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Kadura S, Poulakis A, Roberts DE, Arora VM, Darrow SN, Eisner L, Ibarra M, Lin J, Wang L, Pigeon WR. Sleeping with one cerebrum open: patient and staff perceptions of sleep quality and quantity on an inpatient neurology unit. J Clin Sleep Med 2024; 20:619-629. [PMID: 38063214 PMCID: PMC10985310 DOI: 10.5664/jcsm.10958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 04/04/2024]
Abstract
STUDY OBJECTIVES This study sought to investigate perceptions of sleep disruptions among patients and staff in the inpatient neurology setting. The objectives were to explore the differences between these groups regarding factors that impact sleep, identify the most significant sleep disruptions, and examine the barriers and opportunities suggested to improve inpatient sleep. METHODS A survey-based observational study was conducted on a 25-bed inpatient neurology unit at an academic medical center. Staff and patients completed the Potential Hospital Sleep Disruptions and Noises Questionnaire, and focus groups were held to gather qualitative data. Patient-reported sleep measures were collected for additional assessment. Responses were dichotomized for comparison. Regression models were used to assess associations between disruptors and patient-reported sleep measures. Qualitative thematic analyses were performed. RESULTS Forty-nine inpatient staff and 247 patients completed sleep surveys. Top primary patient diagnoses included stroke, epilepsy, autoimmune diseases, and psychogenic nonepileptic attacks. Medical interventions, environmental factors, patient-related factors, and unit workflows emerged as key themes related to sleep disruptions. Patient-reported sleep efficiency was significantly reduced when pain, anxiety, stress, temperature, and medication administration disrupted sleep. Staff perspectives highlighted medical interventions as most disruptive to sleep, while patients did not find them as disruptive as expected. CONCLUSIONS Differing perspectives on sleep disruption exist between staff and patients in the inpatient neurology setting. Medical interventions may be overstated in staff perceptions and inpatient sleep research, as pain, anxiety, and stress had the most significant impact on patient-reported sleep efficiency. CITATION Kadura S, Poulakis A, Roberts DE, et al. Sleeping with one cerebrum open: patient and staff perceptions of sleep quality and quantity on an inpatient neurology unit. J Clin Sleep Med. 2024;20(4):619-629.
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Affiliation(s)
- Sullafa Kadura
- Department of Medicine, Pulmonary Diseases and Critical Care, University of Rochester Medical Center, Rochester, New York
| | - Alexander Poulakis
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Debra E. Roberts
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Vineet M. Arora
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Stephanie N. Darrow
- Department of Operations Excellence, University of Rochester Medical Center, Rochester, New York
| | - Lauren Eisner
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Michael Ibarra
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Jennifer Lin
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Lu Wang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Wilfred R. Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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Krishnamoorthi VR, Johnson DY, Asay S, Beem A, Vuppaladhadiam L, Keegan GE, Zietowski ML, Chen S, Jain S, Arora VM. An Op-Ed Writing Curriculum for Medical Students to Engage in Advocacy Through Public Writing. J Gen Intern Med 2024:10.1007/s11606-024-08629-6. [PMID: 38413538 DOI: 10.1007/s11606-024-08629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Op-ed writing can be a powerful and accessible advocacy tool for physicians, but training is lacking in undergraduate medical education. AIM To train and engage first-year medical students in op-ed writing. SETTING Midwestern research-intensive medical school. PARTICIPANTS All students in a required first-year health policy course in 2021 and 2022. PROGRAM DESCRIPTION For their health policy course's final assignment, students could opt to write an op-ed on a healthcare issue of their choice. All students received written instruction on op-ed writing. Additionally, they could access a seminar, coaching and editing by peers and faculty, and publication guidance. PROGRAM EVALUATION Of 179 students over 2 years, 105 chose to write op-eds. Fifty-one attended the seminar, 35 attended peer coaching sessions, 33 accessed structured peer editing, and 23 received faculty assistance. Thirty-eight students submitted a total of 42 op-eds for publication. Twenty-two pieces were published in major outlets and 17 in the university's health policy review. Of the 22 in major outlets, 21 received editing from either peers or faculty. DISCUSSION An op-ed writing curriculum can be integrated into an existing medical school health policy course, resulting in a high level of engagement and in published op-eds by medical students.
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Affiliation(s)
- V Ram Krishnamoorthi
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Daniel Y Johnson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Spencer Asay
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Alexandra Beem
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Grace E Keegan
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Samuel Chen
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Shikha Jain
- University of Illinois Cancer Center, University of Illinois College of Medicine, Chicago, IL, USA
| | - Vineet M Arora
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
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Vidyasagar N, Bunting SR, Arora VM, Ari M. Availability of Long-Acting Injectable Buprenorphine at Substance Use Treatment Facilities in 2021. JAMA 2024; 331:524-526. [PMID: 38236586 PMCID: PMC10797524 DOI: 10.1001/jama.2023.26522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
This study assesses the proportion of US substance use and mental health care facilities that offered any medications for opioid use disorder and, specifically, long-acting injectable buprenorphine in 2021.
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Affiliation(s)
- Nitin Vidyasagar
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Samuel R. Bunting
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - Vineet M. Arora
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Mim Ari
- Department of Medicine, The University of Chicago, Chicago, Illinois
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4
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Martinez M, Cerasale M, Baig M, Johnson JK, Dugan C, Brown A, Robinson M, Schram A, Greysen SR, Meltzer D, Baccile R, Arora VM. Reducing Physical Therapy Consults for Patients With High Functional Mobility in the Acute Medical Inpatient Setting: A Difference-in-Difference Analysis. Arch Phys Med Rehabil 2024; 105:125-130. [PMID: 37669704 PMCID: PMC10840724 DOI: 10.1016/j.apmr.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of clinical decision support for reducing misallocation of physical therapy (PT) consults. DESIGN A prospective quasi-experimental study. Between October 2018 and November 2021, routinely documented data on functional status and physical therapy referrals were collected from electronic medical records. SETTING Hospital Medicine and General Internal Medicine service lines at a large quaternary academic medical center. PARTICIPANTS 20,810 adult patients hospitalized on any of the included treatment (hospital medicine) or control (general internal medicine) service lines. MAIN OUTCOME MEASURE The primary outcome was "change in proportion of misallocated PT consults" measured as likelihood of PT consults for patients admitted with high functional mobility scores. Changes in the primary outcome from the pre-intervention to post-intervention period were compared in the control and treatment groups using propensity score-weighted difference-in-differences multivariable logit regression adjusting for clinically relevant covariates. INTERVENTION The intervention period was measured for 20 months and consisted of a clinical decision support tool embedded in the daily note templates for hospital medicine providers. The tool provided education on patient mobility scores and their relation to need for PT consult. The tool was rolled out without any further announcements or education. RESULTS Our cohort included 20,810 unique admissions (mean age 58.9, 55% women, 83% Black). Post-intervention, the likelihood of PT referrals for patients with high baseline mobility (AM-PAC >18) decreased by 7.3% (P<.001) for the treatment group compared with control, adjusted for age, sex, race, ethnicity, length-of-stay, and mobility change. CONCLUSION Mobility score-based clinical decision support can decrease unneeded PT consults in the inpatient setting. This could help allocate therapy time for at-risk patients while also having a positive effect on health care systems.
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Affiliation(s)
- Maylyn Martinez
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL.
| | - Matthew Cerasale
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | | | - Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| | - Claire Dugan
- Section of General Internal Medicine, Department of Medicine, University of Chicago, IL
| | | | - Marla Robinson
- Inpatient Therapy Services Department, University of Chicago, Chicago, IL
| | - Andrew Schram
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - S Ryan Greysen
- Section of Hospital Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Rachel Baccile
- Center for Health and Social Sciences, University of Chicago, Chicago, IL
| | - Vineet M Arora
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
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Neborak JM, Press VG, Parker WF, Rojas JC, Byron M, Goyal S, Meltzer DO, Mokhlesi B, Arora VM. Association of pre-admission insomnia symptoms with objective in-hospital sleep and clinical outcomes among hospitalized patients. J Clin Sleep Med 2023. [PMID: 38156422 DOI: 10.5664/jcsm.10964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
STUDY OBJECTIVES To determine the prevalence of pre-admission insomnia symptoms among hospitalized patients and assess the association of insomnia symptoms with objective in-hospital sleep and clinical outcomes. METHODS We conducted a prospective cohort study of medicine inpatients (age ≥50, no previously diagnosed sleep disorders). Participants answered the Insomnia Severity Index (ISI) questionnaire to assess for pre-admission insomnia symptoms (scored 0-28, higher scores suggest more insomnia symptoms). Sleep duration and efficiency were measured with actigraphy. Participants self-reported 30-day post-discharge readmissions and emergency department (ED) and/or urgent care visits. RESULTS Of 568 participants, 49% had ISI scores suggestive of possible undiagnosed insomnia (ISI ≥8). Higher ISI scores were associated with shorter sleep duration (β=-2.6, 95% CI -4.1 to -1.1, p=0.001) and lower sleep efficiency (β=-0.39, 95% CI -0.63 to -0.15, p=0.001). When adjusted for age, sex, BMI, and co-morbidities, higher ISI scores were associated with longer length of stay (IRR 1.01, 95% CI 1.00-1.02, p=0.011), increased risk of 30-day readmission (OR 1.04, 95% CI 1.01-1.07, p=0.018), and increased risk of 30-day ED or urgent care visit (OR 1.04, 95% CI 1.00-1.07, p=0.043). CONCLUSIONS Among medicine inpatients, there was a high prevalence of pre-admission insomnia symptoms suggestive of possible undiagnosed insomnia. Participants with higher ISI scores slept less with lower sleep efficiency during hospitalization. Higher ISI scores were associated with longer length of stay, increased risk of a 30-day post-discharge readmission, and increased risk of a 30-day post-discharge ED or urgent care visit.
