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Lewis KO, Kilbride HW, Bose C, Burchfield DJ. Fundamentals of designing high-quality surveys: revisiting neonatal perinatal medicine survey applications. J Perinatol 2024; 44:777-784. [PMID: 37863984 DOI: 10.1038/s41372-023-01801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
Surveys in neonatal perinatal medicine are practical instruments for gathering information about medical practices, and outcomes related to the care of newborns and infants. This includes research for identifying needs, assessing requirements, analyzing the effects of change, creating policies, and developing curriculum initiatives. Surveys also provide useful data for enhancing the provision of healthcare services, assessing medical specialties, and evaluating training programs. However, creating a high-quality survey can be difficult for many practitioners, particularly when deciding how to formulate the right questions, whether to utilize various types of questions and how best to arrange or format the survey tool for effective responses. Problems with design principles have been evident in many surveys submitted for dissemination to the members of the Section of Neonatal Perinatal Medicine (SoNPM). To prevent potential measurement errors and increase the quality of surveys, it is crucial to follow a systematic approach in developing surveys by adhering to the principles of effective survey design. This review article provides a brief summary of survey use within the SoNPM, and offers guidance for creating high-quality surveys, including identifying important factors to consider in survey development and characteristics of well-written and effective questions. We briefly note techniques that optimize survey design for distribution through digital media.
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Affiliation(s)
- Kadriye O Lewis
- Children's Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Howard W Kilbride
- Children's Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Carl Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bozzolan M, Bighi E, Occhi A, Mottaran S, Simoni G, Valpiani G, Bombardi S, Da Roit M. Professional practice, competence, and education related to COVID-19: A mixed-methods light study of physiotherapists' experiences. Physiother Theory Pract 2024; 40:1215-1231. [PMID: 36369771 DOI: 10.1080/09593985.2022.2142083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/16/2022] [Accepted: 10/16/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) became a significant challenge for the work and personal experience of physiotherapists (PTs). OBJECTIVE To investigate how the work activities of PTs in a region in Italy have changed, describe the reasons for change, perceived competence, and effectiveness of professional education, and explore their personal experience. METHODS We adopted a monocentric convergent mixed-methods light-questionnaire variant study. The questionnaire contains both closed-ended and open-ended questions. Quantitative and qualitative data were combined to interpret the results. RESULTS Among 78 respondents (response rate 24.4%), 87.2% worked during the pandemic, 52.9% treated patients with COVID-19, and 45.6% changed their working activities. Professional competence was perceived as low in intensive and sub-intensive care settings. The major critical aspect of professional education was respiratory rehabilitation. Life-learning education was judged as effective, even if mainly focused on safety. Nine themes emerged from the analysis of the PTs' experiences: 1) Physiotherapy during COVID-19; 2) Fear and negative feelings; 3) Positive aspects; 4) Organization and management; 5) Prevention measures; 6) Patients; 7) Change; 8) Information; and 9) Professional education. CONCLUSIONS PTs who have direct experience with patients with COVID-19 showed great resilience. They overcame the first phase of disorientation and fear, despite a specific lack of competence in the respiratory field.
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Affiliation(s)
- Michela Bozzolan
- Interdepartmental Educational Service, S. Anna University Hospital of Ferrara via Aldo Moro, Ferrara, Italy
| | - Elisa Bighi
- Fondazione "San Salvatore" Via Piave, Ficarolo (RO), Italy
| | - Antonella Occhi
- Rehabilitation Medicine Unit - S. Anna University Hospital of Ferrara via Aldo Moro, Ferrara, Italy
| | - Silvia Mottaran
- Acquired Brain Injuries Unit - S. Anna University Hospital of Ferrara via Aldo Moro, Ferrara, Italy
| | | | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, S. Anna University Hospital of Ferrara via Aldo Moro, Ferrara, Italy
| | - Sandra Bombardi
- Research Innovation Quality and Accreditation Unit, S. Anna University Hospital of Ferrara via Aldo Moro, Ferrara, Italy
| | - Marco Da Roit
- Belluno Community Hospital, Azienda AULSS1 Dolomiti via Feltre, Belluno, Italy
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Bann M, Manjarrez E, Kellner CP, Greysen R, Davis C, Lee T, Soleimanpour N, Tambe N, Auerbach A, Schnipper JL. Post-Hospitalization Home Monitoring Programs During the COVID-19 Pandemic: Survey Results from the Hospital Medicine Re-engineering Network (HOMERuN). J Gen Intern Med 2024; 39:1288-1293. [PMID: 38151604 PMCID: PMC11169426 DOI: 10.1007/s11606-023-08581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, hospitals and healthcare systems launched innovative responses to emerging needs. The creation and use of programs to remotely follow patient clinical status and recovery after COVID-19 hospitalization has not been thoroughly described. OBJECTIVE To characterize deployment of remote post-hospital discharge monitoring programs during the COVID-19 pandemic METHODS: Electronic surveys were administered to leaders of 83 US academic hospitals in the Hospital Medicine Re-engineering Network (HOMERuN). An initial survey was completed in March 2021 with follow-up survey completed in July 2022. RESULTS There were 35 responses to the initial survey (42%) and 15 responses to the follow-up survey (43%). Twenty-two (63%) sites reported a post-discharge monitoring program, 16 of which were newly developed for COVID-19. Physiologic monitoring devices such as pulse oximeters were often provided. Communication with medical teams was often via telephone, with moderate use of apps or electronic medical record integration. Programs launched most commonly between January and June 2020. Only three programs were still active at the time of follow-up survey. CONCLUSIONS Our findings demonstrate rapid, ad hoc development of post-hospital discharge monitoring programs during the COVID-19 pandemic but with little standardization or evaluation. Additional study could identify the benefits of these programs, instruct their potential application to other disease processes, and inform further development as part of emergency preparedness for upcoming crises.
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Affiliation(s)
- Maralyssa Bann
- University of Washington School of Medicine, Seattle, WA, USA.
- Division of GIM/Hospital Medicine, Harborview Medical Center, Seattle, WA, USA.
| | - Efren Manjarrez
- Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | | | - Ryan Greysen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Clark Davis
- Brigham and Women's Hospital, Boston, MA, USA
| | - Tiffany Lee
- University of California San Francisco, San Francisco, CA, USA
| | | | - Neal Tambe
- University of California San Francisco, San Francisco, CA, USA
| | - Andrew Auerbach
- University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey L Schnipper
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Elsallab M, Bourgeois F, Maus MV. National Survey of FACT-Accredited Cell Processing Facilities: Assessing Preparedness for Local Manufacturing of Immune Effector Cells. Transplant Cell Ther 2024; 30:626.e1-626.e11. [PMID: 38494077 DOI: 10.1016/j.jtct.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
The utilization of the human immune system as a therapeutic modality has materialized in the form of novel biologics known as immune effector cells (IECs). However, currently approved IECs rely on autologous cells for manufacturing that are funneled through costly centralized supply chains leading to long wait times and potentially increased mortality. Alternative models for manufacturing at or near the point-of-care in a distributed and local approach are being proposed to overcome such a bottleneck. Cell processing facilities for minimally manipulated products, as well as academic good manufacturing practice facilities, are being considered for such manufacturing tasks. However, the infrastructure and the practices of these facilities remains unstudied. Here, we surveyed the cell processing facilities accredited by the Foundation for Accreditation of Cellular Therapy (FACT) in the United States to better understand their preparedness for local manufacturing of IECs. A structured survey consisting of 40 items was distributed to the directors of 157 facilities. The survey evaluated 6 domains, including facility characteristics, quality practices, personnel, use of automation, experience with IECs, and the perception of the point-of-care model. Thirty-eight facilities completed the survey (24.2%). Most facilities were involved in handling IEC products (35/38, 92.1%), and the majority had infrastructure to support basic operations and quality control such as viability (36/36, 100%), identity (33/36, 91.7%), and sterility (33/36, 91.7%). The quality practices varied among the facilities depending on the types of products processed. A slight majority implemented automation in their workflows (22/38, 57.9%). Facilities expressed a general interest in adopting point-of-care models (23/38, 61%), with financial and human resources identified as the most significant constraints. In conclusion, FACT-accredited cell processing facilities may provide the infrastructure required for local manufacturing. However, there is a need for standardization and minimum quality requirements to effectively implement such models.
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Affiliation(s)
- Magdi Elsallab
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts; Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Florence Bourgeois
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Marcela V Maus
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Cancer Center, Massachusetts General Hospital, Boston, Massachusetts.
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Klein J, Koens S, Scherer M, Strauß A, Härter M, von dem Knesebeck O. Public Beliefs About Accessibility and Quality of Emergency Departments in Germany. West J Emerg Med 2024; 25:389-398. [PMID: 38801046 PMCID: PMC11112668 DOI: 10.5811/westjem.18224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background It is well established that emergency department (ED) crowding leads to worse health outcomes. Although various patient surveys provide information about reasons to visit EDs, less is known in terms of beliefs about EDs among the general population. This study examines public beliefs regarding accessibility and quality of EDs and their associations with social characteristics (gender, age, education, immigration background) as well as knowledge about emergency care services and health literacy. Methods We conducted a cross-sectional study based on a random sample of 2,404 adults living in Hamburg, Germany, in winter 2021/2022. We developed eight statements regarding accessibility and quality of EDs leading to two scales (Cronbach's α accessibility = 0.76 and quality of care = 0.75). Descriptive statistics of the eight items are shown and linear regression were conducted to determine associations of the two scales with social characteristics as well as knowledge about emergency care services and health literacy (HLS-EU-Q6). Results Nearly 44% of the respondents agreed that "you can always go to an ED, if you do not get a short-term appointment with a general practitioner or specialist." And 38% agreed with the statement, "If you do not have the time during normal practice hours due to your work, you can always go to an ED." In terms of quality, 38% believed that doctors in EDs are more competent than doctors in general practice, and 25% believed that doctors in EDs are more competent than doctors in specialized practices. In the fully adjusted model, public beliefs about emergency care accessibility and quality of EDs were significantly associated with all social characteristics and knowledge of emergency care options with the strongest associations between knowledge and accessibility (β = -0.17; P < 0.001) and between education and quality (β = -0.23; P < 0.001). Conclusion We found endorsement of public beliefs about accessibility and quality of EDs that can lead to inappropriate utilization. Our results also suggest that knowledge of different emergency services plays an important role. Therefore, after system-related reorganizations of emergency care, information campaigns about such services tailored to socially deprived populations may help alleviate the issue of crowding.
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Affiliation(s)
- Jens Klein
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Hamburg, Germany
| | - Sarah Koens
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Hamburg, Germany
| | - Martin Scherer
- University Medical Center Hamburg-Eppendorf, Department of General Practice and Primary Care Hamburg, Germany
| | - Annette Strauß
- University Medical Center Hamburg-Eppendorf, Department of General Practice and Primary Care Hamburg, Germany
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Hamburg, Germany
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Jalil R, Nkemdirim M, Roach P, Panaccione R, Ruzycki SM. The association between applicant gender and racial or ethnic identity and success in the admissions process at a Canadian medical school: a prospective cohort study. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:39-48. [PMID: 38827917 PMCID: PMC11139781 DOI: 10.36834/cmej.75255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Background Canadian data suggests that Black candidates may be less successful than other groups when applying to medical school. We sought to comprehensively describe the racial and/or ethnic identity, gender identity, sexual orientation, and ability of applicants to a single Canadian medical school. We also examined for an association between success at each application stage and applicant gender and racial identity. Methods Class of 2024 applicants to a single Canadian medical school were invited to complete a demographics survey. The odds of achieving each application stage (offered an interview, offered a position, and matriculating) were determined for each demographic group. Results There were 595 participants (32.4% response rate). The demographics of the applicant pool and matriculating class were similar. There was no difference in interview offers or matriculation between BIPOC and white candidates. Cisgender men were overrepresented in interviews compared to cisgender women (OR 0.64; 95%CI 0.43-0.95; p = 0.03) but not in matriculation. BIPOC cisgender women received more interview invitations compared to other groups (OR 2.74, 95%CI 1.20-6.25; p = 0.02). Conclusions Differences in applicant success for differing demographic groups were most pronounced being offered an interview.
