1
|
Kassem S, Hijazi N, Stein N, Zaina A, Ganaim M. Clinical outcomes of clostridioides difficile infection in the very elderly. Intern Emerg Med 2024; 19:1041-1049. [PMID: 38615301 PMCID: PMC11186863 DOI: 10.1007/s11739-024-03580-0] [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: 10/26/2023] [Accepted: 03/07/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) causes considerable morbidity, mortality, and economic cost. Advanced age, prolonged stay in healthcare facility, and exposure to antibiotics are leading risk factors for CDI. Data on CDI clinical outcomes in the very elderly patients are limited. METHODS A retrospective cohort study of patients hospitalized between 2016 and 2018 with CDI. We evaluated demographic clinical and laboratory parameters. Major clinical outcomes were evaluated including duration of hospital stay, admission to intensive care unit (ICU), in-hospital mortality, 30 days post-discharge mortality, and readmission/mortality composite outcome. We compared patients aged up to 80 years (elderly) to those of 80 years old or more (very elderly). RESULTS Of 196 patients included in the study, 112 (57%) were very elderly with a mean age of 86 versus 67 years in the elderly group. The duration of hospital stays, and intensive care unit admission frequency were significantly reduced in the very elderly (13 vs. 22 days p = 0.003 and 1.8% vs. 10.7% p = 0.01, respectively). No significant difference was found in the frequencies of in-hospital and in 30 days post-discharge mortality. CONCLUSIONS In our cohort, the duration of hospital stay seemed to be shorter in the very elderly with no increase of in-hospital and post-discharge mortality. Although admitted less frequently to ICU, the in-hospital survival of the very elderly was not adversely affected compared to the elderly, suggesting that very advanced age per se should not be a major factor to consider in determining the prognosis of a patient with CDI.
Collapse
Affiliation(s)
- Sameer Kassem
- Department of Internal Medicine, Lady Davis Carmel Medical Centre, The Ruth and Bruce Rappaport Medical School, Technion Israel Institute of Technology, Michal 7, 3436212, Haifa, Israel.
| | - Nizar Hijazi
- Department of Internal Medicine, Lady Davis Carmel Medical Centre, The Ruth and Bruce Rappaport Medical School, Technion Israel Institute of Technology, Michal 7, 3436212, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Adnan Zaina
- Institute of Endocrinology and Metabolism, Zvulon Medical Center, Clalit Health Services and Azrieli School of Medicine, Bar-Ilan University, Safed, Israel
| | - Mohammad Ganaim
- Department of Internal Medicine, Lady Davis Carmel Medical Centre, The Ruth and Bruce Rappaport Medical School, Technion Israel Institute of Technology, Michal 7, 3436212, Haifa, Israel
| |
Collapse
|
2
|
Antar RM, Xu VE, Adesanya O, Drouaud A, Longton N, Gordon O, Youssef K, Kfouri J, Azari S, Tafuri S, Goddard B, Whalen MJ. Income Disparities in Survival and Receipt of Neoadjuvant Chemotherapy and Pelvic Lymph Node Dissection for Muscle-Invasive Bladder Cancer. Curr Oncol 2024; 31:2566-2581. [PMID: 38785473 PMCID: PMC11119047 DOI: 10.3390/curroncol31050192] [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: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Muscle-invasive bladder cancer (MIBC) is a potentially fatal disease, especially in the setting of locally advanced or node-positive disease. Adverse outcomes have also primarily been associated with low-income status, as has been reported in other cancers. While the adoption of neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy (RC) and pelvic lymph node dissection (PLND) has improved outcomes, these standard-of-care treatments may be underutilized in lower-income patients. We sought to investigate the economic disparities in NAC and PLND receipt and survival outcomes in MIBC. Methods: Utilizing the National Cancer Database, a retrospective cohort analysis of cT2-4N0-3M0 BCa patients with urothelial histology who underwent RC was conducted. The impact of income level on overall survival (OS) and the likelihood of receiving NAC and PLND was evaluated. Results: A total of 25,823 patients were included. This study found that lower-income patients were less likely to receive NAC and adequate PLND (≥15 LNs). Moreover, lower-income patients exhibited worse OS (Median OS 55.9 months vs. 68.2 months, p < 0.001). Our findings also demonstrated that higher income, treatment at academic facilities, and recent years of diagnosis were associated with an increased likelihood of receiving standard-of-care modalities and improved survival. Conclusions: Even after controlling for clinicodemographic variables, income independently influenced the receipt of standard MIBC treatments and survival. Our findings identify an opportunity to improve the quality of care for lower-income MIBC patients through concerted efforts to regionalize multi-modal urologic oncology care.
