Education
10 Sep Advanced MRI Methods Can Predict Academic Difficulties in Preterm Children
MedicalResearch.com Interview with:
Henrik Ullman, MD, PhD Candidate
Department of Neuroscience
Karolinska Institutet
Stockholm, Sweden
Megan Spencer-Smith, PhD
School of Psychological Sciences
Monash University
Melbourne, Australia
Medical Research: What is the background for this study? What are the main findings?
Response: Infants born preterm are at risk for school-age cognitive and academic impairments. While some will suffer severe impairments, many more will experience mild impairments, and it is these children who might not raise sufficient concern for referral and intervention. Identifying early markers and methods for classifying preterm infants at risk for school-age impairments, many years before difficulties emerge, would provide important information for clinicians in advising families regarding intervention and ongoing monitoring.
Brain alterations are common in preterm populations. Any brain alterations associated with school-age impairments are likely already present in the neonatal period but are not detected with the current standard clinical and radiological evaluations.
In this study we wanted to see how well we could use advanced analysis of volumetric and diffusion MRI collected in the neonatal period from 224 very preterm children to predict cognitive functions at five and seven years of age. We used statistical models to look for localised regions as well as machine learning methods to correlate patterns in the neonatal MRI data that could predict school-age outcomes.
We found that localised volumes in the insula and basal ganglia as well as a distributed patterns of diffusion MRI could predict working memory and early mathematical skills even after co-varying for important perinatal clinical factors.
It has previously been shown that quantitative and pattern analysis can catch subtle patterns in MRI data not easily detected by eye and may predict cognitive development. The current study builds further on these results showing clinically relevant predictions in preterm children.
31 Aug Popular TV Shows Depict Overly Optimistic CPR Success
MedicalResearch.com Interview with:
Jaclyn Portanova, Ph.D student
School of Gerontology
University of Southern California Davis
Medical Research: What is the background for this study?
Response: Over the past two decades, we have made a lot of progress in educating the public about the need to engage in advance care planning and make health care decisions, such as whether or not to receive CPR in a medical crisis. The media plays a major role in shaping the way people think about life-saving measures such as cardiopulmonary resuscitation (CPR). In fact, a study published in 1996 showed that popular medical shows portrayed CPR as having a much higher rate of success than actual rates. We sought to determine if popular media has improved in the accuracy of their depiction of CPR survival rates.
Medical Research: What are the main findings?
Response: Nearly 70% of TV show patients who received CPR survived the initial incident. This success rate is twice as high as actual rates. Even more striking, survival rate to hospital discharge following receipt of CPR was four times higher in popular medical television shows than actual rates. Advance care planning discussions between physicians and patients were rarely portrayed, but when they did occur patient preferences were honored.
21 Aug Polygenetic Score Predicts Educational Attainment
MedicalResearch.com Interview with:
Ben Domingue
Assistant Professor (starting 9/2015)
Stanford Graduate School of Education
Medical Research: What is the background for this study? What are the main findings?
Response: Earlier research has started to illuminate which genetic variants are associated with educational attainment. Subsequent work has taken these variants, combined them into a "polygenic score", and studied how that polygenic score predicts educational attainment. Our research continues this line of inquiry by examining the predictive performance of that polygenic score in a representative sample of US adults who are now in their 30s. A few notable findings include that:
(A) the polygenic score predicts educational attainment in the African Americans in our sample and
(B) that the polygenic score is associated with neighborhood characteristics. As with earlier research, we are able to show that the higher score sibling from within a family will complete more years of schooling (on average) than their lower score co-sib.
22 Jul Bystander CPR Programs Can Save Lives After Cardiac Arrest
MedicalResearch.com Interview with:
Carolina Malta Hansen, M.D
Duke Clinical Research Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Hansen: Approximately 300,000 persons in the United States suffer an out-of-hospital cardiac arrest every year and under 10% survive. Cardiopulmonary resuscitation (CPR) and defibrillation within the first few minutes of cardiac arrest can increase the chance of survival from under 10% to over 50%. In 2010, the HeartRescue program in North Carolina initiated statewide multifaceted interventions to improve care and outcomes for cardiac arrest patients in North Carolina. The project included public training programs in defibrillators and compression-only CPR at schools, hospitals and major events such as the N.C. State Fair, plus additional instruction for EMS and other emergency workers on optimal care for patients in cardiac arrest.