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Affiliation(s)
| | | | | | | | - Max Byron
- University of Chicago Hospitals, Chicago, IL
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6
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Makhni S, Andrews B, Maxey S, Scales K, Bernstein S, Georginis P, Shah S, Kao CK, Weber S, Arora VM. A crowdsourced campaign in IT optimization to improve ease of practice. J Hosp Med 2023; 18:1144-1147. [PMID: 37753838 DOI: 10.1002/jhm.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Sonya Makhni
- University of Chicago Medicine and Biological Sciences Division, Chicago, Illinois, USA
| | - Bree Andrews
- Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois, USA
| | - Simone Maxey
- Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kayla Scales
- University of Chicago Medicine and Biological Sciences Division, Chicago, Illinois, USA
| | - Sean Bernstein
- University of Chicago Medicine and Biological Sciences Division, Chicago, Illinois, USA
| | - Peter Georginis
- University of Chicago Medicine and Biological Sciences Division, Chicago, Illinois, USA
| | - Sachin Shah
- University of Chicago Medicine and Biological Sciences Division, Chicago, Illinois, USA
| | - Cheng Kai Kao
- University of Chicago Medicine and Biological Sciences Division, Chicago, Illinois, USA
| | - Stephen Weber
- University of Chicago Medicine and Biological Sciences Division, Chicago, Illinois, USA
| | - Vineet M Arora
- University of Chicago Medicine and Biological Sciences Division, Chicago, Illinois, USA
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Pendergrast TR, Royan R, Arora VM. Temporal Trends in Childhood Household Income Among Medical School Applicants and Matriculants. JAMA 2023; 330:1288. [PMID: 37787800 DOI: 10.1001/jama.2023.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
| | - Regina Royan
- Department of Emergency Medicine, University of Michigan, Ann Arbor
| | - Vineet M Arora
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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Vayani OR, Asif H, Klein A, Hahn OM, Pearson AT, Arora VM, Olopade OI, Golden DW. Adapting a Medical School Cancer Research Education Program to the Virtual Environment: a Mixed-Methods Study. J Cancer Educ 2023; 38:1501-1508. [PMID: 37058222 PMCID: PMC10102672 DOI: 10.1007/s13187-023-02291-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
With cancer incidence increasing worldwide, physicians with cancer research training are needed. The Scholars in Oncology-Associated Research (SOAR) cancer research education program was developed to train medical students in cancer research while exposing them to the breadth of clinical oncology. Due to the COVID-19 pandemic, SOAR transitioned from in-person in 2019 to virtual in 2020 and hybrid in 2021. This study investigates positive and negative aspects of the varying educational formats. A mixed-methods approach was used to evaluate the educational formats. Pre- and post-surveys were collected from participants to assess their understanding of cancer as a clinical and research discipline. Structured interviews were conducted across all three cohorts, and thematic analysis was used to generate themes. A total of 37 students participated in SOAR and completed surveys (2019 n = 11, 2020 n = 14, and 2021 n = 12), and 18 interviews were conducted. Understanding of oncology as a clinical (p < 0.01 for all) and research discipline (p < 0.01 for all) improved within all three cohorts. There was no difference between each cohort's improvement in research understanding (p = 0.6). There was no difference between each cohort's understanding of oncology-related disciplines as both clinical and research disciplines (p > 0.1 for all). Thematic analysis demonstrated that hybrid and in-person formats were favored over a completely virtual one. Our findings demonstrate that a medical student cancer research education program is effective using in-person or hybrid formats for research education, although virtual experiences may be suboptimal to learning about clinical oncology.
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Affiliation(s)
- Omar R Vayani
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Hassaan Asif
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Aviva Klein
- Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Olwen M Hahn
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Alexander T Pearson
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Vineet M Arora
- Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Olufunmilayo I Olopade
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA.
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Levy MS, Kelly AG, Mueller C, Brown AD, Caban-Martinez AJ, Arora VM, Salles A. Psychosocial Burdens Associated With Family Building Among Physicians and Medical Students. JAMA Intern Med 2023; 183:1018-1021. [PMID: 37486671 PMCID: PMC10366942 DOI: 10.1001/jamainternmed.2023.2570] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/13/2023] [Indexed: 07/25/2023]
Abstract
This survey study uses responses from physicians and medical students to assess psychosocial burdens of family building in the physician workforce.
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Affiliation(s)
- Morgan S. Levy
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida
| | - Amelia G. Kelly
- Division of Reproductive Endocrinology and Infertility, New York University Langone Health, New York
| | - Claudia Mueller
- Department of Surgery, Stanford University, Palo Alto, California
| | - Alyssa D. Brown
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Vineet M. Arora
- Department of Medicine, University of Chicago Pritzker School of Medicine, Illinois
| | - Arghavan Salles
- Department of Medicine, Stanford University, Palo Alto, California
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10
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Brewer A, Nelson L, Mueller AS, Ewert R, O’Connor DM, Dayal A, Arora VM. Gender and Inconsistent Evaluations: A Mixed-methods Analysis of Feedback for Emergency Medicine Residents. West J Emerg Med 2023; 24:847-854. [PMID: 37788024 PMCID: PMC10527837 DOI: 10.5811/westjem.58153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/23/2023] [Accepted: 05/25/2023] [Indexed: 10/04/2023] Open
Abstract
Objectives: Prior research has demonstrated that men and women emergency medicine (EM) residents receive similar numerical evaluations at the beginning of residency, but that women receive significantly lower scores than men in their final year. To better understand the emergence of this gender gap in evaluations we examined discrepancies between numerical scores and the sentiment of attached textual comments. Methods: This multicenter, longitudinal, retrospective cohort study took place at four geographically diverse academic EM training programs across the United States from July 1, 2013-July 1, 2015 using a real-time, mobile-based, direct-observation evaluation tool. We used complementary quantitative and qualitative methods to analyze 11,845 combined numerical and textual evaluations made by 151 attending physicians (94 men and 57 women) during real-time, direct observations of 202 residents (135 men and 67 women). Results: Numerical scores were more strongly positively correlated with positive sentiment of the textual comment for men (r = 0.38, P < 0.001) compared to women (r = -0.26, P < 0.04); more strongly negatively correlated with mixed (r = -0.39, P < 0.001) and negative (r = -0.46, P < 0.001) sentiment for men compared to women (r = -0.13, P < 0.28) for mixed sentiment (r = -0.22, P < 0.08) for negative; and women were around 11% more likely to receive positive comments alongside lower scores, and negative or mixed comments alongside higher scores. Additionally, on average, men received slightly more positive comments in postgraduate year (PGY)-3 than in PGY-1 and fewer mixed and negative comments, while women received fewer positive and negative comments in PGY-3 than PGY-1 and almost the same number of mixed comments. Conclusion: Women EM residents received more inconsistent evaluations than men EM residents at two levels: 1) inconsistency between numerical scores and sentiment of textual comments; and 2) inconsistency in the expected career trajectory of improvement over time. These findings reveal gender inequality in how attendings evaluate residents and suggest that attendings should be trained to provide all residents with feedback that is clear, consistent, and helpful, regardless of resident gender.
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Affiliation(s)
- Alexandra Brewer
- University of Southern California: Los Angeles, Department of Sociology, Los Angeles, California
| | - Laura Nelson
- University of British Columbia, Department of Sociology, Vancouver, British Columbia, Canada
| | - Anna S. Mueller
- Indiana University, Department of Sociology, Bloomington, Indiana
| | | | - Daniel M. O’Connor
- Massachusetts General Brigham Wentworth-Douglass Hospital, Dermatology and Skin Health, Dover, New Hampshire
| | | | - Vineet M. Arora
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois
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11
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Bernstein SA, Levy MS, McNeilly S, Fishbach S, Jain S, Gold JA, Arora VM. Practice Location Preferences in Response to State Abortion Restrictions Among Physicians and Trainees on Social Media. J Gen Intern Med 2023; 38:2419-2423. [PMID: 36823418 PMCID: PMC10406982 DOI: 10.1007/s11606-023-08096-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Simone A Bernstein
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Morgan S Levy
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Shira Fishbach
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Shikha Jain
- Department of Medicine, University of Illinois Cancer Center, Chicago, IL, USA
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Vineet M Arora
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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12
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Royan R, Pendergrast TR, Woitowich NC, Trueger NS, Wooten L, Jain S, Arora VM. Physician and Biomedical Scientist Harassment on Social Media During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2318315. [PMID: 37314808 DOI: 10.1001/jamanetworkopen.2023.18315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Regina Royan
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Assistant Editor, JAMA Network Open , Chicago, Illinois
| | | | - Nicole C Woitowich
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - N Seth Trueger
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Digital Media Editor, JAMA Network Open , Chicago, Illinois
| | - Lawren Wooten
- Department of Pediatrics, University of California, San Francisco, San Francisco
| | - Shikha Jain
- Division of Hematology and Oncology, Department of Medicine, University of Illinois, Chicago
| | - Vineet M Arora
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago
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Arora VM, Krishnamoorthi VR, Bloomgarden E, Jain S, Sunderrajan A, Tesema N, Zietowski M, Farnan J, Serritella S. Restoring Trust in Science and Medicine: Empowering and Educating Future Physicians in Science Communication With the Public. Acad Med 2023; 98:S30-S33. [PMID: 36811980 DOI: 10.1097/acm.0000000000005178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
While the traditional medical school curriculum specializes in teaching doctor-patient communication at the individual patient level, the need to train physicians to communicate science and medicine effectively to the public at large is, for the most part, ignored. With the unchecked proliferation of misinformation and disinformation during the COVID-19 pandemic, it is critical that current and future medical professionals learn to engage in the public arena using multiple methods (written, oral, social media) across multimedia platforms to dispel misinformation and accurately educate the public. This article describes the authors' interdisciplinary approach at the University of Chicago Pritzker School of Medicine to teaching science communication to medical students, early experiences, and future directions in this vein. The authors' experiences show that medical students are viewed as trusted sources of health-related information, and thus, need the skills and training to tackle misinformation and that students across these learning experiences appreciated the opportunity to choose a topic of their interest according to what matters to them and their communities most. The feasibility of successfully teaching scientific communication in an undergraduate and medical education curriculum is confirmed. These early experiences support the feasibility and impact of training medical students to improve communication about science with the general public.