Collapse
Affiliation(s)
- Ryan M. Antar
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Vincent E. Xu
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | | | - Arthur Drouaud
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Noah Longton
- College of Medicine, Drexel University, Philadelphia, PA 19104, USA;
| | - Olivia Gordon
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Kirolos Youssef
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Jad Kfouri
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Sarah Azari
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Sean Tafuri
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Briana Goddard
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Michael J. Whalen
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| |
Collapse
|
3
|
Sharma MR, Sedain G, Kafle P, Pradhanang AB, Sapkota S, Niyaf A, Farrokhi F, Garozzo D. Academic neurosurgery in Nepal: Present status and future directions. BRAIN & SPINE 2023; 3:101779. [PMID: 38020989 PMCID: PMC10668070 DOI: 10.1016/j.bas.2023.101779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 12/01/2023]
Abstract
Introduction The establishment of local neurosurgery training programs in Nepal has proven critical for the expansion of the discipline across the country. This paper aims to describe the evolution, current status, challenges, and future directions of academic neurosurgery in Nepal. Research question What is the current status and international standing of academic neurosurgery in Nepal? Material and methods Information related to growth and development in Nepal was obtained from universities and regulatory bodies in Nepal. Variables described are the current number of neurosurgeons, the number of neurosurgical centers and centers with accreditation for training, the description of existing training models, the number of graduates, and the contribution of Nepalese neurosurgeons to world literature. Results Formal neurosurgical training started in Nepal in 1999. Of 67 hospitals with neurosurgical facilities, 10 (14.9%) are accredited. Three training models (MCh, NBMS, and FCPS) currently exist. Of 116 neurosurgeons currently practicing in the country, 47 (40.5%) are homegrown. The contribution of the Nepalese neurosurgical community to the world includes the training of the first two Maldivian neurosurgeons and an increasing presence in world neurosurgical literature. Conclusions Although comparable to other countries with similar economies, Nepal still faces some challenges to the sustainability and further developments of Neurosurgery. Continued concerted efforts will help Nepalese neurosurgeons achieve the goal of securing self-reliance in neurosurgical education.
Collapse
Affiliation(s)
- Mohan Raj Sharma
- Department of Neurosurgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Gopal Sedain
- Department of Neurosurgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Prakash Kafle
- Department of Neurosurgery, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Amit Bahadur Pradhanang
- Department of Neurosurgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Shabal Sapkota
- Department of Neurosurgery, Shiekh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Ali Niyaf
- Department of Neurosurgery, ADK Hospital, Male, Maldives
| | - Farrokh Farrokhi
- Neuroscience Institute, Virginia Mason Franciscan Health, Seattle, WA, United States
| | | |
Collapse
|
4
|
Soklaridis S, Black G, LeBlanc C, MacKinnon KR, Holroyd-Leduc J, Clement F, Schrewe B, Ross HJ, Calleja S, Stergiopoulos V, Taylor VH, Kuper A. Academic Productivity of Equity-Deserving Physician Scholars During COVID-19: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:123-135. [PMID: 36576772 PMCID: PMC9779983 DOI: 10.1097/acm.0000000000004971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The COVID-19 pandemic presented new barriers and exacerbated existing inequities for physician scholars. While COVID-19's impact on academic productivity among women has received attention, the pandemic may have posed additional challenges for scholars from a wider range of equity-deserving groups, including those who hold multiple equity-deserving identities. To examine this concern, the authors conducted a scoping review of the literature through an intersectionality lens. METHOD The authors searched peer-reviewed literature published March 1, 2020, to December 16, 2021, in Ovid MEDLINE, Ovid Embase, and PubMed. The authors excluded studies not written in English and/or outside of academic medicine. From included studies, they extracted data regarding descriptions of how COVID-19 impacted academic productivity of equity-deserving physician scholars, analyses on the pandemic's reported impact on productivity of physician scholars from equity-deserving groups, and strategies provided to reduce the impact of the COVID-19 pandemic on academic productivity of physician scholars from equity-deserving groups. RESULTS Of 11,587 unique articles, 44 met inclusion criteria, including 15 nonempirical studies and 29 empirical studies (22 bibliometrics studies, 6 surveys, and 1 qualitative study). All included articles focused on the gendered impact of the pandemic on academic productivity. The majority of their recommendations focused on how to alleviate the burden of the pandemic on women, particularly those in the early stages of their career and/or with children, without consideration of scholars who hold multiple and intersecting identities from a wider range of equity-deserving groups. CONCLUSIONS Findings indicate a lack of published literature on the pandemic's impact on physician scholars from equity-deserving groups, including a lack of consideration of physician scholars who experience multiple forms of discrimination. Well-intentioned measures by academic institutions to reduce the impact on scholars may inadvertently risk reproducing and sustaining inequities that equity-deserving scholars faced during the pandemic.