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Affiliation(s)
- Rabiya Jalil
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Makela Nkemdirim
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Pamela Roach
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Remo Panaccione
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Azoulay D, Desterke C, Bhangui P, Serrablo A, De Martin E, Cauchy F, Salloum C, Allard MA, Golse N, Vibert E, Sa Cunha A, Cherqui D, Adam R, Saliba F, Ichai P, Feray C, Scatton O, Lim C. Rescue Liver Transplantation for Posthepatectomy Liver Failure: A Systematic Review and Survey of an International Experience. Transplantation 2024; 108:947-957. [PMID: 37749790 DOI: 10.1097/tp.0000000000004813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Rescue liver transplantation (LT) is the only life-saving option for posthepatectomy liver failure (PHLF) whenever it is deemed as irreversible and likely to be fatal. The goals were to perform a qualitative systematic review of rescue LT for PHLF and a survey among various international LT experts. METHODS A literature search was performed from 2000 to 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Population, Intervention, Comparison, Outcome framework, and to this, the authors' experience was added. The international online open survey included 6 cases of PHLF extracted from the literature and submitted to 976 LT experts. The primary outcome was whether experts would consider rescue LT for each case. Interrater agreement among experts was calculated using the free-marginal multirater kappa methodology. RESULTS The review included 40 patients. Post-LT mortality occurred in 8 (20%) cases (7/28 with proven cancer and 1/12 with benign disease). In the long term, 6 of 21 (28.6%) survivors with cancer died of recurrence (median = 38 mo) and 15 (71.4%) were alive with no recurrence (median = 111 mo). All 11 survivors with benign disease were alive and well (median = 39 mo). In the international survey among experts in LT, the percentage agreement to consider rescue LT was 28%-98%, higher for benign than for malignant disease ( P = 0.011). Interrater agreement for the primary endpoint was low, expected 5-y survival >50% being the strongest independent predictor to consider LT. CONCLUSIONS Rescue LT for PHLF may achieve good results in selected patients. Considerable inconsistencies of decision-making exist among LT experts when considering LT for PHLF.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Christophe Desterke
- University of Medicine Paris Saclay, Le Kremlin-Bicêtre, France
- INSERM Unit UMR1310, Villejuif, France
| | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Eleonora De Martin
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - François Cauchy
- Department of Hepato-biliary and Pancreatic Surgery and Liver Transplantation, University of Geneva, Geneva, Switzerland
| | - Chady Salloum
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Marc Antoine Allard
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Nicolas Golse
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Eric Vibert
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Philippe Ichai
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Cyrille Feray
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Olivier Scatton
- Département de Chirurgie et Transplantation Hépatique, Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Université, Paris, France
- Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Chetana Lim
- Département de Chirurgie et Transplantation Hépatique, Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Université, Paris, France
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Gadgil R, Siracuse MV, Fuji KT, Bramble JD. Impact of the COVID-19 pandemic on pharmacists practicing in community pharmacies in the state of Nebraska. J Am Pharm Assoc (2003) 2024:102075. [PMID: 38522581 DOI: 10.1016/j.japh.2024.102075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The rapid increase in COVID-19 combined with uncertainty surrounding transmission and treatment protocols resulted in unprecedented burnout amongst health care workers. As other health care workers scrambled to support patients, community pharmacists quickly responded to the pandemic by extending their services. This constantly changing environment amongst other factors created a high degree of psychological burden associated with COVID-19 for pharmacists. Although studies have examined the psychological impact of the pandemic on frontline health care workers, pharmacists are rarely included in these studies. OBJECTIVE To examine the impact of COVID-19 on work and personal well-being from the perspective of pharmacists practicing in community pharmacies in Nebraska. METHODS A cross-sectional online survey collected data from pharmacists with an active Nebraska Pharmacist license (N=2763) from November 2022 to January 2023. The survey was a hybrid of researcher-developed items and the validated abbreviated Maslach Burnout Inventory (aMBI). The aMBI is a 9-item Likert-scale scored instrument, which captures three domains of burnout: Personal Accomplishment; Emotional Exhaustion; and Depersonalization. Data was analyzed using IBM SPSS Statistics version 27. RESULTS The response rate to the survey was 12.3% (n=339). Mean age of the respondents was 44.8 years with an average of 18.7 years in practice. Most respondents (n = 113, 50.7%) practiced in a community pharmacy followed by hospital (n = 72, 32.3%). 55.8% of community pharmacists reported that they considered leaving their current employer. Chi-square analysis confirmed that community pharmacists are more burned out than noncommunity pharmacists. CONCLUSIONS Pharmacists realized they had not been recognized for their contributions as frontline health care workers, which motivated them to consider leaving their employer and even the profession of pharmacy. This study found community pharmacists are burned out more than non-community pharmacists. Within community pharmacies, it was found that pharmacists practicing at corporate-owned community pharmacies had increased burnout compared to those practicing in independent community pharmacies.
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Broadbent P, Shen Y, Pearce A, Katikireddi SV. Trends in inequalities in childhood overweight and obesity prevalence: a repeat cross-sectional analysis of the Health Survey for England. Arch Dis Child 2024; 109:233-239. [PMID: 38262695 PMCID: PMC10894838 DOI: 10.1136/archdischild-2023-325844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/22/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To examine trends in socio-economic and ethnic inequalities in childhood overweight and obesity in the England between 1995 and 2019 in survey data and to compare these to administrative data. DESIGN Observational repeated cross-sectional study using the Health Survey for England (HSE) and National Child Measurement Programme (NCMP). OUTCOME Age and sex standardised overweight, obesity and overweight including obesity. ANALYSIS Inequalities assessed by parental education, family structure, ethnicity (binary non-white vs white) and area-level Index of Multiple Deprivation. Estimates stratified by age and sex. Trends compared against NCMP data (age 4-5 and 10-11 years). RESULTS Prevalence of childhood overweight including obesity increased from 26.0% in 1995 to 31.7% in 2019, with the highest and fastest growing levels in those aged 11-15 years, rising from 29.7% to 38.0%. Despite a plateau in overall childhood obesity since 2004, differences between groups demonstrated widening inequalities over time. Inequalities widened by area-level deprivation, household educational attainment, household structure and ethnicity driven primarily by increased prevalence among socioeconomically disadvantaged children. For example, the gap between children from households with no qualifications versus degree-level qualifications increased from -1.1% to 13.2%, and the gap between single-parent households and couple households increased from 0.5% to 5.3%. HSE trends in prevalence of childhood overweight and obesity by deprivation quintile were consistent with those in NCMP. CONCLUSION Overall levels of child overweight and obesity increased between 1995 and 2004. Since then, increases in prevalence among less advantaged groups have driven widening of inequalities.
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Affiliation(s)
- Philip Broadbent
- University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
- NHS Education for Scotland, Edinburgh, UK
| | - Yue Shen
- University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | - Anna Pearce
- University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
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Terefe B, Mekonnen BA, Tamir TT, Assimamaw NT, Limenih MA. Evaluation of Quality of Prevention of Mother to Child Transmission of HIV Service Provision and Its Determinants: The Case of Health Facility Readiness and Mothers' Perspectives. J Multidiscip Healthc 2024; 17:93-110. [PMID: 38205128 PMCID: PMC10778913 DOI: 10.2147/jmdh.s446035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Background Prevention of Mother-To-Child Transmission of HIV (PMTCT) is a comprehensive intervention aimed at reducing vertical transmission. More than 90% of pediatric AIDS cases are caused by MTCT. However, the quality of care has lagged in terms of service integration, client satisfaction, and facility readiness, although improvements have been observed. Evidence on the quality of PMTCT services is required by clinicians, and policymakers. Therefore, this study aimed to evaluate the effectiveness of PMTCT services provided by public health facilities in Northwest Ethiopia. Methods This cross-sectional study was conducted at nine public health facilities in Gondar city between June 1 and July 17, 2022. A total of 334 mothers were participated. The Structure-Process-Outcome components were used to evaluate service quality. About 135 counseling sessions were observed. The SPSS 26 software was used for statistical analyses. To identify mothers' satisfaction with the service, P-values < 0.25, and < 0.05 were considered in the binary and multiple logistic regression analyses to identify significant variables, respectively. Results The overall performance of the health facilities was 74.09% (72.19-76.01 CI 95%). In 88.89% of cases, the output quality was higher and rated as good. However, the quality of the input and process services was 60.40% and 72.97%, respectively. Women's satisfaction was 67.09%. Women aged 15-24 years (AOR= 0.31; 95% CI:0.06, 0.79), formally educated (AOR=0.59; 95% CI:0.35, 0.67), > one hour of arrival (AOR=0.71; 95% CI:0.55, 0.93), > 30 minutes waiting time (AOR=0.23; 95% CI:0.11, 0.37), sufficient time for counseling (AOR=2.83; 95% CI:1.72, 3.97), and opening hours (AOR=4.27; 95% CI:2.09, 6.67) were factors associated with satisfaction in women. Conclusion The quality of PMTCT service provision and mothers' satisfaction were low. Reducing waiting time, punctuality of service providers, adequate counselling, and availability of basic resources can boost mothers' satisfaction.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhanu Abie Mekonnen
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Miteku Andualem Limenih
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Beckett MK, Elliott MN, Hambarsoomian K, Tamayo L, Lehrman WG, Agniel D, Khau M, Goldstein E, Giordano LA, Ng JH, Martino SC. Do Hospital Characteristics Predict Racial-and-Ethnic Disparities in Patient Experience? National Results From the HCAHPS Survey. Med Care 2024; 62:37-43. [PMID: 37962434 DOI: 10.1097/mlr.0000000000001949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Assess whether hospital characteristics associated with better patient experiences overall are also associated with smaller racial-and-ethnic disparities in inpatient experience. BACKGROUND Hospitals that are smaller, non-profit, and serve high proportions of White patients tend to be high-performing overall, but it is not known whether these hospitals also have smaller racial-and-ethnic disparities in care. RESEARCH DESIGN We used linear mixed-effect regression models to predict a summary measure that averaged eight Hospital CAHPS (HCAHPS) measures (Nurse Communication, Doctor Communication, Staff Responsiveness, Communication about Medicines, Discharge Information, Care Coordination, Hospital Cleanliness, and Quietness) from patient race-and-ethnicity, hospital characteristics (size, ownership, racial-and-ethnic patient-mix), and interactions of race-and-ethnicity with hospital characteristics. SUBJECTS Inpatients discharged from 4,365 hospitals in 2021 who completed an HCAHPS survey ( N =2,288,862). RESULTS While hospitals serving larger proportions of Black and Hispanic patients scored lower on all measures, racial-and-ethnic disparities were generally smaller for Black and Hispanic patients who received care from hospitals serving higher proportions of patients in their racial-and-ethnic group. Experiences overall were better in smaller and non-profit hospitals, but racial-and-ethnic differences were slightly larger. CONCLUSIONS Large, for-profit hospitals and hospitals serving higher proportions of Black and Hispanic patients tend to be lower performing overall but have smaller disparities in patient experience. High-performing hospitals might look at low-performing hospitals for how to provide less disparate care whereas low-performing hospitals may look to high-performing hospitals for how to improve patient experience overall.
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Affiliation(s)
| | | | | | - Loida Tamayo
- Centers for Medicare & Medicaid Services, Baltimore, MD
| | | | | | - Meagan Khau
- Centers for Medicare & Medicaid Services, Baltimore, MD
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Wilson AB, Brooks WS, Edwards DN, Deaver J, Surd JA, Pirlo OJ, Byrd WA, Meyer ER, Beresheim A, Cuskey SL, Tsintolas JG, Norrell ES, Fisher HC, Skaggs CW, Mysak D, Levin SR, Escutia Rosas CE, Cale AS, Karim MN, Pollock J, Kakos NJ, O'Brien MS, Lufler RS. Survey response rates in health sciences education research: A 10-year meta-analysis. ANATOMICAL SCIENCES EDUCATION 2024; 17:11-23. [PMID: 37850629 DOI: 10.1002/ase.2345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023]
Abstract
Growth in the online survey market may be increasing response burden and possibly jeopardizing higher response rates. This meta-analysis evaluated survey trends over one decade (2011-2020) to determine: (1) changes in survey publication rates over time, (2) changes in response rates over time, (3) typical response rates within health sciences education research, (4) the factors influencing survey completion levels, and (5) common gaps in survey methods and outcomes reporting. Study I estimated survey publication trends between 2011 and 2020 using articles published in the top three health sciences education research journals. Study II searched the anatomical sciences education literature across six databases and extracted study/survey features and survey response rates. Time plots and a proportional meta-analysis were performed. Per 2926 research articles, the annual estimated proportion of studies with survey methodologies has remained constant, with no linear trend (p > 0.050) over time (Study I). Study II reported a pooled absolute response rate of 67% (95% CI = 63.9-69.0) across 360 studies (k), totaling 115,526 distributed surveys. Despite response rate oscillations over time, no significant linear trend (p = 0.995) was detected. Neither survey length, incentives, sponsorship, nor population type affected absolute response rates (p ≥ 0.070). Only 35% (120 of 339) of studies utilizing a Likert scale reported evidence of survey validity. Survey response rates and the prevalence of studies with survey methodologies have remained stable with no linear trends over time. We recommend researchers strive for a typical absolute response rate of 67% or higher and clearly document evidence of survey validity for empirical studies.
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Affiliation(s)
- Adam B Wilson
- Department of Anatomy and Cell Biology, Rush University, Chicago, Illinois, USA
| | - William S Brooks
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama, USA
| | - Danielle N Edwards
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama, USA
| | - Jill Deaver
- Lister Hill Library of the Health Sciences Clinical, Academic, & Research Engagement (CARE) Department, University of Alabama at Birmingham Libraries, Birmingham, Alabama, USA
| | - Jessica A Surd
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama, USA
| | - Obadiah J Pirlo
- School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - William A Byrd
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edgar R Meyer
- Department of Advanced Biomedical Education, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Amy Beresheim
- Department of Anatomy and Cell Biology, Rush University, Chicago, Illinois, USA
| | | | | | - Eric S Norrell
- Rush Medical College, Rush University, Chicago, Illinois, USA
| | | | | | - Dmytro Mysak
- Rush Medical College, Rush University, Chicago, Illinois, USA
| | | | | | - Andrew S Cale
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Md Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Rebecca S Lufler
- Department of Medical Education, Tufts University School of Medicine, Boston, Massachusetts, USA
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Schiff JW, Weissman E, Schiff R, Liu J, Pitoulis T, Jones A. Increase in Trauma Leading to Psychological Injury Among Canadian Homelessness Services Workers During the COVID-19 Pandemic. J Occup Environ Med 2024; 66:71-77. [PMID: 37853610 DOI: 10.1097/jom.0000000000002996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES This study examined the traumatic psychological impact of the pandemic on frontline workers in homelessness services. METHODS Staff from homelessness serving organizations completed pre- and mid-COVID pandemic surveys measuring traumatic stress symptoms (PTSS), burnout, and job-related traumatic experiences. The mid-pandemic survey was expanded to seven Canadian cities to determine prevalence of workplace PTSS nationally. RESULTS In the comparison group, baseline rates of PTSS (41%) rose to 47.3% ( n = 164), while 75% reported low-moderate levels of burnout both times. Nationwide, PYSS was 51% ( n = 574). Case managers working at remotely had greater levels of PTSS. CONCLUSIONS COVID-19 exacerbated risk of psychological workplace injury from traumatic stress; however, burnout did not increase significantly, indicating the primary dynamic as anxiety and emotional exhaustion associated with ubiquitous trauma induced by COVID-19. Working remotely increased the hazards of psychological workplace injury.
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Affiliation(s)
- Jeannette Waegemakers Schiff
- From the University of Calgary, Faculty of Social Work, Calgary, Canada (J.W.S.); Department of Sociology, University of New Brunswick, Saint John, Canada (E.W.); Department of Health Sciences, Lakehead University, Thunder Bay, Canada (R.S.); University of Calgary, Faculty of Social Work, Calgary, Canada (J.L.); and University of Calgary, Faculty of Social Work, Calgary, AB, Canada (T.P.); and Fred Victor, Toronto, Canada (A.J.)