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Affiliation(s)
- Vineet M Arora
- V.M. Arora is Herbert T. Abelson Professor of Medicine, senior scholar, Bucksbaum Institute for Clinical Excellencedean for medical education, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - V Ram Krishnamoorthi
- V.R. Krishnamoorthi is assistant professor of medicine, Section of Hospital Medicine, University of Chicago Medicinecourse director, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Eve Bloomgarden
- E. Bloomgarden is director of thyroid care and director of endocrine innovation and education, Division of Endocrinology, NorthShore University HealthSystem, Chicago, Illinois
| | - Shikha Jain
- S. Jain is director of communications strategies in medicine and associate director of oncology communication and digital innovation, University of Illinois Cancer Center, Chicago, Illinois
| | - Aashna Sunderrajan
- A. Sunderrajan is research manager, Collaboratory on Improving Research and Innovations in Clinical and Learning Excellence (CIRCLE), University of Chicago, Chicago, Illinois
| | - Naomi Tesema
- N. Tesema is a medical student, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Maeson Zietowski
- M. Zietowski is a medical student, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Jeanne Farnan
- J. Farnan is professor of medicine, senior scholar, Bucksbaum Institute for Clinical Excellenceassociate dean for medical school education, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Sara Serritella
- S. Serritella is director of communications, Institute for Translational Medicinelecturer, University of Chicago Pritzker School of Medicine and University of Chicago, Chicago, Illinois
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14
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Cheng J, Arora VM, Kappel N, Vollbrecht H, Meltzer DO, Press V. Assessing Disparities in Video-Telehealth Use and eHealth Literacy Among Hospitalized Patients: Cross-sectional Observational Study. JMIR Form Res 2023; 7:e44501. [PMID: 37171854 PMCID: PMC10221502 DOI: 10.2196/44501] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Medicare coverage for audio-only telehealth is slated to end this year after the public health emergency concludes. When the time comes, many patients may be unable to make the transition from audio-only to video telehealth due to digital inexperience. This study explores the second digital divide within video telehealth use, which is primarily characterized by skills and capabilities rather than access, by measuring eHealth literacy (eHL) and video capabilities in hospitalized patients. OBJECTIVE The aim of this study is to evaluate video capabilities, eHealth literacy, and engagement with video telehealth among hospitalized patients. METHODS The study design is a cross-sectional observational study of adult inpatients at the University of Chicago Medical Center. We assessed self-reported rates of audio versus video telehealth usage as well as the participants' self-reported willingness to use video telehealth for future health care visits. We used a multivariable binary logistic regression to determine the odds ratio for being unwilling to use video telehealth, adjusted for age, sex, race or ethnicity, educational level, eHL literacy scale (eHEALS), health literacy (brief health literacy screen), technology access, internet access, and video capability. RESULTS Of the 297 enrolled participants, median age was 58 years, most (n=185, 62%) identified as Black, half (n=149, 50%) were female, one-quarter (n=66, 22%) lacked home internet access, and one-third (n=102, 34%) had inadequate eHL. CONCLUSIONS Patients with low eHL reported greater participation in audio-only telehealth over video telehealth, of which the former may lose its flexible pandemic reimbursement policy. This may widen the existing health disparities as older adults and patients with low eHL face challenges in accessing video telehealth services. Low eHL is associated with lack of web-based skills, lower rates of video telehealth usage, and lower willingness to use video technology. The study results raise the question of how to improve video capability among patients who, despite having access to smartphones and laptops, face challenges in using telehealth optimally.
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Affiliation(s)
- Jessica Cheng
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Vineet M Arora
- General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Nicole Kappel
- General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Hanna Vollbrecht
- Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - David O Meltzer
- Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Valerie Press
- General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
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15
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Dorsey C, Arora VM, Carter K. Fixing Flexner: Disrupting and Rebuilding Academic Medicine for Women of Color to Lead. J Med Internet Res 2023; 25:e47773. [PMID: 37163317 DOI: 10.2196/47773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
In an effort to address the lack of compositional diversity seen in academic leadership, our generation has an opportunity to rebuild academic medicine in a way that welcomes, values, and supports the development and success of women of color.
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Affiliation(s)
- Chelsea Dorsey
- Department of Surgery, University of Chicago Medicine, Chicago, IL, United States
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Vineet M Arora
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
- Department of Medicine, University of Chicago Medicine, Chicago, IL, United States
| | - Keme Carter
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
- Department of Medicine, University of Chicago Medicine, Chicago, IL, United States
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16
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Rieger EY, Anderson IJ, Press VG, Cui MX, Arora VM, Williams BC, Tang JW. Implementation of a Biopsychosocial History and Physical Exam Template in the Electronic Health Record: Mixed Methods Study. JMIR Med Educ 2023; 9:e42364. [PMID: 36802337 PMCID: PMC9993233 DOI: 10.2196/42364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/10/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patients' perspectives and social contexts are critical for prevention of hospital readmissions; however, neither is routinely assessed using the traditional history and physical (H&P) examination nor commonly documented in the electronic health record (EHR). The H&P 360 is a revised H&P template that integrates routine assessment of patient perspectives and goals, mental health, and an expanded social history (behavioral health, social support, living environment and resources, function). Although the H&P 360 has shown promise in increasing psychosocial documentation in focused teaching contexts, its uptake and impact in routine clinical settings are unknown. OBJECTIVE The aim of this study was to assess the feasibility, acceptability, and impact on care planning of implementing an inpatient H&P 360 template in the EHR for use by fourth-year medical students. METHODS A mixed methods study design was used. Fourth-year medical students on internal medicine subinternship (subI) services were given a brief training on the H&P 360 and access to EHR-based H&P 360 templates. Students not working in the intensive care unit (ICU) were asked to use the templates at least once per call cycle, whereas use by ICU students was elective. An EHR query was used to identify all H&P 360 and traditional H&P admission notes authored by non-ICU students at University of Chicago (UC) Medicine. Of these notes, all H&P 360 notes and a sample of traditional H&P notes were reviewed by two researchers for the presence of H&P 360 domains and impact on patient care. A postcourse survey was administered to query all students for their perspectives on the H&P 360. RESULTS Of the 13 non-ICU subIs at UC Medicine, 6 (46%) used the H&P 360 templates at least once, which accounted for 14%-92% of their authored admission notes (median 56%). Content analysis was performed with 45 H&P 360 notes and 54 traditional H&P notes. Psychosocial documentation across all H&P 360 domains (patient perspectives and goals, mental health, expanded social history elements) was more common in H&P 360 compared with traditional notes. Related to impact on patient care, H&P 360 notes more commonly identified needs (20% H&P 360; 9% H&P) and described interdisciplinary coordination (78% H&P 360; 41% H&P). Of the 11 subIs completing surveys, the vast majority (n=10, 91%) felt the H&P 360 helped them understand patient goals and improved the patient-provider relationship. Most students (n=8, 73%) felt the H&P 360 took an appropriate amount of time. CONCLUSIONS Students who applied the H&P 360 using templated notes in the EHR found it feasible and helpful. These students wrote notes reflecting enhanced assessment of goals and perspectives for patient-engaged care and contextual factors important to preventing rehospitalization. Reasons some students did not use the templated H&P 360 should be examined in future studies. Uptake may be enhanced through earlier and repeated exposure and greater engagement by residents and attendings. Larger-scale implementation studies can help further elucidate the complexities of implementing nonbiomedical information within EHRs.
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Affiliation(s)
- Erin Y Rieger
- Department of Internal Medicine, Columbia University Medical Center, New York, NY, United States
| | - Irsk J Anderson
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Valerie G Press
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Michael X Cui
- Department of Internal Medicine, Rush University, Chicago, IL, United States
| | - Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Brent C Williams
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Joyce W Tang
- Department of Medicine, University of Chicago, Chicago, IL, United States
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17
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Kondo R, Austin J, Akel M, Arora VM, Press VG. Estimated cost-savings from optimizing use of inhaled medications for inpatients with obstructive lung disease. J Asthma 2023; 60:323-330. [PMID: 35230210 PMCID: PMC9549903 DOI: 10.1080/02770903.2022.2047718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Abstract
CONCLUSIONS Models representing transitions from all-nebulized to nebulizer-plus-MDI respiratory medications resulted in cost savings, largely from the reduction of labor cost of nebulizer administration with nebs-only treatment. Therefore, transitioning from nebs to MDIs can lead to cost savings and could allow greater opportunities for inhaler education.