Collapse
Affiliation(s)
- Sophie Soklaridis
- S. Soklaridis is a senior scientist, Department of Education, Centre for Addiction and Mental Health, and associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-5119-8473
| | - Georgia Black
- G. Black is a research analyst, Department of Education, Centre for Addiction and Mental Health, Department of Education, Toronto, Ontario, Canada
| | - Constance LeBlanc
- C. LeBlanc is professor, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; ORCID: http://orcid.org/0000-0003-0553-3335
| | - Kinnon R. MacKinnon
- K.R. MacKinnon is assistant professor, School of Social Work, York University, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-2039-6746
| | - Jayna Holroyd-Leduc
- J. Holroyd-Leduc is professor and head, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- F. Clement is professor, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brett Schrewe
- B. Schrewe is clinical assistant professor, Department of Pediatrics, University of British Columbia, Victoria, British Columbia, Canada; ORCID: http://orcid.org/0000-0001-9743-2894
| | - Heather J. Ross
- H.J. Ross is division head of cardiology, Peter Munk Cardiac Centre, and professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-4384-3027
| | - Sabine Calleja
- S. Calleja is a librarian, Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-5297-0736
| | - Vicky Stergiopoulos
- V. Stergiopoulos is a clinician scientist, Centre for Addiction and Mental Health, and professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3941-9434
| | - Valerie H. Taylor
- V.H. Taylor is professor, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Ayelet Kuper
- A. Kuper is a scientist and associate director, Wilson Centre, University Health Network/University of Toronto, and associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6399-6958
| |
Collapse
|
5
|
Matetic A, Mohamed MO, Roberts DJ, Rana JS, Alraies MC, Patel B, Sauer AJ, Diaz-Arocutipa C, Sattar Y, Van Spall HGC, Mamas MA. Real-world management and outcomes of 7 million patients with acute coronary syndrome according to clinical research trial enrolment status: a propensity matched analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:409-419. [PMID: 34940843 DOI: 10.1093/ehjqcco/qcab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 01/01/2023]
Abstract
AIMS We aimed to determine whether clinical outcomes and invasive care of acute coronary syndrome (ACS) patients participating in trials differed from those of non-participants, particularly including those who were trial eligible. METHODS AND RESULTS We included all hospitalizations with a principal diagnosis of ACS in the US National Inpatient Sample between January 2004 and September 2015, stratified by trial enrolment and eligibility using the International Classification of Diseases, ninth revision. We conducted propensity score matching to investigate the following outcomes: all-cause mortality; major bleeding; stroke; composite of mortality, stroke, and cardiac complications [major adverse cardiovascular and cerebrovascular events (MACCEs)]; coronary angiography (CA); and percutaneous coronary intervention (PCI). A total of 7 091 179 weighted ACS hospitalizations were analysed, including 19 684 (0.3%) trial participants and 7 071 495 non-participants (3 485 514 of whom were trial eligible). Trial participants were more likely to receive CA [Δ% 28.73%, 95% confidence interval (CI) 27.22-30.24, P < 0.001] and PCI (Δ% 27.13%, 95% CI 24.86-29.41, P < 0.001), with decreased mortality (Δ% -3.51%, 95% CI -4.72 to -2.31, P < 0.001), MACCEs (Δ% -3.04%, 95% CI -4.55 to -1.53, P < 0.001), and bleeding (Δ% -0.89%, 95% CI -1.59 to -0.19, P = 0.013) compared with non-participants. After accounting for eligibility, trial participants were more likely to undergo CA (Δ% 22.78%, 95% CI 21.58-23.99, P < 0.001) and PCI (Δ% 23.95%, 95% CI 21.77-26.13, P < 0.001), and had no difference in mortality (Δ% -0.21%, 95% CI -0.65 to 0.24, P = 0.362). CONCLUSION Among ACS patients, trial enrolment was associated with significantly greater invasive care and lower mortality than among matched non-participants. Trial participants were more likely to be invasively managed even when compared with eligible non-participants, even though there was no difference in mortality.