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14
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Žarković M, Attanasio R, Nagy EV, Negro R, Papini E, Perros P, Cohen CA, Akarsu E, Alevizaki M, Ayvaz G, Bednarczuk T, Berta E, Bodor M, Borissova AM, Boyanov M, Buffet C, Burlacu MC, Ćirić J, Díez JJ, Dobnig H, Fadeyev V, Field BCT, Fliers E, Frølich JS, Führer D, Galofré JC, Hakala T, Jiskra J, Kopp P, Krebs M, Kršek M, Kužma M, Lantz M, Lazúrová I, Leenhardt L, Luchytskiy V, McGowan A, Melo M, Metso S, Moran C, Morgunova T, Mykola T, Beleslin BN, Niculescu DA, Perić B, Planck T, Poiana C, Puga FM, Robenshtok E, Rosselet P, Ruchala M, Riis KR, Shepelkevich A, Unuane D, Vardarli I, Visser WE, Vrionidou A, Younes YR, Yurenya E, Hegedüs L. Characteristics of specialists treating hypothyroid patients: the "THESIS" collaborative. Front Endocrinol (Lausanne) 2023; 14:1225202. [PMID: 38027187 PMCID: PMC10660282 DOI: 10.3389/fendo.2023.1225202] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Thyroid specialists influence how hypothyroid patients are treated, including patients managed in primary care. Given that physician characteristics influence patient care, this study aimed to explore thyroid specialist profiles and associations with geo-economic factors. Methods Thyroid specialists from 28 countries were invited to respond to a questionnaire, Treatment of Hypothyroidism in Europe by Specialists: an International Survey (THESIS). Geographic regions were defined according to the United Nations Statistics Division. The national economic status was estimated using World Bank data on the gross national income per capita (GNI per capita). Results 5,695 valid responses were received (response rate 33·0%). The mean age was 49 years, and 65·0% were female. The proportion of female respondents was lowest in Northern (45·6%) and highest in Eastern Europe (77·2%) (p <0·001). Respondent work volume, university affiliation and private practice differed significantly between countries (p<0·001). Age and GNI per capita were correlated inversely with the proportion of female respondents (p<0·01). GNI per capita was inversely related to the proportion of respondents working exclusively in private practice (p<0·011) and the proportion of respondents who treated >100 patients annually (p<0·01). Discussion THESIS has demonstrated differences in characteristics of thyroid specialists at national and regional levels, strongly associated with GNI per capita. Hypothyroid patients in middle-income countries are more likely to encounter female thyroid specialists working in private practice, with a high workload, compared to high-income countries. Whether these differences influence the quality of care and patient satisfaction is unknown, but merits further study.
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Affiliation(s)
- Miloš Žarković
- University of Belgrade Faculty of Medicine, Internal Medicine, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, Thyroid Department, Belgrade, Serbia
| | - Roberto Attanasio
- Associazione Medici Endocrinologi, Scientific Committee, Milan, Italy
| | - Endre V. Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Roberto Negro
- Ospedale Vito Fazzi, Department of Endocrinology, Lecce, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Roma, Italy
| | - Petros Perros
- Institute of Translational and Clinical Research, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | - Ersin Akarsu
- Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Maria Alevizaki
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Faculty of Medicine, Athens, Greece
| | - Göksun Ayvaz
- Department of Endocrinology and Metabolism, Koru Ankara Hospital, Ankara, Türkiye
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Eszter Berta
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklos Bodor
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna Maria Borissova
- Sofia University Saint Kliment Ohridski, Medical Faculty, Clinic of Endocrinology and Metabolism, University Hospital “Sofiamed”, Sofia, Bulgaria
| | - Mihail Boyanov
- University Hospital Alexandrovska, Clinic of Endocrinology and Metabolism, Medical University-Sofia, Internal Medicine, Sofia, Bulgaria
| | - Camille Buffet
- GRC n 16, GRC Thyroid Tumors, Thyroid Disease and Endocrine Tumor Department, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne University, Paris, France
| | - Maria-Cristina Burlacu
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Université Catholique De Louvain, Brussels, Belgium
| | - Jasmina Ćirić
- University of Belgrade Faculty of Medicine, Internal Medicine, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, Thyroid Department, Belgrade, Serbia
| | - Juan J. Díez
- Department of Endocrinology, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain
- Instituto De Investigación Sanitaria Puerta De Hierro Segovia De Arana, Majadahonda, Madrid, Spain
- Department of Medicine, Universidad Autónoma De Madrid, Madrid, Spain
| | - Harald Dobnig
- Thyroid Endocrinology, Osteoporosis Institute Dobnig, Graz, Austria
| | - Valentin Fadeyev
- Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Benjamin C. T. Field
- University of Surrey Faculty of Health and Medical Sciences, Section of Clinical Medicine, Prague, United Kingdom
| | - Eric Fliers
- Department of Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Dagmar Führer
- University Hospital Essen, Department of Endocrinology, Diabetes and Metabolism, University-Duisburg-Essen, Essen, Germany
| | - Juan Carlos Galofré
- Departmento De Endocrinologia e Nutrición, Clínica Universidad De Navarra, Pamplona, Spain
| | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Jan Jiskra
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czechia
| | - Peter Kopp
- Division of Endocrinology, Diabetology and Metabolism, University of Lausanne, Lausanne, Switzerland
| | - Michael Krebs
- Department of Medicine III, Division of Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Michal Kršek
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czechia
| | - Martin Kužma
- 5th Department of Internal Medicine, Medical Faculty of Commenius University and University Hospital, Bratislava, Slovakia
| | - Mikael Lantz
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Ivica Lazúrová
- P. J. Šafárik University Košice, 1st Department of Internal Medicine of the Medical Faculty, Košice, Slovakia
| | - Laurence Leenhardt
- Hopital Pitie-Salpetriere, Thyroid and Endocrine Tumors Unit, Institut of Endocrinology, Sorbonne University, Paris, France
| | - Vitaliy Luchytskiy
- Department of Reproductive Endocrinogy, Institute of Endocrinology and Metabolism named after V.P. Komissarenko, National Academy of Medical Science of Ukraine, Kyiv, Ukraine
| | - Anne McGowan
- Robert Graves Institute, Tallaght University Hospital, Dublin, Ireland
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, Medical Faculty, University of Coimbra, Coimbra, Portugal
| | - Saara Metso
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Carla Moran
- Diabetes & Endocrinology Section, Beacon Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Tatyana Morgunova
- Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tronko Mykola
- Institute of Endocrinology and Metabolism named after V.P. Komissarenko, National Academy of Medical Science of Ukraine, Kyiv, Ukraine
| | - Biljana Nedeljković Beleslin
- University of Belgrade Faculty of Medicine, Internal Medicine, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, Thyroid Department, Belgrade, Serbia
| | - Dan Alexandru Niculescu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Božidar Perić
- Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sisters of Mercy”, Zagreb, Croatia
| | - Tereza Planck
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Catalina Poiana
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Francisca Marques Puga
- Endocrinology, Diabetes and Metabolism Service, Porto Hospital and University Centre, Porto, Portugal
| | - Eyal Robenshtok
- Endocrinology Institute, Rabin Medical Center, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Kamilla Ryom Riis
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Alla Shepelkevich
- Department of Endocrinology, Belarusian State Medical University, Minsk, Belarus
| | - David Unuane
- Department of Internal Medicine, Endocrine Unit, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Irfan Vardarli
- Department of Medicine I, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
- 5th Medical Department, Division of Endocrinology and Diabetes, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - W. Edward Visser
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Andromachi Vrionidou
- Department of Endocrinology and Diabetes Centre, Hellenic Red Cross Hospital, Athens, Greece
| | - Younes R. Younes
- East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, United Kingdom
| | | | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Ryll LS, Pellegrini WR, Richards PQ, Zhou MT, Newlands SD, Levi JR. A Cross-Sectional Survey Study Evaluating United States Medical School Curricula in Otolaryngology. Ann Otol Rhinol Laryngol 2023; 132:1412-1417. [PMID: 37010056 DOI: 10.1177/00034894231164220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVES With an ever-expanding medical knowledge base and requirements for clinical training, medical schools struggle to incorporate subspecialty education, such as otolaryngology (OTO), into curricula. This study aims to assess the current state of OTO education, and evaluate factors contributing to the extent of OTO teaching in United States (U.S.) medical schools. METHODS A 48-question survey evaluated the extent and practices of OTO teaching. The survey was distributed by email to all 155 LCME accredited U.S. allopathic medical schools in 2020 and 2021. RESULTS Sixty-eight unique responses were received (43.9% of U.S. allopathic medical schools). 36.8% (n = 25) of schools reported having formal expectations of OTO knowledge in their core curriculum. Only 1 school (1.5%) had a required OTO rotation; the majority of schools offered an optional third or fourth year clerkship rotation (76.5% and 95.6%, respectively). Schools with residency programs and who employ their faculty through an OTO or surgery department were more likely to have otolaryngologists teach basic science lectures and the Head & Neck exam, offer an optional third year rotation, and have formal expectations of rotating students. CONCLUSIONS Medical schools with residency programs and who employ their faculty through an OTO or surgery department have more robust OTO curricula. Despite the ubiquity of OTO presentations across specialties, incorporation of OTO knowledge in U.S. medical school curricula remains variable, and at times limited.
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Affiliation(s)
- Lucia S Ryll
- Boston University School of Medicine, Boston, MA, USA
| | - William R Pellegrini
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | | | - Maya T Zhou
- Boston University School of Medicine, Boston, MA, USA
| | - Shawn D Newlands
- Department of Otolaryngology - Head and Neck Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, MA, USA
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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Akuu JA, Amagnya MA. Community-based management of acute malnutrition: Implementation quality, and staff and user satisfaction with services. J Taibah Univ Med Sci 2023; 18:988-996. [PMID: 36890797 PMCID: PMC9986645 DOI: 10.1016/j.jtumed.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/22/2022] [Accepted: 02/08/2023] [Indexed: 02/19/2023] Open
Abstract
Background Malnutrition is a problem that affects many children and therefore is the focus of multiple interventions worldwide. One intervention is community-based management of acute malnutrition (CMAM). Objective This study assessed CMAM implementation quality in the Builsa North District of Ghana, and the satisfaction among both users and CMAM staff. Design The study used a convergent mixed-method design involving in-depth interviews with CMAM staff and users, document reviews, and observations of the CMAM implementation. The data were collected across eight health care facilities in eight sub-districts. The data were qualitatively and thematically analysed in Nvivo software. Results Several factors were found to adversely affect the quality of CMAM implementation. Significant factors included inadequate training of CMAM workers; religious belief systems; and a lack of implementation materials, such as ready-to-use therapeutic food (RUTF), CMAM registration forms/cards, and computers. These factors adversely affected programme quality, thus resulting in dissatisfaction among CMAM users and staff. Conclusion This study established that the CMAM programme in the Builsa North District of Ghana is hindered by a lack of primary resources and logistics necessary for successful programme implementation. Most health facilities in the district lack such resources and are not delivering the intended results.
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Affiliation(s)
- Joshua A Akuu
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Moses A Amagnya
- Institute of Policing, School of Justice, Security and Sustainability, Staffordshire University, Stoke-on-Trent, United Kingdom
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Cross H, Bremner S, Meads C, Pollard A, Llewellyn C. Bisexual People Experience Worse Health Outcomes in England: Evidence from a Cross-Sectional Survey in Primary Care. JOURNAL OF SEX RESEARCH 2023:1-9. [PMID: 37487519 DOI: 10.1080/00224499.2023.2220680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Persistent inequalities in relation to health outcomes continue to exist among patients identifying as lesbian, gay, and bisexual (LGB), and very little is known about outcomes specific to bisexual populations. This study's aim was to compare the health of individuals identifying as LGB with heterosexual counterparts within primary care in England. Cross-sectional survey data from the year 10 (2015/2016) English General Practice Patient Survey (GPPS) dataset, which consisted of 836,312 responses (38.9% response rate), including 23,834 people who identified as gay, lesbian, bisexual or "other" was analyzed. Health outcomes were assessed through self-reported quality of life, physical and mental health, and confidence in managing own health. Multifactorial logistic regression (adjusting for age, ethnic group, working status, and socioeconomic status) were conducted. Long-term physical and mental health problems were more than twice as likely to be reported for people within LGB groups compared to the heterosexual group for both genders, except bisexual women where the odds were more than four times greater (OR = 4.275, 95% CI, 3.896, 4.691; p < .001). Bisexual women were half as likely to report the absence of a long-term health problem (OR = 0.452, 95% CI 0.419, 0.488; p < .001). LGB groups across both genders, reported a higher proportion of individuals that did not feel confident in managing their health and experienced significantly worse quality of life compared to heterosexuals. LGB patients consistently report poorer health outcomes than heterosexual patients. Bisexual people of both genders consistently experienced worse physical and mental health outcomes compared with the other recorded sexual orientations.