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Affiliation(s)
- Ryuhei Kondo
- Integral Corporation and The University of Chicago Booth School of Business, Chicago, IL, USA
| | - Jennifer Austin
- Department of Pharmacy, The Johns Hopkins Medicine, Baltimore, MD, USA
| | - Mary Akel
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Vineet M Arora
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Valerie G Press
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
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18
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Kadura S, Siala T, Arora VM. Perspective: leveraging the electronic health record to improve sleep in the hospital. J Clin Sleep Med 2023; 19:421-423. [PMID: 36448329 PMCID: PMC9892746 DOI: 10.5664/jcsm.10360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/05/2022] [Accepted: 10/16/2022] [Indexed: 12/05/2022]
Abstract
Inpatient sleep loss can worsen health outcomes, including delirium and falls. Sleep disruptions in the hospital often originate from provider-patient interactions ordered electronically through computerized provider order entry. These orders contain clinical decision support systems with default schedules. These defaults are often around-the-clock, may not align with patients' needs, and cause iatrogenic sleep loss. Optimizing clinical decision support in the electronic health record can decrease unnecessary sleep disruptions and influence sleep-friendly decision-making. CITATION Kadura S, Siala T, Arora VM. Perspective: Leveraging the electronic health record to improve sleep in the hospital. J Clin Sleep Med. 2023;19(2):421-423.
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Affiliation(s)
- Sullafa Kadura
- University of Rochester Medical Center, Rochester, New York
| | - Tarek Siala
- University of Rochester Medical Center, Rochester, New York
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19
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Shirkhodaie C, Avila S, Seidel H, Gibbons RD, Arora VM, Farnan JM. The Association Between USMLE Step 2 Clinical Knowledge Scores and Residency Performance: A Systematic Review and Meta-Analysis. Acad Med 2023; 98:264-273. [PMID: 36512984 DOI: 10.1097/acm.0000000000005061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE With the change in Step 1 score reporting, Step 2 Clinical Knowledge (CK) may become a pivotal factor in resident selection. This systematic review and meta-analysis seeks to synthesize existing observational studies that assess the relationship between Step 2 CK scores and measures of resident performance. METHOD The authors searched MEDLINE, Web of Science, and Scopus databases using terms related to Step 2 CK in 2021. Two researchers identified studies investigating the association between Step 2 CK and measures of resident performance and included studies if they contained a bivariate analysis examining Step 2 CK scores' association with an outcome of interest: in-training examination (ITE) scores, board certification examination scores, select Accreditation Council for Graduate Medical Education core competency assessments, overall resident performance evaluations, or other subjective measures of performance. For outcomes that were investigated by 3 or more studies, pooled effect sizes were estimated with random-effects models. RESULTS Among 1,355 potential studies, 68 met inclusion criteria and 43 were able to be pooled. There was a moderate positive correlation between Step 2 CK and ITE scores (0.52, 95% CI 0.45-0.59, P < .01). There was a moderate positive correlation between Step 2 CK and ITE scores for both nonsurgical (0.59, 95% CI 0.51-0.66, P < .01) and surgical specialties (0.41, 95% CI 0.33-0.48, P < .01). There was a very weak positive correlation between Step 2 CK scores and subjective measures of resident performance (0.19, 95% CI 0.13-0.25, P < .01). CONCLUSIONS This study found Step 2 CK scores have a statistically significant moderate positive association with future examination scores and a statistically significant weak positive correlation with subjective measures of resident performance. These findings are increasingly relevant as Step 2 CK scores will likely become more important in resident selection.
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Affiliation(s)
- Camron Shirkhodaie
- C. Shirkhodaie is a medical student, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4279-3251
| | - Santiago Avila
- S. Avila is a medical student, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-3633-4304
| | - Henry Seidel
- H. Seidel is a medical student, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-7364-1365
| | - Robert D Gibbons
- R.D. Gibbons is professor, Center for Health Statistics and Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Vineet M Arora
- V.M. Arora is professor, Department of Medicine, University of Chicago Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4745-7599
| | - Jeanne M Farnan
- J.M. Farnan is professor, Department of Medicine, University of Chicago Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-1138-9416
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20
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Kushniruk A, Arora VM, Vollbrecht H, Meltzer DO, Press V. eHealth Literacy and Patient Portal Use and Attitudes: Cross-sectional Observational Study. JMIR Hum Factors 2023; 10:e40105. [PMID: 36705947 PMCID: PMC9919456 DOI: 10.2196/40105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/28/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, patient portals have become more widely used tools of patient care delivery. However, not all individuals have equivalent access or ability to use patient portals. OBJECTIVE The aim of this study is to evaluate the relationships between eHealth literacy (eHL) and patient portal awareness, use, and attitudes among hospitalized patients. METHODS Inpatients completed patient portal surveys; eHL was assessed (eHealth Literacy Scale). Multivariable logistic regression analyses adjusted for age, self-reported race, gender, and educational attainment were completed with significance at P<.006 (Bonferroni correction). RESULTS Among 274 participants, most identified as Black (n=166, 61%) and female (n=140, 51%), mean age was 56.5 (SD 16.7) years, and 178 (65%) reported some college or higher educational attainment. One-quarter (n=79, 28%) had low eHL (mean 27, SD 9.5), which was associated with lower odds of portal access awareness (odds ratio 0.11, 95% CI 0.05-0.23; P<.001), having ever used portals (odds ratio 0.19, 95% CI 0.10-0.36; P<.001), less perceived usefulness of portals (odds ratio 0.20, 95% CI 0.10-0.38; P=.001), and lower likelihood of planning to use portals in the coming years (odds ratio 0.12, 95% CI 0.06-0.25; P<.001). As time through the COVID-19 pandemic passed, there was a trend toward increased perceived usefulness of patient portals (53% vs 62%, P=.08), but average eHL did not increase through time (P=.81). CONCLUSIONS Low eHL was associated with less awareness, use, and perceived usefulness of portals. Perceived usefulness of portals likely increased through the COVID-19 pandemic, but patients' eHL did not. Interventions tailored for patients with low eHL could ensure greater equity in health care delivery through the COVID-19 pandemic.
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Affiliation(s)
| | - Vineet M Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Hanna Vollbrecht
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Valerie Press
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
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21
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Patel BK, Wolfe KS, Patel SB, Dugan KC, Esbrook CL, Pawlik AJ, Stulberg M, Kemple C, Teele M, Zeleny E, Hedeker D, Pohlman AS, Arora VM, Hall JB, Kress JP. Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. Lancet Respir Med 2023:S2213-2600(22)00489-1. [PMID: 36693400 DOI: 10.1016/s2213-2600(22)00489-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Patients who have received mechanical ventilation can have prolonged cognitive impairment for which there is no known treatment. We aimed to establish whether early mobilisation could reduce the rates of cognitive impairment and other aspects of disability 1 year after critical illness. METHODS In this single-centre, parallel, randomised controlled trial, patients admitted to the adult medical-surgical intensive-care unit (ICU), at the University of Chicago (IL, USA), were recruited. Inclusion criteria were adult patients (aged ≥18 years) who were functionally independent and mechanically ventilated at baseline and within the first 96 h of mechanical ventilation, and expected to continue for at least 24 h. Patients were randomly assigned (1:1) via computer-generated permuted balanced block randomisation to early physical and occupational therapy (early mobilisation) or usual care. An investigator designated each assignment in consecutively numbered, sealed, opaque envelopes; they had no further involvement in the trial. Only the assessors were masked to group assignment. The primary outcome was cognitive impairment 1 year after hospital discharge, measured with a Montreal Cognitive Assessment. Patients were assessed for cognitive impairment, neuromuscular weakness, institution-free days, functional independence, and quality of life at hospital discharge and 1 year. Analysis was by intention to treat. This trial was registered with ClinicalTrials.gov, number NCT01777035, and is now completed. FINDINGS Between Aug 11, 2011, and Oct 24, 2019, 1222 patients were screened, 200 were enrolled (usual care n=100, intervention n=100), and one patient withdrew from the study in each group; thus 99 patients in each group were included in the intention-to-treat analysis (113 [57%] men and 85 [43%] women). 65 (88%) of 74 in the usual care group and 62 (89%) of 70 in the intervention group underwent testing for cognitive impairment at 1 year. The rate of cognitive impairment at 1 year with early mobilisation was 24% (24 of 99 patients) compared with 43% (43 of 99) with usual care (absolute difference -19·2%, 95% CI -32·1 to -6·3%; p=0·0043). Cognitive impairment was lower at hospital discharge in the intervention group (53 [54%] 99 patients vs 68 [69%] 99 patients; -15·2%, -28·6 to -1·7; p=0·029). At 1 year, the intervention group had fewer ICU-acquired weaknesses (none [0%] of 99 patients vs 14 [14%] of 99 patients; -14·1%; -21·0 to -7·3; p=0·0001) and higher physical component scores on quality-of-life testing than did the usual care group (median 52·4 [IQR 45·3-56·8] vs median 41·1 [31·8-49·4]; p<0·0001). There was no difference in the rates of functional independence (64 [65%] of 99 patients vs 61 [62%] of 99 patients; 3%, -10·4 to 16·5%; p=0·66) or mental component scores (median 55·9 [50·2-58·9] vs median 55·2 [49·5-59·7]; p=0·98) between the intervention and usual care groups at 1 year. Seven adverse events (haemodynamic changes [n=3], arterial catheter removal [n=1], rectal tube dislodgement [n=1], and respiratory distress [n=2]) were reported in six (6%) of 99 patients in the intervention group and in none of the patients in the usual care group (p=0·029). INTERPRETATION Early mobilisation might be the first known intervention to improve long-term cognitive impairment in ICU survivors after mechanical ventilation. These findings clearly emphasise the importance of avoiding delays in initiating mobilisation. However, the increased adverse events in the intervention group warrants further investigation to replicate these findings. FUNDING None.