We found that following these four years of initiatives to improve care and outcomes for cardiac arrest patients, the proportion of patients who received bystander CPR and first responder defibrillation increased by more than 25% to approximately 50%, the combination of bystander CPR and first responder defibrillation increased from 14% to 23%. Survival with favorable neurologic outcome increased from 7% to 10% and this increase was only observed among patients who received bystander CPR. Finally, we found that compared to patients who received CPR and defibrillation by emergency medical services (EMS), patients who received bystander and/or first responder CPR, defibrillation, or both, were more likely to survive. The combination of bystander CPR and bystander defibrillation was associated with the best survival rates but remained low during the study period with no increase over time.
17 Jul Patients With Lower Health Literacy May Find Electronic Health Care Portals Challenging
MedicalResearch.com Interview with:
Dr. Courtney Lyles Ph.D.
Assistant Professor
UCSF School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Lyles: In our commentary (http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852), we describe the Meaningful Use program sponsored by the federal government to incentivize healthcare systems to implement electronic health records (EHRs). This Meaningful Use program also includes financial incentives for healthcare systems who can get substantial proportions of their patient population to access their electronic health records – that is, by logging into an online patient portal website to view medical information like lab results or immunization lists or to perform a healthcare task like requesting a medication refill or messaging their provider. Because there are billions of dollars at stake in this program for EHR implementation, there is a lot of attention on this issue right now. Many thought leaders are discussing how we can transform healthcare by digitizing medical information and connecting with patients in their everyday life outside of office or hospital visits. Portals are key to a lot of changes we might make in healthcare delivery in an attempt to increase convenience and satisfaction for patients. Perhaps most importantly, these online portal websites are also one of the first health technologies that will be relatively uniformly distributed across healthcare settings, from private doctor’s offices to public clinics/hospitals serving vulnerable patient populations.
However, our main message is that we in the medical and healthcare fields should be paying more attention to how patients are able to understand and use the information provided through portal websites. There is a lot of evidence that patients who have lower education/income, are from racial/ethnic minority groups, or have limited health literacy are significantly less likely to use the existing portal websites. There is also evidence that portal websites are not extremely usable or accessible, which is an additional barrier for those with communication barriers like lower literacy or limited English proficiency. Therefore, we don’t want widespread EHR implementation to result in only the most well-resourced individuals gaining the potential benefits of portal access.
10 Jul Surgeons Need To Document Why Patient Care May Fall Outside Standard Guidelines
MedicalResearch.com Interview with:
Judy A. Tjoe, MD, FACS
Breast Oncology Surgeon
Aurora Health Care
Milwaukee, WI
Medical Research: What is the background for this study? What are the main findings?
Dr. Tjoe: Numerous national health organizations have confirmed minimally invasive breast biopsy (MIBB), which uses a percutaneous core needle as opposed to open surgical techniques, as the biopsy procedure of choice when a patient’s diagnostic test reveals a breast lesion suggestive of malignancy. Unfortunately, despite the overwhelming evidence supporting use of MIBB, open breast biopsy rates in the United States remain as high as 24-39%. Our study was designed to determine if measuring individual practice patterns and providing subsequent feedback to surgeons across a large, multihospital healthcare system would improve their adherence to the quality metric of using minimally invasive breast biopsy to diagnose indeterminate breast lesions.
We found that the proportion of studied surgeons (n=46) appropriately adhering to the MIBB quality metric in every instance (i.e. those who achieved 100% adherence) significantly improved from 80.4% to 95.7% (p=0.0196) after receiving feedback on not only their own practice patterns, but those of their blinded peers. As might be expected, the handful of breast-dedicated surgeons (n=4) who cared for nearly half of the analyzed patient population achieved perfect adherence throughout the study, but interestingly, the gains made in total adherence were driven by the general surgeons (n=42), showing that the study’s direct educational efforts were effective in changing practice patterns for the better. These efforts included sending letters describing adherence to the quality metric to individual surgeons and organizational leadership.
08 Jul Residents Participation In Neurosurgery Did Not 30-Day Outcomes
Posted at 13:32h
in Author Interviews, Education, Johns Hopkins, Outcomes & Safety, Surgical Research
MedicalResearch.com Interview with:
Judy Huang, M.D.
Professor of Neurosurgery
Program Director, Neurosurgery Residency Program
Fellowship Director, Cerebrovascular Neurosurgery
Johns Hopkins Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Huang: Residents are medical school graduates who are in training programs working alongside and under supervision of more senior physicians, known as attendings. Patients are sometimes wary of having residents assist in their operations, but an analysis of 16,098 brain and spine surgeries performed across the United States finds that resident participation does not raise patient risks for postoperative complications or death.
