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Mastour H, Dehghani T, Jajroudi M, Moradi E, Zarei M, Eslami S. Prediction of medical sciences students' performance on high-stakes examinations using machine learning models: a protocol for a systematic review. BMJ Open 2023; 13:e064956. [PMID: 37142312 PMCID: PMC10163468 DOI: 10.1136/bmjopen-2022-064956] [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] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Predicting medical science students' performance on high-stakes examinations has received considerable attention. Machine learning (ML) models are well-known approaches to enhance the accuracy of determining the students' performance. Accordingly, we aim to provide a comprehensive framework and systematic review protocol for applying ML in predicting medical science students' performance on high-stakes examinations. Improving the current understanding of the input and output features, preprocessing methods, setting of ML models and required evaluation metrics seems essential. METHODS AND ANALYSIS A systematic review will be conducted by searching the electronic bibliographic databases of MEDLINE/PubMed, EMBASE, SCOPUS and Web of Science. The search will be limited to studies published from January 2013 to June 2023. Studies explicitly predicting student performance in high-stakes examinations and referencing their learning outcomes and use of ML models will be included. Two team members will first screen literature meeting the inclusion criteria at the title, abstract and full-text levels. Second, the Best Evidence Medical Education quality framework rates the included literature. Later, two team members will extract data, including the studies' general data and the ML approach's details. Finally, the information consensus will be reached and submitted for analysis. The synthesised evidence from this review provides helpful information for medical education policy-makers, stakeholders and other researchers in adopting the ML models to evaluate medical science students' performance in high-stakes exams. ETHICS AND DISSEMINATION This systematic review protocol summarises findings of existing publications rather than primary data and does not require an ethics review. The results will be disseminated in publications of peer-reviewed journals.
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Affiliation(s)
- Haniye Mastour
- Department of Medical Education, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Toktam Dehghani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdie Jajroudi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Moradi
- Head of Information Technology at vice president for Education, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mitra Zarei
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
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Vranken L, Wyers CE, Van der Velde RY, Janzing HMJ, Kaarsemakers S, Driessen J, Eisman J, Center JR, Nguyen TV, Tran T, Bliuc D, Geusens P, van den Bergh JP. Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study. BMJ Open 2022; 12:e058983. [PMID: 35896286 PMCID: PMC9335024 DOI: 10.1136/bmjopen-2021-058983] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the risk of subsequent fractures in patients who attended the Fracture Liaison Service (FLS), with and without incident falls after the index fracture. DESIGN A 3-year prospective observational cohort study. SETTING An outpatient FLS in the Netherlands. PARTICIPANTS Patients aged 50+ years with a recent clinical fracture. OUTCOME MEASURES Incident falls and subsequent fractures. RESULTS The study included 488 patients (71.9% women, mean age: 64.6±8.6 years). During the 3-year follow-up, 959 falls had been ascertained in 296 patients (60.7%) (ie, fallers), and 60 subsequent fractures were ascertained in 53 patients (10.9%). Of the fractures, 47 (78.3%) were fall related, of which 25 (53.2%) were sustained at the first fall incident at a median of 34 weeks. An incident fall was associated with an approximately 9-fold (HR: 8.6, 95% CI 3.1 to 23.8) increase in the risk of subsequent fractures. CONCLUSION These data suggest that subsequent fractures among patients on treatment prescribed in an FLS setting are common, and that an incident fall is a strong predictor of subsequent fracture risk. Immediate attention for fall risk could be beneficial in an FLS model of care. TRIAL REGISTRATION NUMBER NL45707.072.13.
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Affiliation(s)
- Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Robert Y Van der Velde
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Sjoerd Kaarsemakers
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - Johanna Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University, Maastricht, The Netherlands
| | - John Eisman
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Jacqueline R Center
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Tuan V Nguyen
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Thach Tran
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Dana Bliuc
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Piet Geusens
- Department of Internal Medicine, Subdivision Rheumatology, Research School CAPHRI, Maastricht Univeristy Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Fullerton PD, Sarkar M, Haque S, McKenzie W. Culture and understanding the role of feedback for health professions students: realist synthesis protocol. BMJ Open 2022; 12:e049462. [PMID: 35190412 PMCID: PMC8860032 DOI: 10.1136/bmjopen-2021-049462] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Clinical education has moved to a 'competency-based' model with an emphasis on workplace-based learning and assessment which, in turn, depends on feedback to be effective. Further, the understanding of feedback has changed from information about a performance directed to the learner performing the task, to a dialogue, which enables the learner to act and develop.In health professional education, feedback is a complex interaction between trainee, supervisor and the healthcare system. Most published research on feedback in health professional education originates in Europe and North America. Our interest is on the impact of Culture on this process, particularly in the context of Asian cultures.The (scientific) realist approach of Pawson and Tilley provides a means to examine complex interventions in social situations, and thus is an appropriate lens to use for this study. This is a protocol for a realist synthesis which asks how, why and in what circumstances do Asian Cultures influence health professional trainees to seek, respond to and use feedback given in the clinical environment, if at all. METHODS AND ANALYSIS An initial search was performed to help define the scope of the review question and develop our initial programme theory. The formal electronic search was carried out in February 2020 and included: CINAHL, ERIC, Medline and PsycInfo, and repeated in October 2020. Retrieved articles were imported into Covidence for screening and data extraction, after which components of the Context-Mechanisms-Outcomes configurations will be sought to refine the initial programme theory. ETHICS AND DISSEMINATION As this study is a literature review, ethics approval is not required.The findings will be documented in line with the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) publications standards for Realist syntheses, and we plan to disseminate the findings by means of a peer-reviewed journal article and conference presentation(s).
