.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The impact of neurosurgical resident hospital coverage system, performed via a night float (12-hour shifts overnight) or a 24-hour call, on neurological surgery resident training and patient care is unknown. DESIGN Retrospective review comparing night float and 24-hour call coverage on trainee surgical experience, elective time, annual program surveys, patient outcomes, and length of stay. SETTING The Ohio State Wexner Medical Center Neurosurgery residency program, Columbus, Ohio. PARTICIPANTS The neurosurgical residents from 2016 to 2019. RESULTS Monthly cases performed by junior residents significantly increased after transitioning to a 24-hour call schedule (18 versus 30, p < 0.001). There were no differences for total cases among program graduates during this time (p = 0.7). Trainee elective time significantly increased after switching to 24-hour call coverage (18 versus 24 months after the transition; p = 0.004). Risk-adjusted mortality and length of stay indices were not different (0.5 versus 0.3, p = 0.1; 0.9 versus 0.9; p = 0.3). Program surveys had minimal change after the transition to 24-hour call. CONCLUSIONS Transitioning from a night float to a 24-hour call coverage system led to improved junior resident case volume and elective time without detrimental effect on patient-related outcomes.
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Affiliation(s)
- Ben G McGahan
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Jeffrey Hatef
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ammar Shaikhouni
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey Leonard
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Andrew J Grossbach
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Russell R Lonser
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ciaran J Powers
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Kling SM, Raman S, Taylor GA, Philp MM, Poggio JL, Dauer ED, Oresanya LB, Ross HM, Kuo LE. Trends in General Surgery Resident Experience with Colorectal Surgery: An Analysis of the Accreditation Council for Graduate Medical Education Case Logs. J Surg Educ 2022; 79:632-642. [PMID: 35063391 DOI: 10.1016/j.jsurg.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/29/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Colorectal surgery is a core component of general surgery. The volume of colorectal surgery performed by general surgery residents throughout training has not been studied. This study aims to analyze trends observed in colorectal-specific case numbers logged by general surgery residents over 16 years. DESIGN Case number data for general surgery residents was extracted from the publicly available, annually published Accreditation Council for Graduate Medical Education (ACGME) database from 2003 to 2019. Cases were categorized as open or laparoscopic colectomy/proctectomy, colectomy with ileoanal pull-thru, abdomino-perineal resection (APR), transanal rectal tumor excision (TRE), anorectal procedure, colonoscopy, and total colorectal cases. The average case numbers per category was calculated for each year. Linear regression analyzed trends in case categories for all residents and those logged as surgeon chief and junior residents. SETTING ACGME accredited general surgery residency programs. PARTICIPANTS Not applicable. RESULTS General surgery residents reported increased numbers of all, chief, and junior resident colorectal cases over the study period (124.5-173.7 cases/yr; 38.4-53.0 cases/yr; 86.4-120.6 cases/yr, all p = 0.00). Average cases for all, chief, and junior residents have increased for laparoscopic colectomy/proctectomy (4.6-26.4 cases/year; 2.7-12.9 cases/year; 2.0-13.5 cases/year, all p = 0.00), anorectal surgeries (26.7-37.7 cases/year; 5.4-9.9 cases/year; 21.3-27.8 cases/year, all p = 0.00), and colonoscopies (35.9-70.6 cases/year, p = 0.00; 6.6-14.1 cases/year, p = 0.01; 29.4-56.5 cases/year, p = 0.00). Average cases for all, chief, and junior residents have decreased for open colectomy/proctectomy (52.0-34.9 cases/year; 21.2-14.3 cases/year; 30.9-20.6 cases/year, all p = 0.00), APR (3.3-2.7 cases/year, p = 0.00; 1.8-1.3 cases/year, p = 0.00; 1.5-1.4 cases/year, p = 0.02), TRE (1.9-1.1 cases/year; 0.7-0.4 cases/year; 1.2-0.6 cases/year, all p = 0.00). Ileoanal pull-thru did not demonstrate a linear trend. CONCLUSIONS The increase in exposure to colectomies/proctectomies, anorectal procedures and colonoscopies is encouraging, as these common colorectal operations will be encountered in general surgery practice. The observed low case numbers for TRE, APR, and ileoanal pull-thru suggest a need for specialized training.
