Obsessive-Compulsive Disorder Associated With Educational Underachievment

MedicalResearch.com Interview with:

Ana Pérez-Vigil MD Department of Clinical Neuroscience Child and Adolescent Psychiatry Research Center Karolinska Institutet

Dr. Perez-Vigil

Ana Pérez-Vigil MD
Department of Clinical Neuroscience
Child and Adolescent Psychiatry Research Center
Karolinska Institutet

MedicalResearch.com: What is the background for this study?

Response: Everyone who regularly works with persons who have obsessive-compulsive disorder (OCD) has seen that their patients often struggle with school work. It is not uncommon for these individuals to have poor school attendance and severe patients can be out of the education system altogether. This applies to persons of all ages, from school children to young adults who may be at university.

On the other hand there is a group of patients who, against all odds, working 10 times as hard as everybody else, manage to stay in education and eventually get a degree. So we have long suspected that OCD has a detrimental impact on the person’s education, with all the consequences that this entails (worse chances to enter the labour market and have a high paid job). But we did not really know to what extent OCD impacts education. So we wanted to know what is the actual impact of OCD on educational attainment using objectively collected information from the unique Swedish national registers. Previous work had been primarily based on small clinical samples from specialist clinics, using either self or parent report and cross-sectional designs. Previous work also tended not to control for important confounders such as psychiatric comorbidity or familial factors (genetic and environmental factors that could explain both OCD and the outcomes of interest).

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More Lab Tests Ordered At Teaching vs Non-Teaching Hospitals

MedicalResearch.com Interview with:

Victoria Valencia, MPH Assistant Director for Healthcare Value Dell Medical SchoolThe University of Texas at Austin

Victoria Valencia

Victoria Valencia, MPH
Assistant Director for Healthcare Value
Dell Medical SchoolThe University of Texas at Austin

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We were surprised to find that despite the common anecdote that resident physicians in teaching environments order more lab tests, there was a lack of empirical data to support the claim that more lab tests are ordered for patients at teaching hospitals than at non-teaching hospitals. Our study of 43,329 patients with pneumonia or cellulitis across 96 hospitals  in the state of Texas found that major teaching hospitals order significantly more lab tests than non-teaching hospitals.  We found this to be true no matter how we looked at the data, including when restricting to the least sick patients in our dataset. We also found that major teaching hospitals that ordered more labs for pneumonia tended to also more labs for cellulitis, indicating there is some effect from the environment of the teaching hospital that affects lab ordering overall.

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Children Can Save Lives By Learning CPR in School

MedicalResearch.com Interview with:
Young girl learning Hands-Only CPR at the American Heart Association Hands-Only CPR training kiosk at Cincinnati-Northern Kentucky International Airport. copyright American Heart Association 2017 Photos by Tommy Campbell Photography
Mimi Biswas M.D., MHSc
University of California Riverside School of Medicine and
Riverside Community Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This started as  My son’s science project. He wanted to make a video game to teach CPR based on a science fair website. It grew to teaching the whole 6th grade using the AHA CPR training kit alone vs adding the video game or music, staying alive, to help with compression rate.  We found that a 12 year can easily learn the basic concepts of calling for help and starting hands only CPR and they can physically perform effective CPR at this age.

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Montessori Education Has Potential To Equalize Performance For Low Income School Children

“Tempura Finger Paint Grand Rapids Montessori School” by Steven Depolo is licensed under CC BY 2.0

“Tempura Finger Paint Grand Rapids Montessori School” by Steven Depolo

MedicalResearch.com Interview with:
Angeline Lillard PhD

Professor of Psychology
University of Virginia
Charlottesville, VA

MedicalResearch.com: What is the background for this study?

Response: Montessori education was developed in the first half of the last century, but has been subject to little formal research. Prior research on its outcomes was problematic in using poor control groups, very small samples, demographically limited samples, a single school or classroom, or poor quality Montessori, or data from just a single time point and limited measurements.

This study addressed all these issues: it collected data 4 times over 3 years from 141 children, experimental children were in 11 classrooms at 2 high quality Montessori schools at which the control children were waitlisted and admission was done by a randomized lottery, family income ranged from $0-200K, groups were demographically equivalent at the start of the study, and many measures were taken.

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Gay and Bisexual Men With Less Education and Income At Greater Risk of Suicide

MedicalResearch.com Interview with:
Oliver Ferlatte PhD

Men’s Health Research Program
University of British Columbia
Vancouver , British Columbia , Canada

MedicalResearch.com: What is the background for this study?

Response: Suicide, like many other health inequities, is unevenly distributed among the population, with marginalized groups being most affected. In Canada, suicide has been found to particularly affect gay and bisexual men, aboriginal people and people living in rural and remote communities.

While the populations affected by suicide are not mutually exclusive – for example someone can be a bisexual Aboriginal man living in a remote community – much of the suicide prevention literature tends to treat these groups as such. Moreso, very little attention is given in suicide prevention research to diversity within groups: for example, we know very little about which gay and bisexual men are most at risk of attempting suicide. This situation creates a vacuum of knowledge about suicide among gay and bisexual and deprives us of critical information for the development of effective suicide prevention activities.

We therefore investigated in a survey of Canadian gay and bisexual men (Sex Now Survey), which gay and bisexual men are at increased risk of reporting a recent suicide attempt. The large sample of gay and bisexual men with 8493 participants allows for this unique analysis focused on the multiple, intersecting identities of the survey participants.

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Healthy Behaviors and Academic Success Go ‘Hand in Hand’

MedicalResearch.com Interview with:

Catherine N. Rasberry, PhD Health Scientist, Division of Adolescent and School Health CDC Atlanta

Dr.Raspberry

Catherine N. Rasberry, PhD
Health Scientist, Division of Adolescent and School Health
CDC Atlanta

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For many years, researchers have documented links between health-related behaviors and educational outcomes such as letter grades, test scores, and other measures of academic achievement. However, many of those studies are becoming out-of-date or have used samples that were not nationally representative. The aim of this study was to see if previous findings held in a current, national sample of high school students.

Consistent with previous studies, our findings revealed that regardless of sex, race/ethnicity and grade-level, high school students who received mostly A’s, mostly B’s, or mostly C’s had higher levels of most protective health-related behaviors and lower levels of most health-related risk behaviors. For example, we found that:

  • Students who reported receiving mostly Ds and Fs, were nine times more likely than students who received mostly As to report having ever injected any illegal drugs.
  • Also, students who reported receiving mostly Ds and Fs were more than four times more likely than students who received mostly As to report that they had four or more sexual partners.
  • Conversely, students who reported receiving mostly As were twice as likely as students who received mostly Ds and Fs to report eating breakfast every day in the past week.

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More Time in School Associated With Less Cardiovascular Disease

MedicalResearch.com Interview with:

Dr. Julien Vaucher  Physician and clinical research fellow (joint first author) Department of Internal Medicine Lausanne University Hospital Lausanne, Switzerland

Dr. Vaucher

Dr. Julien Vaucher 
Physician and clinical research fellow (joint first author)
Department of Internal Medicine
Lausanne University Hospital
Lausanne, Switzerland

MedicalResearch.com: What is the background for this study?