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Affiliation(s)
- Paul Douglas Fullerton
- Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Johor, Malaysia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Shamsul Haque
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Wendy McKenzie
- Office of Deputy Dean, Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Jantsch AG, Burström B, Nilsson GH, Ponce de Leon A. Residency training in family medicine and its impact on coordination and continuity of care: an analysis of referrals to secondary care in Rio de Janeiro. BMJ Open 2022; 12:e051515. [PMID: 35168968 PMCID: PMC8852675 DOI: 10.1136/bmjopen-2021-051515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To measure the effect that residency training in family medicine (RTFM) has on continuity and coordination of care. DESIGN Observational cohort study using electronic health records. SETTING Rio de Janeiro, Brazil, public primary care system. PARTICIPANTS 504 940 patients, 633 generalists (physicians without RTFM) and 204 family physicians (FP-doctors with 2 years of RTFM) from one health district between January 2015 and December 2018. INTERVENTION Two years of RTFM. MAIN OUTCOME MEASURES Relative risks of patients being referred to secondary care for outpatient consultations and diagnostics tests; and having a follow-up medical consultation in primary care within 3 and 6 months after being referred. RESULTS We examined 2 414 508 medical consultations and 284 754 referrals to secondary care. FPs were less likely to request ambulatory care services (including surgical specialties), but were more likely to request ophthalmology, physiotherapy, rehabilitationand surgical evaluations for their patients. Patients referred to secondary care by FPs were more likely to have a follow-up visit in primary care for almost every service requested. If all medical consultations were performed by FPs, a 37.6% (95% CI 32.4% to 42.4%) increased demand for rehabilitation services would be noticed. Oppositely, 1532 (95% CI 1458 to 1602) fewer requests for dermatology would happen every year. CONCLUSIONS RTFM improves coordination and continuity of care by making FPs more competent to retain those health conditions that can be properly managed in primary care and making FPs more competent to detect health conditions that require specific biomedical technologies and skills, increasing the demand for those services. Besides, it increases the chances of patients having follow-up visits in primary care. Policy-makers in low-income and middle-income countries must consider investing in RTFM to make primary care systems more comprehensive, with better coordination and continuity of care.
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Affiliation(s)
- Adelson Guaraci Jantsch
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Maracanã, Brazil
| | - Bo Burström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
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Gavrilov B, Schmidt M, Kasten S, Sommer S, Hunzelar C, Bockheim F, Paños-Willuhn J, Offenberg L, Oberholz M, Ikar N, Weltermann B. More GP contacts and poorer health of informal caregivers with low socioeconomic status in Germany: results from the population-based DEGS1 and the cross-sectional GPCare-1 study. BMJ Open 2021; 11:e053146. [PMID: 36916141 PMCID: PMC8719219 DOI: 10.1136/bmjopen-2021-053146] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Informal caregivers are known to have poorer mental health. Risk factors for caregiver burden include low education, female gender, cohabitation with the care recipient and lack of resources. General practitioners (GPs) have an important role in supporting caregivers. Drawing on data from two surveys, associations between caregivers' socioeconomic status (SES), psychophysical health and GP contacts are analysed. DESIGN Cross-sectional study. The study draws on data from two surveys (German Health Interview and Examination Survey for Adults, DEGS1 and General Practice Care-1, GPCare-1). SETTING Germany. PARTICIPANTS DEGS1: German general population (18+ years) n=7987. GPCare-1: general practice patients (18+ years) n=813. PRIMARY OUTCOME Psychophysical health, GP contacts and communication. METHODS Using representative DEGS1 data, the prevalence of informal caregivers, caregivers' burden, chronic stress, various health conditions and frequency of GP contacts were evaluated stratified by SES. Data from the GPCare-1 study addressed caregivers' experiences and communication preferences with GPs. RESULTS In the DEGS1, the prevalence of caregivers was 6.5%. Compared with non-caregivers, caregivers scored significantly higher for chronic stress (15.45 vs 11.90), self-reported poor health (37.6% vs 23.7%) and GP visits last year (3.95 vs 3.11), while lifestyle and chronic diseases were similar. Compared with caregivers with medium/high SES, those with low SES had a significantly lower prevalence of high/medium caregiver burden (47.9% vs 67.7%) but poorer self-reported health (56.9% vs 33.0%), while other characteristics did not differ. In the GPCare-1 study, the prevalence of caregivers was 12.6%. The majority of them felt that their GP takes their problems seriously (63.6%) without difference by SES. CONCLUSION Caregivers with low SES constitute an especially high-risk group for psychological strain, requiring special GP attention to support their needs.