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Affiliation(s)
- Sarah M Kling
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Swathi Raman
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - George A Taylor
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Matthew M Philp
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Juan Lucas Poggio
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Elizabeth D Dauer
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Lawrence B Oresanya
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Howard M Ross
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Lindsay E Kuo
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
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Esposito AC, Coppersmith NA, White EM, Yoo PS. Video Coaching in Surgical Education: Utility, Opportunities, and Barriers to Implementation. J Surg Educ 2022; 79:717-724. [PMID: 34972670 DOI: 10.1016/j.jsurg.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This review discusses the literature on Video-Based Coaching (VBC) and explores the barriers to widespread implementation. DESIGN A search was performed on Scopus and PubMed for the terms "operation," "operating room," "surgery," "resident," "house staff," "graduate medical education," "teaching," "coaching," "assessment," "reflection," "camera," and "video" on July 27, 2021, in English. This yielded 828 results. A single author reviewed the titles and abstracts and eliminated any results that did not pertain to operative VBC or assessment. All bibliographies were reviewed, and appropriate manuscripts were included in this study. This resulted in a total of 52 manuscripts included in this review. SETTING/PARTICIPANTS Original, peer-reviewed studies focused on VBC or assessment. RESULTS VBC has been both subjectively and objectively found to be a valuable educational tool. Nearly every study of video recording in the operating room found that subjects, including surgical residents and seasoned surgeons alike, overwhelmingly considered it a useful, non-redundant adjunct to their training. Most studies that evaluated skill acquisition via standardized assessment tools found that surgical residents who underwent a VBC program had significant improvements compared to their counterparts who did not undergo video review. Despite this evidence of effectiveness, fewer than 5% of residency programs employ video recording in the operating room. Barriers to implementation include significant time commitments for proposed coaching curricula and difficulty with integration of video cameras into the operating room. CONCLUSIONS VBC has significant educational benefits, but a scalable curriculum has not been developed. An optimal solution would ensure technical ease and expediency, simple, high-quality cameras, immediate review, and overcoming entrenched surgical norms and culture.
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Affiliation(s)
- Andrew C Esposito
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut
| | | | - Erin M White
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut
| | - Peter S Yoo
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut.
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Liddy C, Singh J, Mitchell R, Guglani S, Keely E. How One eConsult Service Is Addressing Emerging COVID-19 Questions. J Am Board Fam Med 2022; 35:601-4. [PMID: 35641045 DOI: 10.3122/jabfm.2022.03.210264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has made innovative solutions to providing safe, effective care paramount. eConsult allows primary care providers to access specialist advice for their patients without necessitating an in-person visit. This study aims to explain how an eConsult service adapted to providing care for COVID-19 patients and examine its impact on patient care. METHODS We conducted a cross-sectional analysis of cases submitted to COVID-19 specialties through the Ontario eConsult service between October 2020 and April 2021. Utilization data were extracted from all eligible cases to assess number of cases submitted, patterns of use, response times, and case outcomes (ie, whether eConsult resulted in new or additional information, whether or not a referral was needed). RESULTS 2783 eConsults were submitted to 5 COVID-19 specialty groups during the study period. 71% of the cases were for vaccine-related questions. The median response interval was 12 hours. Providers received advice for a new or additional course of action in 36% of cases. 84% of the cases did not require a referral. CONCLUSIONS Our study demonstrated the effectiveness of rapidly adapting eConsult for COVID-19 care and supports similar action for other services.
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Warshawsky NE, Cramer E, Grandfield EM, Schlotzhauer AE. The influence of nurse manager competency on practice environment, missed nursing care, and patient care quality: A cross-sectional study of nurse managers in U.S. hospitals. J Nurs Manag 2022; 30:1981-1989. [PMID: 35474621 DOI: 10.1111/jonm.13649] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
Abstract
AIMS Identify and examine drivers of nurse manager competency and high-quality practice environments. BACKGROUND Nurse managers are a key predictor of positive professional practice environments which are, in turn, associated with nurse, patient, and organizational outcomes. However, little work has examined the factors that contribute to nurse manager competency. METHODS Nurse managers completed online surveys which were matched to unit-level aggregate data of their subordinate direct care nurses' responses on the National Database of Nursing Quality Indicators. This resulted in a final sample of 541 nurse managers across 47 U.S. hospitals. Multilevel path analysis was utilized to assess a model of the antecedents and consequences of nurse manager competency. RESULTS Nurse manager competency and practice environments were predictive of missed nursing care and nurse-reported quality of care. Nurse manager experience was found to have twice the effect on competency as advanced education. CONCLUSIONS Nurse manager competency and its downstream effects are achieved through nurse manager experience and advanced education. IMPLICATIONS FOR NURSING MANAGEMENT Nurse manager competency yields better practice environments and nursing care. Considering the influence of experience, careful attention should be paid to the competency development process of more novice nurse managers.
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Affiliation(s)
| | - Emily Cramer
- Research Faculty, Health Services and Outcomes Research, Children's Mercy Kansas City.,Associate Professor, School of Medicine, University of Missouri-, Kansas City
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Olumolade OO, Rollins PD, Daignault-Newton S, George BC, Kraft KH. Closing the Gap: Evaluation of Gender Disparities in Urology Resident Operative Autonomy and Performance. J Surg Educ 2022; 79:524-530. [PMID: 34782271 DOI: 10.1016/j.jsurg.2021.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/05/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Gender disparities have demonstrated influence on several areas of medical trainee academic performance and surgeon professional attainment. The impact of gender on perceived operative autonomy and performance of urology residents is not well understood. This single-institution pilot study explores this relationship by evaluating urology faculty and resident assessment of resident operative autonomy and performance using the Society for Improving Medical Professional Learning app. DESIGN Using Society for Improving Medical Professional Learning, trainees in a single urology residency program were assessed in operative cases on three scales (autonomy, performance, and case complexity). Intraoperative assessments were completed by both faculty and residents (self-evaluation). Respective evaluations were compared to explore differences in ratings by gender. SETTING University of Michigan Health, Ann Arbor, MI. PARTICIPANTS University of Michigan Urology Residents and Faculty. RESULTS A total of 516 evaluations were submitted from 18 urology residents and 20 urology faculty. Self-reported ratings among female and male residents did not differ significantly for autonomy (p = 0.20) or performance (p = 0.82). Female and male residents received overall similar autonomy ratings that were not significantly different from female faculty (p = 0.66) and male faculty (p = 0.81). For female residents, there was no significant difference in performance ratings by faculty gender (p = 0.20). This finding was consistent when the resident was male (p = 0.70). CONCLUSIONS At our institution, there is no overall gender-based difference in self-rated or faculty-rated operative autonomy or performance among urology trainees. Understanding relevant facets of institutional culture as well as educational strategies between faculty and residents may identify factors contributing to this outcome.