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Affiliation(s)
- Bhakti K Patel
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Krysta S Wolfe
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Shruti B Patel
- Loyola University Chicago Stritch School of Medicine, Department of Medicine, Division of Pulmonary/Critical Care, Maywood, IL, USA
| | - Karen C Dugan
- Section of Pulmonary/Critical Care, Northwest Permanente, Hillsboro, OR, USA
| | - Cheryl L Esbrook
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Amy J Pawlik
- Vitality Women's Physical Therapy and Wellness, Elmhurst, IL, USA
| | - Megan Stulberg
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Crystal Kemple
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Megan Teele
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Erin Zeleny
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Anne S Pohlman
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Vineet M Arora
- Section of General Internal Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Jesse B Hall
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John P Kress
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA.
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22
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Ren M, Zhang H, Meltzer D, Arora VM, Prochaska M. Changes in Patient Perceptions of the Provider Most Involved in Care During COVID-19 and Corresponding Effects on Patient Trust. J Patient Exp 2023; 10:23743735231166501. [PMID: 37035096 PMCID: PMC10074613 DOI: 10.1177/23743735231166501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
During COVID-19 routine clinical operations were disrupted, including limits on the types of providers allowed to perform in-person care and frequency of times they could enter a patient's room. Whether these changes affected patients’ trust in the care they received during hospitalization is unknown. Hospitalized patients on the general medicine service were called after discharge and asked to identify who (attending, resident, etc.) was most involved in their inpatient care, and how much trust they had in the physician caring for them. During the pandemic patients were more likely to report attending physicians (29% to 34%) and nurses (30% to 35%), and less likely to report residents/interns (8.1% to 6.5%) or medical students (1.7% to 1.4%) as most involved in their care (chi-squared test, p = 0.04). Patients reporting their attending physician as most involved in their care were more likely to report trusting their doctor (chi-squared test, p < 0.01). As such, trends in medical education that limit trainees’ time in direct patient care may affect the development of clinical and interpersonal skills necessary to establish patient trust.
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Affiliation(s)
- Megan Ren
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Hui Zhang
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
| | - David Meltzer
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
| | - Vineet M. Arora
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Micah Prochaska
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
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23
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Jagsi R, Beeland TD, Sia K, Szczygiel LA, Allen MR, Arora VM, Bair-Merritt M, Bauman MD, Bogner HR, Daumit G, Davis E, Fagerlin A, Ford DE, Gbadegesin R, Griendling K, Hartmann K, Hedayati SS, Jackson RD, Matulevicius S, Mugavero MJ, Nehl EJ, Neogi T, Regensteiner JG, Rubin MA, Rubio D, Singer K, Tucker Edmonds B, Volerman A, Laney S, Patton C, Escobar Alvarez S. Doris Duke Charitable Foundation Fund to Retain Clinical Scientists: innovating support for early-career family caregivers. J Clin Invest 2022; 132:166075. [PMID: 36453546 PMCID: PMC9711869 DOI: 10.1172/jci166075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | - Kevin Sia
- Doris Duke Charitable Foundation, New York, New York, USA
| | | | - Matthew R. Allen
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vineet M. Arora
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | - Hillary R. Bogner
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gail Daumit
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Esa Davis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Angela Fagerlin
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Daniel E. Ford
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Michael A. Rubin
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Doris Rubio
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | | - Anna Volerman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Affiliation(s)
- Morgan S Levy
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shira Fishbach
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Arghavan Salles
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Vineet M Arora
- Department of Medicine, University of Chicago Pritzker School of Medicine, 924 E. 57th Street, Suite 104, Chicago, IL, 60637, USA.
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Rojas JC, Rohweder G, Guptill J, Arora VM, Umscheid CA. Predictive Analytics Programs at Large Healthcare Systems in the USA: a National Survey. J Gen Intern Med 2022; 37:4015-4017. [PMID: 35396657 PMCID: PMC9640476 DOI: 10.1007/s11606-022-07517-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Juan C Rojas
- Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA.
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6076, Chicago, IL, 60637, USA.
| | | | | | - Vineet M Arora
- Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Craig A Umscheid
- Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA
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Arora VM, Carter K, Babcock C. Bias in Assessment Needs Urgent Attention-No Rest for the "Wicked". JAMA Netw Open 2022; 5:e2243143. [PMID: 36409501 DOI: 10.1001/jamanetworkopen.2022.43143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Vineet M Arora
- University of Chicago Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Keme Carter
- University of Chicago Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Christine Babcock
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
- Graduate Medical Education, University of Chicago Medicine, Chicago, Illinois
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Tang JW, Kostas T, Verma A, Press VG, Kushner J, Gier N, Wiklund LO, Arora VM, Farnan J, Meltzer DO. A Qualitative Study of Preclinical Medical Students Randomized to Patient-Partnered vs Traditional Clinical Experiences. J Patient Cent Res Rev 2022; 9:290-297. [PMCID: PMC9584085 DOI: 10.17294/2330-0698.1930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Joyce W. Tang
- Section of Hospital Medicine, University of Chicago, Chicago, IL
| | - Tia Kostas
- Section of Geriatrics, University of Chicago, Chicago, IL
| | | | - Valerie G. Press
- Section of General Internal Medicine, University of Chicago, Chicago, IL
| | - Josef Kushner
- Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Nicole Gier
- Section of Hospital Medicine, University of Chicago, Chicago, IL
| | - Lauren O. Wiklund
- Department of Psychology, Michigan State University, East Lansing, MI
| | - Vineet M. Arora
- Section of General Internal Medicine, University of Chicago, Chicago, IL
| | - Jeanne Farnan
- Section of Hospital Medicine, University of Chicago, Chicago, IL
| | - David O. Meltzer
- Section of Hospital Medicine, University of Chicago, Chicago, IL
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Arora VM, Klein A, Coe A, Patel A, Albert D, Blanchard A. Implementation and evaluation of IGNITE (Improving GME Nursing Interprofessional Team Experiences) to improve care in an academic health system. Healthcare (Basel) 2022; 10:100642. [DOI: 10.1016/j.hjdsi.2022.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/22/2022] [Accepted: 07/02/2022] [Indexed: 11/04/2022] Open
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Chen PW, O’Brien MK, Horin AP, McGee Koch LL, Lee JY, Xu S, Zee PC, Arora VM, Jayaraman A. Sleep Monitoring during Acute Stroke Rehabilitation: Toward Automated Measurement Using Multimodal Wireless Sensors. Sensors (Basel) 2022; 22:6190. [PMID: 36015951 PMCID: PMC9414899 DOI: 10.3390/s22166190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Sleep plays a critical role in stroke recovery. However, there are limited practices to measure sleep for individuals with stroke, thus inhibiting our ability to identify and treat poor sleep quality. Wireless, body-worn sensors offer a solution for continuous sleep monitoring. In this study, we explored the feasibility of (1) collecting overnight biophysical data from patients with subacute stroke using a simple sensor system and (2) constructing machine-learned algorithms to detect sleep stages. Ten individuals with stroke in an inpatient rehabilitation hospital wore two wireless sensors during a single night of sleep. Polysomnography served as ground truth to classify different sleep stages. A population model, trained on data from multiple patients and tested on data from a separate patient, performed poorly for this limited sample. Personal models trained on data from one patient and tested on separate data from the same patient demonstrated markedly improved performance over population models and research-grade wearable devices to detect sleep/wake. Ultimately, the heterogeneity of biophysical signals after stroke may present a challenge in building generalizable population models. Personal models offer a provisional method to capture high-resolution sleep metrics from simple wearable sensors by leveraging a single night of polysomnography data.
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Affiliation(s)
- Pin-Wei Chen
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
| | - Megan K. O’Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA
| | - Adam P. Horin
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
| | - Lori L. McGee Koch
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
| | | | - Shuai Xu
- Sibel Health Inc., Niles, IL 60714, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL 60611, USA
| | - Vineet M. Arora
- Department of Medicine, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA
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Affini MI, Arora VM, Gulati J, Mason N, Klein A, Cho HJ, Clarke K, Lee V, McDaniel LM, Orlov NM. Defining existing practices to support the sleep of hospitalized patients: A mixed-methods study of top-ranked hospitals. J Hosp Med 2022; 17:633-638. [PMID: 35854665 PMCID: PMC9544101 DOI: 10.1002/jhm.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
Abstract
The objective of this study was to understand the existing practices and attitudes regarding inpatient sleep at the 2020 US News and World Report (USNWR) Honor Roll pediatric (n = 10) and adult (n = 20) hospitals. Section chiefs of Hospital Medicine from these institutions were surveyed and interviewed between June and August 2021. Among 23 of 30 surveyed physician leaders (response rate = 77%), 96% (n = 22) rated patient sleep as important, but only 43% (n = 10) were satisfied with their institutions' efforts. A total of 96% (n = 22) of institutions lack sleep equity practices. Fewer than half (48%) of top hospitals have sleep-friendly practices, with the most common practices including reducing overnight vital sign monitoring (43%), decreasing ambient light in the wards (43%), adjusting lab and medication schedules (35%), and implementing quiet hours (30%). Major themes from qualitative interviews included: importance of universal sleep-friendly cultures, environmental changes, and external incentives to improve patient sleep.