Response: Since the sixties, traditional studies have found that people who stay longer in the educational system subsequently develop less coronary heart disease. However, whether this association is causal is not clear, partly because randomised controlled trials are practically infeasible in this area. In our study, we used a genetic approach, called Mendelian randomization, that represents the next best thing to do.Based on genetic variants randomized by nature, we were able to randomize individuals according to 162 genetic markers that associate with more or less education. In other words, we used genetic markers, free from condounding factors, as proxies of education to reproduce the conditions of a trial. Then, if the genetic markers also associate together with coronary heart disease, the association between education and coronary heart disease is likely to be causal.

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Despite Sleep Benefits To Teens, Only Half of Parents Support Later School Start Times

MedicalResearch.com Interview with:

Galit Dunietz, Ph.D., MPH Doctor of Philosophy Department of Neurology University of Michigan  Ann Arbor MI

Dr. Dunietz

Galit Dunietz, Ph.D., MPH
Epidemiologist, Sleep Disorders Center
Department of Neurology
University of Michigan
Ann Arbor MI

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Insufficient sleep has a negative impact on health, cognition and mood and is linked to motor vehicle accidents. However, sleep loss in adolescents has become an epidemic and arises in part from biological processes that delay sleep and wake timing at the onset of puberty. This biology does not fit well with early school start times (before 8:30 a.m.). Despite recommendations from the American Academy of Pediatrics and the American Academy of Sleep Medicine to delay school start times, most schools in the U.S. have current start times before 8:30 a.m.

In this nationally representative study of US parents of teens, we examined whether parents supported or opposed later school start times (after 8:30 a.m.). We also examined what may have influenced their opinions.

We found that only about half of surveyed parents of teens with early school start times supported later school start times. Opinions appeared to depend in part on what challenges and benefits were expected to result from the change.

For example, parents who expected an improvement in their teen’s academic performance or sleep quantity tended to support the change, whereas parents that expected negative impact on afterschool activities or transportation opposed delays in school start times.  We also found that parents had misconception about sleep needs of their adolescents, as the majority perceived 7-7.5 hours of sleep as sufficient, or possibly sufficient even at this young age when 8-10 hours are typically recommended.

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“Positive Manifold” : Vocabulary and Reasoning Skills Reinforce Each Other In Adolescents

MedicalResearch.com Interview with:

Dr Rogier Kievit PhD Cambridge Neuroscience

Dr. Kievit

Dr Rogier Kievit PhD
Cambridge Neuroscience

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the most robust findings in psychology is the so-called ‘positive manifold’ – The fact that people who are better at cognitive task A are, on average, also better at task B (and C, D etcetera). Despite over a hundred years of empirical investigations, we don’t really know why this is the case. Here, we aimed to investigate the mechanisms that underlie the positive manifold. To do so, we studied almost 800 adolescents and young adults from Cambridge and London (the NSPN study; Www.nspn.org

We measured both their abstract reasoning skills (e.g. solving a puzzle) and vocabulary knowledge (e.g. example) on two occasions, about 1.5 years apart.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our main finding was that abstract reasoning skills and vocabulary knowledge seem to reinforce each other during development. In other words, the adolescents who started out with higher vocabulary abilities had largest increases in reasoning skills, and those with better reasoning skills gained more vocabulary knowledge. This is exciting as we know mathematically that such a process can (at least partially) help explain the emergence of the positive manifold.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: That cognitive abilities interact with each other during development. It is tempting (also for scientists!) to think about skills like memory, reading and as separate domains. However, in reality they are part of a larger network of cognitive, mental and emotional processes that interact throughout the lifespan. We simple can’t fully understand humans as psychological agents by taking only ‘snapshots’.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The field of psychology has recently realized it needs to increase sample sizes to gain robust knowledge about human behaviour and mental processes. I think the next step is realizing the importance of studying development (i.e. testing people on multiple occasions) as a way to look at longstanding questions in new and exciting ways. Secondly, we find that that mathematical models are a very exciting way to translate theories into directly testable propositions – Although such models are always oversimplifications, they often move scientific debates forward.

MedicalResearch.com: Is there anything else you would like to add?

Response: With the emergence of experience sampling methods (e.g. performing cognitive tests on smartphones), ideally combined with longitudinal brain imaging, I think the next two decades will prove an incredibly exciting time for understanding human cognition.

Disclosures: The Medical Research Council Cognition and Brain Sciences Unit is part of the University of Cambridge, funded through a strategic partnership between the MRC and the University.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Rogier A. Kievit et al, Mutualistic Coupling Between Vocabulary and Reasoning Supports Cognitive Development During Late Adolescence and Early Adulthood, Psychological Science (2017). DOI: 10.1177/0956797617710785

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

USPSTF: Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors

MedicalResearch.com Interview with:

Carol M. Mangione, MD, MSPH, FACP Barbara A. Levey, MD, and Gerald S. Levey, MD Endowed chair in medicine David Geffen School of Medicine University of California, Los Angeles Professor of public health at the UCLA Fielding School of Public Health

Dr. Mangione

Carol M. Mangione, MD, MSPH, FACP
Barbara A. Levey, MD, and Gerald S. Levey, MD
Endowed chair in medicine
David Geffen School of Medicine
University of California, Los Angeles
Professor of public health at the UCLA Fielding School of Public Health

MedicalResearch.com: What is the background for this study?

Response: Americans can experience several health benefits from consuming healthy foods and engaging in physical activity. The Task Force recommends that primary care professionals work together with their patients when making the decision to offer or refer adults who are not obese and do not have hypertension, high cholesterol, high blood sugar, or diabetes to behavior counseling to promote healthful diet and physical activity. Our focus was on the impact of a healthful diet and physical activity on cardiovascular risk because this condition is the leading cause of premature morbidity and mortality. The Task Force evaluates what the science tells us surrounding the potential benefits and harms of a particular preventive service. In this case, the Task Force found high quality evidence focusing on the impact a healthful diet and physical activity can have on a patient’s risk of cardiovascular disease. Relying on this evidence, the Task Force was able to conclude that there is a positive but small benefit of behavioral counseling to prevent cardiovascular disease.

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More Education Means Lowers Cardiovascular Risk, Regardless of Income

MedicalResearch.com Interview with:

Yasuhiko Kubota, MD, MPH Visiting Scholar Division of Epidemiology and Community Health School of Public Health University of Minnesota, Minneapolis, MN

Dr. Kubota

Yasuhiko Kubota, MD, MPH
Visiting Scholar
Division of Epidemiology and Community Health
School of Public Health
University of Minnesota, Minneapolis, MN

MedicalResearch.com: What is the background for this study?

Response: Educational inequality is one of the most important socioeconomic factors contributing to cardiovascular disease. Since education is usually completed by young adulthood, educational inequality may affect risk of cardiovascular disease early in the life course. We thought it would be useful to calculate the lifetime risk of cardiovascular disease according to educational levels in order to increase public awareness of the importance of education.