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Affiliation(s)
| | - Paris D Rollins
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, Michigan.
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Ji YD, McKinley SK, Farrell M, Hemingway M, Qadan M, Saillant N, Phitayakorn R. Operating Room Staff Perceptions of Medical Students. J Surg Educ 2022; 79:370-382. [PMID: 34876370 DOI: 10.1016/j.jsurg.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/27/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE While the operating room (OR) is a keystone experience, medical students often report negative experiences and intimidation in the OR. The purpose of this study is to describe the perceived role of medical students in the OR by registered nurses and certified surgical technologists to improve medical student education. DESIGN A cross-sectional survey of select Massachusetts General Hospital perioperative staff in surgery was conducted through an anonymous survey in March 2021. Statistical analysis included inductive thematic analysis, descriptive statistics, and Mann-Whitney U tests, with a p-value of <0.05. The survey instrument characterized the perception of medical student preparedness for OR-related tasks and free-text responses on the role of medical students in the OR and opportunities for improvement. SETTING The study was conducted at the Massachusetts General Hospital, Boston, MA. PARTICIPANTS Participants included Massachusetts General Hospital perioperative staff in the Department of Surgery, with 262 registered nurses and 90 certified surgical technologists receiving the survey. RESULTS There were 86 completed responses (24.4% response rate). A total of 71.23% of respondents believe medical students should be observational learners in the OR. Areas for improvement include OR etiquette (37.5%), awareness of the surgical field (26.79%), and scrubbing skills (26.79%). A total of 48.8% of staff agreed they enjoy working with medical students, followed by 20.9% who somewhat agree. A total of 27.91% of respondents somewhat agreed that medical students were knowledgeable about OR sterility and scrubbing procedures, followed by 25.58% who somewhat disagreed. CONCLUSIONS Operating room staff enjoy working with medical students. The majority of staff believe medical students' role in the OR is that of observational learning. Areas of improvement for medical students include OR etiquette, awareness of the surgical field, scrubbing and gowning skills, and assisting staff whenever needed. Possible solutions include incorporating nursing staff as surgery clerkship stakeholders to optimize medical student experiences in the OR.
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Affiliation(s)
- Yisi D Ji
- Harvard Medical School, Boston, Massachusetts.
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Farrell
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Maureen Hemingway
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Bamdad MC, Vitous CA, Rivard SJ, Anderson M, Lussiez A, Jafri SM, Roo AD, Suwanabol PA. "You Remember Those Days"-A Qualitative Study of Resident Surgeon Responses to Complications and Deaths. J Surg Educ 2022; 79:452-462. [PMID: 34756685 PMCID: PMC10249722 DOI: 10.1016/j.jsurg.2021.09.011] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/04/2021] [Accepted: 09/16/2021] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Postoperative complications and deaths are unavoidable aspects of a surgical career, but little is known about the impacts of these unwanted outcomes on resident surgeons. The goal of this study was to characterize the impact of complications and deaths on surgery residents in order to facilitate development of improved support systems. DESIGN This qualitative study was designed to explore resident surgeons' experiences with unwanted outcomes, including postoperative complications and death. Semi-structured interviews explored a range of topics related to personal experiences with unwanted outcomes. Analyses of interview transcripts were performed iteratively and informed by thematic analysis. SETTING An anthropologist at the University of Michigan conducted interviews with general surgery residents from academic, community, and hybrid training programs across the country. PARTICIPANTS Twenty-eight mid-level and senior residents (PGY3 and above) were recruited for participation from 14 different training programs across the United States. RESULTS Resident surgeons described an initial period of emotional response, characterized by feelings of sadness, frustration, or grief. Simultaneously or soon afterward, interviewees described a period of intellectual response aimed at understanding how and why an outcome occurred, with the expressed goal of learning from it. Many residents described impacts to their personal lives. Several factors that influenced the duration and intensity of these responses were identified, including a sense of ownership, which was a powerful driver for improvement. CONCLUSIONS This qualitative study provides a nuanced description of resident surgeons' responses to unwanted outcomes. While emotional responses were characterized by strong feelings, such as sadness and grief, intellectual responses were focused on learning from the events. These data may help inform the development of structured support systems by residency programs. STRUCTURED ABSTRACT Facing post-operative complications and deaths is an unavoidable aspect of surgical training, but the impacts on surgery residents has not been well characterized. Through semi-structured interviews with general surgery residents from programs across the United States, this qualitative study explored the ways that residents respond to unwanted outcomes. Residents described an initial period of emotional response, characterized by strong feelings, often of sadness or grief. There was a subsequent or concomitant period of intellectual response, in which residents examined how and why this outcome occurred, with the goal of learning from it. A feeling of ownership was strengthened by involvement in patient care and length of rotation. In light of this detailed description of resident experiences, residency programs can foster the development of improved support for trainees as they navigate these profoundly impactful events.