24 Jun ACOs Find Engaging Chronically Ill Patients is Challenging Work
MedicalResearch.com Interview with: Stephen M. Shortell, PhD, MPH, MBA Blue Cross of California Distinguished Professor of Health Policy and Management and Director, Center for Healthcare Organizational and Innovation Research (CHOIR) School of Public Health UC-Berkeley Medical Research: What is the background for this study? What are the main findings? Dr. Shortell: To meet quality and expenditure targets, Accountable Care Organization (ACOs) need to change how care is delivered to patients to reduce preventable hospitalizations, readmissions, emergency department visits, and unnecessary tests. To do this they need to increase their engagement with patients and patient families. With support from the Gordon and Betty Moore Foundation, we undertook the study to assess the extent to which ACOs are engaging their patients and patient families and to identify some of the barriers and facilitators of such engagement. We did a survey of 101 ACOs, in-depth phone interviews with eleven ACOs and two on site visits. Among our key findings are: 1) There are some "early adopters" of patient engagement activities with, for example, respondents reporting an average of 62 percent of primary care physicians working with patients/families to set treatment goals and 61 percent of high risk chronic illness patients participating in formal care transition programs; but 2) Only 18 percent of ACO high risk chronic illness patients participate in peer support groups or group visits, and only 24 percent of patients have access to both medical records and clinical notes in the record; 3) ACO leaders strongly believe patient activation and engagement is critical to ACO success and those who have such beliefs do have greater patient engagement at the actual point of care; 4) Engaging patients is very difficult challenging work as it often involves a total re-organization of workflow within physician practices including the re-allocation of tasks to other healthcare professionals, reorganization of time commitments, adjustment to use of electronic health records and training in communication methods.16 Jun High Coronary Calcium Score May Encourage Healthier Lifestyle
MedicalResearch.com Interview with: Ms. Rikke Elmose Mols Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current ESC guidelines for patients with chest pain and low to intermediate pre-test probability of coronary artery disease (CAD) recommend control and modification of risk factors. However, patients with an elevated cardiovascular risk profile are frequently inadequately motivated for lifestyle changes and medicine adherence from knowledge about risk factors and information about risk reduction alone. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis. The degree of coronary artery calcification may be assessed by the Agatston score (AS) derived by non-enhanced cardiac computed tomography, whereas non-invasive CT imaging of the coronary arteries require contrast-enhancement (coronary computed tomography angiography [CTA]). The presence of CAC is associated with an elevated probability of obstructive coronary artery disease (CAD) and an unfavorable clinical outcome. In symptomatic patients, demonstration of non-obstructive CAD identified by coronary CTA is associated with risk modifying behavior and intensified prophylactic medical treatment in observational studies. Among asymptomatic individuals, those with the highest Agatston score levels seem to be motivated for the adoption of risk modifying behaviour and visualization of CAC may stimulate adherence to lipid-lowering therapy and aspirin and a healthier lifestyle. The aim of the present prospective, randomized controlled study was to test the effect of adding visualization of coronary artery calcification to the standard information about risk and lifestyle modification on cholesterol levels and other risk markers in patients with a new diagnosis of non-obstructive CAD. Visualization of coronary artery calcification and brief recommendations about risk modification (ESC guidelines) after coronary CTA in symptomatic patients with hyperlipidemia and non-obstructive CAD may have a favorable influence on plasma total-cholesterol concentration, adherence to statin therapy and risk behavior. Further investigations are needed.15 Jun ACA Medicaid Expansion Will Require More Primary Care Providers, Especially In Low Income Areas
MedicalResearch.com Interview with: Eric T. Roberts and Darrell Gaskin Johns Hopkins University Bloomberg School of Public Health Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Response: This study looked at the implications of the Affordable Care Act’s expansion of Medicaid on the need for additional physicians working in primary care. Since 2014, 11 million low-income adults have signed up for Medicaid, and this figure will likely increase as more states participate in the expansion. Many new Medicaid enrollees lacked comprehensive health insurance before, and will be in need of primary and preventive care when their Medicaid coverage begins. In light of these questions, in this study, we projected the number of primary care providers that are needed to provide care for newly-enrolled adults. We forecast that, if all states expand Medicaid, newly-enrolled adults will make 6.1 million additional provider visits per year. This translates into a need for 2,100 additional full time-equivalent primary care providers. We conclude that this need for additional providers is manageable, particularly if Congress fully funds key primary care workforce training programs, such as the National Health Service Corps.12 Jun Some Prostate Cancer Patient Decision Aids Need Updating