Thus, our aim was to evaluate the association of educational attainment with cardiovascular disease risk by estimating the lifetime risks of cardiovascular disease using a US. biracial cohort. Furthermore, we also assessed how other important socioeconomic factors were related to the association of educational attainment with lifetime risk of cardiovascular disease.

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Babies As Young as 3-5 Months Taught To Stand

MedicalResearch.com Interview with:
Professor Hermundur Sigmundsson

Department of Psychology
Norwegian University of Science and Technology

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are around 23 baby-swimming instructors in Iceland who are offering baby swimming-courses. However, Snorris way to do this is unice after my knowledge.

He has been doing baby swimming from 1990 – and has had around 7.000.- babies

He heard about this from Norway and discovered that very young babies can stand in this way. He discovered this through practical experience.

It works like this:  When holding children in the water – He put his hand under the feet of the children – and lift little bit under i.e gives some pressure (tactile stimuli) the children are gradually able to stand in the feet – so stimuli and experience is important. When they are able to stand once they are able to stand again.

How long time it takes for each baby to be able to stand varies a lot – as in our study – the youngest was 3.6 months old. One of the participants was standing in 15 sec in the hands of Snorri in the first week of baby swimming course.

I did see babies stand first soon after Snorri started baby swimming instruction around 1990-1991.

I was very surprised – and was thinking how is it possible? This is not supported by the literature. My colleagues an I thought about this as a window to study development of balance and coordination in infants. The issue about reflexes versus voluntary movement through experience was central.

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STEM activities do not seem to encourage students to make STEM subject choices for AS/A levels

MedicalResearch.com Interview with:

Dr-Pallavi-Amitava-Banerjee.jpg

Dr. Banerjee

Pallavi Amitava Banerjee, PhD, FRS
Lecturer, Graduate School of Education
St Luke’s Campus
University of Exeter 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Several educational programs are being run to increase an awareness and understanding of STEM generally and more specifically to encourage young people to take up STEM learning trajectories.

A longitudinal study was conducted where nearly 60,000 year 7 students were followed up through secondary school. Every year these students took part in several hands on activities, ambassador led events, school STEM trips throughout each academic year from the beginning of year 7 till they took GCSEs.

Two main educational outcomes were considered –
a) GCSE attainment in science and math and
b) continued post-16 STEM participation (AS- and A-levels).

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ADHD Less Common in Girls, But Has More Serious Consequences

MedicalResearch.com Interview with:

Professor Jill Pell MD Director of Institute (Institute of Health and Wellbeing) Associate (School of Medicine, Dentistry and Nursing) University of Glasgow

Prof. Pell

Professor Jill Pell MD
Director of Institute (Institute of Health and Wellbeing)
Associate (School of Medicine, Dentistry and Nursing)
University of Glasgow

MedicalResearch.com: What is the background for this study?

Response: The novelty of our study lies in its scale and scope. In terms of scope, it reported on six educational outcomes and three health outcomes in the same group of children.

In terms of scale, it is the first study of a whole country to compare educational outcomes of children with treated ADHD with their unaffected peers and is more than 20 times larger than previous studies on similar educational outcomes. The only previous countrywide study on health outcomes, included only children with very severe ADHD who were in psychiatric hospitals.

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Using Virtual Reality To Teach Medical Student Empathetic Communication Skills

MedicalResearch.com Interview with:
Frederick W. Kron, MD

President and Founder of Medical Cyberworlds, Inc
Department of Family Medicine,Ann Arbor, MI and
Michael D. Fetters, M.D., M.P.H., M.A.
Professor of Family Medicine
University of Michigan

MedicalResearch.com: What is the background for this technology and study?

Dr. Kron: Communication is the most important component of the doctor-patient relationship. I know that through research, but also through personal experience. As a cancer survivor, I’ve seen first-hand the difference that outstanding communication skill can make to a vulnerable patient.

At the beginning of the project, we asked medical educators about the challenges they had in assessing and training communication competency. They told us that technical skills are easy to teach and assess, but communication skills are mainly behavioral skills that involve verbal and nonverbal behaviors, facial expressions, and many other cues that pass between patient and provider. That’s hard to teach and assess. Activities like role play with standardized patients (SPs) have been widely used, but it’s impossible for SPs to accurately portray these behaviors, or for faculty to fully assess the nuanced behaviors of both learner and patient. Supporting this idea is a lack of evidence proving that SP encounters translate in behavioral changes or transfer into clinical settings.

Developments in virtual reality provided us with a great opportunity for assessing and teaching of communication behaviors. Working with a national group of experts, we created computer-based Virtual Humans that interact with learners using the full range of behaviors you’d expect from two people talking together. They are so behaviorally realistic and compelling, that they trigger emotional responses in learners, and make learners want to learn so they can do their best.

Dr. Fetters: Our team has particular interest in doctor-patient communication in the context of cancer. There are many critical aspects of cancer communication: breaking the bad news to the patient, negotiating sometimes conflicting family opinions about treatment, and communication among team members about the patient’s care, just to name a few. We’ve begun building out those scenarios in the technological platform we developed, Mpathic-VR.

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Simulation Exercises Reduce Anxiety of Taking Baby Home From NICU

MedicalResearch.com Interview with:

Deborah A. Raines PhD, EdS, RN, ANEF School of Nursing University at Buffalo

Dr. Raines

Deborah A. Raines PhD, EdS, RN, ANEF
School of Nursing
University at Buffalo

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This research grew from my experience as a neonatal nurse. I have worked with many families preparing to take their baby home and have seen the anxiety they experience wondering if they will be able to take care of their baby’s medical needs at home.

Parents are usually most anxious about emergency situations that may occur. Majority of these parents are able to state what they should do, but have never experienced the actual situation with their baby. This study was designed to see if a simulation experience would fill this gap in parents’ preparation for the discharge of their baby from the NICU. This study had parents participated in a customized simulation to have them experience the care needed by their baby at home following discharge from the NICU.

The findings revealed that parents reported a nearly 30 percent increase in confidence in their abilities to care for their baby after participating in the simulation.

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Too Much Categorizing of Information Inhibits Creativity

MedicalResearch.com Interview with:
Yeun Joon Kim | Ph.D. Student

Organizational Behavior and Human Resource Management
Joseph L. Rotman School of Management
University of Toronto
Toronto, Ontario Canada  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:   Managers in organizations tend to emphasize the importance of organizing and clustering information so that other employees can

(1) readily find information they want and

(2) easily learn and understand the information in terms of categories. For instance, our school system categorize information by higher-order categories such as mathematics, history, English, biology, geology, and so on. Also, within the mathematics, there are several sub-categories such algebra, geometry, calculus, and so on.

In other words, people prefer hierarchical information structure. Why? That is because conceptual categories reduce complexity of memorizing information and thus facilitate our learning process. For this reason, when we learn new information, we firstly question which category the information belongs, and then initiate learning.