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Affiliation(s)
- Michaela C Bamdad
- Center for Health care Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - C Ann Vitous
- Center for Health care Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Samantha J Rivard
- Center for Health care Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Maia Anderson
- Center for Health care Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alisha Lussiez
- Center for Health care Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sara M Jafri
- Center for Health care Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Ana De Roo
- Center for Health care Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Pasithorn A Suwanabol
- Center for Health care Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Mayoral E, Ravé R, Rodriguez de Vera P, Rojo-Martinez G, Olveira G, Aguilar-Diosdado M, León-Justel A, Martinez-Brocca MA. Temporal trends in hospitalizations due to diabetes complications during COVID-19 pandemic in Andalusia, Spain. BMJ Open Diabetes Res Care 2022; 10:10/2/e002623. [PMID: 35351686 PMCID: PMC8965863 DOI: 10.1136/bmjdrc-2021-002623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/06/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Eduardo Mayoral
- Plan Integral de Diabetes de Andalucía, D.G. de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y Familias, Sevilla, Spain
| | - Reyes Ravé
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Pablo Rodriguez de Vera
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Gemma Rojo-Martinez
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga/Universidad de Málaga, Instituto de Investigación Biomédica de Málaga. CIBERDEM, CIBER de Diabetes y Enfermedades Metabólicas asociadas, Málaga, Spain
| | - Gabriel Olveira
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga/Universidad de Málaga, Instituto de Investigación Biomédica de Málaga. CIBERDEM, CIBER de Diabetes y Enfermedades Metabólicas asociadas, Málaga, Spain
| | | | - Antonio León-Justel
- Servicio de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Maria Asuncion Martinez-Brocca
- Plan Integral de Diabetes de Andalucía, D.G. de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y Familias, Sevilla, Spain
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Sullivan EE, Breton M, McKinstry D, Phillips RS. COVID-19's Perceived Impact on Primary Care in New England: A Qualitative Study. J Am Board Fam Med 2022; 35:265-73. [PMID: 35379714 DOI: 10.3122/jabfm.2022.02.210317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/07/2021] [Accepted: 12/21/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND COVID-19 impacted primary care delivery, as clinicians and practices implemented changes to respond to the pandemic while safely caring for patients. This study aimed to understand clinicians' perceptions of the positive and negative impacts of COVID-19 on primary care in New England. METHODS This qualitative interview study was conducted from October through December 2020. Participants included 22 physicians and 2 nurse practitioners practicing primary care in New England. Data were thematically coded and analyzed deductively and inductively using content analysis. RESULTS Through qualitative content analysis, 4 areas were identified in which clinicians perceived that COVID-19 impacted primary care: 1) bureaucracy, 2) leadership, 3) telemedicine and patient care, and 4) clinician work-life. Our findings suggest that the positive impacts of COVID-19 included changes in primary care delivery, new leadership opportunities for clinicians, flexible access to care for patients via telemedicine, and a better work-life balance for clinicians. Respondents identified negative impacts related to sustaining pandemic-inspired changes, the inability for some populations to access care via telemedicine, and the rapid implementation of telemedicine causing frustration for clinicians. CONCLUSIONS Understanding clinician perspectives on how primary care transformed to respond to COVID-19 helps to identify beneficial pandemic-related changes that should be sustained and ideas for improvement that will support patient care and clinician engagement.
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Oatis C, Franklin P. On "Phase III Trials of Enhanced Versus Usual Care Physical Therapy for Patients at Risk for Poor Outcomes Following Knee Arthroplasty: A Perspective on Meaning and a Way Forward." Riddle DL, Hamilton DF, Dumenci L, Beard DJ. Phys Ther. 2021;101:pzab186. https://doi.org/10.1093/ptj/pzab186. Phys Ther 2022; 102:6504778. [PMID: 35023561 DOI: 10.1093/ptj/pzab276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Carol Oatis
- Department of Physical Therapy, Arcadia University, Glenside, PA 19038, USA
| | - Patricia Franklin
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Lake ET, Riman KA, Lee C. The association between hospital nursing resource profiles and nurse and patient outcomes. J Nurs Manag 2022; 30:836-845. [PMID: 35106865 PMCID: PMC8989670 DOI: 10.1111/jonm.13553] [Citation(s) in RCA: 2] [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] [Received: 10/30/2021] [Revised: 01/12/2022] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
Abstract
AIMS To identify and describe profiles of nursing resources and compare nurse and patient outcomes among the identified nursing resource profiles. BACKGROUND Research linking nurse education, staffing, and the work environment treats these nursing resources as separate variables. Individual hospitals exhibit distinct profiles of these resources. METHODS This cross-sectional secondary analysis used 2006 data from 692 hospitals in four states. Latent class mixture modeling was used to identify resource profiles. Regression models estimated the associations among the profiles and outcomes. RESULTS Three profiles were identified (better, mixed, and poor) according to their nursing resource levels. Hospitals with poor profiles were disproportionately mid-sized, not-for-profit, non-teaching, urban, and had lower technology capability. Nurse job outcomes, patient mortality and care experiences were significantly improved in hospitals with better resource profiles. CONCLUSIONS Hospitals exhibit distinct profiles of nursing resources that reflect investments into nursing. Nurse and patient outcomes and patients' experiences are improved in hospitals with better nursing resource profiles. This finding is consistent with the literature that has examined these resources independently. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers can identify their nursing resource profile and the associated outcomes. Our results show the advantages of improving one's hospital nursing resource profile, motivating managers to make an informed decision regarding investments in nursing resources.
