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
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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.
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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.
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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.
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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.
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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’.
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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.
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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. (more…)
MedicalResearch.com Interview with:
Lisa Diamond, MD, MPH, FACP | Assistant Attending
Memorial Sloan-Kettering Cancer Center
Immigrant Health and Cancer Disparities Service
Department of Psychiatry & Behavioral Sciences | Department of Medicine Evelyn Lauder Breast Center New York, NY 10065
Medical Research: What is the background for this study? What are the main findings?
Dr. Diamond: More than 25 million U.S. residents have limited English proficiency, an 80 percent increase from 1990 to 2010. Limited English proficiency (LEP) may impede participation in the English language-dominant health care system. Little is known about the non-English-language skills of physicians in training. In our analysis of the non-English-language skills of applicants to residency programs in the U.S., we found that although applicants are linguistically diverse, most of their languages do not match the languages spoken by the U.S. population with Limited English proficiency.
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MedicalResearch.com Interview with:
Catherine A. Marco, MD, FACEP Professor
Department of Emergency Medicine
Wright State University
Kettering, OH 45429
Medical Research: What is the background for this study? What are the main findings?
Dr. Marco: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented standards on duty hours and supervision. A maximum of 80 hours of duty per week were stipulated. The aim of these standards was to promote resident learning and patient safety. However, evidence has not clearly demonstrated whether the 2003 requirements improved trainee well-being or patient safety. On July 1, 2011, the ACGME implemented additional regulations on duty hours and supervision, including a 16 hour maximum shift length for PGY1 residents. The duty hours standards were implemented to ensure patient safety and provide an excellent teaching environment. Emergency Medicine has additional duty hours requirements for emergency department rotations, including a maximum of 12 continuous scheduled hours, and a maximum 60 scheduled hours per week seeing patients in the emergency department, and no more than 72 duty hours per week.
We found that among a large cohort of 4134 Emergency Medicine residents, the majority of residents stated that they are working the appropriate number of hours to practice independently at graduation. The majority of residents believe that current duty hours regulations improve patient safety. The majority of residents agreed that duty hour regulations are currently appropriate.
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MedicalResearch.com Interview with:
Dr. Arthur Reynolds PhD, Professor
Institute of Child Development
Humphrey School of Public Affairs
University of Minnesota
Medical Research: What is the background for this study? What are the main findings?
Dr. Reynolds: Given the high national priority on enhancing early childhood development, evidence about the relationship between full-day preschool participation and school readiness is meager.
The study found that among about 1000 children attending 11 schools in low-income neighborhood. participation in full-day preschool at ages 3 or 4 for 7 hours per day was associated with significantly higher school readiness skills at the end of preschool in language and literacy, socio-emotional development, math, and physical health than part-day participation for 3 hours per day. This translate to about a half of a year of growth in learning. Full-day preschool was also associated with significantly higher attendance and lower rates of chronic absences. No differences were found in parent involvement in school.
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MedicalResearch.com Interview with:
Chester G. Chambers PhD
Armstrong Institute for Patient Safety and Quality
Johns Hopkins Carey Business School, Baltimore, Maryland
Medical Research: What are the main findings of the study?
Dr. Chambers: The main findings of this study are that several metrics of system performance can be improved by using simple methods proven to be effective in many production settings.
Specifically, the idea of using “Pre-processing” as an aspect of medical education improves patient flow times, waiting times, system throughput, and system capacity.
When fixed costs are spread across more patients, we are effectively reducing the cost per patient as well.
In this context “Pre-processing” simply refers to the practice of having medical trainees present and review cases with the attending prior to patient clinic visits as opposed to doing it in the midst of the patient visit. This simple idea is common in many areas including surgery but tends to get omitted in other settings involving ambulatory care. Our simple experiment verified that this practice has real value in a wide array of settings.
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MedicalResearch.com Interview with
Lynn E. Fiellin, M.D.
Associate Professor of Medicine
Director, play2PREVENT Lab
Yale University School of Medicine
New Haven, CT 06510
Medical Research: What are the main findings of the study?