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Affiliation(s)
- Boris Gavrilov
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Manuela Schmidt
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Stefanie Kasten
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Samira Sommer
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Carmen Hunzelar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Florian Bockheim
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Joana Paños-Willuhn
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Luisa Offenberg
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Maja Oberholz
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Nur Ikar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
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O'Shaughnessy Í, Robinson K, O'Connor M, Conneely M, Ryan D, Steed F, Carey L, Leahy A, Galvin R. Effectiveness of acute geriatric unit care on functional decline and process outcomes among older adults admitted to hospital with acute medical complaints: a protocol for a systematic review. BMJ Open 2021; 11:e050524. [PMID: 34706953 PMCID: PMC8552169 DOI: 10.1136/bmjopen-2021-050524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Older adults are clinically heterogeneous and are at increased risk of adverse outcomes during hospitalisation due to the presence of multiple comorbid conditions and reduced homoeostatic reserves. Acute geriatric units (AGUs) are units designed with their own physical location and structure, which provide care to older adults during the acute phase of illness and are underpinned by an interdisciplinary comprehensive geriatric assessment model of care. This review aims to update and synthesise the totality of evidence related to the effectiveness of AGU care on clinical and process outcomes among older adults admitted to hospital with acute medical complaints. DESIGN Updated systematic review and meta-analysis METHODS AND ANALYSIS: MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Controlled Trials in the Cochrane Library and Embase electronic databases will be systematically searched from 2008 to February 2021. Trials with a randomised design that deliver an AGU intervention to older adults admitted to hospital for acute medical complaints will be included. The primary outcome measure will be functional decline at discharge from hospital and at follow-up. Secondary outcomes will include length of stay, cost of index admission, incidence of unscheduled hospital readmission, living at home (the inverse of death or institutionalisation combined; used to describe someone who is in their own home at follow-up), mortality, cognitive function and patient satisfaction with index admission. Title and abstract screening of studies for full-text extraction will be conducted independently by two authors. The Cochrane risk of bias 2 tool will be used to assess the methodological quality of the included trials. The quality of evidence for outcomes reported will be assessed using the Grading of Recommendations Assessment, Development and Evaluations framework. A pooled meta-analysis will be conducted using Review Manager, depending on the uniformity of the data. ETHICS AND DISSEMINATION Formal ethical approval is not required as all data collected will be secondary data and will be analysed anonymously. The authors will present the findings of the review to a patient and public involvement stakeholder panel of older adults that has been established at the Ageing Research Centre in the University of Limerick. This will enable the views and opinions of older adults to be integrated into the discussion section of the paper. PROSPERO REGISTRATION NUMBER CRD42021237633.
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Affiliation(s)
- Íde O'Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Limerick, Ireland
| | - Damien Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Fiona Steed
- Department of Medicine, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Leonora Carey
- Department of Occupational Therapy, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Aoife Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Limerick, Ireland
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Abstract
OBJECTIVE This study aimed to examine German patients': (1) self-estimation of the impact of the pandemic on their health and healthcare; and (2) use of digital self-care practices during the pandemic. DESIGN Cross-sectional mixed-methods survey. SETTING AND PARTICIPANTS General practice patients from four physicians' offices located in urban and rural areas of Bavaria, Germany, between 21 July 2020 and 17 October 2020. A total of 254 patients participated (55% response rate); 57% (262 of 459) identified as female and participants had an average age of 39.3 years. Patients were eligible to participate if they were 18 years or older and spoke German, and had access to the internet. RESULTS (1) Healthcare for patients was affected by the pandemic, and the mental health of a small group of respondents was particularly affected. The risk of depression and anxiety disorder was significantly increased in patients with quarantine experience. (2) Self-care practices have increased; more than one-third (39%) of participants indicated that they started a new or additional self-care practice during the pandemic, and about a quarter (23%) of patients who were not previously engaged in self-care practices started new self-care activities for the first time; however, such practices were not necessarily digital. CONCLUSIONS Further investigation is required to understand the relationship between digital self-care and public health events such as the COVID-19 pandemic, and to develop strategies to alleviate the burden of the quarantine experience for patients.