Collapse
Affiliation(s)
- Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split, Croatia.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jamal S Rana
- Department of Cardiology, Kaiser Permanente Northern California, Oakland, CA, USA
| | - M Chadi Alraies
- Division of Interventional Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Yasar Sattar
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| |
Collapse
|
6
|
Lu DW, Lee J, Alvarez A, Sakamoto JT, Bird SB, Sundaram V, Lall MD, Nordenholz KE, Manfredi RA, Blomkalns AL. Drivers of professional fulfillment and burnout among emergency medicine faculty: A national wellness survey by the Society for Academic Emergency Medicine. Acad Emerg Med 2022; 29:987-998. [PMID: 35304931 DOI: 10.1111/acem.14487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Professional fulfillment and the mitigation of burnout can enhance clinician well-being and the resiliency of the health care organization. This study examined the extent to which specific individual and workplace factors are associated with professional fulfillment and burnout among a national sample of academic emergency physicians. METHODS This was a cross-sectional survey of faculty members of the Society for Academic Emergency Medicine. Primary outcomes were professional fulfillment and burnout. The survey also examined individual and workplace factors as well as faculty's thoughts of attrition from academic and clinical medicine. Logistic regression was performed to determine the relationships between each outcome and each factor, respectively. RESULTS A total of 771 of 3130 faculty completed the survey (response rate 24.6%). A total of 38.7% reported professional fulfillment and 39.1% reported burnout. Meaningfulness of work (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.9-2.5), perceived appreciation (OR 1.9, 95% CI 1.7-2.1), and the academic work environment (OR 1.7, 95% CI 1.5-1.9) had the highest odds of being associated with professional fulfillment. In contrast, low score responses for meaningfulness of work (OR 0.6, 95% CI 0.5-0.6), self-compassion (0.6, 95% CI 0.5-0.6), and control over schedule (OR 0.6, 95% CI 0.6-0.7) were most associated with burnout. Faculty with professional fulfillment were less likely to report plans for attrition from academics (OR 0.1, 95% CI 0.1-0.2) and from clinical medicine (OR 0.2, 95% CI 0.1-0.4). Faculty with burnout were more likely to report plans for attrition from academics (OR 7, 95% CI 4.8-10.4) and clinical medicine (OR 5.7, 95% CI 3.9-8.6). CONCLUSIONS Individual and workplace factors that contributed to professional fulfillment and burnout were identified, with meaningfulness of clinical work demonstrating the strongest association with both occupational phenomena. Knowledge of which factors are most impactful in promoting professional fulfillment and mitigating burnout may be useful in guiding efforts to enhance clinician well-being.
Collapse
Affiliation(s)
- Dave W. Lu
- Department of Emergency Medicine University of Washington School of Medicine Seattle Washington USA
| | - Justin Lee
- Quantitative Sciences Unit, Department of Medicine Stanford University School of Medicine Stanford California USA
| | - Alai Alvarez
- Department of Emergency Medicine Stanford University School of Medicine Stanford California USA
| | - Jeffrey T. Sakamoto
- Department of Emergency Medicine Stanford University School of Medicine Stanford California USA
| | - Steven B. Bird
- Department of Emergency Medicine UMass Memorial Healthcare and University of Massachusetts Medical School Worcester Massachusetts USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Department of Medicine Stanford University School of Medicine Stanford California USA
| | - Michelle D. Lall
- Department of Emergency Medicine Emory University Atlanta Georgia USA
| | | | - Rita A. Manfredi
- Department of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Andra L. Blomkalns
- Department of Emergency Medicine Stanford University School of Medicine Stanford California USA
| |
Collapse
|
7
|
Shahian DM, McCloskey D, Liu X, Schneider E, Cheng D, Mort EA. The Association of Hospital Research Publications and Clinical Quality. Health Serv Res 2022; 57:587-597. [DOI: 10.1111/1475-6773.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/17/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- David M. Shahian
- Center for Quality and Safety, Massachusetts General Hospital, Division of Cardiac Surgery and Department of Surgery Massachusetts General Hospital, Harvard Medical School 55 Fruit St Boston MA
| | - Dan McCloskey
- Treadwell Library, Massachusetts General Hospital 125 Nashua St. Boston MA
| | - Xiu Liu
- Center for Quality and Safety Massachusetts General Hospital 55 Fruit St Boston MA
| | | | - David Cheng
- Biostatistics Center, Massachusetts General Hospital Harvard Medical School 50 Staniford Street Boston MA
| | - Elizabeth A. Mort
- Center for Quality and Safety, Massachusetts General Hospital, Department of Medicine, Massachusetts General Hospital, Department of Health Care Policy Harvard Medical School 55 Fruit St Boston MA
| |
Collapse
|
8
|
Lu DW, Germann CA, Nelson SW, Jauregui J, Strout TD. "Pulling the Parachute": A Qualitative Study of Burnout's Influence on Emergency Medicine Resident Career Choices. AEM EDUCATION AND TRAINING 2021; 5:e10535. [PMID: 34099988 PMCID: PMC8166306 DOI: 10.1002/aet2.10535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/30/2020] [Accepted: 09/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES About half of all resident physicians report symptoms of burnout. Burnout negatively influences multiple aspects of their education and training. How burnout may impact residents' career choices remains unclear. The authors explored the role burnout played in residents' career decisions. METHODS This was a qualitative study among a sample of 29 emergency medicine residents from four institutions. Qualitative data were generated through four semistructured focus groups. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major themes. RESULTS Five major themes connecting burnout with residents' career choices emerged: 1) residents' current burnout and the prevention of future burnout figured prominently in their career considerations, 2) residents aimed to mitigate sources of burnout through their career choices, 3) residents' view of clinical work as a burden and a burnout contributor spurred the pursuit of other interests, 4) faculty advice and role modeling in relation to burnout shaped residents' career perspectives, and 5) residents weighed long-term burnout concerns with short-term financial needs. CONCLUSION Burnout played an important role in multiple aspects of residents' career considerations. Educators, program directors, and organization leaders can focus on identified target areas to address burnout's influence on residents' career decisions.