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Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes and Policy Research, Professor of Nursing and Sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, US
| | - Kathryn A Riman
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, US
| | - Christopher Lee
- Boston College William F. Connell School of Nursing 140 Commonwealth Avenue, Chestnut Hill, MA, US
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Thompson R, Haws J, Rhodus NL, Ondrey FG. Patients with oral preneoplastic lesions and integration of dental pathology referrals. Am J Otolaryngol 2022; 43:103270. [PMID: 34757252 PMCID: PMC8670077 DOI: 10.1016/j.amjoto.2021.103270] [Citation(s) in RCA: 2] [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] [Received: 09/07/2021] [Accepted: 10/14/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Oral cancers lack standardized monitoring systems. Our institution has developed an active surveillance system which provides detailed monitoring and follow up of patients with oral preneoplastic lesions (OPL). We examined a historic cohort of patients with OPL seen by regional dental professionals and a current cohort of clinic patients. The major aim was to examine follow up practices for biopsy proven dysplasia to gauge appropriateness of an active monitoring system for oral carcinoma. MATERIALS AND METHODS Questionnaires regarding patients with OPL were sent to 285 dentists who had requested oral pathology services from our institution. The follow up practices of 141 dentists were evaluated for patients with OPL. We then examined our current clinic referral patterns for the number of dental referrals after the creation of an oral carcinoma active surveillance clinic. RESULTS There were 76.5% (108/141) of patients who received follow up after diagnosis of preneoplastic oral lesions with 14.1% who underwent repeat biopsy. There was a malignant transformation rate of 11.3% including transformation of 42.8% of severe dysplasias into carcinoma within 2 years. After establishment of a dental referral clinic, 21.8% of tumor visits in a six-week period were referred from the regional dental community. CONCLUSIONS A high rate of transformation of OPL to cancer in this cohort may support a role for joint dental and otolaryngology surveillance of dysplasia with longitudinal follow up.
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Affiliation(s)
- Rachel Thompson
- Department of Otolaryngology – Head and Neck Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, Minnesota 55455, USA
| | - Jayson Haws
- Department of Diagnostic and Biological Sciences, University of Minnesota, 515 Delaware St SE, Minneapolis, Minnesota 55455, USA
| | - Nelson L. Rhodus
- Department of Diagnostic and Biological Sciences, University of Minnesota, 515 Delaware St SE, Minneapolis, Minnesota 55455, USA
| | - Frank G. Ondrey
- Department of Otolaryngology – Head and Neck Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, Minnesota 55455, USA
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Jackson TN, Wheeler TP, Truitt MS, Nelson PR, Kempe K. Recruitment of General Surgery Residents into Vascular Surgery. J Surg Educ 2022; 79:165-172. [PMID: 34301522 DOI: 10.1016/j.jsurg.2021.07.001] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Vascular surgery fellowship applications among general surgery residents have declined. Given this steady downward trend in vascular applicants in conjunction with a predicted critical shortage of vascular surgeons, a call to action for increased recruitment is needed. To improve recruitment efforts, a subgroup analysis of general surgery residents was performed to explore factors that influence interest in vascular surgery. METHODS A cross-sectional national survey of residents (n = 467) was conducted from September 2016 to May 2017. In addition to collection of demographic and occupational characteristics, assessment of psychological, work-life balance, and job-satisfaction variables were obtained. Residents were grouped based on their interest in pursuing a fellowship. Chi-squared and Fisher's exact test was performed to determine significant variables. RESULTS Residents were grouped into "interest in non-vascular fellowship" (n = 350), "interest in vascular fellowship" (n = 21), and "not interested in fellowship" (n = 96). Significant variables between the groups included age, geographic location, residency size, and type of institution (p < 0.05). Those interested in vascular surgery tended to be older. Residents not interested in fellowship were more commonly located in the Midwest and at smaller, community residencies. No significant difference was found between mental wellness and work-life balance variables. Those residents interested in a vascular surgery fellowship were more dissatisfied with their current salary as compared to other residents (p = 0.021). CONCLUSIONS There is a predicted critical shortage in the vascular surgery workforce making recruitment of the best and brightest residents into the specialty vital to its future. In order to invigorate and broaden our group of vascular surgeons, focused recruitment of younger, Midwest, general surgery residents at smaller, community programs may provide the most yield. Publicizing the strengths of a vascular surgery career including the diversity of patients, continuity of care, proficiency in technical skill, and higher monetary rewards should be emphasized in recruiting these target populations.
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Affiliation(s)
- Theresa N Jackson
- Department of General Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma
| | - Tiffany P Wheeler
- Department of General Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma
| | - Michael S Truitt
- Department of Trauma Surgery, Methodist Dallas Medical Center, Dallas, Texas
| | - Peter R Nelson
- Department of Vascular Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma
| | - Kelly Kempe
- Department of Vascular Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma.