MedicalResearch.com Interview with: Prajakta Adsul, MBBS, MPH, PhD; Ricardo Wray, PhD, and Sameer Siddiqui, MD Center for Cancer Prevention, Research and Outreach Saint Louis University MedicalResearch: What is the background for this study? What are the main findings? Response: Patient decision aids are interventions designed to help patients engage in shared decision making with their providers when multiple choices with more or less equivalent efficacy are available for a particular medical decision. Several patient decision aids exists for numerous medical conditions and previous research has demonstrated them to be effective in improving the patient's knowledge and understanding of treatment options and their relative efficacy and side-effects and resulting in a higher proportion of decision that are consistent with patient's values and personal preferences. In the context of prostate cancer treatment, the practice of shared decision making is vital as highlighted by recent calls from the American Urological Association and the American Cancer Society. To aid with this process, several patient decision aids exist. However, the content presented, the format and presentation styles of decision aids can be variable and can have an influence on the choice made by the patients. The purpose of this study was to assess the characteristics of the patient decision aids designed for men facing prostate cancer treatment. We used the widely accepted International Patient Decision Aids Standards (IPDAS) for the assessment, supplemented with implementation criteria to strategize successful future improvement and promotion of decision aids in routine urological practice. The main findings of the review were that none of the decision aids reviewed met all standards. The aids had variable content, format and presentation of prostate cancer treatment information. Several decision aids were outdated and critical issues such as the risk of overtreatment and active surveillance as a treatment option for prostate cancer were not always covered in decision aids.10 Jun Early Autism Intervention Produces Long Term Benefits
MedicalResearch.com Interview with:
Annette Estes, Ph.D.
Research Associate Professor of Speech and Hearing Sciences
Adjunct Research Associate Professor of Psychology
Director, University of Washington Autism Center
Susan & Richard Fade Endowed Chair
Center on Human Development and Disability
University of Washington
Medical Research: What is the background for this study? What are the main findings?
Dr. Estes: Although a number of studies have shown the positive effects of early intervention on children’s abilities during the preschool period, there have been few studies to date that have followed children longitudinally to find out if these gains are sustained. We found that two years after completing the intervention, children maintained their gains in cognitive and adaptive behavior skills and also showed a reduction in autism symptoms. The results suggest that early intervention results in long term benefits for children across a wide range of skills. Children who received the ESDM intervention as toddlers later showed fewer autism symptoms at school age.
Medical Research: What should clinicians and patients take away from your report?
Dr. Estes: Early intensive behavioral intervention has been found to be efficacious in improving developmental outcomes for young children with autism spectrum disorder. Children were able to maintain the developmental gains that they made in early, intensive, in-home intervention over a 2-year follow-up period. These children did not exhibit developmental regression or lose skills, even after substantial reductions in services. Intellectual, language, and adaptive functioning gains made as a result of early intervention may generalize to new domains of functioning, such as reduced Autism Spectrum Disorder symptom severity, 2 years later.
06 May Low Health Literacy Linked To Increased Mortality
MedicalResearch.com Interview with:
Candace McNaughton, MD MPH
Assistant Professor
Department of Emergency Medicine
Vanderbilt University, Nashville, TN
Medical Research: What is the background for this study?
Dr. McNaughton: Heart failure affects more than 5 million Americans, is a frequent cause of hospitalization, and by 2030 is projected to cost as much $70 billion, so there is a lot of interest in helping patients with heart failure manage their condition. Health literacy, or the ability to use and understand healthcare information, is important for all patients, but the stakes are very high for patients with heart failure. Some people who are highly literate or highly educated in other areas may have difficulty reading and understanding healthcare information. Patients with lower health literacy skills may have difficulty communicating with healthcare providers, navigating the healthcare system, recognizing signs of health decline, and knowing when and who to contact when they do become ill.
Medical Research: What are the main findings?
Dr. McNaughton: To our knowledge, this is the first study in which health literacy was measured by nurses when patients were admitted to the hospital for heart failure. Nurses asked patients three questions about whether they have problems learning about their medical condition, their confidence filling out medical forms, and how often they have someone help them read hospital materials. With these three questions, information about the health literacy level of individual patients can be made easily available their healthcare providers.
We found that among 1,379 patients hospitalized for acute heart failure, those with low health literacy had 32% greater risk of death compared to patients with a literacy score of 10 or higher, even after adjusting age, sex, race, insurance status, education, other medical conditions, and how long they were in the hospital.