Collapse
Affiliation(s)
- Dave W. Lu
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Carl A. Germann
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Sara W. Nelson
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Joshua Jauregui
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | - Tania D. Strout
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| |
Collapse
|
9
|
Chumbley SD, Devaraj VS, Mattick K. An Approach to Economic Evaluation in Undergraduate Anatomy Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:171-183. [PMID: 32745338 DOI: 10.1002/ase.2008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
Medical education research is becoming increasingly concerned with the value (defined as "educational outcomes per dollar spent") of different teaching approaches. However, the financial costs of various approaches to teaching anatomy are under-researched, making evidence-based comparisons of the value of different teaching approaches impossible. Therefore, the aims of this study were to report the cost of six popular anatomy teaching methods through a specific, yet generalizable approach, and to demonstrate a process in which these results can be used in conjunction with existing effectiveness data to undertake an economic evaluation. A cost analysis was conducted to report the direct and indirect costs of six anatomy teaching methods, using an established approach to cost-reporting. The financial information was then combined with previously published information about the effectiveness of these six teaching methods in increasing anatomy knowledge, thereby demonstrating how estimations of value can be made. Dissection was reported as the most expensive teaching approach and computer aided instruction/learning (CAI/L) was the least, based on an estimation of total cost per student per year and assuming a student cohort size of just over 1,000 (the United Kingdom average). The demonstrated approach to economic evaluation suggested computer aided instruction/learning as the approach that provided the most value, in terms of education outcomes per dollar spent. The study concludes by suggesting that future medical education research should incorporate substantially greater consideration of cost, in order to draw important conclusions about value for learners.
Collapse
Affiliation(s)
- Samuel D Chumbley
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Devon, United Kingdom
| | - Vikram S Devaraj
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Devon, United Kingdom
| | - Karen Mattick
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Devon, United Kingdom
| |
Collapse
|
10
|
Babenko O, Ding M, Koppula S. Lifelong learning practices and leisure-time exercise habits of academic and community-based physicians. MEDEDPUBLISH 2019; 8:21. [PMID: 38089291 PMCID: PMC10712484 DOI: 10.15694/mep.2019.000021.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Objective: Physicians are required to be lifelong learners for the provision of quality patient care. At the same time, physician wellbeing is a critical component in the delivery of such care. This study was designed to examine: (1) lifelong learning practices and leisure-time exercise habits of academic and community-based physicians; and (2) associations of leisure-time exercise with work engagement, exhaustion, and professional life satisfaction. Methods: Using an online survey, quantitative data were collected from physicians practicing in Canada. The survey contained validated scales of physician lifelong learning, leisure-time exercise, work engagement, work exhaustion, and professional life satisfaction. Descriptive, chi-square, t-test, and correlational analyses were performed. Results: Physicians (n=57) reported moderately high levels of lifelong learning, with no significant difference between academic and community-based physicians. To stay current in their practice, the majority of physicians reported exchanging ideas/asking colleagues and searching databases as questions arise (>90%), followed by engaging in clinical teaching and attending conferences and meetings of professional organizations (>80%). Watching podcasts and webinars was the least preferred lifelong learning activity (<50%). With respect to leisure-time exercise habits, more community-based physicians reported engaging in mild and/or moderate forms of exercising, whereas more academic physicians reported engaging in strenuous exercising in a typical week. Correlational analyses revealed that physicians' leisure-time exercise scores were positively correlated with professional life satisfaction (r = 0.25; p = 0.058) and work engagement (r = 0.29; p = 0.028) and negatively correlated with work exhaustion (r = -0.34; p = 0.01). Conclusions: Irrespective of the practice type, physicians tend to engage in lifelong learning activities that offer in-person interactions with colleagues and trainees. Regular participation in leisure-time exercise appears to enhance physicians' professional wellbeing. As such, these activities and habits should be encouraged, supported, and promoted within institutional culture and health systems in general.