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Affiliation(s)
- Amelia Fiske
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stuart McLennan
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Siranush Karapetyan
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Alena Buyx
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Hale C, Crocker J, Vanka A, Ricotta DN, McSparron JI, Huang GC. Cohort study of hospitalists' procedural skills: baseline competence and durability after simulation-based training. BMJ Open 2021; 11:e045600. [PMID: 34400443 PMCID: PMC8370503 DOI: 10.1136/bmjopen-2020-045600] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Hospitalists are expected to be competent in performing bedside procedures, which are associated with significant morbidity and mortality. A national decline in procedures performed by hospitalists has prompted questions about their procedural competency. Additionally, though simulation-based mastery learning (SBML) has been shown to be effective among trainees whether this approach has enduring benefits for independent practitioners who already have experience is unknown. We aimed to assess the baseline procedural skill of hospitalists already credentialed to perform procedures. We hypothesised that simulation-based training of hospitalists would result in durable skill gains after several months. DESIGN Prospective cohort study with pretraining and post-training measurements. SETTING Single, large, urban academic medical centre in the USA. PARTICIPANTS Twenty-two out of 38 eligible participants defined as hospitalists working on teaching services where they would supervise trainees performing procedures. INTERVENTIONS One-on-one, 60 min SBML of lumbar puncture (LP) and abdominal paracentesis (AP). PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was the percentage of hospitalists obtaining minimum passing scores (MPS) on LP and AP checklists; our secondary outcomes were average checklist scores and self-reported confidence. RESULTS At baseline, only 16% hospitalists met or exceeded the MPS for LP and 32% for AP. Immediately after SBML, 100% of hospitalists reached this threshold. Reassessment an average of 7 months later revealed that only 40% of hospitalists achieved the MPS. Confidence increased initially after training but declined over time. CONCLUSIONS Hospitalists may be performing invasive bedside procedures without demonstration of adequate skill. A single evidence-based training intervention was insufficient to sustain skills for the majority of hospitalists over a short period of time. More stringent practices for certifying hospitalists who perform risky procedures are warranted, as well as mechanisms to support skill maintenance, such as periodic simulation-based training and assessment.
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Affiliation(s)
- Caleb Hale
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Crocker
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anita Vanka
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel N Ricotta
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jakob I McSparron
- Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Grace C Huang
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Shanahan CW, Reding O, Holmdahl I, Keosaian J, Xuan Z, McAneny D, Larochelle M, Liebschutz J. Opioid analgesic use after ambulatory surgery: a descriptive prospective cohort study of factors associated with quantities prescribed and consumed. BMJ Open 2021; 11:e047928. [PMID: 34385249 PMCID: PMC8362709 DOI: 10.1136/bmjopen-2020-047928] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To prospectively characterise: (1) postoperative opioid analgesic prescribing practices; (2) experience of patients undergoing elective ambulatory surgeries and (3) impact of patient risk for medication misuse on postoperative pain management. DESIGN Longitudinal survey of patients 7 days before and 7-14 days after surgery. SETTING Academic urban safety-net hospital. PARTICIPANTS 181 participants recruited, 18 surgeons, follow-up data from 149 participants (82% retention); 54% women; mean age: 49 years. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES Total morphine equivalent dose (MED) prescribed and consumed, percentage of unused opioids. RESULTS Surgeons postoperatively prescribed a mean of 242 total MED per patient, equivalent to 32 oxycodone (5 mg) pills. Participants used a mean of 116 MEDs (48%), equivalent to 18 oxycodone (5 mg) pills (~145 mg of oxycodone remaining per patient). A 10-year increase in patient age was associated with 12 (95% CI (-2.05 to -0.35)) total MED fewer prescribed opioids. Each one-point increase in the preoperative Graded Chronic Pain Scale was associated with an 18 (6.84 to 29.60) total MED increase in opioid consumption, and 5% (-0.09% to -0.005%) fewer unused opioids. Prior opioid prescription was associated with a 55 (5.38 to -104.82) total MED increase in opioid consumption, and 19% (-0.35% to -0.02%) fewer unused opioids. High-risk drug use was associated with 9% (-0.19% to 0.002%) fewer unused opioids. Pain severity in previous 3 months, high-risk alcohol, use and prior opioid prescription were not associated with postoperative prescribing practices. CONCLUSIONS Participants with a preoperative history of chronic pain, prior opioid prescription, and high-risk drug use were more likely to consume higher amounts of opioid medications postoperatively. Additionally, surgeons did not incorporate key patient-level factors (eg, substance use, preoperative pain) into opioid prescribing practices. Opportunities to improve postoperative opioid prescribing include system changes among surgical specialties, and patient education and monitoring.