27 Apr Dashboard Metrics Improve Physician Compliance With Guidelines
MedicalResearch.com Interview with:
Henry J. Michtalik MD, MPH, MHS
Department of Medicine, Johns Hopkins University
Armstrong Institute for Patient Safety and Quality
Baltimore, Maryland
Medical Research: What is the background for this study? What are the main findings?
Dr. Michtalik: Current healthcare reform emphasizes providing high-value, evidence-based care. Compliance with practice guidelines and best-practices remains a challenge in the ever-changing healthcare environment. Multiple methods are typically used to enhance compliance with these guidelines, including physician education, computerized order entry systems with clinical decision support, provider feedback, and payment incentives. These strategies are used for many conditions, including heart failure and venous thromboembolism (VTE), blood clots.
The purpose of this study was to examine the impact of an individualized physician dashboard and pay-for-performance program on improving VTE prophylaxis rates amongst hospitalists. We performed a retrospective analysis of over 3000 inpatient admissions to a hospitalist service. We examined the impact of a web-based hospitalist dashboard which provided VTE prophylaxis feedback, both alone and in combination with a pay-for performance program which provided a small financial payment for achieving compliance rates greater than 80%.
We found that compliance significantly increased from 86% during baseline to 90% during the dashboard alone phase. Addition of the pay-for-performance program further increased compliance to 94%. The fastest improvement occurred during the dashboard only phase. Annual physician payments ranged from $53 to $1244, with 17 of the 19 payments under $1000.
22 Apr Parent-Training Improves Behavioral Problems In Children With Autism
MedicalResearch.com Interview with: Lawrence Scahill, MSN, PhD and Karen Bearss, PhD Department of Pediatrics, Marcus Autism Center Children’s Healthcare of Atlanta and Emory University Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Response: Autism spectrum disorder (ASD) affects an estimated 0.6 to 1% of children worldwide. In young children with ASD (e.g. 3 to 7 years of age) up to 50% also have disruptive behaviors such as tantrums, aggression, self-injury and noncompliance. When present, these disruptive behaviors interfere with the child’s readiness to make use of educational and other supportive services. The presence of disruptive behaviors also hinders the acquisition of routine daily living skills. Parent Training has been shown to be effective for young children with disruptive behaviors who do not have Autism spectrum disorder – but it has not be well-studied in children with ASD. The current multisite study shows that parent training is effective in reducing serious behavioral problems in young children with ASD. This is the largest randomized trial of a behavioral intervention in children with ASD. 180 children were randomly assigned to parent training or parent education. Both treatments were delivered individually to parents over 24 weeks. Serious behavioral problems were reduced by almost 50% in the parent-training group compared to about 30% for parent education. A clinician who was blind to treatment assignment rated positive response in 69% of children in the parent training group compared to 40% for parent education. In addition, 79% of children who showed a positive response to parent training at the end of the 24-week trial maintained benefit at 6 months post treatment. Parent training provided parents with specific strategies on how to manage tantrums, aggression, self-injury and noncompliance in children with autism spectrum disorder. Parent education provided up-to-date and useful information about ASD, but no instruction on how to address behavioral problems. Parents were engaged in the study treatments as evidenced by the low drop-out rate of 10% .31 Mar It’s Time To Stop Blaming the Moon For Hospital Admissions or Births
MedicalResearch.com Interview with:
Dr. Jean-Luc Margot PhD
Professor, Department of Earth, Planetary, and Space Sciences and Department of Physics and Astronomy,
University of California, Los Angeles
Medical Research: What is the background for this study? What are the main findings?
Dr. Margot: Some professionals who work in emergency rooms or maternity wards believe that the number of hospital admissions or human births is larger during the full moon than at other times. This belief is incorrect. Analysis of the data shows conclusively that the moon does not influence the timing of hospital admissions or human births.
Results of a new analysis have been published online in the journal Nursing Research. The Nursing Research article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. It reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions.
21 Mar More Neurosurgeons Will Be Needed As Population Ages
MedicalResearch.com Interview with:
Uzma Samadani, MD, PhD
Chief of Neurosurgery, New York Harbor Health Care System
Assistant Professor, Departments of Neurosurgery, Psychiatry, Neuroscience and Physiology
Co-Director, Steven and Alexandra Cohen Veterans Center
NYU Langone Medical Center
Medical Research: What is the background for this study? What are the main findings?