However, we found that for creativity such hierarchical information structure is rather detrimental. This is because the categories, which were intended to ease our learning, lock our information processing into the categories. That is, the pieces of information classified by higher-order categories reduce cognitive flexibility, which in turn decreases creativity.

MedicalResearch.com: What should readers take away from your report?

Response:  Managers in organizations may need to create a flat information structure when they want their employees to be creative in idea generation processes. One way to create a temporary flat information structure would be asking employees to generate ideas as many as possible in the group discussion; writing down the generated ideas on the white board without categorizing them; asking them to combining the ideas to generate better ones.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: It is possible that there can be other types of information structure other than the flat vs. hierarchical information structure. It would be interesting to investigate various kinds of information structure in relation to not only creativity, but also productivity or task performance.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Yeun Joon Kim, Chen-Bo Zhong. Ideas rise from chaos: Information structure and creativity. Organizational Behavior and Human Decision Processes, 2017; 138: 15 DOI: 1016/j.obhdp.2016.10.001

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Membership In Medical Schools’ Honor Society Skews Toward White Students

MedicalResearch.com Interview with:

Dowin Boatright, MD, MBA</strong> Department of Emergency Medicine Yale School of Medicine New Haven, Connecticut Fellow, Robert Wood Johnson Clinical Scholars Program Veterans Affairs Scholar

Dr. Dowin Boatright

Dowin Boatright, MD, MBA
Department of Emergency Medicine
Yale School of Medicine
New Haven, Connecticut
Fellow, Robert Wood Johnson Clinical Scholars Program
Veterans Affairs Scholar

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Studies have demonstrated racial and ethnic inequities in medicine, including disparities in the receipt of awards, research funding, and promotions. Yet few studies have examined the link between race and ethnicity and opportunities for medical school students.

Our results show that black and Asian medical school students are less likely to be selected for membership in a prestigious medical honor society, Alpha Omega Alpha (AΩA), than white medical school students.

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Parents Can Encourage Children To Enter and Succeed in STEM Studies

MedicalResearch.com Interview with:

Janet Shibley Hyde Evjue-Bascom Professor Helen Thompson Woolley Professor of Psychology and Gender & Women’s Studies Director, Center for Research on Gender & Women University of Wisconsin Madison, WI

Dr. Janet Shibley Hyde

Janet Shibley Hyde
Evjue-Bascom Professor
Helen Thompson Woolley Professor of
Psychology and Gender & Women’s Studies
Director, Center for Research on Gender & Women
University of Wisconsin
Madison, WI

MedicalResearch.com: What is the background for this study?

Response: The background is that, in the U.S. and many other Western nations, we don’t have enough people going into STEM fields (Science, Technology, Engineering, and Mathematics). Innovations in STEM fields are enormously important in 21st century economies. So, we need to encourage more people to go into STEM fields. To do that, they have to major in a STEM field in college, and to do that, they need to prepare in high school.

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Most Biomedical PostDocs Lose Out on Salary and Tenure

MedicalResearch.com Interview with:

Prof. Shulamit (Shu) Kahn Department of Markets, Public Policy and Law Questrom School of Business Boston University

Prof. Shulamit Kahn

Prof. Shulamit (Shu) Kahn
Department of Markets, Public Policy and Law
Questrom School of Business
Boston University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We started this research because Donna Ginther (Kansas) and I had an NIH R01 to study gender differences in biomedical careers. We quickly discovered that a major problem for women was the fact that between many years of graduate study and long postdocs, their biological clocks had almost expired before they would have a decent amount of time in their lives to think about having children.

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STEM Enrichment Activities Did Not Improve Math or Science Scores

MedicalResearch.com Interview with:

Pallavi Amitava Banerjee, PhD Lecturer, Graduate School of Education University of Exeter

Dr. Banerjee

Pallavi Amitava Banerjee, PhD
Lecturer, Graduate School of Education
University of Exeter, UK

MedicalResearch.com: What is the background for this study?

Response: Science technology engineering mathematics skills are highly valued in the UK as in most other developed countries of the world. Concerns were raised in the past by the Royal Society, Science Council and other learned societies and the UK Parliament about the insufficient number of young people wanting to take up these subjects beyond school. What then followed were a range of STEM enrichment and enhancement activities delivered at the local and national level. These activities were run to help young people appreciate science and math better to break the myth that these are only for the brainy. Students from secondary schools did hands-on practical activities, had STEM ambassador visits and several other events organized.

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Pre-K ParentCorps Reduces Educational Disparities and Mental Health Issues

MedicalResearch.com Interview with:

Laurie Miller Brotman, PhD Bezos Family Foundation Professor of Early Childhood Development Director, Center for Early Childhood Health and Development Department of Population Health NYU Langone Medical Center

Dr. Laurie Brotman

Laurie Miller Brotman, PhD
Bezos Family Foundation Professor of Early Childhood Development
Director, Center for Early Childhood Health and Development
Department of Population Health
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Children attending high-poverty schools are often exposed to an accumulation of stressors and adverse childhood experiences that can interfere with optimal mental health and learning. This study examines mental health and academic outcomes through second grade in nearly 800 Black and Latino children who participated in a randomized controlled trial of ParentCorps–a family-centered, school-based intervention in pre-kindergarten.

In the original trial, elementary schools with pre-k programs serving primarily Black and Latino children from low-income families were randomized to receive ParentCorps or standard pre-k programming. ParentCorps includes professional development for pre-k and kindergarten teachers on family engagement, social-emotional learning, and behavioral regulation, and a program for families and pre-k students provided over four months at the school by specially trained pre-k teachers and mental health professionals. ParentCorps creates a space for families to come together, reflect on their cultural values and beliefs, and set goals for their children. Parents learn a set of evidence-based strategies and choose which ones fit for their families—such as helping children solve problems and manage strong feelings, reinforcing positive behavior, setting clear rules and expectations, and providing effective consequences for misbehavior. Teachers and parents help children learn social, emotional and behavioral regulation skills such as identifying feeling sad, mad, or scared, calming bodies during stressful situations, paying attention, and solving problems together.

This three year follow-up study finds that ParentCorps as an enhancement to pre-k programming in high-poverty schools results in fewer mental health problems (behavioral and emotional problems) and better academic performance through second grade.

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Leukoencephalopathy As Marker of Cognitive Impairment After Chemotherapy For Childhood ALL

MedicalResearch.com Interview with:
Yin Ting Cheung, PhD

Department of Epidemiology and Cancer Control and
Noah D Sabin, MD
Department of Diagnostic Imaging
St Jude Children’s Research Hospital
Memphis, TN

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Long-term survivors of childhood acute lymphoblastic leukemia (ALL) who are treated with high-dose intravenous methotrexate or intrathecal chemotherapy are at risk for neurocognitive impairment, particularly in cognitive processes such as processing speed, attention and executive function. However, many children who receive these therapies do not experience significant impairments, suggesting the need for biomarkers to identify patients at greatest risk. Prior research from our team demonstrated that, during chemotherapy, patients were at risk for white matter changes in the brain, also known as leukoencephalopathy. No studies documented the persistence or impact of brain leukoencephalopathy in long-term survivors of childhood ALL treated on contemporary chemotherapy-only protocols.