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Affiliation(s)
- Harry Cross
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex
| | - Catherine Meads
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University
| | - Alex Pollard
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex
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Kimerling R, Zulman DM, Lewis ET, Schalet BD, Reise SP, Tamayo GC. Clinical Validity of the PROMIS Healthcare Engagement 8-Item Short Form. J Gen Intern Med 2023; 38:2021-2029. [PMID: 37118561 PMCID: PMC10361929 DOI: 10.1007/s11606-022-07992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/22/2022] [Indexed: 04/30/2023]
Abstract
BACKGROUND Healthcare engagement is a key measurement target for value-based healthcare, but a reliable and valid patient-reported measure has not yet been widely adopted. OBJECTIVE To assess the validity of a newly developed patient-reported measure of healthcare engagement, the 8-item PROMIS Healthcare Engagement (PHE-8a). DESIGN Prospective cohort study of the association between healthcare engagement and quality of care over 1 year. We fit mixed effects models of quality indicators as a function of engagement scores, adjusting for age, race/ethnicity, rural residence, and risk scores. PARTICIPANTS National stratified random sample of 9552 Veterans receiving Veterans Health Administration care for chronic conditions (hypertension, diabetes) or mental health conditions (depression, post-traumatic stress disorder). MAIN MEASURES Patient experience: Consumer Assessment of Health Plans and Systems communication and self-management support composites; no-show rates for primary care and mental health appointments; use of patient portal My HealtheVet; and Healthcare Effectiveness Data and Information Set electronic quality measures: HbA1c poor control, controlling high blood pressure, and hyperlipidemia therapy adherence. KEY RESULTS Higher engagement scores were associated with better healthcare quality across all outcomes, with each 5-point increase (1/2 standard deviation) in engagement scores associated with statistically significant and clinically meaningful gains in quality. Across the continuum of low to high engagement scores, we observed a concomitant reduction in primary care no-show rates of 37% and 24% for mental health clinics; an increased likelihood of My HealtheVet use of 15.4%; and a decreased likelihood of poor diabetes control of 44%. CONCLUSIONS The PHE-8a is a brief, reliable, and valid patient-reported measure of healthcare engagement. These results confirm previously untested hypotheses that patient engagement can promote healthcare quality.
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Affiliation(s)
- Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA.
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Eleanor T Lewis
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC, USA
| | - Benjamin D Schalet
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Steven P Reise
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Gisselle C Tamayo
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
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Renaud J, McClellan SR, DePriest K, Witgert K, O'Connor S, Abowd Johnson K, Barolin N, Gottlieb LM, De Marchis EH, Rojas-Smith L, Haber SG. Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities. Health Aff (Millwood) 2023:101377hlthaff202201507. [PMID: 37196207 DOI: 10.1377/hlthaff.2022.01507] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The Center for Medicare and Medicaid Innovation launched the Accountable Health Communities (AHC) Model in 2017 to assess whether identifying and addressing Medicare and Medicaid beneficiaries' health-related social needs reduced health care use and spending. We surveyed a subset of AHC Model beneficiaries with one or more health-related social needs and two or more emergency department visits in the prior twelve months to assess their use of community services and whether their needs were resolved. Survey findings indicated that navigation-connecting eligible patients with community services-did not significantly increase the rate of community service provider connections or the rate of needs resolution, relative to a randomized control group. Findings from interviews with AHC Model staff, community service providers, and beneficiaries identified challenges connecting beneficiaries to community services. When connections were made, resources often were insufficient to resolve beneficiaries' needs. For navigation to be successful, investments in additional resources to assist beneficiaries in their communities may be required.
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Affiliation(s)
| | | | | | | | - Shannon O'Connor
- Shannon O'Connor, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | | | | | - Laura M Gottlieb
- Laura M. Gottlieb, University of California San Francisco, San Francisco, California
| | | | | | - Susan G Haber
- Susan G. Haber, RTI International, Waltham, Massachusetts
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20
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Solnick RE, Jarou ZJ, Zogg CK, Boatright D. Political Priorities, Voting, and Political Action Committee Engagement of Emergency Medicine Trainees: A National Survey. West J Emerg Med 2023; 24:469-478. [PMID: 37278793 PMCID: PMC10284518 DOI: 10.5811/westjem.59351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Medicine is increasingly influenced by politics, but physicians have historically had lower voter turnout than the general public. Turnout is even lower for younger voters. Little is known about the political interests, voting activity, or political action committee (PAC) involvement of emergency physicians in training. We evaluated EM trainees' political priorities, use of and barriers to voting, and engagement with an emergency medicine (EM) PAC. METHODS Resident/medical student Emergency Medicine Residents' Association members were emailed a survey between October-November 2018. Questions involved political priorities, perspective on single-payer healthcare, voting knowledge/behavior, and EM PACs participation. We analyzed data using descriptive statistics. RESULTS Survey participants included 1,241 fully responding medical students and residents, with a calculated response rate of 20%. The top three healthcare priorities were as follows: 1) high cost of healthcare/price transparency; 2) decreasing the number of uninsured; and 3) quality of health insurance. The top EM-specific issue was ED crowding and boarding. Most trainees (70%) were supportive of single-payer healthcare: "somewhat favor" (36%) and "strongly favor" (34%). Trainees had high rates of voting in presidential elections (89%) but less frequent use of other voting options: 54% absentee ballots; 56% voting in state primary races; and 38% early voting. Over half (66%) missed voting in prior elections, with work cited as the most frequent (70%) barrier. While overall, half of respondents (62%) reported awareness of EM PACs, only 4% of respondents had contributed. CONCLUSION The high cost of healthcare was the top concern among EM trainees. Survey respondents had a high level of knowledge of absentee and early voting but less frequently used these options. Encouragement of early and absentee voting can improve voter turnout of EM trainees. Concerning EM PACs, there is significant room for membership growth. With improved knowledge of the political priorities of EM trainees, physician organizations and PACs can better engage future physicians.
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Affiliation(s)
- Rachel E. Solnick
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York (Current)
- Yale School of Medicine, Department of Emergency Medicine, New Haven Connecticut (Previously at)
| | | | | | - Dowin Boatright
- NYU Grossman School of Medicine, Department of Emergency Medicine, New York
- Yale School of Medicine, Department of Emergency Medicine, New Haven Connecticut (Previously at)
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21
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Chilman LB, Meredith PJ, Kennedy-Behr A, Campbell G, Frakking T, Swanepoel L, Verdonck M. Picky eating in children: Current clinical trends, practices, and observations within the Australian health-care context. Aust Occup Ther J 2023. [PMID: 37127548 DOI: 10.1111/1440-1630.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND/AIM Childhood picky eating occurs when there is limited intake or variety of food and/or unwillingness to try new foods. Within research settings, standardised assessments are used to describe picky eating behaviours in children. However, little is known about assessment practices of occupational therapists. Similarly, occupational therapy interventions for picky eating in the literature focus on; providing strategies for parents, and working with the child on self-feeding skills. Despite this, interventions and strategies utilised by occupational therapists in clinical practice within an Australian health-care context are unknown. This study examines Australian health professionals' observations of picky eating behaviours, the use of childhood picky eating assessments and interventions, and differences between occupational therapists and other professionals. METHODS Health professionals (n = 179) were recruited through professional organisations, such as Occupational Therapy Australia. Participants completed an online survey between March and May 2021. Independent variables were reported using descriptive statistics, with logistic regression used to consider differences between occupational therapists and other health professionals. Conventional content analysis was used to analyse responses to open-ended questions. RESULTS The final sample included 109 eligible participants, with an average of 8.5 years working with picky eaters. Results indicated picky eating behaviours aligned with those reported in the literature. Participants relied on clinical observations and workplace designed assessments. The most common interventions were education, coaching, and the sequential oral sensory approach to feeding. Occupational therapy participants were significantly more likely than other health professional participants to report always using coaching and education. CONCLUSION Although few health professionals used standardised or validated assessments, the use of education and coaching by occupational therapists aligned with the literature. Results highlight the need for more rigorous investigation to determine the sensitivity of current assessments to differentiate between clinical and typical picky eating, and the effectiveness of interventions for childhood picky eating.
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Affiliation(s)
- Laine B Chilman
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Pamela J Meredith
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Kennedy-Behr
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- School of Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Gabrielle Campbell
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Thuy Frakking
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Research Development Unit, Caboolture Hospital, Metro North Hospital and Health Service, Queensland Health, Caboolture, Queensland, Australia
- Centre for Clinical Research, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Speech Pathology Department, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Queensland Health, Gold Coast, Queensland, Australia
| | - Libby Swanepoel
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Australian Centre for Pacific Islands Research, School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Michèle Verdonck
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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22
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Ryll LS, Pellegrini WR, Richards PQ, Zhou MT, Newlands SD, Levi JR. An evaluation of otolaryngology resources at United States medical schools. Am J Otolaryngol 2023; 44:103904. [PMID: 37148847 DOI: 10.1016/j.amjoto.2023.103904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Otolaryngology (OTO) is a competitive specialty, and medical school factors outside an applicant's control, such as presence of OTO student resources and an affiliated OTO residency program, can impact the competitiveness of a student's application. This study sought to evaluate the extent of OTO resources United States (U.S.) allopathic medical schools provide to help their students be successful, and to evaluate for medical school factors which may bias toward inequitable distribution of student OTO resources. METHODS A 48-question cross-sectional survey evaluating the extent of OTO resources was distributed by email to LCME accredited U.S. allopathic medical schools in 2020 and 2021. RESULTS Schools with residency programs and where faculty were employed through an OTO or surgery department were more likely to have an Otolaryngology Interest Group (OIG), an Otolaryngology Medical Student Education Director (OMSED), and were more likely to provide opportunities for OTO research.
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Affiliation(s)
- Lucia S Ryll
- Boston University School of Medicine, Boston, MA, United States of America.
| | - William R Pellegrini
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, United States of America
| | - Phillip Q Richards
- Boston University School of Medicine, Boston, MA, United States of America
| | - Maya T Zhou
- Boston University School of Medicine, Boston, MA, United States of America
| | - Shawn D Newlands
- Department of Otolaryngology - Head and Neck Surgery, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Jessica R Levi
- Boston University School of Medicine, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, United States of America
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23
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Ladwig KH, Johar H, Miller I, Atasoy S, Goette A. Covid-19 pandemic induced traumatizing medical job contents and mental health distortions of physicians working in private practices and in hospitals. Sci Rep 2023; 13:5284. [PMID: 37002346 PMCID: PMC10064592 DOI: 10.1038/s41598-023-32412-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The Covid-19 pandemic during its early phases posed significant psychological threats particularly for medical frontline personal. It is unclear whether the medical workforce with the passage of time has adapted to these threats or have generalized to wider medical settings. An online survey was conducted reaching 1476 physicians in Germany with valid data from 1327 participants. Depression and anxiety were screened with the PHQ-2 and the GAD-2. Among a subtotal of 1139 (86.6%) physicians reporting personal treatment experiences with Covid-19 patients, 553 (84.8%) worked in a private practice (PP) and 586 (88.3%) in a hospital (HP). Covid-19 provoked profound conflicts between professional and ethical values: more physicians in PPs than HPs reported external constraints on their medical care being in conflict with the code of medical ethics (39.1 vs. 34.4%, p < 0.002) and significantly more HPs failed to maintain the dignity of their patients during the pandemic (48 vs. 27%, p < 0.0001). Comparison with reference groups among physicians with comparable size and settings during the first wave of Covid-19 revealed a significant increase in the prevalence of depression (23.0%) and anxiety (24.16%). Feelings of helplessness (63.3% in HPs and 53.4% in PPs) were associated with female sex, minor years of medical experience, sleeping problems and being encountered to unsettling events. Exposure to unsettling events and helplessness was significantly mediated by sleep disturbances (ß = 0.29, SE = 0.03, p < 0.0001). Covid-19 induced stress job content issues have broadened to medical disciplines beyond frontline workers. Emotional perturbations among physicians have attained a critical magnitude.
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Affiliation(s)
- Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partnersite Munich Heart Alliance, Munich, Germany
| | - Hamimatunnisa Johar
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia
| | - Inna Miller
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partnersite Munich Heart Alliance, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
| | - Andreas Goette
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.
- St. Vincenz-Krankenhaus GmbH, Medizinische Klinik II, Am Busdorf 2, 33098, Paderborn, Germany.
- MAESTRIA Consortium AFNET e.V., Münster, Germany.
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24
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Cronin S, Li A, Bai YQ, Ammi M, Hogg W, Wong ST, Wodchis WP. How do respondents of primary care surveys compare to typical users of primary care? A comparison of two surveys. BMC PRIMARY CARE 2023; 24:80. [PMID: 36959533 PMCID: PMC10037805 DOI: 10.1186/s12875-023-02029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Primary care surveys are a key source of evaluative data; understanding how survey respondents compare to the intended population is important to understand results in context. The objective of this study was to examine the physician and patient representativeness of two primary care surveys (TRANSFORMATION and QUALICOPC) that each used different sampling and recruitment techniques. METHODS We linked the physician and patient participants of the two surveys to health administrative databases. Patients were compared to other patients visiting the practice on the same day and other randomly selected dates using sociodemographic data, chronic disease diagnosis, and health system utilization. Physicians were compared to other physicians in the same practice, and other physicians in the intended geographic area using sociodemographic and practice characteristics. RESULTS Physician respondents of the TRANSFORMATION survey included more males compared to their practice groups, but not to other physicians in the area. TRANSFORMATION physicians cared for a larger roster of patients than other physicians in the area. Patient respondents of the QUALICOPC survey did not have meaningful differences from other patients who visit the practice. Patient respondents of the TRANSFORMATION survey resided in more rural areas, had less chronic disease, and had lower use of health services than other patients visiting the practice. CONCLUSION Differences in survey recruitment methods at the physician and patient level may help to explain some of the differences in representativeness. When conducting primary care surveys, investigators should consider diverse methods of ensuring representativeness to limit the potential for nonresponse bias.