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Affiliation(s)
- Murtala I. Affini
- Division of Biological Sciences, Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Vineet M. Arora
- Division of Biological Sciences, Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
- Department of Medicine, Section of General Internal MedicineUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Jasmine Gulati
- Georgetown University School of MedicineGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Noah Mason
- Division of Biological Sciences, Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
- Department of PediatricsUniversity of ColoradoDenverColoradoUSA
| | - Aviva Klein
- Division of Biological Sciences, Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Hyung J. Cho
- Department of Medicine, Grossman School of MedicineNew York UniversityNew York CityNew YorkUSA
| | - Karen Clarke
- Division of Hospital Medicine | Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Vivian Lee
- Division of Hospital MedicineChildren's Hospital of Los AngelesLos AngelesCaliforniaUSA
- Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Lauren M. McDaniel
- Johns Hopkins Children's CenterJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nicola M. Orlov
- Division of Biological Sciences, Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
- Department of Pediatrics, Section of Hospital MedicineUniversity of Chicago Medical CenterChicagoIllinoisUSA
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Paz MI, Marino-Nunez D, Arora VM, Baig AA. Spanish Language Access to COVID-19 Vaccination Information and Registration in the 10 Most Populous Cities in the USA. J Gen Intern Med 2022; 37:2604-2606. [PMID: 35060004 PMCID: PMC8776323 DOI: 10.1007/s11606-021-07325-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Isabel Paz
- Pritzker School of Medicine, University of Chicago, 924 E 57th Street, Chicago, IL, 60637, USA.
| | - Diana Marino-Nunez
- Pritzker School of Medicine, University of Chicago, 924 E 57th Street, Chicago, IL, 60637, USA
| | - Vineet M Arora
- Pritzker School of Medicine, University of Chicago, 924 E 57th Street, Chicago, IL, 60637, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, USA
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Royan R, Pendergrast TR, Del Rios M, Rotolo SM, Trueger NS, Bloomgarden E, Behrens D, Jain S, Arora VM. Use of Twitter Amplifiers by Medical Professionals to Combat Misinformation During the COVID-19 Pandemic. J Med Internet Res 2022; 24:e38324. [PMID: 35839387 PMCID: PMC9311387 DOI: 10.2196/38324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/10/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Social media is an important tool for disseminating accurate medical information and combating misinformation (ie, the spreading of false or inaccurate information) and disinformation (ie, spreading misinformation with the intent to deceive). The prolific rise of inaccurate information during a global pandemic is a pressing public health concern. In response to this phenomenon, health professional amplifiers such as IMPACT (Illinois Medical Professional Action Collaborative Team) have been created as a coordinated response to enhance public communication and advocacy around the COVID-19 pandemic.
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Affiliation(s)
- Regina Royan
- Department of Emergency Medicine, Northwestern University, Chicago, IL, United States
| | | | - Marina Del Rios
- Department of Emergency Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Shannon M Rotolo
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, United States
| | - N Seth Trueger
- Department of Emergency Medicine, Northwestern University, Chicago, IL, United States.,JAMA Network Open, Chicago, IL, United States
| | - Eve Bloomgarden
- Division of Endocrinology, Northshore University Health System, Evanston, IL, United States
| | - Deanna Behrens
- Department of Pediatric Critical Care Medicine, Advocate Children's Hospital, Park Ridge, IL, United States
| | - Shikha Jain
- Division of Hematology and Oncology, University of Illinois, Chicago, IL, United States
| | - Vineet M Arora
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Gupta JC, Arora VM, Vollbrecht H, Kappel N, Meltzer DO, Press VG. The Relationship Between Insufficient Vision and Technology Access and Usage among Hospitalized Adults at an Urban Academic Hospital: An Observational Study (Preprint). JMIR Form Res 2022; 7:e40103. [DOI: 10.2196/40103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
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Vayani O, Klein A, Hahn OM, Pearson AT, Arora VM, Olopade OI, Golden DW. Adapting a medical school cancer research education program to the virtual environment. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11029 Background: As the number of patients with a cancer diagnosis grows in the United States, there is an increasing need for physician scientists with oncology-related research training to develop new approaches to screening, diagnosis, therapy, and survivorship. A single US medical school developed the National Cancer Institute-funded Scholars in Oncology-Associated Research (SOAR) cancer research education program. Due to the COVID-19 pandemic, SOAR transitioned from fully in-person in 2019 to virtual in 2020 and hybrid in 2021. This study examines whether the in-person, virtual, or hybrid formats provide better educational experiences as rated by participants. Methods: SOAR includes a seminar series, an 11-week full-time cancer research experience, weekly research cluster group meetings, and tumor board and interprofessional shadowing experiences. In 2019 all program activities were in-person. In 2020 all activities were virtual with the shadowing suspended. In 2021, seminars and tumor boards were virtual, shadowing was in-person, and all other activities were hybrid. Pre- and post-surveys were collected from all participants to assess understanding of oncology and associated medical specialties. How participant understanding of oncology and related specialties changed within each year’s program was analyzed with a Wilcoxon rank-sum test. The Kruskal-Wallis test was used to examine change in understanding between the cohorts. Results: 37 students participated in SOAR (2019 n = 11, 2020 n = 14, 2021 n = 12). Self-reported understanding of oncology as a clinical (p < 0.01 for all) and research discipline (p < 0.01 for all) improved within all three cohorts. There was no significant difference between each cohort’s improvement in research understanding (p = 0.6158). However, there was a trend towards more of an improvement in the in-person cohort (p = 0.0796) for clinical understanding. There was no significant difference between each cohort’s improvement in understanding of oncology-related disciplines such as medical oncology, radiation oncology, pediatric oncology, surgical oncology, and survivorship as both clinical and research disciplines (p > 0.1 for all). Conclusions: A virtual cancer research education program can be as effective as an in-person or hybrid program for research education although it may be suboptimal for learning about clinical oncology. Given the ongoing challenges presented by the COVID-19 pandemic, flexibility is needed in delivering cancer research education programs such as SOAR. With modern research methodology and communications technology, cancer research is becoming increasingly diverse and flexible in terms of research environment. If program leaders are steadfast in their adaptation of research education programs to a virtual or hybrid environment, participant understanding of oncology as a clinical and research discipline remains robust.
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Affiliation(s)
- Omar Vayani
- The University of Chicago Pritzker School of Medicine, Chicago, IL
| | | | | | | | | | | | - Daniel William Golden
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL
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Affiliation(s)
- Nicola M Orlov
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Section of Hospital Medicine, Department of Pediatrics, University of Chicago Medical Center, Chicago, IL, USA
| | - Vineet M Arora
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, IL, USA
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Affiliation(s)
- Vineet M Arora
- From University of Chicago Medicine (V.M.A.), NorthShore University Health System (E.B.), and the University of Illinois College of Medicine (S.J.) - all in Chicago
| | - Eve Bloomgarden
- From University of Chicago Medicine (V.M.A.), NorthShore University Health System (E.B.), and the University of Illinois College of Medicine (S.J.) - all in Chicago
| | - Shikha Jain
- From University of Chicago Medicine (V.M.A.), NorthShore University Health System (E.B.), and the University of Illinois College of Medicine (S.J.) - all in Chicago
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Levy MS, Kelly AG, Brown AD, Caban-Martinez A, Arora VM, Salles A. The Impact of COVID-19 on Family Building Among Physicians and Trainees. J Gen Intern Med 2022; 37:1582-1584. [PMID: 35199263 PMCID: PMC8865727 DOI: 10.1007/s11606-022-07442-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/28/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Morgan S Levy
- University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amelia G Kelly
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Alyssa D Brown
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,University of Louisville School of Medicine, Louisville, KY, USA
| | - Alberto Caban-Martinez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vineet M Arora
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Arghavan Salles
- Stanford University Department of Medicine, Clayman Institute for Gender Research, Palo Alto, CA, USA.
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Jain S, Dhaon SR, Majmudar S, Zimmermann LJ, Mordell L, Walker G, Wallia A, Akbarnia H, Khan A, Bloomgarden E, Arora VM. Empowering Healthcare Workers on Social Media to Bolster Trust in Science and Vaccination During the Pandemic: Making IMPACT Using a Place-Based Approach (Preprint). J Med Internet Res 2022; 24:e38949. [PMID: 35917489 PMCID: PMC9578519 DOI: 10.2196/38949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background Given the widespread and concerted efforts to propagate health misinformation on social media, particularly centered around vaccination during the pandemic, many groups of clinicians and scientists were organized on social media to tackle misinformation and promote vaccination, using a national or international lens. Although documenting the impact of such social media efforts, particularly at the community level, can be challenging, a more hyperlocal or “place-based approach” for social media campaigns could be effective in tackling misinformation and improving public health outcomes at a community level. Objective We aimed to describe and document the effectiveness of a place-based strategy for a coordinated group of Chicago health care workers on social media to tackle misinformation and improve vaccination rates in the communities they serve. Methods The Illinois Medical Professionals Action Collaborative Team (IMPACT) was founded in March 2020 in response to the COVID-19 pandemic, with representatives from major academic teaching hospitals in Chicago (eg, University of Chicago, Northwestern University, University of Illinois, and Rush University) and community-based organizations. Through crowdsourcing on multiple social media platforms (eg, Facebook, Twitter, and Instagram) with a place-based approach, IMPACT engaged grassroots networks of thousands of Illinois health care workers and the public to identify gaps, needs, and viewpoints to improve local health care delivery during the pandemic. Results To address vaccine misinformation, IMPACT created 8 “myth debunking” infographics and a “vaccine information series” of 14 infographics that have generated >340,000 impressions and informed the development of vaccine education for the Chicago Public Libraries. IMPACT delivered 13 policy letters focusing on different topics, such as health care worker personal protective equipment, universal masking, and vaccination, with >4000 health care workers signatures collected through social media and delivered to policy makers; it published over 50 op-eds on COVID-19 topics in high-impact news outlets and contributed to >200 local and national news features.