Response: The purpose of this study was to determine the current and future incidence of chronic subdural hemorrhage in the United States civilian and Veterans' Administration populations. It's main findings are that, as the population ages, the incidence of subdural hemorrhage is increasing.
13 Mar Medical Students Have Mixed Knowledge and Expectations of ACA
MedicalResearch.com Interview with: Tyler Winkelman, M.D. Internal Medicine and Pediatrics - PGY 4 University of Minnesota MedicalResearch: What is the background for this study? What are the main findings? Dr. Winkelman: Future physicians will practice after key provisions of the Affordable Care Act (ACA) have been enacted. Whether medical students support or understand the legislation or are willing to engage in its implementation or modification as part of their professional obligation is unknown. We surveyed medical students at 8 U.S. medical schools to assess their views and knowledge of the ACA (RR=52%). We found that the majority of students support the ACA and indicate a professional obligation to assist with its implementation. There are, however, gaps in knowledge with regards to Medicaid expansion and insurance plans available within the health exchanges. Students anticipating a surgical or procedural specialty, compared to those anticipating a medical specialty, were less likely to support the ACA, less likely to indicate a professional obligation to implement the ACA, and more likely to have negative expectation of the ACA. Moderates, liberals, and those with above average knowledge scores were more likely to support the ACA and indicate a professional obligation to assist with its implementation.11 Mar ‘Traffic Light’ Nutrition Labels Help Consumers Make Healthier Choices
MedicalResearch.com Interview with:
Professor Dr. Bernd Weber
Heisenberg Professor
Department of Epileptology
Head - NeuroCognition | Imaging
Life&Brain Center Board of Directors
Center for Economics and Neuroscience Bonn
25 Feb New and Experienced Surgeons Have Similar Patient Mortality Rates
Posted at 12:34h
in Author Interviews, Education, Outcomes & Safety, Surgical Research, University of Pennsylvania
MedicalResearch.com Interview with:
Samuel D. Pimentel
Doctoral student Statistics Department
Wharton School of the University of Pennsylvania
MedicalResearch: What is the background for this study? What are the main findings?
Response: Surgical training has undergone major changes in recent years – including a reduction of six to twelve months of training time – and there is controversy about whether these changes have been good or bad for patient outcomes. Our work partially addresses the issue by asking whether newly-trained surgeons perform better or worse than experienced surgeons. We compared surgical patients treated by new surgeons to a similar group of patients treated by experienced surgeons using a new statistical technique called large, sparse optimal matching. Our analysis found no significant differences in mortality rates between the two groups.
20 Feb Delayed School Entry May Disadvantage Preterm Children
MedicalResearch.com Interview with:
Julia Jaekel PhD
Department of Developmental Psychology
Ruhr-University Bochum in Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Jaekel: Recent reports suggest that delayed school entry (DSE) may be beneficial for children with developmental delays. However, studies of the effects of DSE are inconclusive. Our study investigated the effects of delayed school entry versus age-appropriate entry (ASE) in a large sample after minimizing selection bias and accounting for confounding effects of preschool knowledge. We found that delayed school entry has no effect on Year 1 teacher ratings of academic performance. In contrast, DSE children’s standardized mean test scores of mathematics, reading, writing and attention at 8 years of age were lower than ASE children’s mean scores.
13 Feb Education Remains Strong Predictor of Longevity
MedicalResearch.com Interview with: Robert M. Kaplan Office of Behavioral and Social Sciences Research National Institutes of Health Bethesda, MD 20892 Medical Research: What is the background for this study? What are the main findings? Response: Years of formal education is one of the strongest correlates of life expectancy. The purpose of this study was to examine the relationship between educational attainment and life expectancy with adjustments for other social, behavioral, and biological factors. Using data from a large cohort of nearly 30,000 adults, we found that education was a very strong predictor of survival and that biological and behavioral factors only partially explained the relationship.30 Jan Performance Improvement CME Improved Psoriasis Care By Dermatologists
MedicalResearch.com Interview with:
Robert S. Kirsner, MD, PhD, FAAD
Interim Chairman and Harvey Blank Professor in Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine
Director, University of Miami Hospital Wound Center
Chief of Dermatology, University of Miami Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Kirsner: Psoriasis is common, affecting 7.5 million Americans. The major indication of psoriasis is chronic inflammation of the skin. It is characterized by disfiguring, scaling and erythematous plaques that may be painful or pruritic and may cause significant quality of life issues. Psoriasis may also cause joint pain and more recently has been associated with metabolic syndrome, diabetes, cardiovascular disease, dyslipidemia, hypertension and nonalcoholic fatty liver disease. Thus, patients may be physically and emotionally impacted by psoriasis.