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Affiliation(s)
- Christopher W Shanahan
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Olivia Reding
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Inga Holmdahl
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Julia Keosaian
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ziming Xuan
- Community Health Sciences, Boston University, Boston, Massachusetts, USA
| | - David McAneny
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Marc Larochelle
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jane Liebschutz
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Demuth I, Banszerus V, Drewelies J, Düzel S, Seeland U, Spira D, Tse E, Braun J, Steinhagen-Thiessen E, Bertram L, Thiel A, Lindenberger U, Regitz-Zagrosek V, Gerstorf D. Cohort profile: follow-up of a Berlin Aging Study II (BASE-II) subsample as part of the GendAge study. BMJ Open 2021; 11:e045576. [PMID: 34162642 PMCID: PMC8230995 DOI: 10.1136/bmjopen-2020-045576] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The study 'Sex- and gender-sensitive prevention of cardiovascular and metabolic disease in older adults in Germany', the GendAge study, focuses on major risk factors for cardiovascular and metabolic diseases and on the development of major outcomes from intermediate phenotypes in the context of sex and gender differences. It is based on a follow-up examination of a subsample (older group) of the Berlin Aging Study II (BASE-II). PARTICIPANTS The GendAge study assessments took place between 22 June 2018 and 10 March 2020. A total of 1100 participants (older BASE-II subsample, aged ≥65 years) with baseline data assessed at least by one of the BASE-II partner sites were investigated in the follow-up. These participants had a mean age of 75.6 years (SD ±3.8), with a mean follow-up at 7.4 years (SD ±1.5). FINDINGS TO DATE Data from different domains such as internal medicine, geriatrics, immunology and psychology were collected, with a focus on cardiometabolic diseases and in the context of sex and gender differences. Diabetes mellitus type 2 was reported by 15.6% and 8.6% of men and women, respectively. In contrast, this disease was diagnosed in 20.7% of men and 13.3% of women, indicating that a substantial proportion of almost 30% was unaware of the disease. Echocardiography revealed that left ventricular ejection fraction was higher in women than in men, in agreement with previous reports. FUTURE PLANS A gender questionnaire assessing sociocultural aspects implemented as part of the follow-up described here will allow to calculate a gender score and its evaluation based on the newly collected data. At the same time, the other BASE-II research foci established over the past 10 years will be continued and strengthened by the BASE-II transition into a longitudinal study with follow-up data on the older subsample. TRIAL REGISTRATION NUMBER DRKS00016157.
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Affiliation(s)
- Ilja Demuth
- Department of Endocrinology and Metabolic Diseases (including Division of Lipid Metabolism), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- BCRT - Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Banszerus
- Department of Endocrinology and Metabolic Diseases (including Division of Lipid Metabolism), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Drewelies
- Department of Psychology, Humboldt University of Berlin, Berlin, Berlin, Germany
| | - Sandra Düzel
- Center for Lifespan Psychology, Max-Planck-Institute for Human Development, Berlin, Germany
| | - Ute Seeland
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Dominik Spira
- Department of Endocrinology and Metabolic Diseases (including Division of Lipid Metabolism), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Esther Tse
- Berlin Institute for Gender in Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Julian Braun
- Si-M / "Der Simulierte Mensch" a science framework of Technische, Universitat Berlin andCharité - Universitatsmedizin Berlin, Berlin, Germany
- Regenerative Immunology and Aging, BIH Center for Regenerative Therapies, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Department of Endocrinology and Metabolic Diseases (including Division of Lipid Metabolism), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics, University of Lübeck, Lübeck, Germany
- Center for Lifespan Changes in Brain and Cognition (LCBC), Dept of Psychology, University of Oslo, Oslo, Norway
| | - Andreas Thiel
- Si-M / "Der Simulierte Mensch" a science framework of Technische, Universitat Berlin andCharité - Universitatsmedizin Berlin, Berlin, Germany
- Regenerative Immunology and Aging, BIH Center for Regenerative Therapies, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max-Planck-Institute for Human Development, Berlin, Germany
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany
| | - Vera Regitz-Zagrosek
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
- Berlin Institute for Gender in Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
- Department of Cardiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Denis Gerstorf
- Department of Psychology, Humboldt University of Berlin, Berlin, Berlin, Germany
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Lee ES, Koh HL, Ho EQY, Teo SH, Wong FY, Ryan BL, Fortin M, Stewart M. Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes. BMJ Open 2021; 11:e041219. [PMID: 33952533 PMCID: PMC8103380 DOI: 10.1136/bmjopen-2020-041219] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES There are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling individuals. The secondary objective was to provide details of the requirements, strengths and limitations of these instruments, and the chosen outcomes. METHODS We conducted the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018105297). We searched MEDLINE, Embase and CINAHL electronic databases published in English and manually searched the Journal of Comorbidity between 1 January 2010 and 23 October 2020 inclusive. Studies also had to select adult patients from primary care or general population and had at least one specified outcome variable. Two authors screened the titles, abstracts and full texts independently. Disagreements were resolved with a third author. The modified Newcastle-Ottawa Scale was used for quality assessment. RESULTS Ninety-six studies were identified, with 69 of them rated to have a low risk of bias. In total, 33 unique instruments were described. Disease Count and weighted indices like Charlson Comorbidity Index were commonly used. Other approaches included pharmaceutical-based instruments. Disease Count was the common instrument used for measuring all three essential core outcomes of multimorbidity research: mortality, mental health and quality of life. There was a rise in the development of novel weighted indices by using prognostic models. The data obtained for measuring multimorbidity were from sources including medical records, patient self-reports and large administrative databases. CONCLUSIONS We listed the details of 33 instruments for measuring the level of multimorbidity as a resource for investigators interested in the measurement of multimorbidity for its association with or prediction of a specific outcome.
