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Direct observation of medical residents

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https://www.readbyqxmd.com/read/28633171/examining-accuracy-of-self-assessment-of-in-training-examination-performance-in-a-context-of-guided-self-assessment
#1
Oksana Babenko, Denise Campbell-Scherer, Shirley Schipper, John Chmelicek, Tanya Barber, Kimberley Duerksen, Shelley Ross
BACKGROUND AND OBJECTIVES: In our family medicine residency program, we have established a culture of guided self-assessment through a systematic approach of direct observation of residents and documentation of formative feedback. We have observed that our residents have become more accurate in self-assessing their clinical performance. The objective of this study was to examine whether this improved accuracy extended to residents' self-assessment of their medical knowledge and clinical reasoning on the In-Training Examination (ITE)...
June 2017: Family Medicine
https://www.readbyqxmd.com/read/28610692/a-didactic-experiment-showing-the-compton-scattering-by-means-of-a-clinical-gamma-camera
#2
Ernesto Amato, Lucrezia Auditore, Alfredo Campennì, Fabio Minutoli, Mariapaola Cucinotta, Alessandro Sindoni, Sergio Baldari
We describe a didactic approach aimed to explain the effect of Compton scattering in nuclear medicine imaging, exploiting the comparison of a didactic experiment with a gamma camera with the outcomes from a Monte Carlo simulation of the same experimental apparatus. We employed a (99m)Tc source emitting 140.5keV photons, collimated in the upper direction through two pinholes, shielded by 6mm of lead. An aluminium cylinder was placed on the source at 50mm of distance. The energy of the scattered photons was measured on the spectra acquired by the gamma camera...
June 2017: Physica Medica: PM
https://www.readbyqxmd.com/read/28585405/type-of-oral-solid-medication-packaging-and-medication-preparation-time-in-nursing-homes-a-direct-observation-study
#3
C M Cready, C Hudson, K Dreyer
WHAT IS KNOWN AND OBJECTIVE: Medication administration is a substantial portion of the workday in nursing homes, with the medication preparation step being the most time-consuming. However, little is known about how medication preparation time is affected by the type of packaging used for oral solid medications (ie, tablets/capsules). We examined the effects of two types of packaging. As fewer steps are associated with strip packaging compared to bingo card packaging, we hypothesized that the increase in medication preparation seconds per resident with each additional oral solid medication would be smaller when strip packaging was used...
June 5, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28557946/a-patient-centered-approach-to-developing-entrustable-professional-activities
#4
Carlos El-Haddad, Arvin Damodaran, H Patrick McNeil, Wendy Hu
PURPOSE: The medical education community is rapidly accepting the use of entrustable professional activities (EPAs) as a means of assessing residents. Stakeholder engagement is advised in developing EPAs, but no studies have investigated the role of patient input. In this qualitative study, the authors investigated what patient input may add to designing a patient-centered EPA. METHOD: The authors chose "management of acute low back pain (LBP)" as a common, important clinical task on which to base the patient-centered EPA...
June 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28557935/constructing-a-shared-mental-model-for-faculty-development-for-the-core-entrustable-professional-activities-for-entering-residency
#5
Michele A Favreau, Linda Tewksbury, Carla Lupi, William B Cutrer, Janet A Jokela, Lalena M Yarris
In 2014, the Association of American Medical Colleges identified 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs), which are activities that entering residents might be expected to perform without direct supervision. This work included the creation of an interinstitutional concept group focused on faculty development efforts, as the processes and tools for teaching and assessing entrustability in undergraduate medical education (UME) are still evolving. In this article, the authors describe a conceptual framework for entrustment that they developed to better prepare all educators involved in entrustment decision making in UME...
June 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28557735/inpatient-hospital-factors-and-resident-time-with-patients-and-families
#6
Lauren Ann Destino, Melissa Valentine, Farnoosh H Sheikhi, Amy J Starmer, Christopher P Landrigan, Lee Sanders
OBJECTIVES: To define hospital factors associated with proportion of time spent by pediatric residents in direct patient care. METHODS: We assessed 6222 hours of time-motion observations from a representative sample of 483 pediatric-resident physicians delivering inpatient care across 9 pediatric institutions. The primary outcome was percentage of direct patient care time (DPCT) during a single observation session (710 sessions). We used one-way analysis of variance to assess a significant difference in the mean percentage of DPCT between hospitals...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28551053/socio-environmental-risk-factors-for-medically-attended-agricultural-injuries-in-wisconsin-dairy-farmers
#7
Jeffrey J VanWormer, Kathrine L Barnes, Stephen C Waring, Matthew C Keifer
BACKGROUND: Accidents are common in the agricultural industry, particularly among dairy farmers. How said farmers get hurt is well established, but far less is known about how distal, socio-environmental factors influence injuries. This study examined associations between medically-attended agricultural injuries and: (1) personal sociodemographic characteristics, and (2) farm environment features and general safety practices. METHODS: A cross-sectional survey was implemented with linked data from electronic health records on prior agricultural injuries that occurred between 01/01/2002-12/31/2015...