Collapse
|
11
|
Asserson DB, Patel NB, Arsalai MM, Pu LL. The plastic surgeon as employee: Survey of the American Society of Plastic Surgeons. J Plast Reconstr Aesthet Surg 2019; 72:137-171. [DOI: 10.1016/j.bjps.2018.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/21/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
|
12
|
Banneheke H, Nadarajah VD, Ramamurthy S, Sumera A, Ravindranath S, Jeevaratnam K, Efendie B, Chellamuthu L, Krishnappa P, Peterson R. Student preparedness characteristics important for clinical learning: perspectives of supervisors from medicine, pharmacy and nursing. BMC MEDICAL EDUCATION 2017; 17:130. [PMID: 28789645 PMCID: PMC5549327 DOI: 10.1186/s12909-017-0966-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/20/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Student perspectives of clinical preparedness have been studied in the literature, but the viewpoint of supervisors is limited. Hence, the aim was to examine the perspective of supervisors on the characteristics of health professional students important for preparedness for clinical learning. METHODS This was a descriptive, questionnaire-based, cross-sectional study conducted at three higher education institutions in Malaysia. A previously published questionnaire with 62 characteristics was adopted with modifications after pre-testing. Descriptive analysis was completed for the demographic data. The sample was grouped based on health profession, clinical practice experience and teaching experience for further analysis. Non-parametric Kruskal-Wallis test was selected to evaluate differences in mean ranks to assess the null hypothesis that the medians are equal across the groups. Kruskal-Wallis post-hoc pair wise comparison was performed on samples with significant differences across samples. RESULTS The sample was comprised of 173 supervisors from medicine (55, 32%), pharmacy (84, 48%) and nursing (34, 20%). The majority (63%) of the supervisors were currently in professional practice. A high percentage (40%) of supervisors had less than 4 years of teaching experience. The highest theme ratings were for willingness (6.00) and professionalism (5.90). There was a significant difference (p < 0.05) in the medians, among medicine, pharmacy and nursing professional speciality for willingness (5.70, 6.00 and 6.00), professionalism (5.70, 5.90 and 6.15), communication and interaction (5.42, 5.67 and 6.00), personal attributes (5.42, 5.71 and 6.02) and the professional and interpersonal skills (5.50, 5.63 and 6.00) themes. Post-hoc analysis showed a significant difference (p < 0.05) between medicine and nursing groups in the willingness (5.70 and 6.00), professionalism (5.70 and 6.15) and personal attributes (5.42 and 6.02) themes. Supervisors who are currently in practice had given high ratings compared to other groups. There were no significant differences observed within groups with different level of teaching experiences. CONCLUSIONS All supervisors rated professionalism and willingness as the most important characteristics followed by personal attributes. Further strengthening learning opportunities related to these characteristics in the curriculum may improve the students' preparedness in clinical learning.
Collapse
Affiliation(s)
- Hasini Banneheke
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Vishna Devi Nadarajah
- School of Medicine, International Medical University, No 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | | | - Afshan Sumera
- School of Medicine, International Medical University, No 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Sneha Ravindranath
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | | | - Benny Efendie
- School of Pharmacy, Monash University, Selangor, Malaysia
| | - Leela Chellamuthu
- School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Purushotham Krishnappa
- School of Medicine, International Medical University, No 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Ray Peterson
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| |
Collapse
|
13
|
Kim YD, Jung YH, Norrving B, Ovbiagele B, Saposnik G. Does national expenditure on research and development influence stroke outcomes? Int J Stroke 2017; 12:827-834. [PMID: 28355959 DOI: 10.1177/1747493017702667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Expenditure on research and development is a macroeconomic indicator representative of national investment. International organizations use this indicator to compare international research and development activities. Aim We investigated whether differences in expenditures on research and development at the country level may influence the incidence of stroke and stroke mortality. Methods We compared stroke metrics with absolute amount of gross domestic expenditure on R&D (GERD) per-capita adjusted for purchasing power parity (aGERD) and relative amount of GERD as percent of gross domestic product (rGERD). Sources included official data from the UNESCO, the World Health Organization, the World Bank, and population-based studies. We used correlation analysis and multivariable linear regression modeling. Results Overall, data on stroke mortality rate and GERD were available from 66 countries for two periods (2002 and 2008). Age-standardized stroke mortality rate was associated with aGERD (r = -0.708 in 2002 and r = -0.730 in 2008) or rGERD (r = -0.545 in 2002 and r = -0.657 in 2008) (all p < 0.001). Multivariable analysis showed a lower aGERD and rGERD were independently and inversely associated with higher stroke mortality (all p < 0.05). The estimated prevalence of hypertension, diabetes, or obesity was higher in countries with lower aGERD. The analysis of 27 population-based studies showed consistent inverse associations between aGERD or rGERD and incident risk of stroke and 30-day case fatality. Conclusions There is higher stroke mortality among countries with lower expenditures in research and development. While this study does not prove causality, it suggests a potential area to focus efforts to improve global stroke outcomes.