The American Academy of Dermatology (Academy) developed a Performance Improvement (PI) CME activity to enhance dermatologists’ care of psoriasis patients by allowing them to evaluate their practice using patient charts, utilize evidence-based strategies to overcome self-identified gaps, and then re-measure their performance using charts for patients seen after practice changes were implemented.
It was found that the PI CME activity significantly improved dermatologists’ overall documentation of patient history, patient counseling for lifestyle behaviors and shared decision-making ability. For example, dermatologists who participated in and completed this PI CME activity improved practice performance by either inquiring about or documenting to a greater extent comorbidities (particularly cardiovascular disease), drug costs and interactions, patient preference, other medical problems, and severity of disease, resulting in an overall improvement in documented clinical behaviors.
21 Jan Working In Pairs Improved Medical Students’ Diagnostic Accuracy
MedicalResearch.com Interview with:
Dr. Juliane Kämmer Postdoctoral Researcher
on behalf of the authors
Max Planck Institute for Human Development
Center for Adaptive Rationality Berlin Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Kämmer: Diagnostic errors contribute substantially to preventable medical error. Of the multiple reasons for diagnostic error (such as technical failures or poorly cooperating patients), cognitive error is among the most frequent. Although a vast amount of literature explores ways to reduce cognitive errors, for example, during data synthesis, the collaborative character of clinical decision making has been largely neglected so far. Thus, the aim of our study was to investigate the effect of working in teams as opposed to working alone on diagnostic accuracy and the diagnostic decision process as such (including the time to diagnosis, number of ordered diagnostic tests and calibration of diagnostic confidence to diagnostic accuracy).
In our study, we asked senior medical students to imagine being at the emergency ward and having to diagnose six simulated patients with respiratory distress on a computer – either working individually or in pairs. We indeed found that working in pairs reduced diagnostic error without requiring more diagnostic data gathering. Interestingly, neither differences in knowledge nor in amount and relevance of acquired diagnostic information could explain the superior accuracy of the pairs; neither did the statistically increased likelihood of containing a knowledgeable member. We thus have shown that – similar to other studies outside medicine – collaboration may help correct errors, fill knowledge gaps and counteract reasoning flaws – and thus save lives. Moreover, we found that reflecting on their personal confidence may point members of teams towards an increased probability of a diagnostic error.
12 Jan E-Learning May Facilitate Education of Health Professionals
MedicalResearch.com Interview with: Živa Cotič Research Assistant & PhD Student,Global eHealth Unit Imperial College London and A/Prof Josip Car Director of Health Services and Outcomes Research Programme Lee Kong Chian School of Medicine, Director of Global eHealth Unit School of Public Health, Imperial College London Medical Research: What is the background for this study? What are the main findings? Response: The Department of Health Workforce in collaboration with the Department of Knowledge, Ethics and Research at the World Health Organization commissioned the report to provide countries with evidence to inform and guide the adoption of innovative, technology enabled models into health professional education. The report aims to address complex challenges of 21st century global workforce development through eLearning, which has been recognised as key to building more effective health education and a stronger, better qualified workforce. Global workforce development is one of the most pressing global health issues. The World Health Organization estimates the shortage of the health workforce at approximately 7.2 million health workers, with an expected increase to 12.9 million by 2035. The magnitude of the health workforce challenges the health care systems are facing require both greater investment and more effective and strategic use of available resources. The findings of the report suggest that eLearning could be equivalent to traditional forms of learning in regard to knowledge and skill acquisition in health education. This information is crucial for policy makers and educators who are forming future education.26 Dec July Effect of Medical Residents’ Care: No Adverse Stroke Outcomes
MedicalResearch.com Interview with:
Gustavo Saposnik, MD, MSc., FAHA, FRCPC
Director, Stroke Outcomes Research Center
Co-Director, Stroke Program - Research & Innovation
Associate Professor & Clinician Scientist
Departments of Medicine (Neurology) and
Health Policy, Management and Evaluation (HPME)
St. Michael’s Hospital University of Toronto
Medical Research: What is the background for this study? What are the main findings?