Using the crowdsourcing approach on IMPACT social media channels, IMPACT mobilized health care and lay volunteers to staff >400 vaccine events for >120,000 individuals, many in Chicago’s hardest-hit neighborhoods. The group’s recommendations have influenced public health awareness campaigns and initiatives, as well as research, advocacy, and policy recommendations, and they have been recognized with local and national awards. Conclusions A coordinated group of health care workers on social media, using a hyperlocal place-based approach, can not only work together to address misinformation but also collaborate to boost vaccination rates in their surrounding communities.
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Affiliation(s)
- Shikha Jain
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Serena R Dhaon
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, United States
| | - Shivani Majmudar
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Laura J Zimmermann
- Department of Preventive Medicine, Department of Internal Medicine, Rush University, Chicago, IL, United States
| | - Lisa Mordell
- Loyola University Stritch School of Medicine, Maywood, IL, United States
| | - Garth Walker
- Department of Emergency Medicine, Northwestern University, Evanston, IL, United States
| | - Amisha Wallia
- Department of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University, Evanston, IL, United States
| | - Halleh Akbarnia
- Advocate Condell Medical Center, Libertyville, IL, United States
| | - Ali Khan
- Oak Street Health, Chicago, IL, United States
| | - Eve Bloomgarden
- NorthShore University HealthSystem, Evanston, IL, United States
| | - Vineet M Arora
- University of Chicago Pritzker School of Medicine, Chicago, IL, United States
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O'Glasser AY, Arora VM, Chan TM. Capturing and Articulating Visual Media as Scholarship. J Grad Med Educ 2022; 14:233-234. [PMID: 35463166 PMCID: PMC9017259 DOI: 10.4300/jgme-d-22-00112.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Avital Y. O'Glasser
- Avital Y. O'Glasser, MD, FACP, SFHM, is Associate Professor, Department of Medicine, Division of Hospital Medicine, and Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University
| | - Vineet M. Arora
- Vineet M. Arora, MD, MAPP, is the Herbert T. Abelson Professor of Medicine and Dean for Medical Education, Pritzker School of Medicine, University of Chicago
| | - Teresa M. Chan
- Teresa M. Chan, MD, MHPE, is Associate Professor, Department of Medicine, Division of Emergency Medicine and Division of Education & Innovation, Clinician Scientist, McMaster Education Research, Innovation, and Theory (MERIT), and Associate Dean of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Prochaska MT, Zhang H, Meltzer DO, Arora VM. Patient Characteristics Associated with and Changes Over Time in Trust in Inpatient Physicians. J Gen Intern Med 2022; 37:266-268. [PMID: 33634381 PMCID: PMC8738824 DOI: 10.1007/s11606-021-06649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/31/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Micah T Prochaska
- Department of Medicine, The University of Chicago, Chicago, IL, USA.
| | - Hui Zhang
- Center for Health and The Social Sciences, The University of Chicago, Chicago, IL, USA
| | - David O Meltzer
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Vineet M Arora
- Department of Medicine, The University of Chicago, Chicago, IL, USA
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Moore PQ, Cheema N, Follman S, Celmins L, Scott G, Pho MT, Farnan J, Arora VM, Carter K. Medical Student Screening for Naloxone Eligibility in the Emergency Department: A Value-Added Role to Fight the Opioid Epidemic. MedEdPORTAL 2021; 17:11196. [PMID: 34950768 PMCID: PMC8654700 DOI: 10.15766/mep_2374-8265.11196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Opioid overdose education and naloxone distribution (OEND) for use by laypersons are safe and effective at preventing deaths from opioid overdose, but emergency department (ED) implementation is challenging. Curricula addressing OEND could enable students to serve in value-added roles on the clinical team, overcome challenges of naloxone distribution, and improve patient care. METHODS We created a 1-hour didactic session on opioid use disorder and OEND for first-year medical students in the emergency medicine elective. During two clinical shifts, students used this knowledge to perform screenings to identify patients at high risk of overdose. If a patient screened positive, students performed patient education and then notified the physician, who ordered a naloxone kit. RESULTS Thirty students received the didactic and conducted screening shifts. Of 147 patients screened, 40% (n = 59) were positive for naloxone eligibility, 21% (n = 31) reported that someone close to them used opioids, 18% (n = 26) had witnessed an opioid overdose, 12% (n = 17) had previously overdosed themselves, and 12% (n = 18) previously knew what naloxone was. Fifty-nine naloxone kits were distributed over the 3-month pilot versus 13 naloxone prescriptions for patients discharged from the ED the prior year. DISCUSSION Through didactic training and structured patient engagement, medical students gained knowledge of and hands-on experience with addiction medicine, discussed sensitive topics with patients, and identified a high volume of patients eligible to receive naloxone. Medical student screening for OEND in ED patients is feasible and adds significant value to the clinical team.
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Affiliation(s)
- P. Quincy Moore
- Assistant Professor of Medicine, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine
| | - Navneet Cheema
- Assistant Professor of Medicine, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine
| | - Sarah Follman
- Resident Physician, Section of Emergency Medicine, University of Chicago Medicine
| | - Laura Celmins
- Clinical Pharmacist Specialist, Department of Pharmacy, University of Chicago Medicine
| | - Greg Scott
- Professor, Department of Sociology, DePaul University
| | - Mai T. Pho
- Associate Professor of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Pritzker School of Medicine
| | - Jeanne Farnan
- Professor of Medicine, Section of Hospital Medicine, University of Chicago Pritzker School of Medicine
| | - Vineet M. Arora
- Herbert T. Abelson Professor of Medicine, Section of Hospital Medicine, University of Chicago Pritzker School of Medicine
| | - Keme Carter
- Associate Professor of Medicine, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine
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Carter K, Podczerwinski J, Love L, Twiss M, Blanchard A, Arora VM, Martin SK. Utilizing Telesimulation for Advanced Skills Training in Consultation and Handoff Communication: A Post-COVID-19 GME Bootcamp Experience. J Hosp Med 2021; 16:730-734. [PMID: 34797994 DOI: 10.12788/jhm.3733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 11/20/2022]
Abstract
COVID-19 forced the switch to virtual for many educational strategies, including simulation. Virtual formats have the potential to broaden access to simulation training, especially in resource-heavy "bootcamp"-type settings. We converted our in-person communication skills bootcamp to telesimulation and compared effectiveness and satisfaction between formats. During June 2020 orientation, 130 entering interns at one institution participated, using Zoom® to perform one mock consultation and three mock handoffs. Faculty rated performance with checklists and gave feedback. Post-bootcamp surveys assessed participant satisfaction and practice preparedness. Telesimulation performance was comparable to in-person for consultations and slightly inferior for handoffs. Survey response rate was 100%. Compared to in-person, there was higher satisfaction with telesimulation, and interns felt more prepared for practice (95% vs 78%, P < .01); 99% recommended the experience. Fifty percent fewer faculty were required for implementation. Telesimulation was well-received and comparable to in-person bootcamp, representing a feasible, scalable training strategy for communication skills essential in hospital medicine.
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Affiliation(s)
- Keme Carter
- University of Chicago Pritzker School of Medicine, Department of Medicine, Chicago, Illinois
| | - Jeremy Podczerwinski
- University of Chicago Medicine, Office of Graduate Medical Education, Chicago, Illinois
| | - Latassa Love
- University of Chicago Medicine, Office of Graduate Medical Education, Chicago, Illinois
| | - Megham Twiss
- University of Chicago Medicine, Office of Graduate Medical Education, Chicago, Illinois
| | - Anita Blanchard
- University of Chicago Pritzker School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Vineet M Arora
- University of Chicago Pritzker School of Medicine, Department of Medicine, Chicago, Illinois
| | - Shannon K Martin
- University of Chicago Pritzker School of Medicine, Department of Medicine, Chicago, Illinois
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Whaley CM, Koo T, Arora VM, Ganguli I, Gross N, Jena AB. Female Physicians Earn An Estimated $2 Million Less Than Male Physicians Over A Simulated 40-Year Career. Health Aff (Millwood) 2021; 40:1856-1864. [PMID: 34871074 PMCID: PMC9910787 DOI: 10.1377/hlthaff.2021.00461] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Differences in income between male and female academic physicians are well known, but differences for community physicians and career differences in income have not been quantified. We used earnings data from 80,342 full-time US physicians to estimate career differences in income between men and women. The differences in annual income between male and female physicians that we observed in our simulations increased most rapidly during the initial years of practice. Over the course of a simulated forty-year career, male physicians earned an average adjusted gross income of $8,307,327 compared with an average of $6,263,446 for female physicians-an absolute adjusted difference of $2,043,881 and relative difference of 24.6 percent. Gender differences in career earnings were largest for surgical specialists ($2.5 million difference), followed by nonsurgical specialists ($1.6 million difference) and primary care physicians ($0.9 million difference). These findings imply that over the course of a career, female US physicians were estimated to earn, on average, more than $2 million less than male US physicians after adjustment for factors that may otherwise explain observed differences in income, such as hours worked, clinical revenue, practice type, and specialty.