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Eden AR, Bazemore A, Morgan ZJ, Jabbarpour Y. Family Physicians Increasingly Deliver Care in Diverse Languages. J Am Board Fam Med 2022; 35:5-6. [PMID: 35039405 DOI: 10.3122/jabfm.2022.01.210190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/08/2022] Open
Abstract
The proportion of family physicians reporting provision of patient care in Spanish changed little between 2013 to 2020 but rose substantially for care delivered in other non-English languages. Physician-patient language concordance is associated with better clinical outcomes and higher patient satisfaction, serves as a proxy indicator for workforce diversity, and should be monitored and encouraged as the US population continues to diversify.
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Halonen LM, Stenroos A, Vasara H, Kosola J. Intramedullary Fixation of Trochanteric Fractures Can Be Safely Performed by Senior Residents Without Immediate Consultant Supervision. J Surg Educ 2022; 79:260-265. [PMID: 34301521 DOI: 10.1016/j.jsurg.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/16/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the safety of senior residents performing trochanteric hip fracture surgery without immediate consultant supervision DESIGN: A retrospective chart review of trochanteric hip fractures (AO-OTA 31-A) operated in a single center between years 2011 and 2016 (inclusive). Operations were divided into three groups: Group 1 - surgeon was a senior resident without any immediate supervision; Group 2 - surgeon was a consultant and Group 3 - surgeon was a senior resident supervised by a consultant. The follow-up period was a minimum of 2 years or until death. All re-operations and surgical related mortality were assessed. SETTING Helsinki University Hospital, Finland. A tertiary level trauma center. PARTICIPANTS 987 consecutive trochanteric fractures on 966 patients treated by operative fixation of an intertrochanteric fracture with an intramedullary nail between 2011and 2016 (inclusive). RESULTS The total number of reoperations was smaller in Group 1 where the surgeon was a senior resident without any immediate supervision compared to Group 2 where the surgeon was a consultant (5.5 % vs 8.8 %, p < 0.05). There were no significant differences in mortality or length of surgery. The total rate of mechanical complications was 2.0 %, with no significant differences between groups. The observed blade cut-out rate was low: 1.3 %, suggesting a good overall quality of surgery. CONCLUSIONS Senior residents can safely perform intramedullary nailing of trochanteric fractures without immediate supervision.
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Affiliation(s)
- Lauri M Halonen
- South Karelia Central Hospital, Department of Orthopedics and Traumatology, and University of Helsinki, Lappeenranta, Finland.
| | - Antti Stenroos
- Helsinki University Hospital, Department of Orthopedics and Traumatology, and University of Helsinki, Helsinki, Finland
| | - Henri Vasara
- Helsinki University Hospital, Department of Orthopedics and Traumatology, and University of Helsinki, Helsinki, Finland
| | - Jussi Kosola
- Kanta-Häme Central Hospital, Department of Orthopedics and Traumatology, Hämeenlinna, Finland
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Guerin J, Engelmann A, Mattamana M, Borgelt L. Use of Hormonal Contraceptives in Perimenopause: A Systematic Review. Pharmacotherapy 2021; 42:154-164. [PMID: 34967466 DOI: 10.1002/phar.2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/09/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Hormonal contraceptives have been used in perimenopausal women to manage a variety of symptoms and prevent unintended pregnancy. However, it is unclear what contraceptive regimen is best for these women. OBJECTIVE To evaluate hormonal contraceptive methods in women experiencing perimenopause using two prespecified outcomes: perimenopausal symptom management and long-term effects. METHODS A literature search of PubMed and EMBASE databases was performed (January 1990 to October 2021) using search terms "perimenopause" and "contraception." Relevant full-text articles in English were included. RESULTS Fifteen clinical articles were reviewed. Fourteen were internationally-based and one study was conducted in the United States. Nine articles evaluated symptom resolution, and six of these nine reported statistically significant changes in favor of treating perimenopausal women with hormonal contraceptives compared with no treatment. Seven studies evaluated long-term outcomes including bone loss and metabolic parameters, and six of these seven showed statistically significant improvements with hormonal contraceptives. Based on limited data and a lack of comparative studies, the use of a levonorgestrel intrauterine device with supplemental low-dose menopausal estrogen has positive results for the management of disruptive perimenopausal symptoms and long-term outcomes. CONCLUSION Hormonal contraception in perimenopausal women improves symptom management and long-term outcomes if patients do not have contraindications. When selecting a contraceptive for women in perimenopause, clinicians and pharmacists need to address specific patient risk factors, symptom profiles, long-term risks and benefits, and patient preferences.