Dr. Fiellin: The current findings are part of a larger study evaluating an interactive evidence-based video game, PlayForward: Elm City Stories, developed on the iPad and targeting risk reduction and HIV prevention in 333 young teens (ages 11-14). The larger study is examining a range of outcomes including knowledge, intentions, self-efficacy and actual behaviors and we are collecting at baseline, 6 weeks, 3, 6, 12, and 24 months. We are examining these outcomes in our experimental group compared with a control group playing a set of off-the-shelf games on the iPad. The current findings of the 196 teens who have completed the 6 weeks of gameplay and for whom we have baseline and 3 month data, reveal that, while the two groups had no differences in their baseline HIV risk knowledge, the PlayForward group had statistically significant gains in knowledge at 6 weeks (p<0.0001), sustained at 3 months (p<0.01). In addition, examining the association between exposure to the game and performance on the standardized assessments revealed that the number of game levels completed (a measure of exposure to the intervention) was positively correlated with knowledge gains measured at 3 months (r=0.42; p<0.001).
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MedicalResearch.com Interview with:
Erin Brown, MD
General Surgery PGY6
UC Davis Medical Center
Medical Research: What are the main findings of the study?
Dr. Brown: This study sought to determine with childrearing during training put residents at increased risk of quiting. We looked at both male and female surgical residents who chose to have children during residency and found that residents having children during training were not more likely to quit than those who did not have children. We also found that there childrearing had no negative impact on surgical training based on total surgical case numbers, board pass rates, and annual exam scores. Main findings of the study were that neither female gender nor childrearing during training were associated with residents quitting.
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MedicalResearch.com Interview with:
Dr. Price Kerfoot MD, EdM
Rabkin Fellow in Medical Education
Associate Professor of Surgery, Harvard Medical School
MedicalResearch: What are the main findings of the study?
Dr. Kerfoot:
(1) An online spaced education game improved clinicians' knowledge of hypertension intensification and generated a modest but significant improvement in time to blood pressure target among their patients with hypertension.
(2) As a method to increase clinicians' long-term knowledge, the spaced education game was significantly more effective than providing the identical content via a traditional method (online posting with e-mail reminders).
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MedicalResearch.com Interview with:
Sohyun Park, PhD,
Division of Nutrition, Physical Activity, and Obesity
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
Atlanta, GA 30341
MedicalResearch.com: What are the main findings of the study?
Dr. Park: Nearly 1 out of 3 U.S. adults (30.5%) consumed sugar-sweetened beverages at least 1 time per day; 20% consumed sugar-sweetened beverages at least 2 times per day. About 8 out of 10 adults agreed that drinking sugar-sweetened beverages can contribute to weight gain. However, 8 of 10 adults also did not know the actual calorie content of a 24-oz fountain soda. After controlling for sociodemographic factors, adults who were neutral (neither agreed nor disagreed) that drinking sugar-sweetened beverages can contribute to weight gain were more than 1-and-a-half times more likely to consume sugar-sweetened beverages at least 2 times per day. Conversely, knowledge about the calorie content of a 24-oz fountain soda was not associated with sugar-sweetened beverage intake.
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MedicalResearch.com Interview with:
Prof. Raj S Bhopal
Bruce and John Usher Professor of Public Health
Edinburgh Ethnicity and Health Research Group,
Centre for Population Health Sciences,
University of Edinburgh, Teviot Place, Edinburgh EH89AG
MedicalResearch.com: What are the main findings of the study?
Prof. Bhopal: In a randomised controlled trial, a tailored, family orientated intervention whereby dietitians worked in the family home to provide diet and exercise advice in people at high risk of developing diabetes, had a modest but potentially important effect in reducing weight at the end of the three-year intervention, by 1.6 kg more than in the control group.
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MedicalResearch.com Interview with:
Mitesh Patel, MD, MBA
RWJF Clinical Scholar, University of Pennsylvania
Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical Center
MedicalResearch.com: What are the main findings of the study?
Dr. Patel: We evaluated survey responses from nearly 300 internal medicine residency programs directors to assess whether residency programs were teaching residents the fundamental concepts of practicing high-value, cost-conscious care. We found that 85% of program directors feel that graduate medical education has a responsibility to help curtail the rising costs of health care. Despite this, about 6 out of every 7 internal medicine residency programs have not yet adopted a formal curriculum teaching new physicians these important concepts.