May 21, 2017: Injury
https://www.readbyqxmd.com/read/28549706/long-term-effectiveness-of-a-multifactorial-fall-and-fracture-prevention-program-in-bavarian-nursing-homes-an-analysis-based-on-health-insurance-claims-data
#8
Claudia Schulz, Ivonne Lindlbauer, Kilian Rapp, Clemens Becker, Hans-Helmut König
OBJECTIVE: Femoral fractures are frequently consequences of falls in nursing homes and are associated with considerable costs and unfavorable outcomes such as immobility and mortality. The purpose of this study was to examine the long-term effectiveness of a multifactorial fall and fracture prevention program in nursing homes in terms of reducing femoral fractures. DESIGN: Retrospective cohort study. SETTING: Nursing homes. PARTICIPANTS: Health insurance claims data for 2005-2013 including 85,148 insurants of a sickness fund (Allgemeine Ortskrankenkasse Bayern), aged 65 years or older and living in 802 nursing homes in Bavaria, Germany...
June 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28535891/impact-of-rheumatoid-arthritis-in-the-public-health-system-in-santa-catarina-brazil-a-descriptive-and-temporal-trend-analysis-from-1996-to-2009
#9
Rafael Kmiliauskis Santos Gomes, Fabio Antero Pires, Moacyr Roberto Cuce Nobre, Mauricio Felippi de Sá Marchi, Jennifer Cristina Kozechen Rickli
INTRODUCTION: There are few studies that carried out a descriptive and trend analysis based on available data from the Unified Health System (SUS) between pre- and post-free dispensing of pharmacological treatment of rheumatoid arthritis (RA) from the perspective of the public health system, in terms of the direct cost of the disease among adults and elderly residents of the State of Santa Catarina, Brazil. This study aims to characterize the direct cost of medical and surgical procedures before and after the dispensing of drugs in this state...
May 2017: Revista Brasileira de Reumatologia
https://www.readbyqxmd.com/read/28523117/evaluation-of-pediatric-residents-attitudes-toward-ethical-conflict-a-cross-sectional-study-in-tehran-iran
#10
Maliheh Kadivar, Marjan Mardani-Hamooleh, Shiva Shayestefar
Ethical conflicts are recognized as critical aspects in assessing competence in clinical communication. Moreover, pediatrics residents may face more problems, compared to other disciplines; due to the specific characteristics of the age group receiving services as well as the presence of their families. This study has been conducted with the aim of determining the attitude and perspective of pediatric residents toward ethical conflicts in the field of pediatrics. This descriptive, cross-sectional study was carried out on all residents of Tehran University of Medical Sciences (90 residents), selected through census method, in 2014...
2017: Journal of Medical Ethics and History of Medicine
https://www.readbyqxmd.com/read/28501114/evaluation-of-palliative-care-training-and-skills-retention-by-medical-students
#11
Priti P Parikh, Mary T White, Lynne Buckingham, Kathryn M Tchorz
BACKGROUND: Training in palliative and end-of-life care has been introduced in medical education; however, the impact of such training and the retention of skills and knowledge have not been studied in detail. This survey study examines long-term follow-up on end-of-life communication skills training, evaluation, and skills retention in medical students. MATERIALS AND METHODS: During the surgical clerkship, all third-year medical students received communication skills training in palliative care using simulated patients...
May 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28489618/core-competencies-or-a-competent-core-a-scoping-review-and-realist-synthesis-of-invasive-bedside-procedural-skills-training-in-internal-medicine
#12
Ryan Brydges, Lynfa Stroud, Brian M Wong, Eric S Holmboe, Kevin Imrie, Rose Hatala
PURPOSE: Invasive bedside procedures are core competencies for internal medicine, yet no formal training guidelines exist. The authors conducted a scoping review and realist synthesis to characterize current training for lumbar puncture, arthrocentesis, paracentesis, thoracentesis, and central venous catheterization. They aimed to collate how educators justify using specific interventions, establish which interventions have the best evidence, and offer directions for future research and training...