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Affiliation(s)
- Julie Guerin
- University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy, Aurora, Colorado, USA
| | - Alexandra Engelmann
- The University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy, Aurora, Colorado, USA.,Present address: Superior Compounding Pharmacy, Plymouth, Michigan, USA
| | - Meena Mattamana
- The University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy, Aurora, Colorado, USA
| | - Laura Borgelt
- University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy, 12850 E. Montview Blvd. Box C238, Aurora, CO, 80045, USA
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Douglas AD, Zaidi MY, Maatman TK, Choi JN, Meagher AD. Caring for Incarcerated Patients: Can it Ever be Equal? J Surg Educ 2021; 78:e154-e160. [PMID: 34284945 DOI: 10.1016/j.jsurg.2021.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/27/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Incarcerated patients represent one of the most vulnerable populations in the United States healthcare system. Studying disparities in care they receive, however, has been difficult due to a history of abuse at the hands of medical researchers rendering this population excluded from most current medical research. Due to incarceration, these patients are frequently maintained in shackles and under constant guard when receiving healthcare. There is a paucity of literature on the influence these measures exert on healthcare workers and the care they provide. Our study aimed to measure surgical trainee's perception of health inequities and disparities in incarcerated individuals undergoing surgical care. METHODS An anonymous cross-sectional survey was administered at our single institution to all general surgery trainees assessing perceptions in delivering care to incarcerated patients within our hospital system. The survey consisted of 10 items, nine of which were yes or no responses, and 1 open-ended text question. Survey results were averaged, and percentages were reported. RESULTS Of all current general surgery residents (n = 60), 40 (66%) completed the survey. Almost all respondents (n = 39, 97.5%) have cared for a patient that was incarcerated or in police custody. Most respondents (n = 25, 62.5%) have operated on an incarcerated patient with an armed guard present in the operating room. Similarly, most respondents (n = 26, 65%) have cared for a patient intubated and sedated that was shackled to a bed. The majority of respondents (n = 30, 75%) recalled incidents where a trauma patient was actively questioned by law enforcement during the primary/secondary survey during initial trauma evaluation. At the time of hospital discharge, a quarter (n = 10, 25%) of respondents reported being unable to prescribe all of the medications that a non-imprisoned patient would receive with the same condition. In addition, 18 (45%) respondents felt they were unable to arrange outpatient follow-up with physical or occupational therapy and/or the patient's primary/consulting physician due to patient's incarcerated status. Strikingly, half of respondents (n = 19, 47.5%) believed that the incarcerated patient received substandard care, and the majority of respondents (n = 28, 72%) agreed that the holding areas for incarcerated patients in the emergency room provide substandard patient care. CONCLUSIONS The current status of caring for incarcerated patients within our system represents an urgent and needed area for quality improvement. Surgical trainees report difficulty caring for these patients, and they perceive these individuals receive substandard care. Though our cross-sectional study did not assess the origin of this disparity, the challenges trainees face in caring for incarcerated patients, from assessment to diagnosis and treatment, as well as in follow-up signals an area requiring further research and study.
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Affiliation(s)
| | - Mohammad Y Zaidi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`
| | - Thomas K Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`
| | - Jennifer N Choi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`
| | - Ashley D Meagher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`.
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Abbott KL, George BC, Sandhu G, Harbaugh CM, Gauger PG, Ötleş E, Matusko N, Vu JV. Natural Language Processing to Estimate Clinical Competency Committee Ratings. J Surg Educ 2021; 78:2046-2051. [PMID: 34266789 DOI: 10.1016/j.jsurg.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/21/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Residency program faculty participate in clinical competency committee (CCC) meetings, which are designed to evaluate residents' performance and aid in the development of individualized learning plans. In preparation for the CCC meetings, faculty members synthesize performance information from a variety of sources. Natural language processing (NLP), a form of artificial intelligence, might facilitate these complex holistic reviews. However, there is little research involving the application of this technology to resident performance assessments. With this study, we examine whether NLP can be used to estimate CCC ratings. DESIGN We analyzed end-of-rotation assessments and CCC assessments for all surgical residents who trained at one institution between 2014 and 2018. We created models of end-of-rotation assessment ratings and text to predict dichotomized CCC assessment ratings for 16 Accreditation Council for Graduate Medical Education (ACGME) Milestones. We compared the performance of models with and without predictors derived from NLP of end-of-rotation assessment text. RESULTS We analyzed 594 end-of-rotation assessments and 97 CCC assessments for 24 general surgery residents. The mean (standard deviation) for area under the receiver operating characteristic curve (AUC) was 0.84 (0.05) for models with only non-NLP predictors, 0.83 (0.06) for models with only NLP predictors, and 0.87 (0.05) for models with both NLP and non-NLP predictors. CONCLUSIONS NLP can identify language correlated with specific ACGME Milestone ratings. In preparation for CCC meetings, faculty could use information automatically extracted from text to focus attention on residents who might benefit from additional support and guide the development of educational interventions.