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Affiliation(s)
- Shawna Cronin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Unit 425, Toronto, Canada.
| | - Allanah Li
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Unit 425, Toronto, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Yu Qing Bai
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Unit 425, Toronto, Canada
- ICES, Toronto, Canada
| | - Mehdi Ammi
- School of Public Policy & Administration, Carleton University, Ottawa, Canada
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- Institut du Savoir Montfort, Ottawa, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, Canada
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Unit 425, Toronto, Canada
- ICES, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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25
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Roach P, Ruzycki SM, Hernandez S, Carbert A, Holroyd-Leduc J, Ahmed S, Barnabe C. Prevalence and characteristics of anti-Indigenous bias among Albertan physicians: a cross-sectional survey and framework analysis. BMJ Open 2023; 13:e063178. [PMID: 36813494 PMCID: PMC9950908 DOI: 10.1136/bmjopen-2022-063178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Recent deaths of Indigenous patients in the Canadian healthcare system have been attributed to structural and interpersonal racism. Experiences of interpersonal racism by Indigenous physicians and patients have been well characterised, but the source of this interpersonal bias has not been as well studied. The aim of this study was to describe the prevalence of explicit and implicit interpersonal anti-Indigenous biases among Albertan physicians. DESIGN AND SETTING This cross-sectional survey measuring demographic information and explicit and implicit anti-Indigenous biases was distributed in September 2020 to all practising physicians in Alberta, Canada. PARTICIPANTS 375 practising physicians with an active medical licence. OUTCOMES Explicit anti-Indigenous bias, measured by two feeling thermometer methods: participants slid an indicator on a thermometer to indicate their preference for white people (full preference is scored 100) or Indigenous people (full preference, 0), and then participants indicated how favourably they felt toward Indigenous people (100, maximally favourable; 0, maximally unfavourable). Implicit bias was measured using an Indigenous-European implicit association test (negative scores suggest preference for European (white) faces). Kruskal-Wallis and Wilcoxon rank-sum tests were used to compare bias across physician demographics, including intersectional identities of race and gender identity. MAIN RESULTS Most of the 375 participants were white cisgender women (40.3%; n=151). The median age of participants was 46-50 years. 8.3% of participants felt unfavourably toward Indigenous people (n=32 of 375) and 25.0% preferred white people to Indigenous people (n=32 of 128). Median scores did not differ by gender identity, race or intersectional identities. White cisgender men physicians had the greatest implicit preferences compared with other groups (-0.59 (IQR -0.86 to -0.25); n=53; p<0.001). Free-text responses discussed 'reverse racism' and expressed discomfort with survey questions addressing bias and racism. CONCLUSIONS Explicit anti-Indigenous bias was present among Albertan physicians. Concerns about 'reverse racism' targeting white people and discomfort discussing racism may act as barriers to addressing these biases. About two-thirds of respondents had implicit anti-Indigenous bias. These results corroborate the validity of patient reports of anti-Indigenous bias in healthcare and emphasise the need for effective intervention.
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Affiliation(s)
- Pamela Roach
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Santanna Hernandez
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Carbert
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Sofia Ahmed
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bleeser T, Devroe S, Lucas N, Debels T, Van de Velde M, Lemiere J, Deprest J, Rex S. Neurodevelopmental outcomes after prenatal exposure to anaesthesia for maternal surgery: a propensity-score weighted bidirectional cohort study. Anaesthesia 2023; 78:159-169. [PMID: 36283123 DOI: 10.1111/anae.15884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 01/11/2023]
Abstract
Up to 1% of pregnant women undergo anaesthesia for non-obstetric surgery. This study investigated neurodevelopmental outcomes after prenatal anaesthesia for maternal surgery. A bidirectional cohort study of children born between 2001 and 2018 was performed: neurodevelopmental outcomes of children who had received prenatal anaesthesia for maternal surgery were prospectively compared with unexposed children, with exposure status being assessed retrospectively. Children exposed to anaesthesia for obstetric and fetal surgery were excluded. The primary outcome was the global executive composite of the behaviour rating inventory of executive function score. Our secondary outcomes were: total problems; internalising problems and externalising problems derived from the child behaviour checklist; psychiatric diagnoses; and learning disorders. In 90% of exposed children, there was a single mean (SD) antenatal anaesthesia exposure lasting 91(94) min. There was a broad spectrum of indications, with abdominal surgery being most frequent. Parents of 129 exposed (response rate 68%) and 453 unexposed (response rate 63%) children participated. There were no arguments for non-response bias. After propensity weighting, there were no statistically significant differences in primary outcome, with a weighted mean difference (95%CI) of exposed minus unexposed children of 1.9 (-0.4-4.2), p = 0.10; or any of the secondary outcomes. Sensitivity analyses confirmed the robustness. Exploratory analyses, however, showed significant differences in certain subgroups for the primary outcome, (e.g. for intra-abdominal surgery, exposure duration > 1 h) and some cognitive subdomains (e.g. working memory and attention). This bidirectional cohort study, the largest investigation on the subject to date, has found no evidence in the general population for an association between prenatal exposure to anaesthesia and impaired neurodevelopmental outcomes.
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Affiliation(s)
- T Bleeser
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - S Devroe
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - N Lucas
- Department of Anaesthesia, Northwick Park Hospital, Harrow, UK
| | - T Debels
- Faculty of Medicine, KU Leuven, Belgium
| | - M Van de Velde
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - J Lemiere
- Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Belgium
| | - J Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Belgium
| | - S Rex
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
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Hydoub YM, Fischer KM, Hanson KT, Coons TJ, Wilshusen LL, Vista TL, Colbenson GA, Burton MC, Habermann EB, Dugani SB. Multisite analysis of patient experience scores and risk of hospital admission: a retrospective cohort study. Hosp Pract (1995) 2023; 51:35-43. [PMID: 36326005 PMCID: PMC9928911 DOI: 10.1080/21548331.2022.2144055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Routinely collected patient experience scores may inform risk of patient outcomes. The objective of the study was to evaluate the risk of hospital admission within 30-days following third-party receipt of the patient experience survey and guide interventions. METHODS In this retrospective cohort study, we analyzed Hospital Consumer Assessment of Healthcare Providers and Systems surveys, January 2016-July 2019, from an institution's 20 hospitals in four U.S. states. Surveys were routinely sent to patients using census sampling. We analyzed surveys received ≤60 days following discharge from patients living ≤60 miles of any of the institution's hospitals. The exposures were 19 survey items. The outcome was hospital admission within 30 days after third-party receipt of the survey. We evaluated the association of favorable (top-box) vs unfavorable (non-top-box) score for survey items with risk of 30-day hospital admission in models including patient and hospitalization characteristics and reported adjusted odds ratios (aOR [95% confidence interval]). RESULTS Among 40,162 respondents (mean age ± standard deviation: 68.1 ± 14.0 years), 49.8% were women and 4.3% had 30-day hospital admission. Patients with 30-day hospital admission, compared to those not admitted, were more likely to be discharged from a medical service line (62.9% vs 42.3%; P < 0.001) and have a higher Elixhauser index. Favorable vs unfavorable score for hospital rating was associated with lower odds of 30-day hospital admission in the overall cohort (0.88 [0.77-0.99]; P = 0.04), medical service line (0.81 [0.70-0.94]; P = 0.007), and upper tertile of Elixhauser index (0.79 [0.67-0.92]; P = 0.003). Favorable score for recommend hospital was associated with lower odds of 30-day hospital admission in the medical service line (0.83 [0.71-0.97]; P = 0.02) but for others (e.g. cleanliness of hospital environment) showed no association. CONCLUSION In routinely collected patient experience scores, favorable hospital rating was associated with lower odds of 30-day hospital admission and may inform risk stratification and interventions. Evidence-based survey items linked to patient outcomes may also inform future surveys.
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Affiliation(s)
- Yousif M. Hydoub
- Division of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States
| | - Kristine T. Hanson
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Trevor J. Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Tafi L. Vista
- Office of Patient Experience, Mayo Clinic, Rochester, MN, United States
| | | | - M. Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Elizabeth B. Habermann
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Sagar B. Dugani
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
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28
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Barbuto S, Perrone V, Veronesi C, Dovizio M, Zappulo F, Vetrano D, Giannini S, Fusaro M, Ancona DD, Barbieri A, Ferrante F, Lena F, Palcic S, Re D, Rizzi FV, Cogliati P, Soro M, Esposti LD, Cianciolo G. Real-World Analysis of Outcomes and Economic Burden in Patients with Chronic Kidney Disease with and without Secondary Hyperparathyroidism among a Sample of the Italian Population. Nutrients 2023; 15:nu15020336. [PMID: 36678208 PMCID: PMC9867108 DOI: 10.3390/nu15020336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
This real-world analysis evaluated the clinical and economic burden of non-dialysis-dependent CKD patients with and without secondary hyperparathyroidism (sHPT) in Italy. An observational retrospective study was conducted using administrative databases containing a pool of healthcare entities covering 2.45 million health-assisted individuals. Adult patients with hospitalization discharge diagnoses for CKD stages 3, 4, and 5 were included from 1 January 2012 to 31 March 2015 and stratified using the presence/absence of sHPT. Of the 5710 patients, 3119 were CKD-only (62%) and 1915 were CKD + sHPT (38%). The groups were balanced using Propensity Score Matching (PSM). Kaplan-Meier curves revealed that progression to dialysis and cumulative mortality had a higher incidence in the CKD + sHPT versus CKD-only group in CKD stage 3 patients and the overall population. The total direct healthcare costs/patient at one-year follow-up were significantly higher in CKD + sHPT versus CKD-only patients (EUR 8593 vs. EUR 5671, p < 0.001), mostly burdened by expenses for drugs (EUR 2250 vs. EUR 1537, p < 0.001), hospitalizations (EUR 4628 vs. EUR 3479, p < 0.001), and outpatient services (EUR 1715 vs. EUR 654, p < 0.001). These findings suggest that sHPT, even at an early CKD stage, results in faster progression to dialysis, increased mortality, and higher healthcare expenditures, thus indicating that timely intervention can ameliorate the management of CKD patients affected by sHPT.
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Affiliation(s)
- Simona Barbuto
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Chiara Veronesi
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Fulvia Zappulo
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Daniele Vetrano
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | | | - Fulvio Ferrante
- UOC Farmacia, Ufficio di Farmacovigilanza, ASL Frosinone, 03100 Frosinone, Italy
| | - Fabio Lena
- U.O.C. Politiche del Farmaco, USL Toscana Sud Est, 58100 Grosseto, Italy
| | - Stefano Palcic
- SC Farmacia Ospedaliera e Territoriale—Area Giuliana, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Davide Re
- Servizio Farmaceutico Territoriale, ASL Teramo, 64100 Teramo, Italy
| | | | | | | | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
- Correspondence:
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Ruzycki SM, Roach P, Holroyd-Leduc J, Barnabe C, Ahmed SB. Experiences and Perceptions of Racism and Sexism Among Alberta Physicians: Quantitative Results and Framework Analysis of a Cross-Sectional Survey. J Gen Intern Med 2023; 38:165-175. [PMID: 35829875 PMCID: PMC9849641 DOI: 10.1007/s11606-022-07734-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The prevalence of harassment and discrimination in medicine differs by race and gender. The current evidence is limited by a lack of intersectional analysis. OBJECTIVE To evaluate the experiences and perceptions of harassment and discrimination in medicine across physicians stratified by self-identified race and gender identity. DESIGN Quantitative and framework analysis of results from a cross-sectional survey study. PARTICIPANTS Practicing physicians in the province of Alberta, Canada (n=11,688). MAIN MEASURES Participants completed an instrument adapted from the Culture Conducive to Women's Academic Success to capture the perceived culture toward self-identified racial minority physicians (Black, Indigenous, and People of Color (BIPOC)), indicated their perception of gender inequity in medicine using Likert responses to questions about common experiences, and were asked about experiences of reporting harassment or discrimination. Participants were also able to provide open text comments. KEY RESULTS Among the 1087 respondents (9.3% response rate), 73.5% reported experiencing workplace harassment or discrimination. These experiences were least common among White cisgender men and most common among BIPOC cisgender women (52.4% and 85.4% respectively, p<0.00001). Cisgender men perceived greater gender equity than cisgender women physicians, and White cisgender men physicians perceived greatest racial equity. Participant groups reporting the greatest prevalence of harassment and discrimination experiences were the least likely to know where to report harassment, and less than a quarter of physicians (23.8%) who had reported harassment or discrimination were satisfied with the outcome. Framework analysis of open text responses identified key types of barriers to addressing racism, including denial of racism and greater concern about other forms of discrimination and harassment. CONCLUSIONS Our results document the prevalence of harassment and discrimination by intersectional identities of race and gender. Incongruent perceptions and experiences may act as a barrier to preventing and addressing harassment and discrimination in the Canadian medical workplace.
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Affiliation(s)
- Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Pamela Roach
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Rybak A. Survey mode and nonresponse bias: A meta-analysis based on the data from the international social survey programme waves 1996-2018 and the European social survey rounds 1 to 9. PLoS One 2023; 18:e0283092. [PMID: 36928697 PMCID: PMC10019664 DOI: 10.1371/journal.pone.0283092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
The constant increase in survey nonresponse and fieldwork costs are the reality of survey research. Together with other unpredictable events occurring in the world today, this increase poses a challenge: the necessity to accelerate a switch from face-to-face data collection to different modes, that have usually been considered to result in lower response rates. However, recent research has established that the simple response rate is a feeble measure of study quality. Therefore, this article aims to analyze the effect of survey characteristics, especially the survey mode, on the nonresponse bias. The bias measure used is the internal criteria first proposed by Sodeur and first applied by Kohler. The analysis is based on the survey documentation and results from the International Social Survey Programme waves 1996-2018 and the European Social Survey rounds 1 to 9. Random-effects three-level meta-regression models, based on data from countries from each inhabited continent, were created in order to estimate the impact of the survey mode or modes, sampling design, fieldwork experience, year of data collection, and response rate on the nonresponse bias indicator. Several ways of nesting observations within clusters were also proposed. The results suggest that using mail and some types of mixed-mode surveys were connected to lower nonresponse bias than using face-to-face mode surveys.