May 9, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28481570/integrated-behavioral-health-training-for-primary-care-clinicians-five-lessons-learned-from-a-negative-study
#13
Matthew P Martin
INTRODUCTION: There are very few studies examining the effectiveness of integrated behavioral health training for primary care clinicians. The purpose of this article is to review the findings of a negative study examining the effectiveness of medical resident training in integrated behavioral health and offer specific ideas for future research in workforce development. METHODS: Twenty-three family medicine residents from a community-based residency program in the mid-Atlantic region completed a required rotation in which they consulted with behavioral health in primary care, observed psychotherapy, read behavioral medicine books, and received individual instruction...
May 8, 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28469889/a-quality-improvement-approach-to-standardization-and-sustainability-of-the-hand-off-process
#14
Craig Fryman, Carine Hamo, Siddharth Raghavan, Nirvani Goolsarran
There is mounting evidence that communication and hand-off failures are a root cause of two-thirds of sentinel events in hospitals. Several studies have shown that non-standardized hand-offs have yielded poor patient outcomes and adverse events. At Stony Brook University Hospital, there were numerous reported adverse events related to poor hand-off during the transfer of patient responsibility from one resident caregiver to the next. A resident-conducted root cause analysis identified lack of a standardized hand-off process and formal training on safe and efficient hand-off among caregivers as key contributing factors...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28461641/healthcare-use-and-direct-cost-of-giant-cell-arteritis-a-population-based-study
#15
Matthew J Koster, Sara J Achenbach, Cynthia S Crowson, Hilal Maradit-Kremers, Eric L Matteson, Kenneth J Warrington
OBJECTIVE: To determine the healthcare use and direct medical cost of giant cell arteritis (GCA) in a population-based cohort. METHODS: A well-defined, retrospective population-based cohort of Olmsted County, Minnesota, USA, residents diagnosed with GCA from 1982-2009 was compared to a matched referent cohort from the same population. Standardized cost data (inflation-adjusted to 2014 US dollars) for 1987-2014 and outpatient use data for 1995-2014 were obtained...
May 1, 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28433827/a-comparison-of-medication-administration-errors-from-original-medication-packaging-and-multi-compartment-compliance-aids-in-care-homes-a-prospective-observational-study
#16
Julia Fiona-Maree Gilmartin-Thomas, Felicity Smith, Rory Wolfe, Yogini Jani
BACKGROUND: No published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. OBJECTIVES: Compare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. DESIGN: Prospective observational. SETTING: Ten Greater London care homes...
March 28, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28433120/additional-cost-because-of-pneumonia-in-nursing-home-residents-results-from-the-incidence-of-pneumonia-and-related-consequences-in-nursing-home-resident-study
#17
Nadège Costa, Emiel O Hoogendijk, Michael Mounié, Robert Bourrel, Yves Rolland, Bruno Vellas, Laurent Molinier, Matteo Cesari
OBJECTIVES: Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period. DESIGN: This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study. SETTING: Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included...
May 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28418449/association-of-a-communication-training-program-with-use-of-antipsychotics-in-nursing-homes
#18
Jennifer Tjia, Jacob N Hunnicutt, Laurie Herndon, Carolyn R Blanks, Kate L Lapane, Susan Wehry
Importance: Off-label antipsychotic prescribing in nursing homes (NHs) is common and is associated with increased risk of mortality in older adults. Prior large-scale, controlled trials in the NH setting failed to show meaningful reductions in antipsychotic use. Objective: To quantify the influence of a large-scale communication training program on NH antipsychotic use called OASIS. Design, Setting, and Participants: This investigation was a quasi-experimental longitudinal study of NHs in Massachusetts enrolled in the OASIS intervention...
June 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28411323/practice-patterns-for-the-prophylaxis-and-treatment-of-acute-radiation-dermatitis-in-the-united-states
#19
Patricia Lucey, Christos Zouzias, Loren Franco, Sravana K Chennupati, Shalom Kalnicki, Beth N McLellan
PURPOSE: Due to the inconclusive evidence for available treatment options, management of radiation dermatitis (RD) varies among practitioners. This study defines and reviews the current treatment patterns for RD in the USA, providing guidance for practicing physicians as well as directions for future research. METHODS: An online survey of 21 questions was emailed to all 5626 members of the 2013 American Society for Radiation Oncology (ASTRO) directory, which included radiation oncologists, residents, fellows, physician assistants, nurse practitioners, registered nurses and other care providers...
April 14, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28401622/predicting-mortality-in-the-emergency-department-external-validation-and-derivation-of-a-clinical-prediction-tool
#20
Rajat N Moman, Caitlin E Loprinzi Brauer, Katherine M Kelsey, Rachel D Havyer, Christine M Lohse, M Fernanda Bellolio
BACKGROUND: The Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at 1 year to select those who would benefit from advanced care planning. Such goals-of-care discussion can improve patients' ability to communicate what they want out of their healthcare and, in cases of end of life, potentially reduce the number of futile interventions...
April 12, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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