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Affiliation(s)
- Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hui Li Koh
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Elaine Qiao-Ying Ho
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sok Huang Teo
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Fang Yan Wong
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Allan S, Olaiya R, Burhan R. Reviewing the use and quality of machine learning in developing clinical prediction models for cardiovascular disease. Postgrad Med J 2021; 98:551-558. [PMID: 33692158 DOI: 10.1136/postgradmedj-2020-139352] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/23/2022]
Abstract
Cardiovascular disease (CVD) is one of the leading causes of death across the world. CVD can lead to angina, heart attacks, heart failure, strokes, and eventually, death; among many other serious conditions. The early intervention with those at a higher risk of developing CVD, typically with statin treatment, leads to better health outcomes. For this reason, clinical prediction models (CPMs) have been developed to identify those at a high risk of developing CVD so that treatment can begin at an earlier stage. Currently, CPMs are built around statistical analysis of factors linked to developing CVD, such as body mass index and family history. The emerging field of machine learning (ML) in healthcare, using computer algorithms that learn from a dataset without explicit programming, has the potential to outperform the CPMs available today. ML has already shown exciting progress in the detection of skin malignancies, bone fractures and many other medical conditions. In this review, we will analyse and explain the CPMs currently in use with comparisons to their developing ML counterparts. We have found that although the newest non-ML CPMs are effective, ML-based approaches consistently outperform them. However, improvements to the literature need to be made before ML should be implemented over current CPMs.
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Affiliation(s)
- Simon Allan
- Manchester Medical School, The University of Manchester, Manchester, UK
| | - Raphael Olaiya
- UCL Centre for Artificial Intelligence, University College London, London, UK
| | - Rasan Burhan
- St George's Healthcare NHS Trust, St George's Healthcare NHS Trust, London, UK
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13
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Welby-Everard P, Quantick O, Green A. Emergency preparedness, resilience and response to a biological outbreak. BMJ Mil Health 2020; 166:37-41. [PMID: 31999617 DOI: 10.1136/jramc-2019-001323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/25/2019] [Accepted: 11/03/2019] [Indexed: 11/04/2022]
Abstract
Major disease outbreaks continue to be a significant risk to public health, with pandemic influenza or an emerging infectious disease outbreak at the top of the UK National Risk Register. The risk of deliberate release of a biological agent is lower but remains possible and may only be recognised after casualties seek medical attention. In this context the emergency preparedness, resilience and response (EPRR) process protects the public from high consequence infectious diseases, other infectious disease outbreaks and biological agent release. The core elements of the EPRR response are recognition of an outbreak, isolation of patients, appropriate personal protective equipment for medical staff and actions to minimise further disease spread. The paper discusses how high-threat agents may be recognised by clinicians, the initial actions to be taken on presentation and how the public health system is notified and responds. It draws on the national pandemic influenza plans to describe the wider response to a major disease outbreak and discusses training requirements and the potential role of the military.