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MedicalResearch.com Interview with:
J. Randall Curtis, MD, MPH
Professor of Medicine
Director, UW Palliative Care Center of Excellence
Section Head, Pulmonary and Critical Care Medicine, Harborview Medical CenterA. Bruce Montgomery, M.D. – American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98104
MedicalResearch.com: What are the main findings of the study?
Dr. Curtis: We examined the effect of a communication-skills intervention for internal medicine and nurse practitioner trainees on patient- and family-reported outcomes. The study was funded by the National Institutes of Nursing Research of the National Institutes of Heatlh. We conducted a randomized trial with 391 internal medicine and 81 nurse practitioner trainees at two universities. Participants were randomized to either an 8-session simulation-based, communication-skills intervention or to usual education. We collected outcome data from a large number of patients with life-limiting illness and their families, including 1866 patient ratings and 936 family ratings. The primary outcome was patient-reported quality of communication and, overall, this outcome did not change with the intervention. However, when we restricted our analyses to only patients who reported their own health status as poor, the intervention was associated with increased communication ratings. Much to our surprise, the intervention was associated with a small but significant increase in depression scores among post-intervention patients. Overall, this study demonstrates that among internal medicine and nurse practitioner trainees, simulation-based communication training compared with usual education improved communication skills acquisition, but did not improve quality of communication about end-of-life care for all patients. However, the intervention was associated with improved patient ratings of communication for the sickest patients. Furthermore, the intervention was associated with a small increase in patients’ depressive symptoms, and this appeared most marked among patients of the first-year residents.
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MedicalResearch.com Interview with:
James Guevara, MD, MPH
Associate Professor of Pediatrics & Epidemiology
Senior Diversity Search Advisor, Perelman School of Medicine
University of Pennsylvania,Director of Interdisciplinary Initiatives
PolicyLab: Center to Bridge Research, Practice, & Policy
The Children's Hospital of Philadelphia,Philadelphia, PA 19104
MedicalResearch.com: What did the study attempt to address?
Dr. Guevara: Medical schools have sought to build more diverse faculty in their institutions through faculty development programs targeted to underrepresented minority faculty members. This study was conduct by THE CHILDREN'S HOSPITAL OF PHILADELPHIA'S POLICYLAB and The University of Pennsylvania and sought to determine if there was an association between minority faculty development programs and the representation, recruitment, and promotion of underrepresented minority faculty.
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MedicalResearch.com Interview with:
Lauren Block, MD
Assistant Professor, North Shore–LIJ Hofstra School of Medicine
2001 Marcus Ave., Suite S160
Lake Success, NY 11042
MedicalResearch.com: What are the main findings of the study?
Dr. Block: Our goal was to look at how often doctors in training were performing basic niceties with their patients, such as introducing themselves and sitting down. We found that while the doctors usually asked open-ended questions and touched patients, resident physicians were unlikely to introduce themselves, explain their role, or sit down when talking to patients.
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MedicalResearch.com Interview with:
Eva Aagaard, MD
Associate Professor of Medicine, Assistant Dean for Lifelong Learning, Director of the Academy of Medical Educators, Director of the Center for Advancing Professional Excellence, and Director of Faculty Development in General Internal Medicine at the University of Colorado
MedicalResearch.com: What are the main findings of the study?
Dr. Aagaard: We obtained feedback on, and assessed the construct validity and perceived feasibility and utility of, draft Internal Medicine Milestones for Patient Care and Systems-Based Practice used a mixed methods study involving competency committee members in Internal Medicine residency programs. An initial survey assessed participant and program demographics; focus groups obtained feedback on the draft milestones and explored their perceived utility in resident assessment, and an exit survey elicited input on the value of the draft milestones in resident assessment. Thirty-four participants from 17 programs completed surveys and participated in 1 of 6 focus groups. Overall, the milestones were perceived as useful in formative and summative assessment of residents. Participants raised concerns about the length and complexity of some draft milestones and suggested specific changes. The focus groups also identified a need for faculty development. In the exit survey, most participants agreed that the Patient Care and Systems-Based Practice Milestones would help competency committees assess trainee progress toward independent practice.
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