Collapse
Affiliation(s)
- Young Dae Kim
- 1 Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,2 Stroke Outcomes Research Unit (SORCan- www.sorcan.ca ), Division of Neurology, University of Toronto, Toronto, Canada
| | - Yo Han Jung
- 2 Stroke Outcomes Research Unit (SORCan- www.sorcan.ca ), Division of Neurology, University of Toronto, Toronto, Canada.,3 Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Bo Norrving
- 4 Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Bruce Ovbiagele
- 5 Department of Neurology, Medical University of South Carolina, Charleston, USA
| | - Gustavo Saposnik
- 2 Stroke Outcomes Research Unit (SORCan- www.sorcan.ca ), Division of Neurology, University of Toronto, Toronto, Canada
| |
Collapse
|
14
|
Ozdemir BA, Karthikesalingam A, Sinha S, Poloniecki JD, Hinchliffe RJ, Thompson MM, Gower JD, Boaz A, Holt PJE. Research activity and the association with mortality. PLoS One 2015; 10:e0118253. [PMID: 25719608 PMCID: PMC4342017 DOI: 10.1371/journal.pone.0118253] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/04/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aims of this study were to describe the key features of acute NHS Trusts with different levels of research activity and to investigate associations between research activity and clinical outcomes. METHODS National Institute for Health Research (NIHR) Comprehensive Clinical Research Network (CCRN) funding and number of patients recruited to NIHR Clinical Research Network (CRN) portfolio studies for each NHS Trusts were used as markers of research activity. Patient-level data for adult non-elective admissions were extracted from the English Hospital Episode Statistics (2005-10). Risk-adjusted mortality associations between Trust structures, research activity and, clinical outcomes were investigated. RESULTS Low mortality Trusts received greater levels of funding and recruited more patients adjusted for size of Trust (n = 35, 2,349 £/bed [95% CI 1,855-2,843], 5.9 patients/bed [2.7-9.0]) than Trusts with expected (n = 63, 1,110 £/bed, [864-1,357] p<0.0001, 2.6 patients/bed [1.7-3.5] p<0.0169) or, high (n = 42, 930 £/bed [683-1,177] p = 0.0001, 1.8 patients/bed [1.4-2.1] p<0.0005) mortality rates. The most research active Trusts were those with more doctors, nurses, critical care beds, operating theatres and, made greater use of radiology. Multifactorial analysis demonstrated better survival in the top funding and patient recruitment tertiles (lowest vs. highest (odds ratio & 95% CI: funding 1.050 [1.033-1.068] p<0.0001, recruitment 1.069 [1.052-1.086] p<0.0001), middle vs. highest (funding 1.040 [1.024-1.055] p<0.0001, recruitment 1.085 [1.070-1.100] p<0.0001). CONCLUSIONS Research active Trusts appear to have key differences in composition than less research active Trusts. Research active Trusts had lower risk-adjusted mortality for acute admissions, which persisted after adjustment for staffing and other structural factors.
Collapse
Affiliation(s)
- Baris A. Ozdemir
- Department of Outcomes Research, St George’s Vascular Institute, London, United Kingdom
| | - Alan Karthikesalingam
- Department of Outcomes Research, St George’s Vascular Institute, London, United Kingdom
| | - Sidhartha Sinha
- Department of Outcomes Research, St George’s Vascular Institute, London, United Kingdom
| | - Jan D. Poloniecki
- Department of Outcomes Research, St George’s Vascular Institute, London, United Kingdom
| | - Robert J. Hinchliffe
- Department of Outcomes Research, St George’s Vascular Institute, London, United Kingdom
| | - Matt M. Thompson
- Department of Outcomes Research, St George’s Vascular Institute, London, United Kingdom
| | - Jonathan D. Gower
- NIHR Comprehensive Clinical Research Network Coordinating Centre, Leeds, United Kingdom
| | - Annette Boaz
- Centre for Health and Social Care Research, St George’s University of London, Cranmer Terrace, London, United Kingdom
| | - Peter J. E. Holt
- Department of Outcomes Research, St George’s Vascular Institute, London, United Kingdom
| |
Collapse
|
15
|
Stein SL. Scholarship in academic surgery: history, challenges, and ideas for the future. Clin Colon Rectal Surg 2014; 26:207-11. [PMID: 24436678 DOI: 10.1055/s-0033-1356718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The role of academic surgery is changing. Traditional roles of the triple threat researcher, clinician and teacher, were formulated by Osler and improved upon by Boyle in the 1990s. These include application and integration of research to clinical problems. However, new pressures exist on the academic surgeon. Financial pressures rising costs of health care and decreased research funding all need to be addressed. In addition, retention and advancement of faculty is more difficult with increased emphasis of clinical practice in academic medicine. The future of academic medicine will require personal optimization as a multifaceted academician, businessman, and administrator, as well as rethinking how academic medicine may function in the future.