In this study, we included prospective neuroimaging from active therapy to long-term follow-up, and comprehensive assessment of brain structural and functional outcomes in long-term survivors of ALL treated with contemporary risk-adapted chemotherapy. We demonstrated that survivors who developed leukoencephalopathy during therapy displayed more neurobehavioral problems at more than 5 years post-diagnosis. Moreover, these survivors also had reduced white matter integrity at long-term follow-up, and these structural abnormalities were concurrently associated with the neurobehavioral problems.

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Most Physicians Overestimate Efficacy of Common Treatments

MedicalResearch.com Interview with:

Daniel J. Morgan M.D., M.S Associate Professor Epidemiology & Public Health University of Maryland School of Medicine

Dr. Daniel Morgan

Daniel J. Morgan M.D., M.S
Associate Professor
Epidemiology & Public Health
University of Maryland School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Physicians are generally taught if a treatment is indicated, not how well the treatment works. Although this has been part of evidence based medical training, doctors still perform poorly with ability to understand risk and how treatment limits risk (Bayesian reasoning). Many publications focus on relative risk reduction which inflates the perception of an effect over the more accurate absolute risk reduction.

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Before Children Enter Kindergarten, They Need To Know How to Count

MedicalResearch.com Interview with:

David C. Geary, Ph.D. Curators’ Distinguished Professor Thomas Jefferson Fellow Department of Psychological Sciences Interdisciplinary Neuroscience Program University of Missouri Columbia, MO

Dr. David Geary

David C. Geary, Ph.D.
Curators’ Distinguished Professor
Thomas Jefferson Fellow
Department of Psychological Sciences
Interdisciplinary Neuroscience Program
University of Missouri
Columbia, MO

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In an earlier study, we found that children’s understanding of numbers and the relations among them (e.g., that 6 = 5 + 1 & 4 + 2 & 3 + 3…) at the beginning of 1st grade predicted their performance on math measures in adolescence, controlling IQ, working memory, family background and other factors. These are measures that predict employability and wages in young adults and thus is practically important. We were interested in understanding the very early quantitative knowledge that predicts children’s later number knowledge. We tested children on a variety of quantitative measures 2 years before they entered kindergarten and in kindergarten gave them the same type of number test that we used in the first study. We found that 3 year olds’ cardinal knowledge was critical to their later understanding of number relations, controlling IQ and many other factors. Cardinal knowledge is their understanding of the quantities associated with number words. So, if you ask a child to give you 3 toys, and they give you a handful, they do not understand what ‘three’ means. Young children with poor knowledge of number words, we at risk for poor math outcomes in kindergarten, controlling other factors.

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Toddlers Can Understand and Learn From Interactive Facetime

MedicalResearch.com Interview with:

Lauren J. Myers, Ph.D. Assistant Professor Psychology Department Lafayette College Easton, Pennsylvania

Dr. Lauren Myers

Lauren J. Myers, Ph.D.
Assistant Professor
Psychology Department
Lafayette College
Easton, Pennsylvania

MedicalResearch.com: What is the background for this study?

Response: Many families with young children use video chat to connect with family and friends–but what do children understand about the on-screen people and content of these interactions? The American Academy of Pediatrics discourages screen time for kids under 2 years because children who watch a lot of media often have poor language skills, and they miss out on other activities that would be more developmentally appropriate. However, in this study we wondered whether there is a difference between putting a baby in front of a television and having an interactive exchange via video chat.
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NEJM Study Calculates Cost Of Training Residents in Teaching Health Centers

MedicalResearch.com Interview with:

Marsha Regenstein, Ph.D, Professor From the Department of Health Policy and Management Milken Institute School of Public Health George Washington University Washington, DC

Prof. Marsha Regenstein

Marsha Regenstein, Ph.D, Professor
From the Department of Health Policy and Management
Milken Institute School of Public Health
George Washington University
Washington, DC

MedicalResearch.com: What is the background for this study?

Response: Despite the billions of dollars in public spending on graduate medical education (GME) in the United States, little is known about the true cost of training a resident, with the few studies that exist showing wide variation in their methods and results. At the same time, the U.S. appears to be producing too few primary care physicians to meet the health care needs of the population, and especially those who live in underserved areas with high health care needs and shortages of health professionals. The Teaching Health Center (THC) Graduate Medical Education funding program was established under the Affordable Care Act to increase the number of medical and dental residents training in six primary care specialties in underserved areas. The Teaching Health Center funding supports community-based residency training in settings such as Federally-qualified health centers, rural clinics, mental health clinics and other non-profit community-based organizations. Hospitals commonly serve as training partners, but THC funding goes directly to the community-based partner, bringing funding and training closer to the communities where underserved patients live. The Health Resources and Services Administration (HRSA), which manages and funds the program, set an interim payment of $150,000 per resident; currently, 59 THCs are training 690 residents in 27 states and the District of Columbia. The interim payment rate was based on the best available information at the time and was meant to cover the full cost of training a resident.

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Consensus Statement Discusses Successful Implementation of Physical Activity in Schools

MedicalResearch.com Interview with:

Peter Krustrup PhD Professor of Team Sport and Health Department of Nutrition, Exercise and Sports Copenhagen Centre for Team Sport and Health University of Copenhagen, Denmark

Dr. Peter Krustrup

Peter Krustrup PhD
Professor of Team Sport and Health
Department of Nutrition, Exercise and Sports
Copenhagen Centre for Team Sport and Health
University of Copenhagen, Denmark

Dr. Krustrup discusses ideas formulated in the Copenhagen Consensus Conference 2016: children, youth, and physical activity in schools and during leisure time.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A desire to improve children’s and youth’s health, well-being and social inclusion motivated researchers at University of Copenhagen, Department of Nutrition, Exercise and Sports to gather 24 international top level researchers from a variety of academic disciplines at a consensus conference in Denmark on 4-7 April 2016. The aim of the Copenhagen Consensus Conference in 2016 was to reach an evidence-based consensus within the four themes:

1) Physical activity in children and youth: Fitness and health.
2) Physical activity in children and youth: Cognitive functioning
3) Physical activity in children and youth: Engagement, motivation and psychological well-being
4) Physical activity in children and youth: Social inclusion and physical activity implementation strategies.

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Inexpensive Sponsored Meals For Doctors Increase Brand Name Prescriptions

MedicalResearch.com Interview with:
Colette DeJong
Medical student at UCSF and
Research Fellow at the UCSF Center for Healthcare Value.

MedicalResearch.com: What is the background for this study?

Response: Data released under the U.S. Sunshine Act reveals that in the last five months of 2013, over half of American physicians received free meals, gifts, or payments from the pharmaceutical industry. Recent studies have shown that doctors who receive large payments from drug companies—such as speaking fees and royalties—are more likely to prescribe expensive brand-name drugs, even when generics are available. Our findings, however, suggest that physicians’ prescribing decisions may be associated with much smaller industry payments than previously thought. We found that doctors who receive a single industry-sponsored meal—with an average value under $20—are up to twice as likely to prescribe the brand-name drug being promoted.