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Affiliation(s)
- Adam Rybak
- Faculty of Sociology, Adam Mickiewicz University, Poznań, Poland
- * E-mail:
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Kleinman EP, Reimer-Taschenbrecker A, Haller CN, Paller AS, Levy ML, Eichenfield LF. Gastrostomy tube feeding in epidermolysis bullosa: A multi-center assessment of caregiver satisfaction. Pediatr Dermatol 2022; 40:270-275. [PMID: 36461900 DOI: 10.1111/pde.15207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/12/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND/OBJECTIVES Gastrostomy tubes (G-tubes) are a feasible intervention for nutritional support in patients with epidermolysis bullosa (EB) who suffer from gastrointestinal involvement. However, some parents may be apprehensive about this surgical intervention. The purpose of this study is to assess caregiver satisfaction and experiences after G-tube insertion in children with EB. METHODS Nine institutions sent an anonymous 89-item online questionnaire to caregivers of patients with EB and active G-tubes during an 8-week study period. The questionnaire consisted of eight sections and was formatted with multiple choice, Likert scales, dichotomous scales (yes/no), and free text. RESULTS Twenty caregiver surveys were completed. All caregivers were parents (100%). The average age of G-tube placement was 2.7 years (SD: 2.1, range 0-8) and duration of the G-tube utilization was an average of 12.0 years (SD: 7.8, range 1-25). EB subtypes were dystrophic (n = 15/20, 75%), junctional (n = 3/20, 15%), and simplex (n = 2/10, 10%). Almost all caregivers (n = 18/20, 90%) reported high levels of satisfaction with G-tube management (scores > 20 on the modified SAGA-8 scale). More than half of caregivers (n = 12/20, 60%) reported that, retrospectively, they would have desired earlier adoption of the G-tube. Caregivers rated mealtimes as more enjoyable and easier both for themselves and the individual with EB post-G-tube placement. CONCLUSION The survey demonstrates a high rate of satisfaction for G-tube use among caregivers of patients with EB across varying ages and household settings. The free-text responses provide unique insight into caregiver's individual experiences regarding G-tubes to be considered for future studies.
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Affiliation(s)
- Elana P Kleinman
- Rady Children's Hospital of San Diego, San Diego, California, USA.,University of California San Diego School of Medicine, San Diego, California, USA
| | - Antonia Reimer-Taschenbrecker
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Dermatology, Medical Center-University of Freiburg, Freiburg, Germany
| | - Courtney N Haller
- University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Moise L Levy
- University of Texas at Austin Dell Medical School, Austin, Texas, USA.,Dell Children's Medical Center, Austin, Texas, USA
| | - Lawrence F Eichenfield
- Rady Children's Hospital of San Diego, San Diego, California, USA.,University of California San Diego School of Medicine, San Diego, California, USA
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KÖhn S, Schlumbohm A, Marquardt M, Scheel-Sailer A, Tobler S, Vontobel J, Menzi L. Predicting non-response in patient-reported outcome measures: results from the Swiss quality assurance programme in cardiac inpatient rehabilitation. Int J Qual Health Care 2022; 34:6833162. [PMID: 36399024 PMCID: PMC9729760 DOI: 10.1093/intqhc/mzac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quality assurance programmes measure and compare certain health outcomes to ensure high-quality care in the health-care sector. The outcome of health-related quality of life is typically measured by patient-reported outcome measures (PROMs). However, certain patient groups are less likely to respond to PROMs than others. This non-response bias can potentially distort results in quality assurance programmes. OBJECTIVE Our study aims to identify relevant predictors of non-response during assessment using the PROM MacNew Heart Disease questionnaire in cardiac rehabilitation. METHODS This is a cross-sectional study based on data from the Swiss external quality assurance programme. All patients aged 18 years or older who underwent inpatient cardiac rehabilitation in 16 Swiss rehabilitation clinics between 2016 and 2019 were included. Patients' socio-demographic and basic medical data were analysed descriptively by comparing two groups: non-responders and responders. We used a random intercept logistic regression model to estimate the associations of patient characteristics and clinic differences with non-response. RESULTS Of 24 572 patients, there were 33.3% non-responders and 66.7% responders. The mean age was 70 years, and 31.0% were women. The regression model showed that being female was associated with non-response [odds ratio (OR) 1.22; 95% confidence interval (CI) 1.14-1.30], as well as having no supplementary health insurance (OR 1.49; 95% CI 1.39-1.59). Each additional year of age increased the chance of non-response by an OR of 1.02 (95% CI 1.02-1.02). Not being a first language speaker of German, French or Italian increased the chance of non-response by an OR of 6.94 (95% CI 6.03-7.99). Patients admitted directly from acute care had a higher chance of non-response (OR 1.23; 95% CI 1.10-1.38), as well as patients being discharged back into acute care after rehabilitation (OR 3.89; 95% CI 3.00-5.04). Each point on the cumulative illness rating scale total score increased the chance of non-response by an OR of 1.05 (95% CI 1.04-1.05). Certain diagnoses also influenced the chance of non-response. Even after adjustment for known confounders, response rates differed substantially between the 16 clinics. CONCLUSION We have found significant non-response bias among certain patient groups, as well as across different treatment facilities. Measures to improve response rates among patients with known barriers to participation, as well as among different treatment facilities, need to be considered, particularly when PROMs are being used for comparison of providers in quality assurance programmes or outcome evaluation.
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Affiliation(s)
- Stefanie KÖhn
- Address reprint requests to: Stefanie Köhn, Institut für Medizinische Soziologie und Rehabilitationswissenschaften, Abteilung Rehabilitationsforschung, Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany. Tel: +49 30 450 517 156; Fax: +49 30 450 517 932; E-mail:
| | - Anna Schlumbohm
- Abteilung Rehabilitationsforschung, Institute of Medical Sociology and Rehabilitation Science, Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Manuela Marquardt
- Abteilung Rehabilitationsforschung, Institute of Medical Sociology and Rehabilitation Science, Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Guido-A.-Zäch-Strasse 1, Nottwil CH-6207, Switzerland
| | - Stephan Tobler
- Kliniken Valens, Taminaplatz 1, Valens CH-7317, Switzerland
| | - Jan Vontobel
- Hochgebirgsklinik Davos AG, Herman-Burchard-Strasse 1, Davos CH-7265, Switzerland
| | - Luise Menzi
- Swiss National Association for Quality Development in Hospitals and Clinics - ANQ, Weltpoststrasse 5, Bern CH-3015, Switzerland
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Ball HJ, Santanam L, Senan S, Tanyi JA, van Herk M, Keall PJ. Results from the AAPM Task Group 324 respiratory motion management in radiation oncology survey. J Appl Clin Med Phys 2022; 23:e13810. [PMID: 36316761 PMCID: PMC9680579 DOI: 10.1002/acm2.13810] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/12/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To quantify the clinical practice of respiratory motion management in radiation oncology. METHODS A respiratory motion management survey was designed and conducted based on clinician survey guidelines. The survey was administered to American Association of Physicists in Medicine (AAPM) members on 17 August 2020 and closed on 13 September 2020. RESULTS A total of 527 respondents completed the entire survey and 651 respondents completed part of the survey, with the partially completed surveys included in the analysis. Overall, 84% of survey respondents used deep inspiration breath hold for left-sided breast cancer. Overall, 83% of respondents perceived respiratory motion management for thoracic and abdominal cancer radiotherapy patients to be either very important or required. Overall, 95% of respondents used respiratory motion management for thoracic and abdominal sites, with 36% of respondents using respiratory motion management for at least 90% of thoracic and abdominal patients. The majority (60%) of respondents used the internal target volume method to treat thoracic and abdominal cancer patients, with 25% using breath hold or abdominal compression and 13% using gating or tracking. CONCLUSIONS A respiratory motion management survey has been completed by AAPM members. Respiratory motion management is generally considered very important or required and is widely used for breast, thoracic, and abdominal cancer treatments.
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Affiliation(s)
- Helen J. Ball
- ACRF Image X InstituteFaculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Lakshmi Santanam
- Medical Physics DepartmentMemorial Sloan‐Kettering Cancer CenterNew YorkNew YorkUSA
| | - Suresh Senan
- Amsterdam University Medical Centers – VUmc LocationAmsterdamThe Netherlands
| | - James A. Tanyi
- Department of Radiation OncologyGeisinger Cancer InstituteDanvillePennsylvaniaUSA
| | - Marcel van Herk
- Department of Radiotherapy Related Research, Division of Cancer Sciences, Faculty of MedicineBiology and HealthSchool of Medical SciencesThe University of ManchesterManchesterUK
| | - Paul J. Keall
- ACRF Image X InstituteFaculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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Roach P, Hernandez S, Carbert A, Jalil R, Panaccione R, Ruzycki SM. Anti-Indigenous bias of medical school applicants: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:683. [PMID: 36123670 PMCID: PMC9484063 DOI: 10.1186/s12909-022-03739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Structural and interpersonal anti-Indigenous racism is prevalent in Canadian healthcare. The Truth and Reconciliation Commission calls on medical schools to address anti-Indigenous bias in students. We measured the prevalence of interpersonal anti-Indigenous bias among medical school applicants to understand how the medical school selection process selects for or against students with high levels of bias. METHODS All applicants to a single university in the 2020-2021 admissions cycle were invited to participate. Explicit anti-Indigenous bias was measured using two sliding scale thermometers. The first asked how participants felt about Indigenous people (from 0, indicating 'cold/unfavourable' to 100, indicating 'warm/favourable') and the second asked whether participants preferred white (scored 100) or Indigenous people (scored 0). Participants then completed an implicit association test examining preferences for European or Indigenous faces (negative time latencies suggest preference for European faces). Explicit and implicit anti-Indigenous biases were compared by applicant demographics (including gender and racial identity), application status (offered an interview, offered admission, accepted a position), and compared to undergraduate medical and mathematics students. RESULTS There were 595 applicant respondents (32.4% response rate, 64.2% cisgender women, 55.3% white). Applicants felt warmly toward Indigenous people (median 96 (IQR 80-100)), had no explicit preference for white or Indigenous people (median 50 (IQR 37-55), and had mild implicit preference for European faces (- 0.22 ms (IQR -0.54, 0.08 ms)). There were demographic differences associated with measures of explicit and implicit bias. Applicants who were offered admission had warmer feelings toward Indigenous people and greater preference for Indigenous people compared to those were not successful. CONCLUSIONS Medical school applicants did not have strong interpersonal explicit and implicit anti-Indigenous biases. Outlier participants with strong biases were not offered interviews or admission to medical school.
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Affiliation(s)
- Pamela Roach
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Amanda Carbert
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rabiya Jalil
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Remo Panaccione
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- , Calgary, Canada.
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Wille C, De Clerck I, Van Hove G, Van Loon J, Van de Velde D, De Vriendt P. Supporting direct support professionals in enabling people with intellectual disabilities to engage in meaningful activities: protocol for the Meaningful Activities 4 All (MA4A) study based on the human-centred design process. BMJ Open 2022; 12:e061736. [PMID: 35977773 PMCID: PMC9389101 DOI: 10.1136/bmjopen-2022-061736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Meaningful activities (MA) have a positive impact on identity, well-being, participation and inclusion. Although people with intellectual disabilities (PID) depend on their direct support professionals (DSPs) to engage in MA, the DSPs need support which could enable them to offer more qualitative care and support. METHODS AND ANALYSIS To identify DSPs' needs, and to develop a tool/service, an innovative and iterative approach is developed, based on the human-centred design (HCD) process, combined with traditional qualitative and quantitative research methods. In the inspiration phase (needs analysis), in-depth interviews will be conducted in two day care centres in Flanders using an interpretative phenomenological analyses, one with a supply-driven approach and the other with a demand-driven approach, followed by a survey sent to all Flemish day care centres. In the ideation phase, the insights of phase 1 will guide a cocreation process (comprising a World Cafe, brainstorm and prototype sessions) with the DSPs, PID and other stakeholders. In the implementation phase, the solution will be tested in the two day care centres from phase 1 by means of living labs and a realist evaluation. By adopting this protocol, the functionality, quality, usability and acceptance are expected to increase. This protocol adopts all phases of the HCD process and shows the complementarity of HCD with traditional research methods. PID and the DSPs will benefit as the end result is truly grounded in their specific needs and wishes. ETHICS AND DISSEMINATION Ethical approval by the Ethics Committee of the University Hospital Ghent, Belgium (reference numbers: B670202042983 and PA2021-091). All participants will sign informed consent forms. Results of this study will be submitted for publication in relevant peer-reviewed journals and will be presented at relevant conferences.
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Affiliation(s)
- Christophe Wille
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Health and Care, Artevelde University College, Ghent, Belgium
| | - Ine De Clerck
- Health and Care, Artevelde University College, Ghent, Belgium
| | - Geert Van Hove
- Special Needs Education, Ghent University, Ghent, Belgium
| | - Jos Van Loon
- Special Needs Education, Ghent University, Ghent, Belgium
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Special Needs Education, Ghent University, Ghent, Belgium
| | - Patricia De Vriendt
- Health and Care, Artevelde University College, Ghent, Belgium
- Department of Gerontology and Frailty in Ageing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Mazzei D, Whittaker J, Kania-Richmond A, Faris P, Wasylak T, Robert J, Hawker G, Marshall D. Do people with knee osteoarthritis use guideline-consistent treatments after an orthopaedic surgeon recommends nonsurgical care? A cross-sectional survey with long-term follow-up. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100256. [DOI: 10.1016/j.ocarto.2022.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022] Open
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LeBlanc MR, Bryant AL, LeBlanc TW, Yang Q, Sellars E, Chase CC, Smith SK. A cross-sectional observational study of health-related quality of life in adults with multiple myeloma. Support Care Cancer 2022; 30:5239-5248. [PMID: 35262791 PMCID: PMC9050896 DOI: 10.1007/s00520-022-06943-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The purpose of this manuscript is to describe health-related quality of life (HRQoL) outcomes in a United States (US)-based sample of multiple myeloma (MM) patients and identify characteristics associated with poor HRQoL. PATIENTS AND METHODS MM patients identified through the Tumor Registry of a Southeastern US medical center were mailed surveys assessing patient characteristics and HRQoL outcomes. HRQoL outcomes were measured using PROMIS short form instruments which included measures of global health (global physical health and global mental health), physical function, and ability to participate in social roles and activities (social function). HRQoL domain scores were summarized, and best subset linear regression was used to identify predictors of HRQoL. RESULTS A total of 690 patients completed and returned surveys for a response rate of 64.7%. Respondents reported global physical health (44.9), global mental health (47.5), and physical function (44.1) significantly worse than the general population mean of 50 (p < .0001). Social function (49.5) did not differ significantly (p = .09). Worse socioeconomic status, higher comorbidities, not being in remission, and past receipt of radiation therapy were significantly associated with worse HRQoL. Treatment status and time since diagnosis were not associated with HRQoL outcomes. CONCLUSIONS Patients with MM have significantly worse HRQoL than the general population. These findings warrant increased attention from clinicians and researchers. More research is needed to better describe the relationship between treatment patterns and HRQoL in patients with MM, and to identify effective interventions.