Dr. Saposnik: There is some controversy around worse outcomes at the beginning of academic year. Physicians recently graduated from medical schools begin their training and assume responsibilities for patient care in teaching hospitals, usually bearing the first-line duty for managing patients. Consequently, less experienced staff having new roles may influence access to care and contribute to adverse outcomes in patients managed at the beginning of academic year - the so-called “July Effect”. for example, increase of medication errors and in-hospital mortality in July has been reported from teaching hospitals.
In our large cohort study, comprising 10,319 stroke patients, 882 (8.5%) were admitted in July. Those patients were 28% less likely to receive thrombolysis (clot-buster treatment) (12% vs. 16%; odds ratio (OR), 0.72; 95% confidence interval (CI), 0.59-0.89) and 22% less likely to receive stroke unit care (62% vs. 68%; 0.78; 0.68-0.90). July admissions were not associated with either of higher death at 30 days (adjusted OR, 95% CI; 0.88, 0.74-1.03) or poor functional outcome (0.92, 0.74-1.14). Results remained consistent in the sensitivity analysis by including both July and August as part of the ‘July effect’.
17 Dec Celebrity Illness Drives Online Search: Robin Williams Effect
MedicalResearch.com Interview with:
Francesco Brigo, MD
Department of Neurological and Movement Sciences.
Section of Clinical Neurology. University of Verona.
Division of Neurology, "Franz Tappeiner" Hospital.
Merano (BZ), Italy
Medical Research: What is the background for this study? What are the main findings?
Dr. Brigo: Millions of people surf the Internet every day as a source of health care information looking for materials about symptoms, diagnosis, treatments and their possible adverse effects, or diagnostic procedures. The increasing number of online searches conducted using popular Web search engines, such as Google, generates so-called ‘big data’. This data provides information about online health-related behavior. In this study, I found that the highest peak in Google search volumes related to the terms “Parkinson´s disease” since January 2004 was observed on 15th August 2014, the day after Robin Williams' wife has revealed the late actor, who died of suicide on 11th August, was in the early stages of Parkinson's disease. I proposed to call the phenomenon of increased online searches for a certain disease driven by news of celebrities having that disease as “Robin Williams´ phenomenon”, in honor of the American actor.
13 Dec ABIM MOC and Recertification May Have No Impact On Patient Quality Care
MedicalResearch.com Interview with: John Hayes, MD Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin Medical Research: What is the background for this study? What are the main findings? Response: Prominent in the discussions about ABIM MOC and recertification has been an ongoing debate about the evidence that supports a relationship between recertification, MOC and patient care. Since many healthcare organizations use board certification as a criteria for employment consideration, the new status of “certified” but not meeting MOC throws considerable disarray into credentialing and hiring committees. We can now have ABIM labeling a physician who boarded eleven years ago as “not certified” but a physician who boarded 25 years ago as “certified” with an asterisk. And of course discussions like this bring employers and healthcare organizations back to the question: What is the additive value of MOC and recertification on patient care? The integrated Veterans Health Administration electronic health record generates performance reports for primary care physicians at regular intervals. In our study, we were able to observe for any difference based on certification groups. We reviewed ten industry-standard quality care measures in approximately 68,000 patients across 4 VA medical centers and found that internists holding time-unlimited certificates performed just as well as those holding time-limited certificates.10 Dec Reduction of Surgical Resident Duty Hours Resulted In No Change In Outcomes
MedicalResearch.com Interview with:
Ravi Rajaram MD
Division of Research and Optimal Patient Care, American College of Surgeons Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies in the Institute for Public Health and Medicine
Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Medical Research: What is the background for this study? What are the main findings?
Dr. Rajaram: The Accreditation Council for Graduate Medication Education (ACGME) first implemented restrictions to resident duty hours in 2003. In surgical populations, these reforms have not been associated with a change in patient outcomes.
However, in 2011, the ACGME further restricted resident duty hours to include: a maximum of 16 hours of continuous duty for first-year residents (interns), direct supervision of interns at all times, a maximum of 4 hours for transitions in care activities for residents in-house for 24 hours, and that these residents be given 14 hours off prior to returning to work. The association between the 2011 ACGME resident duty hour reform with surgical patient outcomes and resident education has not previously been reported.
The 2011 resident duty hour reform was not associated with a change in death or serious morbidity in the two years after the reform was implemented. Additionally, the 2011 duty hour reform was not associated with a change in any of the secondary outcomes examined, including any morbidity, failure to rescue, surgical site infection, and sepsis.
Furthermore, common measures of surgical resident education, such as in-training examination scores and board certification pass rates, were unchanged after the implementation of the 2011 duty hour reform when compared to scores prior to the reform.