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Women Underperformed Men in High Level Critical Thinking Examinations

MedicalResearch.com Interview with:

Sara E. Brownell PhD School of Life Sciences Arizona State University Tempe, AZ

Dr. Sara Brownell

Sara E. Brownell PhD
School of Life Sciences
Arizona State University
Tempe, AZ

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Brownell: Our group has been broadly interested in gender biases in introductory biology
since we published a study that showed that women underperform on course
exams and under participate in whole class discussions compared to men
(http://www.lifescied.org/content/13/3/478.full). We were curious why women
might be under performing on these course exams so in this new study, we
examined characteristics of the exams to see if that had an impact. What we
found was that women and men perform equally on questions that test basic
memorization. However, when questions tested more higher-level critical
thinking skills, women were not scoring as high as men. This happened even
when we took into account the academic ability of the students – women and men
who had the same ability coming into the class. We also found that students
from lower socioeconomic statuses also underperformed on these higher-level
critical thinking questions compared to students from higher socioeconomic
statuses, again even when we took into account academic ability.
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Polygenetic Score Linked To Educational Attainment

MedicalResearch.com Interview with:

Dr. Daniel J. Benjamin PhD Associate Professor (Research), USC, 2015-present Associate Professor (with tenure), Cornell, 2013-2015 Assistant Professor, Cornell University, 2007-2013 Research Associate, NBER, 2013-present Faculty Research Fellow, NBER, 2009-2013

Dr-Daniel Benjamin

Dr. Daniel J. Benjamin PhD
Associate Professor (Research), USC, 2015-present
Associate Professor (with tenure), Cornell, 2013-2015
Assistant Professor, Cornell University, 2007-2013
Research Associate, NBER, 2013-present
Faculty Research Fellow, NBER, 2009-2013 

MedicalResearch.com: What is the background for this study?

Dr. Benjamin: Educational attainment is primarily determined by environmental factors, but decades of twin and family studies have found that genetic factors also play a role, accounting for at least 20% of variation in educational attainment across individuals. This finding implies that there are genetic variants associated statistically with more educational attainment (people who carry these variants will tend on average to complete more formal education) and genetic variants associated statistically with less educational attainment (people who carry these variants will tend on average to complete less formal education). But none of these genetic variants had been identified until our 2013 paper on educational attainment. That paper, which studied a sample of roughly 100,000 individuals, identified 3 genetic variants associated with educational attainment, each of which has a very small effect. In the current paper, we expanded our sample to roughly 300,000 individuals, with the goal of learning much more about the genetic factors correlated with educational attainment.

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All Preterm Children At Risk of Emotional and Behavioral Problems Upon School Entry

MedicalResearch.com Interview with:
Jorijn Hornman, BSc (MD PhD student)
Departments of Health Sciences
University Medical Center Groningen
University of Groningen, Netherlands

MedicalResearch.com: What is the background for this study?

Response: Preterm children are at increased risk of emotional and behavioral problems compared to full-term children. Prevalences vary with degree of prematurity and assessment age. Unknown was whether stability of these problems upon school entry differs between preterm and full-term children.

MedicalResearch.com: What are the main findings?

Response: We found that preterm children had higher rates than full-term children of persistent (7.2% versus 3.6%), emerging (4.3% versus 2.3%), and resolving (7.5% versus 3.6%) emotional and behavioral problems. Early preterm children –born at <32 weeks gestation- had the highest rates of persistent (8.2%) and emerging (5.2%) problems, and moderately preterm children –born at 32-35 weeks gestation- the highest rates of resolving problems (8.7%).

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Epidemic of Burnout Among Physicians, Especially Surgeons, Is Increasing

MedicalResearch.com Interview with:

Francesca M Dimou, MD Research Fellow University of Texas Medical Branch Galveston, TX

Dr. Francesca Dimou

Francesca M Dimou, MD
Research Fellow University of Texas Medical Branch
Galveston, TX

MedicalResearch.com: What is the background for this study?

Dr. Dimou: Burnout is a syndrome defined by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Over the past decade the problem of physician and surgeon burnout has come to the forefront. The demands on physicians at academic healthcare institutions are expanding rapidly and include increasing regulation, increased demands on clinical productivity, difficulty funding research efforts, medicolegal liability, inefficient systems, loss of autonomy, rising student debt, and difficulty balancing professional and personal lives. This challenges the wellbeing of everyone in the organization, including the physicians and the patients they treat.

MedicalResearch.com: What are the main findings?

Dr. Dimou: Our systematic review identified a significant number of studies reporting on surgeon burnout with rates exceeding 50% in some surgical specialties. Even more striking, is that the incidence of burnout among surgeons is increasing steadily and the consequences of burnout impact all aspects of their professional and personal lives. Review of the literature demonstrates that surgeons meeting criteria for burnout had an increased probability of committing and reporting medical errors, increased depression, and increased suicidal ideation. Most importantly, despite the strong data highlighting that magnitude, acuity, and consequences of the burnout problem, we could not find definitive, reproducible intervention programs for surgeons dealing with burnout, nor could we identify prevention programs.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Dimou:    The epidemic of burnout among physicians, and surgeons in particular is increasing. The unique surgical culture adds additional challenges. Surgeons are perfectly capable of “running on empty”, continuing to see patients and meet other expectations long after they are completely drained and exhausted. In fact, their ability to do this is a core component of their medical education and training. The surgical environment is one that discourages “weakness”; it is an environment that teaches surgeons to feel guilty if they take care of themselves. There are many system and culture issues in surgery and medicine that need to be addressed. The article highlights the need to design interventions to both help physicians who are already burned out as well as develop interventions to improve physician wellbeing at the individual level while working to make needed changes in the system as a whole.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Dimou:    Research has already significantly raised awareness around burnout and its consequences. The next step is to identify intervention and prevention programs for physicians to promote physician wellbeing and resiliency – teaching surgeons to respond to their stressful environment in a way that promotes their wellbeing. Several programs throughout the country are beginning to promote physician wellbeing, such as the Balance in Life Program at Stanford and the Physician Well-being Program at Mayo Clinic. Such programs need to be designed and studied systematically to identify effective, reproducible, and scalable interventions to allow for widespread adoptability.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Dimou:    A career in surgery can be an unparalleled privilege. Being a surgeon truly gives you the ability to change someone’s life and a surgical career will always require time, hard work, and sacrifices; we teach surgeons to operate and teach them to take care of patients, but we don’t teach them to respond to their environment effectively. The ramifications of continuing on the current path are potentially profound. If we do not change the system and create a surgical culture that promotes wellbeing we are at the risk of losing not only our current surgeon workforce, but also the best and brightest of the next generation. Systematic efforts to improve physician wellbeing at the individual level and change surgical culture to support this change are essential. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Surgeon Burnout: A Systematic Review
Dimou, Francesca M. et al.
Journal of the American College of Surgeons , Volume 0 , Issue 0 ,
Published Online:March 25, 2016

DOI: http://dx.doi.org/10.1016/j.jamcollsurg.2016.03.022

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

 

 

 

Video Interaction Project Improved School Readiness In Impoverished Children

MedicalResearch.com Interview with:

Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health

Dr. Alan Mendelsohn

Alan Mendelsohn, MD
Associate professor, Departments of Pediatrics and Population Health

Adriana Weisleder, PhD

Adriana Weisleder, PhD Research scientist, Department of Pediatrics NYU Langone Medical Center

Dr. Adriana Weislander

Research scientist,
Department of Pediatrics
NYU Langone Medical Center

Medical Research: What is the background for this study? What are the main findings?