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Affiliation(s)
- P Welby-Everard
- Anaesthetics Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - O Quantick
- Public Health, Royal Army Medical Corps, Camberley, UK
| | - A Green
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
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Schutz Leuthold M, Schwarz J, Marti J, Perraudin C, Hudon C, Peytremann-Bridevaux I, Senn N, Cohidon C. Protocol for an implementation and realist evaluation of a new organisational model for primary care practices in the canton of Vaud, Switzerland. BMJ Open 2020; 10:e040154. [PMID: 33303447 PMCID: PMC7733189 DOI: 10.1136/bmjopen-2020-040154] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Continuity of care, especially for patients with complex needs, is a major challenge for healthcare systems in many high-income countries, including Switzerland. Since 2015, a collaborative project between Unisanté-Department of Family Medicine (DMF), some general practitioners (GPs) and canton of Vaud's public health authorities has sought to develop a new organisational model for the provision of primary care to ensure better care coordination and to provide adapted care deliveries to patients' healthcare needs. The model's main component is the addition of a primary care nurse to GPs practices. Three additional tools are individualised patient care plans, electronic medical records and patient empanelment. To assess this model, a 2-year pilot study has begun in nine GPs' practices in the canton. This paper presents the protocol for an evaluation of the implementation and effectiveness of the new organisational model. METHOD AND ANALYSIS We will conduct a before-and-after study using a mixed-methods and a realist approach. First, we will use quantitative and qualitative data to assess the new organisational model's implementation (feasibility, fidelity, acceptability and costs) and effectiveness (healthcare services use, patient experience, staff experience and patient-level costs). Combining this data with focus group data will enable a realist evaluation of the pilot project, which will help understand the elements of context and mechanism that affect implementation. ETHICS AND DISSEMINATION The evaluation will inform the canton of Vaud's health authorities about the limits of and perspectives for this organisational model. All results will also be made available to the practices and the patients involved. At the end of the project, we will propose organisational adaptations and a sustainable financial model for extending the model to other practices in the canton and potentially to the national level.The canton of Vaud's Human Research Ethics Committee approved the study, and Data Protection and Information Law Authority gave a favourable opinion concerning data processing procedures.
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Affiliation(s)
- Muriel Schutz Leuthold
- Département Médecine de famille, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Joelle Schwarz
- Département Médecine de famille, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Joachim Marti
- Département Epidémiologie et Systèmes de santé, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Clémence Perraudin
- Département des Policliniques, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Catherine Hudon
- Département de Médecine de Famille et Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Peytremann-Bridevaux
- Département Epidémiologie et Systèmes de santé, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Nicolas Senn
- Département Médecine de famille, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Christine Cohidon
- Département Médecine de famille, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
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15
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Borakati A, Perera A, Johnson J, Sood T. Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study. BMJ Open 2020; 10:e042946. [PMID: 33158840 PMCID: PMC7650091 DOI: 10.1136/bmjopen-2020-042946] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients. DESIGN Retrospective analysis of electronic patient records. SETTING Tertiary academic health science centre and designated centre for high consequence infectious diseases in London, UK. PARTICIPANTS 1198 patients who attended the emergency department with paired reverse transcriptase PCR (RT-PCR) swabs for SARS-CoV-2 and CXR between 16 March and 16 April 2020. MAIN OUTCOME MEASURES Sensitivity and specificity of CXR and CT for diagnosis of COVID-19 using the British Society of Thoracic Imaging reporting templates. Reference standard was any RT-PCR positive naso-oropharyngeal swab within 30 days of attendance. ORs of CXR in association with vital signs, laboratory values and 30-day outcomes were calculated. RESULTS Sensitivity and specificity of CXR for COVID-19 diagnosis were 0.56 (95% CI 0.51 to 0.60) and 0.60 (95% CI 0.54 to 0.65), respectively. For CT scans, these were 0.85 (95% CI 0.79 to 0.90) and 0.50 (95% CI 0.41 to 0.60), respectively. This gave a statistically significant mean increase in sensitivity with CT of 29% (95% CI 19% to 38%, p<0.0001) compared with CXR. Specificity was not significantly different between the two modalities.CXR findings were not statistically significantly or clinically meaningfully associated with vital signs, laboratory parameters or 30-day outcomes. CONCLUSIONS CT has substantially improved diagnostic performance over CXR in COVID-19. CT should be strongly considered in the initial assessment for suspected COVID-19. This gives potential for increased sensitivity and considerably faster turnaround time, where capacity allows and balanced against excess radiation exposure risk.