Collapse
Affiliation(s)
- Sharon L Stein
- Department of Surgery, Case Medical Center, University Hospitals, Cleveland, Ohio
| |
Collapse
|
16
|
Giles E. How do Medical Radiation Science educators keep up with the [clinical] Joneses? J Med Radiat Sci 2014; 61:102-11. [PMID: 26229644 PMCID: PMC4175838 DOI: 10.1002/jmrs.53] [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: 01/09/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Medical radiation science (MRS) disciplines include medical imaging, radiation therapy and nuclear medicine. These allied health fields are technology driven and evolving rapidly with regard to imaging and treatment techniques within the clinical environment. This research aims to identify the activities academics are currently participating in to maintain clinical currency and offer strategies to support academics to connect with an ever-changing clinical environment. METHODS A cross-sectional designed survey was sampled across the nine Australian universities where MRS programmes are offered. The survey targeted academic teaching staff that were working in MRS programmes at the time of distribution (n ≈ 90). Enablers and barriers to maintaining clinical currency as well as support to participate in continuing professional development were rated by the respondents. Descriptive statistics were used to analyse quantitative data, and free-text comment responses were collated and themed. RESULTS There were 38 responses to the survey (42%) and all three disciplines were represented. Responses highlighted activities valued by academics as contributing to their knowledge of current practice and as resources to inform their teaching. Positive elements included participating in clinical work and research, attending clinical sites and training days and attending scientific meetings. Common barriers identified by academics in this area were time constraints, workload allocation and employer/financial support. CONCLUSION This research has identified that Australian MRS academics participate in a broad range of activities to inform their teaching and maintain knowledge of contemporary clinical practice. A connection with the clinical world is valued highly by academics, however, access and support to maintain that link is often a difficulty and as a result for MRS teaching staff keeping up with the clinical [MRS] Joneses is often a challenge.
Collapse
Affiliation(s)
- Eileen Giles
- School of Health Sciences, University of South Australia Adelaide, South Australia, Australia
| |
Collapse
|
17
|
Hanney S, Boaz A, Jones T, Soper B. Engagement in research: an innovative three-stage review of the benefits for health-care performance. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01080] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThere is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence.ObjectivesTo conduct a theoretically and empirically grounded synthesis to map and explore plausible mechanisms through which research engagement might improve health services performance. A review of the effects on patients of their health-care practitioner's or institution's participation in clinical trials was published after submission of the proposal for this review. It identified only 13 relevant papers and, overall, suggested that the evidence that research engagement improves health-care performance was less strong than some thought. We aimed to meet the need for a wider review.MethodsAn hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included inthe focused review if the concept of ‘engagementinresearch’ was an input and some measure of ‘performance’ an output. The search strategy covered the period 1990 to March 2012. MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and other relevant databases were searched. A total of 10,239 papers were identified through the database searches, and 159 from other sources. A further relevance and quality check on 473 papers was undertaken, and identified 33 papers for inclusion in the review. A standard meta-analysis was not possible on the heterogeneous mix of papers in the focused review. Therefore an explanatory matrix was developed to help characterise the circumstances in which research engagement might improve health-care performance and the mechanisms that might be at work, identifying two main dimensions along which to categorise the studies:the degree of intentionalityandthe scope of the impact.ResultsOf the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs. The focused and wider reviews identified the diversity in the mechanisms through which research engagement might improve health care: there are many circumstances and mechanisms at work, more than one mechanism is often operative, and the evidence available for each one is limited.LimitationsTo address the complexities of this evidence synthesis of research we needed to spend significant time mapping the literature, and narrowed the research question to make it feasible. We excluded many potentially relevant papers (though we partially addressed this by conducting a wider additional synthesis). Studies assessing the impact made on clinician behaviour by small, locally conducted pieces of research could be difficult to interpret without full knowledge of the context.ConclusionsDrawing on the focused and wider reviews, it is suggested that when clinicians and health-care organisations engage in research there is the likelihood of a positive impact on health-care performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved health-care performance. Further explorations are required of research networks and schemes to promote the engagement of clinicians and managers in research. Detailed observational research focusing on research engagement within organisations would build up an understanding of mechanisms.Study registrationPROSPERO: CRD42012001990.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- S Hanney
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - A Boaz
- Faculty of Health, Social Care and Education, St George's, University of London and Kingston University, London, UK
| | - T Jones
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - B Soper
- Health Economics Research Group, Brunel University, Uxbridge, UK
| |
Collapse
|
18
|
Bush RW, Nasca TJ. Commentary: clinical faculty, academic culture, and the future of medical professionalism. J Grad Med Educ 2010; 2:488-9. [PMID: 21976104 PMCID: PMC2951795 DOI: 10.4300/jgme-d-10-00130.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Roger W. Bush
- Corresponding author: Roger W. Bush, MD, 925 Seneca Street H8-25, Virginia Mason Medical Center, Seattle, WA 98101, 206.583.6079,
| | | |
Collapse
|