Response: In the last decade, scientists have begun to understand the mechanisms by which poverty can cause changes in brain development that can lead to higher rates of behavior problems and lower educational achievement for disadvantaged children. This study shows that pediatric-based programs that promote reading aloud and play can help prevent these problems before they arise.

The Video Interaction Project (VIP) – the main program studied in the research – takes place at regular pediatric check-ups starting at birth. A trained parenting coach meets with the family at each visit and records the parent and child playing and reading together with materials provided by the program. The coach then reviews the video with the parent to identify and reinforce positive interactions and encourage strong parent-child relationships. The second intervention program, Building Blocks, is a lower-intensity option in which families receive parenting pamphlets and learning materials monthly by mail to facilitate reaching specific developmental goals.

The results of the three-year randomized-controlled trial showed notable benefits for children’s social and emotional development. Children of families who participated in the Video Interaction Project had better attention and play skills as toddlers and reduced hyperactivity and aggression at three years, compared to children in a control group. For the highest risk families, hyperactivity was reduced by more than half.  These findings are important because a child’s ability to control or regulate his or her behavior is a critical factor in their learning and success at school.

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Focus Groups Help Develop Patient-Centered Decision Support For Stroke Patients and Caregivers

MedicalResearch.com Interview with:
Carole Decker, RN, PhD, CPHQ, FAHA

Director, Cardiovascular Outcomes Research
Saint Luke’s Mid America Heart Institute
Kansas City, MO 64111

Medical Research: What is the background for this study? What are the main findings?

Dr. Decker: Stroke is the leading cause of disability and the fifth leading cause of death. The utilization of thrombolytic therapy is the national standard of care for acute ischemic stroke (AIS) treatment resulting in improved outcomes at 90 days and yet only 7% of patients with AIS receive a thrombolytic. The American College of Emergency Physicians emphasizes the importance of using a shared medical decision-making model with AIS patients and their caregivers to discuss benefits and risks of treatment. The recommended door-to-needle (emergency door to thrombolytic administration) is 60 minutes to achieve the optimal patient outcomes which can be problematic in that conversation on benefits and risks occurs in a hurried emergency setting.

Multiple risk models to identify individualized benefits and risks of thrombolytic therapy have been developed but few are used prospectively and are not used at the point of care. Our team created ePRISM (Personalized Risk Information Services Manager), a Web-based tool, to generate personalized documents with patient-specific outcomes based on validated risks models. To support knowledge transfer and creation of a shared decision-making tool, our multidisciplinary team conducted qualitative interviews to define the information needs and preferred presentation format for stroke survivors, caregivers, and clinicians considering thrombolytic treatment.

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Training Physicians To Provide High-Value Cost-Conscious Health Care

Lorette A. Stammen, MD Department of Educational Development and Research Faculty of Health, Medicine, and Life Sciences Maastricht University, Maastricht The Netherlands

Dr. Stammen

MedicalResearch.com Interview with:
Lorette A. Stammen, MD
Department of Educational Development and Research
Faculty of Health, Medicine, and Life Sciences
Maastricht University, Maastricht
The Netherlands

Medical Research: What is the background for this study? What are the main findings?
Dr. Stammen: Research indicated that we can improve the quality of care and reduce the health care costs by eliminating health care waste. Health care waste are health care services that are not beneficial to patients. There are many ways to reduce health care waste, like through insurance and government policies modification,  but we were especially interested in how the medical expertise of physicians could improve high-value, cost-conscious care. We conducted a systematic review with the aim of understanding how training programs cause learning among physicians, residents and medical students. We analyzed 79 articles using realist review method and found three important factors that facilitate the learning of physicians (in training).

  • First, educational programs should focus on knowledge transmission. Knowledge that is essential entails knowledge regarding prices and general health economics, scientific evidence, and patient preferences.
  • Besides knowledge, the second factor of training for high-value, cost-conscious care is reflective practice. Reflective practice for example using feedback and asking reflective questions, by peers, colleagues and supervisors to reflect on decisions made in daily practice.
  • The third element of training programs should address an supportive environment in which physicians, residents and medical students learn. A supportive environment is important to cultivate the importance of high-value, cost-conscious care on multiple levels in the health care system. Since physicians are a part of a health care team their training programs should incorporate the training of health care professionals.
  • Furthermore, it is important that role models demonstrate high-value cost-conscious care.

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Relatively Few Women Physicians Choose Cardiology as Career

Pamela S. Douglas, MD, MACC, FASE, FAHA Ursula Geller Professor of Research in Cardiovascular Disease Duke University School of Medicine

Dr. Douglas

MedicalResearch.com Interview with:
Pamela S. Douglas, MD, MACC, FASE, FAHA

Ursula Geller Professor of Research in Cardiovascular Disease
Duke University School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Douglas: The impetus for our study was the concern that cardiology as a profession might be enhanced by greater diversity. By not attracting women in larger numbers (9% of FACCs are female), our fellowships have incomplete access to the talent pool of outstanding residents, and we do not have a diverse group of clinicians to care for our increasingly diverse patient population, or of researchers to explore potentially important health care disparities.

Our findings were twofold: first, job descriptions for men and women cardiologists are dramatically different. Men are much more likely to do invasive procedures while women are more likely to see patients and perform imaging/noninvasive tests.  While there were slightly more women working part time than men this was still rare, and the difference in number of days worked was just 6, across an entire year.

The second finding was that there was a significant difference in compensation. Unadjusted, this was over $110, 000 per year; after very robust adjustment using over 100  personal, practice, job description and productivity measures, the difference was $37, 000 per year, or over a million dollars across a career. A separate independent economic analysis of wage differentials yield a similar difference of $32,000 per year.

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Breast Radiologist Discusses Screening Mammography Public Education

Jiyon Lee, M.D. Assistant Professor of Radiology, NYU School of Medicine NYU Cancer Institute, Breast Imaging Center New York, New York 10016

Dr. Lee

MedicalResearch.com Interview with:
Jiyon Lee, M.D.
Assistant Professor of Radiology, NYU School of Medicine
NYU Cancer Institute, Breast Imaging Center
New York, New York 10016

Medical Research: What is the background for this study? What are the main findings?
Dr. Lee:   Even before the USPSTF changed their breast screening guidelines in 2009, I conducted community outreach to help educate others on my area of expertise, breast imaging and breast screening. I presented lay friendly, illustrated, and practical explanations in a structured talk, about the big picture and the salient details, in a way that I would want if I were not a breast radiologist. As is customary for such community outreach, we solicited feedback from attendees. It was gratifying to hear the positive responses. That they wished for such education for others served as a clarion call that is understandable. Education should be objective and noncoercive.  “Knowledge is power,” but only if complete and accurate.