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Affiliation(s)
- Matthew R. LeBlanc
- University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center
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Jiskra J, Paleček J, Attanasio R, Hegedüs L, Nagy EV, Papini E, Perros P, Negro R, Kršek M. Use of thyroid hormones in hypothyroid and euthyroid patients: a 2020 THESIS questionnaire survey of members of the Czech Society of Endocrinology. BMC Endocr Disord 2022; 22:117. [PMID: 35501788 PMCID: PMC9063132 DOI: 10.1186/s12902-022-01027-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/12/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Inconsistencies in the management of hypothyroidism have been reported among endocrinologists in different European countries. Aim of this study was to explore Czech endocrinologists' use of thyroid hormones in hypothyroid and euthyroid patients. METHODS We used a web-based survey containing 32 questions regarding the use of thyroid hormones. Four-hundred thirty-two members of the Czech Society of Endocrinology received an e-mail invitation to participate in the survey. RESULTS We received and analysed 157 responses (112 females and 45 males) from the 432 members (36.3%). According to 99.4% of the respondents, levothyroxine (LT4) is the primary drug of choice for the treatment of hypothyroidism. Liothyronine (LT3) was used in clinical practice by 29.9% of responders. According to 90.5% of respondents, thyroid hormones may be indicated in biochemically euthyroid patients. Female physicians prescribe thyroid hormones in euthyroid infertile women with high antibody levels more frequently than male physicians (P = 0.003). Most Czech endocrinologists (76.4%) consider combined therapy with LT4 and LT3 in various clinical scenarios, but only 1 of 29 hypothyroid physicians (3.5%) would recommend it to their patients, and only 4 out of 128 respondents (3.1%) would consider LT3 or desiccated thyroid for themselves, if diagnosed with hypothyroidism. CONCLUSION LT4 is the primary thyroid hormone used in the Czech Republic for treatment of hypothyroidism. At variance with thyroid guideline recommendations, Czech endocrinologists are quite liberal when prescribing thyroid hormones to euthyroid patients and in the use of LT4/LT3 combination treatment for hypothyroid patients with persisting symptoms.
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Affiliation(s)
- Jan Jiskra
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.
| | - Jan Paleček
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Roberto Attanasio
- Scientific Committee of Associazione Medici Endocrinologi, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital, Lecce, Italy
| | - Michal Kršek
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
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Schoenbrunner AR, McIntyre JK, Nthumba P, Muchemwa FC, Sigler A, Gosman AA. Ethical Dilemmas in Global Plastic Surgery: Divergent Perspectives of Local and Visiting Surgeons. Plast Reconstr Surg 2022; 149:789e-799e. [PMID: 35349548 DOI: 10.1097/prs.0000000000008957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As more of the world's resources are directed toward improving patient access to safe surgical and anesthesia care, there is a growing concern that volunteer surgeons' "desire to help" has numerous unintended consequences. The purpose of this study was to ask in-country, local surgeons and visiting volunteer plastic surgeons about the frequency of ethical dilemmas for different types of global surgery collaborations and to assess their perception of compliance with the concepts of autonomy, beneficence, nonmaleficence, and justice. METHODS A cross-sectional email survey tool was sent to a representative sample of domestic American Society of Plastic Surgeons members, all international members of the American Society of Plastic Surgeons, and international partners of the Volunteers in Plastic Surgery committee of the Plastic Surgery Foundation. The survey response rate was 7.7 percent, with 356 respondents from 65 countries. RESULTS This survey data showed a statistically significant divergence of perspectives between local and visiting surgeons in regard to scope of practice, quality of patient care, impact on local health care systems, perception of the quality of care by local providers, the integrity of the informed consent process, and photography in global plastic surgery collaborations. Though the short-term mission trip model was particularly polarizing when comparing the responses of local and visiting surgeons, educational and research exchanges may also significantly interrupt local health care and incite ethical lapses. CONCLUSION This survey provides quantitative insight into the impact of current global plastic surgery collaborations and highlights ethical areas of disagreement between local and visiting surgeons.
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Affiliation(s)
- Anna R Schoenbrunner
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Division of Plastic Surgery, University of Massachusetts Medical School; Department of Surgery, AIC Kijabe Hospital; Department of Surgery, University of Zimbabwe College of Health Sciences; Shriners Ambulatory Clinic; and Division of Plastic Surgery, University of California, San Diego
| | - Joyce K McIntyre
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Division of Plastic Surgery, University of Massachusetts Medical School; Department of Surgery, AIC Kijabe Hospital; Department of Surgery, University of Zimbabwe College of Health Sciences; Shriners Ambulatory Clinic; and Division of Plastic Surgery, University of California, San Diego
| | - Peter Nthumba
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Division of Plastic Surgery, University of Massachusetts Medical School; Department of Surgery, AIC Kijabe Hospital; Department of Surgery, University of Zimbabwe College of Health Sciences; Shriners Ambulatory Clinic; and Division of Plastic Surgery, University of California, San Diego
| | - Faith Chengetavyi Muchemwa
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Division of Plastic Surgery, University of Massachusetts Medical School; Department of Surgery, AIC Kijabe Hospital; Department of Surgery, University of Zimbabwe College of Health Sciences; Shriners Ambulatory Clinic; and Division of Plastic Surgery, University of California, San Diego
| | - Alicia Sigler
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Division of Plastic Surgery, University of Massachusetts Medical School; Department of Surgery, AIC Kijabe Hospital; Department of Surgery, University of Zimbabwe College of Health Sciences; Shriners Ambulatory Clinic; and Division of Plastic Surgery, University of California, San Diego
| | - Amanda A Gosman
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University; Division of Plastic Surgery, University of Massachusetts Medical School; Department of Surgery, AIC Kijabe Hospital; Department of Surgery, University of Zimbabwe College of Health Sciences; Shriners Ambulatory Clinic; and Division of Plastic Surgery, University of California, San Diego
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Hagström J, Woodford J, von Essen A, Lähteenmäki P, von Essen L. Opt-out rates and reasons for non-participation in a single-arm feasibility trial (ENGAGE) of a guided internet-administered CBT-based intervention for parents of children treated for cancer: a nested cross-sectional survey. BMJ Open 2022; 12:e056758. [PMID: 35365530 PMCID: PMC8977820 DOI: 10.1136/bmjopen-2021-056758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Difficulties with recruitment into clinical trials are common. An opt-out recruitment strategy, whereby potential participants can decline further contact about a study (opt-out), and non-responders are contacted, may facilitate participation. Primary objectives examined opt-out and consent rates, mode and time point of opt-out, and sociodemographic characteristics of those who opted out versus those who chose to participate in a single-arm feasibility trial (ENGAGE) of a guided, internet-administered, cognitive-behavioural therapy-based intervention for parents of children treated for cancer. Secondary objectives examined reasons for non-participation. DESIGN A cross-sectional survey nested within the ENGAGE feasibility trial. SETTING The intervention was delivered from Uppsala University, with parents located throughout Sweden. PARTICIPANTS Potential participants were recruited 3 months-5 years following their child ending treatment for cancer and were identified via their personal identification number (via the Swedish Childhood Cancer Registry and Swedish Tax Agency) and invited via postal invitation packs and could opt out via post, online, telephone or email. Those who did not opt out or consent, within 4 weeks, received up to five telephone calls and/or one postal reminder. RESULTS Of 509 invited, 164 (32.2%) opted out, 78 (47.6%) via post, 53 (32.3%) via telephone, 24 (14.6%) online, and 6 (3.7%) via email, 88 (53.7%) opted out after at least one telephone call and/or postal reminder. There was a trend for parents with lower educational levels to opt out. No need of psychological support, lack of time, and no interest in internet-administered self-help were frequently reported reasons for non-participation. CONCLUSIONS Results emphasise the importance of using different opt-out modes and suggest future research should consider how to widen study participation for parents with lower education levels. Self-identifying a need for psychological support and the acceptability of internet-administered self-help are important factors for participation and should be considered in future research to increase recruitment. TRIAL REGISTRATION NUMBER ISRCTN57233429.
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Affiliation(s)
- Josefin Hagström
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Agnes von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Päivi Lähteenmäki
- Department of Paediatrics and Adolescent Medicine, TYKS Turku University Hospital, Turku, Finland
- Pediatric Oncology and Pediatric Surgery, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Beckwith H, Selimi V, Mussad A, Graham-Brown M, Knapton A, Irish B, Carr S. Demographics, distribution and experiences of UK clinical academic trainees using GMC NTS Survey data. Postgrad Med J 2022; 99:postgradmedj-2021-141278. [PMID: 35173053 DOI: 10.1136/postgradmedj-2021-141278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/22/2022] [Indexed: 11/03/2022]
Abstract
Involvement in research plays an integral role in the delivery of high-quality patient care, benefitting doctors, patients and employers. It is important that access to clinical academic training opportunities are inclusive and equitable. To better understand the academic trainee population, distribution of academic posts and their reported experience of clinical training, we analysed 53 477 anonymous responses from General Medical Council databases and the 2019 National Training Survey. Academic trainees are more likely to be men, and the gender divide begins prior to graduation. There are very low numbers of international medical graduates and less than full-time academic trainees. A small number of UK universities produce a greater prevalence of doctors successfully appointed to academic posts; subsequent academic training also clusters around these institutions. At more senior levels, academic trainees are significantly more likely to be of white ethnicity, although among UK graduates, no ethnicity differences were seen. Foundation academic trainees report a poorer experience of some aspects of their clinical training placements, with high workloads reported by all academic trainees. Our work highlights important disparities in the demographics of the UK clinical academic trainee population and raises concerns that certain groups of doctors face barriers accessing and progressing in UK academic training pathways.
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Affiliation(s)
- Hannah Beckwith
- Institute of Clinical Sciences, Imperial College London, London, UK.,Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Matt Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Renal Medicine, Leicester General Hospital, Leicester, UK
| | | | - Bill Irish
- Health Education England, East of England, Cambridge, UK
| | - Sue Carr
- General Medical Council, London, UK .,Department of Renal Medicine, Leicester General Hospital, Leicester, UK
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Heyming TW, Donaldson CD, Ehwerhemuepha L, Feaster W, Fortier MA, Kain ZN. Multivariable Analysis of Patient Satisfaction in the Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e544-e549. [PMID: 34348353 DOI: 10.1097/pec.0000000000002514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Published data on predictive factors associated with parent satisfaction from care in a pediatric emergency department (ED) visit are limited to be descriptive and obtained from small data sets. Accordingly, the purpose of this study was to determine both modifiable and nonmodifiable demographic and operational factors that influence parental satisfaction using a large and ethnically diverse site data set. METHODS Data consist of responses to the National Research Council (NRC) survey questionnaires and electronic medical records of 15,895 pediatric patients seen in a pediatric ED between the ages of 0 and 17 years discharged from May 2018 to September 2019. Bivariate, χ2, and multivariable logistic regression analyses were carried out using the NRC item on rating the ED between 0 and 10 as the primary outcome. Responses were coded using a top-box approach, a response of "9" or "10" represented satisfaction with the facility, and every other response was indicated as undesirable. Demographic data and NRC questionnaire were used as potential predictors. RESULTS Multivariable regression analysis found the following variables as independent predictors for positive parental rating of the ED: Hispanic race/ethnicity (odds ratio [OR], 1.285), primary language Spanish (OR, 2.399), and patients who had government-sponsored insurance (OR, 1.470). Those survey items with the largest effect size were timeliness of care (OR, 0.188) and managing discomfort (OR, 0.412). CONCLUSIONS Parental rating of an ED is associated with nonmodifiable variables such as ethnicity and modifiable variables such as timeliness of care and managing discomfort.
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Ho ISS, Azcoaga-Lorenzo A, Akbari A, Davies J, Khunti K, Kadam UT, Lyons RA, McCowan C, Mercer SW, Nirantharakumar K, Staniszewska S, Guthrie B. Measuring multimorbidity in research: Delphi consensus study. BMJ MEDICINE 2022; 1:e000247. [PMID: 36936594 PMCID: PMC9978673 DOI: 10.1136/bmjmed-2022-000247] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/26/2022] [Indexed: 12/20/2022]
Abstract
Objective To develop international consensus on the definition and measurement of multimorbidity in research. Design Delphi consensus study. Setting International consensus; data collected in three online rounds from participants between 30 November 2020 and 18 May 2021. Participants Professionals interested in multimorbidity and people with long term conditions were recruited to professional and public panels. Results 150 professional and 25 public participants completed the first survey round. Response rates for rounds 2/3 were 83%/92% for professionals and 88%/93% in the public panel, respectively. Across both panels, the consensus was that multimorbidity should be defined as two or more long term conditions. Complex multimorbidity was perceived to be a useful concept, but the panels were unable to agree on how to define it. Both panels agreed that conditions should be included in a multimorbidity measure if they were one or more of the following: currently active; permanent in their effects; requiring current treatment, care, or therapy; requiring surveillance; or relapsing-remitting conditions requiring ongoing care. Consensus was reached for 24 conditions to always include in multimorbidity measures, and 35 conditions to usually include unless a good reason not to existed. Simple counts were preferred for estimating prevalence and examining clustering or trajectories, and weighted measures were preferred for risk adjustment and outcome prediction. Conclusions Previous multimorbidity research is limited by inconsistent definitions and approaches to measuring multimorbidity. This Delphi study identifies professional and public panel consensus guidance to facilitate consistency of definition and measurement, and to improve study comparability and reproducibility.