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Affiliation(s)
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Paul G Gauger
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Erkin Ötleş
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Niki Matusko
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Lund S, Hinduja P, Stulak J, Elli E, Mishra N, Farres H, Rivera M. Impact of Elective Case Postponement Secondary to COVID-19 on General Surgery Residents' Experience: Operative Cases Logged at Three Academic Teaching Hospitals. J Surg Educ 2021; 78:1863-1867. [PMID: 34120880 PMCID: PMC8635496 DOI: 10.1016/j.jsurg.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aims to characterize changes in the total operative cases logged by general surgery residents across three residency programs. DESIGN Retrospective cohort study. De-identified case logs, divided by institution and post graduate year (PGY) level, were obtained from the general surgery training programs at three academic hospitals. Total cases logged were calculated over the pandemic period (start: beginning of residency, end: May 31st, 2020) and the control period (start: beginning of residency, end: May 31st, 2019). SETTING Three academic tertiary hospitals (Mayo Clinic - Arizona, Mayo Clinic - Florida, and Mayo Clinic - Rochester) PARTICIPANTS: All general surgery residents at these three hospitals, including 25 residents at Mayo Clinic - Arizona in both the pandemic and control period, 16 and 15 residents at Mayo Clinic - Florida in the control and pandemic period, respectively, and 81 and 77 residents at Mayo Clinic - Rochester in the control and pandemic period, respectively. RESULTS Only PGY 4 general surgery residents at Mayo Clinic - Rochester had a decrease in operative cases logged in the pandemic period (759 cases on average compared to 1010 cases, p = 0.005), with no other changes in operative cases logged noted. CONCLUSIONS While elective cases were postponed secondary to the COVID-19 pandemic for around 1 month in the spring of 2020, the decrease in elective cases did not greatly impact overall resident operative cases logged for residents in three general surgery residency programs.
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Affiliation(s)
- Sarah Lund
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Pranav Hinduja
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Enrique Elli
- Department of General Surgery, Mayo Clinic, Jacksonville, Florida
| | - Nitin Mishra
- Department of Colon and Rectal Surgery, Mayo Clinic, Phoenix, Arizona
| | - Houssam Farres
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mariela Rivera
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota.
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Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K, Nurko S, Ruddy J, Snyder J, Sperber A. A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology 2021; 161:1670-1688.e7. [PMID: 34331912 DOI: 10.1053/j.gastro.2021.07.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 03/31/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited. METHODS The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR. RESULTS Evidence supports the fact that interventions targeting patient-provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. CONCLUSIONS We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.
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Affiliation(s)
- Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, and the Rome Foundation, Chapel Hill, North Carolina.
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, G. Opopenbhemer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, Calfornia
| | - Jill K Deutsch
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Albena Halpert
- Gastroenterology,Harvard University Health Services, Boston, Massachusetts
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Johannah Ruddy
- Center for Education and Practice of Biopsychosocial Care and Rome Foundation, Raleigh, North Carolina
| | - Julie Snyder
- Gastrointetinal Psychology Service, Boston University, Harvard Medical School, Boston, Massachusetts
| | - Ami Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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49
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Kapoor D, Ramavat AS, Mehndiratta M, Agrawal A, Arora V, Goel A. Impact of coronavirus disease 2019 on ENT clinical practice and training: the resident's perspective. J Laryngol Otol 2021; 135:1-5. [PMID: 34612181 PMCID: PMC8523968 DOI: 10.1017/s0022215121002814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The arrival of the coronavirus disease 2019 pandemic disrupted life suddenly and forcefully, and healthcare systems around the world are still struggling to come to terms with it. This paper reviews the impact of the pandemic on ENT practice and training. METHODS The present manuscript was developed as a narrative review to examine the role of otorhinolaryngologists in the management of the pandemic, and assess its impact on practice and training in the specialty. RESULTS Otorhinolaryngologists handle secretions of organs implicated in disease transmission, leaving them particularly vulnerable even while performing simple procedures. Although the pandemic increased skill expectations, it simultaneously reduced learning opportunities for trainees. In addition, attention to emergencies has been delayed. Further, the suspension of elective procedures has affected patients with malignancies. CONCLUSION While planning service resumption, provisions need to be made for protective equipment and training; improving teleconsultation services will help provide sustainable care during further waves.
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Affiliation(s)
- D Kapoor
- Department of ENT and Head and Neck Surgery, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - A S Ramavat
- Department of Otorhinolaryngology, and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - A Agrawal
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - V Arora
- Department of ENT and Head and Neck Surgery, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - A Goel
- Department of Medicine, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
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50
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Gogalniceanu P, Calder F, Callaghan C, Sevdalis N, Mamode N. Surgeons Are Not Pilots: Is the Aviation Safety Paradigm Relevant to Modern Surgical Practice? J Surg Educ 2021; 78:1393-1399. [PMID: 33579654 DOI: 10.1016/j.jsurg.2021.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/10/2021] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
Error in surgery is common, although not always consequential. Surgical outcomes are often compared to safety data from commercial aviation. This industry's performance is frequently referenced as an example of high-reliability that should be reproduced in clinical practice. Consequently, the aviation-surgery analogy forms the conceptual framework for much patient safety research, advocating for the translation of aviation safety tools to the healthcare setting. Nevertheless, overuse or incorrect application of this paradigm can be misleading and may result in ineffective quality improvement interventions. This article discusses the validity and relevance of the aviation-surgery comparison, providing the necessary context to improve its application at the bedside. It addresses technical and human factors training, as well as more novel performance domains such as professional culture and optimization of operators' condition. These are used to determine whether the aviation-surgery analogy is a valuable source of cross-professional learning or simply another safety cliché.
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Affiliation(s)
- Petrut Gogalniceanu
- Guy's and St. Thomas' NHS Foundation Trust; King's College London, London, England.
| | | | - Chris Callaghan
- Guy's and St. Thomas' NHS Foundation Trust; King's College London, London, England
| | | | - Nizam Mamode
- Guy's and St. Thomas' NHS Foundation Trust; King's College London, London, England
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