Breast cancer is still a common disease, we are all at least at average risk, and screening is still standard of care.  Much of the debate surrounding screening mammography centers on the age of onset of screening and the optimal screening interval. The USPSTF states that shared-decision making between women and their providers may occur, especially for women in 40-49 year group.  But the TF does not stipulate when or how or by whom this talk will ensue, and notice that their guidelines refer to film mammography, and “biennial” mammography.

Since the time of this manuscript, the American Cancer Society issued new guidelines on 10/20/2015 that among its bullet points emphasized annual mammography for women 45-54 years and deemphasized clinical breast exam, while supporting option to start annually at age 40 with shared decision making to weigh what are referred to as “risks” and benefits. Although the fine print does reaffirm that annually starting at age 40 is the screening model that saves the most lives, the ACS is encouraging deliberate value judgment regarding “risks” and “harms.” Their fine print is also intimating that women 55 and over have nondense tissue and that their cancers are indolent. The ensued publicity and mixed messaging have caused another cycle of confusion regarding breast cancer screening. As the experts in this field of image-based screening, radiologists have opportunity to clarify and contextualize the issues and details of the screening discussion, and can do so with objectivity, respect for all sides of the debate, and compassion. All responsible ways to continually educate both women and all providers will enable both sides to engage in the discussion fairly. Because as we discourage paternalistic medicine and promote shared decision making, it’s not fair play if all responsible sides do not get fair say. Do realize that not all women see providers regularly, and depending on the medical subspeciality, not all providers are mentioning screening til women reach a certain age and may not relay importance of the physical exam components that complement imaging.

This article specifically highlights how such direct and interactive public education can effect potential benefit in two ways.

  • First, directly reduce one of the core criticisms about screening: the “anxiety” that women may experience, which is heavily weighed as a “harm” of screening.  Most women do not experience high anxiety, and are glad to have a test that may help them. And education can help demystify much of the process and protocol, and explain up to what may be that patient’s next test results if she engages in screening at all. No one can tell that.
  • Two, education can directly increase one of the necessary components of shared decision making that is presumed in implementing breast screening: informing women. The pre- and post-lecture questionnaire, along with fact-based quiz questions, provided insight and enabled learning opportunity for the audience that are not usual for community outreach.  Education that keeps on going—and is shareable!– after the lecture is done.

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Superlative Terms May Be Overused When Describing Cancer Drugs

Vinay Prasad, MD MPH Assistant Professor of Medicine Division of Hematology Oncology in the Knight Cancer Institute Department of Public Health and Preventive Medicine Senior Scholar in the Center for Health Care Ethics Oregon Health and Sciences University Portland, Oregon 97239

Dr. Prasad

MedicalResearch.com Interview with:
Vinay Prasad, MD MPH
Assistant Professor of Medicine
Division of Hematology Oncology in the Knight Cancer Institute
Department of Public Health and Preventive Medicine
Senior Scholar in the Center for Health Care Ethics
Oregon Health and Sciences University
Portland, Oregon 97239

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Prasad: We wanted to get some information about when and which cancer drugs were called “game changer” or “breakthrough” or “revolutionary”.  What we found was surprising.  The use of these grandiose terms, or superlatives, was common in news articles.  They occurred across many classes of medication, were used for approved and unapproved drugs, and some of the use was questionable.

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Internet Can Deliver Valuable Information To Melanoma Patients

Ashley K. Day, Ph.D., M. Psych (Hlth) Post-Doctoral Associate Rutgers Cancer Institute of New JerseyMedicalResearch.com Interview with:
Ashley K. Day, Ph.D., M. Psych (Hlth)
Post-Doctoral Associate
Rutgers Cancer Institute of New Jersey

Medical Research: What is the background for this study? What are the main findings?

Dr. Day: Skin cancer is one of the most common cancers in the US, and it is estimated that more than 9,000 Americans will die of melanoma this year. Melanoma patients have a 9-times greater risk for a diagnosis of another melanoma compared to the general population. Because of this, it is important that melanoma patients practice regular sun protection and skin self-examination behaviors. There is potential opportunity to use the Internet to deliver information and interventions to help melanoma patients engage in these behaviors. However, it is important to understand patients’ preferences. Our research explored factors associated with the receptivity of patients with melanoma to such Internet-delivered behavioral interventions.

We found that, in a sample of 176 melanoma patients, the vast majority (84.1%) had Internet access and had previously sought melanoma information online (77.7%). More than two-thirds of patients (68.4%) reported being at least moderately interested in participating in an Internet-based intervention to promote engagement in sun protection and skin self-examination behaviors. Receptivity to such an intervention was higher among patients who were younger, had greater knowledge of the ABCDE signs of melanoma (looking at the asymmetry, border irregularity, color, diameter, and evolution of the mole or affected area), and were more comfortable using the Internet.

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Polygenetic Score Predicts Educational Attainment

Ben Domingue Assistant Professor (starting 9/2015) Stanford Graduate School of Education

 

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.

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Residents Participation In Neurosurgery Did Not 30-Day Outcomes

Judy Huang, M.D. Professor of Neurosurgery Program Director, Neurosurgery Residency Program Fellowship Director, Cerebrovascular Neurosurgery Johns Hopkins HospitalMedicalResearch.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.

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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.

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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, MarylandMedicalResearch.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.

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Hispanic and Uninsured Adults May Experience Barriers To Blood Pressure Control

Stella Yi, Ph.D., MPH, Assistant Professor Department of Population Health New York University School of MedicineMedicalResearch.com Interview with:
Stella Yi, Ph.D., MPH, Assistant Professor
Department of Population Health
New York University School of Medicine

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Yi: Self-blood pressure monitoring has been shown to be an effective tool for improving blood pressure control, however most studies have only included white race participants. We were interested in assessing whether distribution of self-blood pressure monitors (intervention) would improve blood pressure and hypertension control over usual care (control) in a 9-month period in a predominantly Hispanic, uninsured population. Systolic blood pressure improved over time in both the intervention (n=409) and the control (n=419) arms by 14.7 mm Hg and 14.1 mm Hg, respectively, as did hypertension control; 39% of study participants overall achieved control at the end of follow-up. However there were no statistical differences between the outcomes in the intervention and usual care groups. Continue reading

New and Experienced Surgeons Have Similar Patient Mortality Rates

Samuel D. Pimentel Doctoral student Statistics Department Wharton School of the University of PennsylvaniaMedicalResearch.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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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.

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Working In Pairs Improved Medical Students’ Diagnostic Accuracy

Dr. Juliane Kämmer  Postdoctoral Researcher on behalf of the authors Max Planck Institute for Human Development Center for Adaptive Rationality  Berlin GermanyMedicalResearch.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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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.

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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.

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