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Affiliation(s)
- Iris S S Ho
- Usher Institute, University of Edinburgh, Edinburgh Medical School, Edinburgh, UK
| | | | - Ashley Akbari
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Jim Davies
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Umesh T Kadam
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ronan A Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Colin McCowan
- Bute Medical School, University of St Andrews, St Andrews, UK
| | - Stewart W Mercer
- Usher Institute, University of Edinburgh, Edinburgh Medical School, Edinburgh, UK
| | | | | | - Bruce Guthrie
- Usher Institute, University of Edinburgh, Edinburgh Medical School, Edinburgh, UK
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Carlsen MH, Andersen LF, Hjartåker A. Reproducibility and feasibility of an online self-administered food frequency questionnaire for use among adult Norwegians. Food Nutr Res 2021; 65:7561. [PMID: 34908922 PMCID: PMC8634621 DOI: 10.29219/fnr.v65.7561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background New methods of dietary assessment are increasingly making use of online technologies. The development of a new online food frequency questionnaire warranted investigation of its feasibility and the reproducibility of its results. Objective To investigate the feasibility and reproducibility of a newly developed online FFQ (WebFFQ). Design The semiquantitative WebFFQ was designed to assess the habitual diet the previous year, with questions about frequency of intake and portion sizes. Estimations of portion sizes include both pictures and household measures, depending on the type of food in question. In two independent cross-sectional studies conducted in 2015 and 2016, adults were recruited by post following random selection from the general population. In the first study, participants (n = 229) filled in the WebFFQ and answered questions about its feasibility, and in two subsequent focus group meetings, participants (n = 9) discussed and gave feedback about the feasibility of the WebFFQ. In the second study, the WebFFQ’s reproducibility was assessed by asking participants (n = 164) to fill it in on two separate occasions, 12 weeks apart. Moreover, in the second study, participants were offered personal dietary feedback, a monetary gift certificate, or both, as incentives to complete the study. Results In the feasibility study, evaluation form results showed that participants raised issues regarding the estimation of portion size and the intake of seasonal foods as being particularly challenging; furthermore, in the focus group discussions, personal feedback on diet was perceived to be a more motivating factor than monetary reward. In the reproducibility study, total food intake was lower in the second WebFFQ; however, 63% of the food groups were not significantly different from those in the first WebFFQ. Correlations of food intake ranged from 0.62 to 0.90, >86% of the participants were classified into the same or adjacent quartiles, and misclassification ranged from 0 to 3%. Average energy intake was 3.5% lower (p = 0.001), fiber showed the least difference at 1.6% (p = 0.007), and sugar intake differed the most at −6.8% (borderline significant, p = 0.08). Percentage energy obtained from macronutrients did not differ significantly between the first and second WebFFQs. Conclusion Our results suggest that at group level, the WebFFQ showed good reproducibility for the estimations of intake of food groups, energy, and nutrients. The feasibility of the WebFFQ is good; however, revisions to further improve portion size estimations should be included in future versions. The WebFFQ is considered suitable for dietary assessments for healthy adults in the Norwegian population.
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Affiliation(s)
- Monica Hauger Carlsen
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Lene F Andersen
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Anette Hjartåker
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway
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Whitman MV, Matthews RA, Williams ES. Examining supervisor undermining through the job-demands resources framework. Health Serv Manage Res 2021; 35:206-214. [PMID: 34882019 DOI: 10.1177/09514848211048608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Supervisor undermining has recently gained increasing attention due to its negative effects on employee health and well-being. In the healthcare context, negative supervisor behaviors have been linked to unfavorable individual and organizational outcomes as well as medical errors and patient mortality. Our study, therefore, examines the influence that supervisor undermining behavior has on employee engagement and performance within a standard job stress framework. METHODS Our sample consisted of occupational therapists, a health professions group who is growing in demand and importance in the U.S. and has unique job demands. Using an observational, cross-sectional study design, a convenience sample of 521 occupational therapists completed an online survey. A series of independent t-test and multiple-groups path analytic modeling was used. RESULTS Participants who had a supervisor perceived as engaging in undermining behaviors reported lower levels of resources, higher levels of demands, less motivation, and more overload than those who did not perceive supervisor undermining. These participants were also less engaged and reported lower levels of performance. CONCLUSION Our results shed further light on the importance of supervisory behaviors specifically in a healthcare setting and the need for organizations to create an environment that promotes positive and productive workplace behaviors.
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Patient-Reported Care Coordination is Associated with Better Performance on Clinical Care Measures. J Gen Intern Med 2021; 36:3665-3671. [PMID: 34545472 PMCID: PMC8642573 DOI: 10.1007/s11606-021-07122-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior studies using aggregated data suggest that better care coordination is associated with higher performance on measures of clinical care process; it is unclear whether this relationship reflects care coordination activities of health plans or physician practices. OBJECTIVE Estimate within-plan relationships between beneficiary-reported care coordination measures and HEDIS measures of clinical process for the same individuals. DESIGN Mixed-effect regression models in cross-sectional data. PARTICIPANTS 2013 Medicare Advantage CAHPS respondents (n=152,069) with care coordination items linked to independently collected HEDIS data on clinical processes. MAIN MEASURES Care coordination measures assessed follow-up, whether doctors had medical records during visits, whether doctors discussed medicines being taken, how informed doctors seemed about specialist care, and help received with managing care among different providers. HEDIS measures included mammography, colorectal cancer screening, cardiovascular LDL-C screening, controlling blood pressure, 5 diabetes care measures (LDL-C screening, retinal eye exam, nephropathy, blood sugar/HbA1c <9%, LCL-C<100 mg/dL), glaucoma screening in older adults, BMI assessment, osteoporosis management for women with a fracture, and rheumatoid arthritis therapy. KEY RESULTS For 9 of the 13 HEDIS measures, within health plans, beneficiaries who reported better care coordination also received better clinical care (p<0.05) and none of the associations went in the opposite direction; HEDIS differences between those with excellent and poor coordination exceeded 5 percentage points for 7 measures. Nine measures had positive associations (breast cancer screening, colorectal cancer screening, cardiovascular care LDL-C screening, 4 of 5 diabetes care measures, osteoporosis management, and rheumatoid arthritis therapy). CONCLUSIONS Within health plans, beneficiaries who report better care coordination also received higher-quality clinical care, particularly for care processes that entail organizing patient care activities and sharing information among different healthcare providers. These results extend prior research showing that health plans with better beneficiary-reported care coordination achieved higher HEDIS performance scores.
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Har-Shai L, Ofek SE, Brandstetter A, Cohen KH, Shay T, Amir A, Ad-El DD. Quality of Patient-Reported Outcome Studies Utilizing the BREAST-Q: A Systematic Review. Aesthet Surg J 2021; 41:NP1448-NP1458. [PMID: 33556165 DOI: 10.1093/asj/sjab057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) studies are essential in the assessment of surgical procedures in plastic surgery. One accepted and validated questionnaire is the BREAST-Q. OBJECTIVES The aim of this study was to assess the quality of PRO studies in plastic surgery utilizing the BREAST-Q questionnaire. METHODS This study involved 2 steps: (1) a systematic review of 23 key criteria assessing the quality of survey research in studies utilizing the BREAST-Q that were published between 2015 and 2018; (2) a review of current guidance for survey research in journals related to plastic surgery and breast surgery which were included in the systematic review. RESULTS Seventy-nine studies were included in the systematic review. Many key criteria were poorly reported: 51.9% of the studies did not provide a defined response rate and almost 90% did not provide a method for analysis of nonresponse error; 67.1% lacked a description of the sample's representativeness of the population of interest, and 82.3% did not present a sample size calculation. The methods used to analyze data were not described in 11.4% of the papers; in 27.8% the data analysis presented could not allow replication of the results. Of the 16 journals in the fields of plastic surgery and breast surgery for which the "instructions to authors" were reviewed, 15 (93.7%) did not provide any guidance for survey reporting. CONCLUSIONS The majority of key criteria are underreported by authors publishing their survey research in peer-reviewed journals in the fields of plastic and breast surgery. There is an urgent need to construct well-developed reporting guidelines for survey research in plastic surgery, and particularly in breast surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Lior Har-Shai
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Sar-El Ofek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Keren H Cohen
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Tamir Shay
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Avraham Amir
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Dean D Ad-El
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
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Rana S, Hania M, Darbar U. Experiences of dental core trainees and specialist registrars before and after redeployment during the COVID-19 pandemic at the Eastman Dental Hospital. Br Dent J 2021:10.1038/s41415-021-3472-3. [PMID: 34616029 PMCID: PMC8494167 DOI: 10.1038/s41415-021-3472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic resulted in an unprecedented shut down of all elective dental services, with normal training activity being suspended. This questionnaire-based survey reports on the experiences of a cohort of dental trainees who participated in redeployment during the pandemic.Materials and methods The questionnaires were distributed via Survey Monkey to 47 trainees, before and eight weeks after redeployment.Results A total of 29 trainees completed the questionnaire before redeployment and 32 completed it eight weeks after redeployment finished. The majority of trainees, before the redeployment, reported that inadequate information was given about the redeployment and a minority reported that they were struggling to cope with the pandemic. The post-redeployment questionnaire showed that all trainees felt that they had been well supported, with structured induction and help being given by the hosting service. They also stated that they had learnt skills beyond what they would have obtained as part of their training, with 86% of trainees saying that they would be happy to be redeployed again.Conclusion This survey shows that despite the initial anxiety expressed by the dental trainees at the outset, they had an overwhelmingly positive experience, enhancing their personal development and overall training experience. The survey highlights the need to ensure that appropriate and timely information and guidance is available for trainees, to help support their general and mental wellbeing when unprecedented events occur.
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Affiliation(s)
- Shivani Rana
- Restorative Dentistry Department, Royal National ENT and Eastman Dental Hospitals, 47-49 Huntley Street, London, WC1E 6DG, UK.
| | - Mohamed Hania
- Orthodontic Department, Royal National ENT and Eastman Dental Hospitals, 47-49 Huntley Street, London, WC1E 6DG, UK
| | - Ulpee Darbar
- Restorative Dentistry Department, Royal National ENT and Eastman Dental Hospitals, 47-49 Huntley Street, London, WC1E 6DG, UK
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Sreedharan S, Cleland H, Lo CH. Plastic surgical trainees' perspectives toward burn surgery in Australia and New Zealand: Changes in the last 17 years? Burns 2021; 47:1766-1772. [PMID: 34598834 DOI: 10.1016/j.burns.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION An emerging amount of literature emphasises the ever-growing shortage of burn surgeons worldwide. Despite burn surgery being a fundamental competency in the Australia and New Zealand plastic and reconstructive surgery training curriculum, a perceived lack of interest amongst trainees exists. The aim of this study was to investigate Australasian plastic surgery trainees' interest in burn surgery as a career and compare with the Brown and Mills survey in 2004. METHODS An electronic survey was distributed to all Australian and New Zealand plastic and reconstructive surgery trainees during the March 2021 registrar trainee conference. This anonymous survey was adapted from the original survey conducted by Brown and Mills in 2004, with additional questions to determine the perceived importance of burns surgery as a subspecialty of plastic and reconstructive surgery, and to elicit possible solutions to the issue of workforce shortage. A reminder email was sent one month following the conference to improve the response rate. The survey was hosted by Survey Monkey (San Mateo, California, USA). RESULTS The survey was distributed to all 121 trainees and 71 (58.7%) responded. An increase in interest amongst trainees in pursuing a career in burn surgery was found, with 34 trainees (48.6% of respondents) interested, mostly on a half time or sessional basis. The three most common barriers to practising burn surgery remain unchanged, and were nature of burn operations, nature of burn care and on-call commitments; inadequacy of exposure or training ranked fourth. We found a strong overall response that burn surgery and burn care remained an important component of plastic and reconstructive surgery. DISCUSSION Inadequate exposure or training has evolved to present a bigger barrier in this study compared to a similar study conducted 17 years ago. Burn units and training bodies may offer additional job placements to address these feelings of insufficient exposure. Facilitating employment of burn surgeons on a half-time or sessional capacity is a sustainable model, and will arguably improve clinical service provision. Strong and early mentorship and allocation of commensurate resources and funding will help to address the high workload. CONCLUSIONS Interest in burn surgery has improved over the last 17 years and the most common deterrents persist, namely nature of burn operations, nature of burn care and on-call commitments. However, many of these issues are modifiable or amenable to change. The opportunity exists for relevant stakeholders to address some of these concerns raised, and thereby addressing the issue of burn surgeon shortage.
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Affiliation(s)
- S Sreedharan
- Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - H Cleland
- Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Department of Surgery, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - C H Lo
- Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Department of Surgery, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
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Durmaz A, Demir H, Sezen B. The role of negative entropy within supply chain sustainability. SUSTAINABLE PRODUCTION AND CONSUMPTION 2021; 28:218-230. [PMID: 34722845 PMCID: PMC8536947 DOI: 10.1016/j.spc.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 05/30/2023]
Abstract
With the COVID-19 pandemic, supply chains are today confronted with more uncertainties than ever before. In the face of unanticipated disruptions, being resilient and sustainable has been rewarding for supply chains in terms of competitive advantage. However, literature is still far from possessing an encompassing sustainable supply chain framework (SSCF). As a contribution to the extant literature, the present study expounds a prominent concept termed negative entropy and explores its role in the SSCF. To accomplish this goal, the effect of negative entropy on supply chain sustainability is tested. Following the open systems theory and drawing from the collaboration and information management aspects of the negative entropy, co-creation, open innovation and network governance concepts which are considered to be relevant in this context are selected to be the antecedents of negative entropy. The empirical research is conducted on prominent logistics service providers and firms from various sectors with approved research and development departments in Turkey. The obtained data were subjected to covariance-based structural equation modeling analysis via Lisrel program. According to results, negative entropy is found to be a robust element in explaining supply chain sustainability. Furthermore, whereas co-creation and network governance reflected significant effects on negative entropy, surprisingly, open innovation demonstrated no substantial impact. This paper opens up a new front in sustainable supply chain management studies with a notable empirical study introducing negative entropy in the context of open systems theory.
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Affiliation(s)
- Ahmet Durmaz
- Gebze Technical University Business Administration Faculty, Gebze, Kocaeli, Turkey
| | - Hakan Demir
- Gebze Technical University Business Administration Faculty, Gebze, Kocaeli, Turkey
| | - Bülent Sezen
- Gebze Technical University Business Administration Faculty, Gebze, Kocaeli, Turkey
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