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Affiliation(s)
| | - Tina Koo
- health policy at the RAND Corporation
| | | | - Ishani Ganguli
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital and Harvard Medical School, both in Boston, Massachusetts
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Abstract
PURPOSE Recent national events, including the COVID-19 pandemic and protests of racial inequities, have drawn attention to the role of physicians in advocating for improvements in the social, economic, and political factors that affect health. Characterizing the current state of advocacy training in U.S. medical schools may help set expectations for physician advocacy and predict future curricular needs. METHOD Using the member school directory provided by the Association of American Medical Colleges, the authors compiled a list of 154 MD-granting medical schools in the United States in 2019-2020. They used multiple search strategies to identify online course catalogues and advocacy-related curricula using variations of the terms "advocacy," "policy," "equity," and "social determinants of health." They used an iterative process to generate a preliminary coding schema and to code all course descriptions, conducting content analysis to describe the structure of courses and topics covered. RESULTS Of 134 medical schools with any online course catalogue available, 103 (76.9%) offered at least 1 advocacy course. Required courses were typically survey courses focused on general content in health policy, population health, or public health/epidemiology, whereas elective courses were more likely to focus specifically on advocacy skills building and to feature field experiences. Of 352 advocacy-specific courses, 93 (26.4%) concentrated on a specific population (e.g., children or persons with low socioeconomic status). Few courses (n = 8) focused on racial/ethnic minorities and racial inequities. CONCLUSIONS Findings suggest that while most U.S. medical schools offer at least 1 advocacy course, the majority are elective rather than required, and the structure and content of advocacy-related courses vary substantially. Given the urgency to address social, economic, and political factors affecting health and health equity, this study provides an important and timely overview of the prevalence and content of advocacy curricula at U.S. medical schools.
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Affiliation(s)
- Teva D Brender
- T.D. Brender is a medical student, Oregon Health & Science University, Portland, Oregon
| | - Wesley Plinke
- W. Plinke is a medical student, Oregon Health & Science University, Portland, Oregon
| | - Vineet M Arora
- V.M. Arora is the Herbert T. Abelson Professor of Medicine and assistant dean, Scholarship and Discovery, University of Chicago School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-4745-7599
| | - Jane M Zhu
- J.M. Zhu is assistant professor of medicine, Division of General Internal Medicine, Oregon Health & Science University, Portland, Oregon; ORCID: http://orcid.org/0000-0002-4868-6078
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Affiliation(s)
| | | | - Ishani Ganguli
- Department of Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA
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Rotolo SM, Jain S, Dhaon S, Dokhanchi JK, Kalata E, Shah T, Mordell LJ, Clayman ML, Kenefake A, Zimmermann LJ, Bloomgarden E, Arora VM. A coordinated strategy to develop and distribute infographics addressing COVID-19 vaccine hesitancy and misinformation. J Am Pharm Assoc (2003) 2021; 62:224-231. [PMID: 34483058 PMCID: PMC8380065 DOI: 10.1016/j.japh.2021.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/09/2022]
Abstract
Background Visual communication strategies are becoming increasingly prevalent for conveying information to health professionals as well as to the general public. The potential of social media for rapid knowledge dissemination using infographics was recognized early in the coronavirus disease (COVID-19) pandemic by health professionals. Objective The purpose of this study was to describe a coalition of health professionals’ approach to developing infographics about COVID-19 vaccines and the reach and engagement of those infographics when shared through social media. Methods Infographics were created by a core team within the coalition following a stepwise approach. Each underwent a multistep review process, readability evaluation, and translation into Spanish. Infographics were then shared through multiple social media platforms. They were grouped into 1 of 3 categories for this analysis: COVID-19 vaccine series, myth debunkers, or other. Results All infographics had greater outreach, impressions, and engagement on Twitter than they did on other platforms. When comparing the 3 groups, no 1 infographic type was consistently performing higher than the others. Conclusion Each infographic reached thousands to tens of thousands of people. We do not know whether those who viewed these infographics changed their perspective on vaccination, so we are unable to draw a conclusion about their impact on vaccine hesitancy based on this study alone.
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Mason NR, Orlov NM, Anderson S, Byron M, Mozer C, Arora VM. Piloting I-SLEEP: a patient-centered education and empowerment intervention to improve patients' in-hospital sleep. Pilot Feasibility Stud 2021; 7:161. [PMID: 34412696 PMCID: PMC8375174 DOI: 10.1186/s40814-021-00895-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/30/2021] [Indexed: 01/11/2023] Open
Abstract
Background Sleep disturbances in hospitalized patients are linked to poor recovery. In preparation for a future randomized controlled trial, this pilot study evaluated the feasibility and acceptability of a multi-component intervention (I-SLEEP) that educates and empowers inpatients to advocate for fewer nighttime disruptions in order to improve sleep during periods of hospitalization. Methods Eligible inpatients received I-SLEEP, which included an educational video, brochure, sleep kit, and three questions patients can ask their team to reduce nighttime disruptions. Following I-SLEEP, inpatients were surveyed on the primary feasibility outcomes of satisfaction with and use of I-SLEEP components. Inpatients were also surveyed regarding empowerment and understanding of intervention materials. Patient charts were reviewed to collect data on nighttime (11 PM–7 AM) vital sign and blood draws disruptions. Results Ninety percent (n = 26/29) of patients were satisfied with the brochure and 87% (n = 27/31) with the video. Nearly all (95%, n = 36/37) patients felt empowered to ask their providers to minimize nighttime disruptions and 68% (n = 26/37) intended to alter sleep habits post-discharge. Forty-nine percent (n = 18/37) of patients asked an I-SLEEP question. Patients who asked an I-SLEEP question were significantly more likely to experience nights with fewer disruptions due to nighttime vitals (19% vs. 2.1%, p = 0.008). Conclusion This pilot study found that I-SLEEP was well-accepted and enabled hospitalized patients to advocate for less disrupted sleep. Educating patients to advocate for reducing nighttime disruptions may be a patient-centered, low-cost strategy to improve patients’ care and in-hospital experience. These results suggest that I-SLEEP is ready to be evaluated against routine care in a future randomized controlled trial. Trial registration ClinicalTrials.Gov NCT04151251.
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Affiliation(s)
- Noah R Mason
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Nicola M Orlov
- Department of Pediatrics, University of Chicago Medicine, Chicago, IL, USA
| | - Samantha Anderson
- Department of Medicine, University of Chicago Medicine, 5841 S Maryland Ave, MC 2007, Chicago, IL, 60637, USA
| | - Maxx Byron
- Department of Medicine, University of Chicago Medicine, 5841 S Maryland Ave, MC 2007, Chicago, IL, 60637, USA
| | - Christine Mozer
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Vineet M Arora
- Department of Medicine, University of Chicago Medicine, 5841 S Maryland Ave, MC 2007, Chicago, IL, 60637, USA.
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Tatineni S, Orlov NM, Riehm JM, Erondu A, Mozer CL, Cook DJ, Byron M, Mordell L, Dimitrov M, Arora VM. Objective Measures of Physical Distancing in the Hospital During the COVID-19 Pandemic. J Hosp Med 2021; 16:jhm.3666. [PMID: 34424197 DOI: 10.12788/jhm.3666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022]
Abstract
During the COVID-19 pandemic, hospitals published physical-distancing guidance and created dedicated respiratory isolation units (RIUs) for patients with COVID-19. The degree to which such distancing occurred between clinicians and patients is unknown. In this study, heat sensors from an existing hospital hand-hygiene monitoring system objectively tracked room entries as a proxy for physical distancing in both RIUs and general medicine units before and during the pandemic. The RIUs saw a 60.6% reduction in entries per room per day (from 85.7 to 33.8). General medicine units that cared for patients under investigation for COVID-19 and other patients experienced a 14.7% reduction in entries per room per day (from 76.9 to 65.1). While gradual extinction was observed in both units as COVID-19 cases declined, the RIUs had a higher degree of physical distancing. Although the optimal level of physical distancing is unknown, sustaining physical distancing in the hospital may require re-education and real-time monitoring.
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Affiliation(s)
- Swetha Tatineni
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Nicola M Orlov
- Section of Pediatric Hospital Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Joseph M Riehm
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Amarachi Erondu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Christine L Mozer
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - David J Cook
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Maxx Byron
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Lisa Mordell
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
| | | | - Vineet M Arora
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
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Martinez M, Cerasale M, Baig M, Dugan C, Robinson M, Sweis M, Prochaska M, Schram A, Meltzer D, Arora VM. Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services. J Hosp Med 2021; 16:jhm.3673. [PMID: 34424191 DOI: 10.12788/jhm.3673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/24/2021] [Indexed: 11/20/2022]
Abstract
Appropriate use of inpatient physical therapy services is important for preventing hospital-associated disability (HAD). We assessed potential overutilization of physical therapy consults on hospital medicine services using the Activity Measure-Post Acute Care (AM-PAC) score. Our sample included 3592 unique admissions (mean age, 66 years; 48% women) at a large academic medical center. Based on an AM-PAC cutoff of >43.63 (raw score, 18) in patients who were discharged to home, 38% of physical therapy consults were considered "potential overutilization." Combined with age <65 years, 18% of consults remained "potential overutilization." After adjustment for age, sex, and length of stay, patients admitted with high mobility scores were 5.38 times more likely to be discharged to home (95% CI, 4.36-2.89) compared with those with low mobility scores. Being more judicious with physical therapy consults and reserving skilled therapy for at-risk patients could help prevent HAD while also having a positive impact on healthcare systems.
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Affiliation(s)
- Maylyn Martinez
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Matthew Cerasale
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Claire Dugan
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Marla Robinson
- Inpatient Therapy Services Department, University of Chicago, Chicago, Illinois
| | - Meghan Sweis
- Department of Nursing Administration and Patient Services, University of Chicago, Chicago, Illinois
| | - Micah Prochaska
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Andrew Schram
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - David Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Vineet M Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
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