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Affiliation(s)
- Aditya Borakati
- Division of Surgery and Interventional Science, University College London, London, London, UK
- Emergency Department, Royal Free Hospital, London, London, UK
| | - Adrian Perera
- Emergency Department, Royal Free Hospital, London, London, UK
| | - James Johnson
- Emergency Department, Royal Free Hospital, London, London, UK
| | - Tara Sood
- Emergency Department, Royal Free Hospital, London, London, UK
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16
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Cusimano MC, Baxter NN, Sutradhar R, Ray JG, Garg AX, McArthur E, Vigod S, Simpson AN. Reproductive patterns, pregnancy outcomes and parental leave practices of women physicians in Ontario, Canada: the Dr Mom Cohort Study protocol. BMJ Open 2020; 10:e041281. [PMID: 33087379 PMCID: PMC7580071 DOI: 10.1136/bmjopen-2020-041281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Surveys and qualitative studies suggest that women physicians may delay childbearing, be at increased risk of adverse peripartum complications when they do become pregnant, and face discrimination and lower earnings as a result of parenthood. Observational studies enrolling large, representative samples of women physicians are needed to accurately evaluate their reproductive patterns, pregnancy outcomes, parental leave practices and earnings. This protocol provides a detailed research plan for such studies. METHODS AND ANALYSIS The Dr Mom Cohort Study encompasses a series of retrospective observational studies of women physicians in Ontario, Canada. All practising physicians in Ontario are registered with the College of Physicians and Surgeons of Ontario (CPSO). By linking a dataset of physicians from the CPSO to existing provincial administrative databases, which hold health data and physician billing records, we will be able to retrospectively assess the healthcare utilisation, work practices and pregnancy outcomes of women physicians at the population level. Specific outcomes of interest include: (1) rates and timing of pregnancy; (2) pregnancy-related care and complications; and (3) duration of parental leave and subsequent earnings, each of which will be evaluated with regression methods appropriate to the form of the outcome. We estimate that, at minimum, 5000 women physicians will be eligible for inclusion. ETHICS AND DISSEMINATION This protocol has been approved by the Research Ethics Board at St. Michael's Hospital in Toronto, Ontario, Canada (#18-248). We will disseminate findings through several peer-reviewed publications, presentations at national and international meetings, and engagement of physicians, residency programmes, department heads and medical societies.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Melbourne School of Population and Global Heath, University of Melbourne, Melbourne, Victoria, Australia
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amit X Garg
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Eric McArthur
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Simone Vigod
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Obstetrics & Gynaecology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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Abstract
INTRODUCTION Effective electronic health record (EHR)-based training interventions facilitate improved EHR use for healthcare providers. One such training intervention is simulation-based training that emphasises learning actual tasks through experimentation in a risk-free environment without negative patient outcomes. EHR-specific simulation-based training can be employed to improve EHR use, thereby enhancing healthcare providers' skills and behaviours. Despite the potential advantages of this type of training, no study has identified and mapped the available evidence. To fill that gap, this scoping review will synthesise the current state of literature on EHR simulation-based training. METHODS AND ANALYSIS The Arksey and O'Malley methodological framework will be employed. Three databases (PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature) will be searched for published articles. ProQuest and Google Scholar will be searched to identify unpublished articles. Databases will be searched from inception to 29 January 2020. Only articles written in English, randomised control trials, cohort studies, cross-sectional studies and case-control studies will be considered for inclusion. Two reviewers will independently screen titles and abstracts against inclusion and exclusion criteria. Then, they will review full texts to determine articles for final inclusion. Citation chaining will be conducted to manually screen references of all included studies to identify additional studies not found by the search. A data abstraction form with relevant characteristics will be developed to help address the research question. Descriptive numerical analysis will be used to describe characteristics of included studies. Based on the extracted data, research evidence of EHR simulation-based training will be synthesised. ETHICS AND DISSEMINATION Since no primary data will be collected, there will be no formal ethical review. Research findings will be disseminated through publications, presentations and meetings with relevant stakeholders.
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Affiliation(s)
- Joseph K Nuamah
- Department of Radiation Oncology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Karthik Adapa
- Department of Radiation Oncology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Health Informatics Program, UNC-Chapel Hill, Chapel Hill, NC, United States
| | - Lukasz Mazur
- Department of Radiation Oncology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Health Informatics Program, UNC-Chapel Hill, Chapel Hill, NC, United States
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Matsuura H, Takiue K, Nakato H, Nishihara C, Sasaki E, Suganami Y, Kishida M. Mexican hat sign. Postgrad Med J 2019; 96:303. [PMID: 31653665 DOI: 10.1136/postgradmedj-2019-137078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Hiroki Matsuura
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Keiichi Takiue
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Hikari Nakato
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Chika Nishihara
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Erika Sasaki
- Endocrinology, Okayama City Hospital, Okayama, Japan
| | - Yuu Suganami
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Masayuki Kishida
- General Internal Medicine, Okayama City Hospital, Okayama, Japan.,Endocrinology, Okayama City Hospital, Okayama, Japan
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19
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Matsuura H, Mizuno M. Whitish-yellow tapeworm. Postgrad Med J 2018; 95:55. [PMID: 30446514 DOI: 10.1136/postgradmedj-2018-136138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/24/2018] [Accepted: 10/27/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Hiroki Matsuura
- Department of General Internal Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Motowo Mizuno
- Department of Gastroenterology, Kurashiki Central Hospital, Kurashiki, Japan
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