Neurology Residents Learn to Identify Physician Burnout Through Simulation

MedicalResearch.com Interview with:
Dr. Rebecca Stainman
Dr. Arielle Kurzweil MD
Adult Neurology Program Director
New York University School of Medicine
NYU Langone Health

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

Response: Physician burnout is prevalent. Neurologists have among the highest burnout rates, ranked third among specialties in a 2011 study, and over half of US Neurologists report at least 1 symptom of burnout in a 2016 survey.  Efforts to address burnout in training programs have mostly been aimed at implementing wellness curricula and offering mental health resources.

Training neurology residents to effectively identify, address, and help impaired colleagues is equally crucial in these efforts, yet there is a paucity of literature on this topic. We used simulation as a means of addressing this topic, via identifying and addressing an impaired colleague through an objective structured clinical examination (OSCE).  Continue reading

Most Diabetes Apps Do Not Provide Real Time Decision Support (yet)

MedicalResearch.com Interview with:

Associate Professor Josip CarMD, PhD, DIC, MSc, FFPH, FRCP (Edin)​Associate Professor of Health Services Outcomes Research,​Director, Health Services Outcomes Research Programme and DirectorCentre for Population Health SciencesPrincipal Investigator, Population Health & Living Laboratory

Prof. Car

Associate Professor Josip Car
MD, PhD, DIC, MSc, FFPH, FRCP (Edin)​
Associate Professor of Health Services Outcomes Research,​
Director, Health Services Outcomes Research Programme and Director
Centre for Population Health Sciences
Principal Investigator, Population Health & Living Laboratory 

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

Response: In 2018, almost 8% of people with diabetes who owned a smartphone used a diabetes app to support self-management. Currently, most apps are not regulated by the US Food and Drug Administration (FDA). We downloaded and assessed 371 diabetes self-management apps, to see if they provided evidence-based decision support and patient education.  Continue reading

Brain Training Can Strengthen Cognitive Function in Patients With Mild Impairment

MedicalResearch.com Interview with:

Dr. Sandra Bond Chapman PhDFounder and Chief Director, Center for BrainHealth,Co-Leader, The BrainHealth ProjectUniversity of Texas, Dallas

Dr. Chapman

Dr. Sandra Bond Chapman PhD
Founder and Chief Director, Center for BrainHealth,
Co-Leader, The BrainHealth Project
University of Texas, Dallas

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

Response: Finding effective treatments to reverse or slow rates of cognitive decline for those at risk for developing dementia is one of the most important and urgent challenges of the 21st century.

Brain stimulation is gaining attention as a viable intervention to increase neuroplasticity when used in isolation or when combined with cognitive training regimens. Given the growing evidence that certain cognitive training protocols, such as SMART, benefit people with Mild Cognitive Impairment (MCI), a population that is vulnerable to Alzheimer’s disease, we were interested in exploring whether we could further increase the gains from cognitive training (i.e., SMART) when the training was preceded by brain stimulation using tDCS.  Continue reading

Changes in Medicare’s Hospital Readmissions Reduction Program Affect Poor and Low Poverty Hospitals Differently

MedicalResearch.com Interview with:

Karen Joynt Maddox, MD, MPHAssistant Professor of MedicineWashington University Brown School of Social Work

Dr. Joynt Maddox

Karen Joynt Maddox, MD, MPH
Assistant Professor of Medicine
Washington University Brown School of Social Work 

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

Response: Medicare’s Hospital Readmissions Reduction Program has been controversial, in part because until 2019 it did not take social risk into account when judging hospitals’ performance. In the 21st Century Cures Act, Congress required that CMS change the program to judge hospitals only against other hospitals in their “peer group” based on the proportion of their patients who are poor. As a result, starting with fiscal year 2019, the HRRP divides hospitals into five peer groups and then assesses performance and assigns penalties.  Continue reading

Home Responsibilities Encourage Physician Mothers in Procedural Specialties To Consider Career Change

MedicalResearch.com Interview with:

Nelya Melnitchouk, MD,MScDirector, Program in Peritoneal Surface Malignancy, HIPECDr. Melnitchouk is an associate surgeon at Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) and instructor of surgery at Harvard Medical Schoo

Dr. Melnitchouk

Nelya Melnitchouk, MD,MSc
Director, Program in Peritoneal Surface Malignancy, HIPEC
Dr. Melnitchouk is an associate surgeon at Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) and
instructor of surgery at Harvard Medical School.

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

Response: Current literature on women in surgery show that female physicians, particularly those in procedural specialties, face many challenges in balancing responsibilities between work and home. We hypothesized that these challenges may affect career satisfaction more negatively for physician mothers in procedural specialties than those in nonprocedural specialties.

In our study, we found that physician mothers in procedural specialties who had more domestic responsibilities were more likely to report a desire to change careers than those in nonprocedural specialties.  Continue reading

Stress from Traumatic Events Linked to Increased Risk of Heart Disease

MedicalResearch.com Interview with:

Huan Song Associated Department of Medical Epidemiology and Biostatistics Karolinska Institutet

Huan Song

Huan Song, PhD
Center of Public Health Sciences, Faculty of Medicine,
University of Iceland, Reykjavík, Iceland
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet, Stockholm, Sweden

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

Response: Cardiovascular disease (CVD) presents a group of diseases that are common and sometimes fatal in general population. The possible role of stress-related disorders in the development of CVD has been reported. However, the main body of the preceding evidence was derived from male samples (veterans or active-duty military personnel) focusing mainly on posttraumatic stress disorder (PTSD) or self-reported PTSD symptoms. Data on the role of stress-related disorders in CVD in women were, until now, limited. Although incomplete control for familial factors and co-occurring psychiatric disorder, as well as the sample size restriction, limit the solid inference on this association, especially for subtypes of CVD.

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Waivers to Allow PAs and NPs to Prescribe Buprenorphine Vary by State

MedicalResearch.com Interview with:

Joanne Spetz, PhDProfessorPhilip R. Lee Institute for Health Policy StudiesSan Francisco, CA 94143-0936

Dr. Spetz

Joanne Spetz, PhD
Professor
Philip R. Lee Institute for Health Policy Studies
San Francisco, CA 94143-0936 

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

Response: Medication treatment is an important component of treatment for opioid use disorder. Buprenorphine has been the focus of policies designed to increase access to treatment and is the most widely-used medication due to well-established evidence of its efficacy and its accessibility outside licensed narcotics treatment programs. The most common brand name for this medication is Suboxone.

There is a shortage of providers authorized to prescribe it, in part because only physicians were permitted to obtain waivers from the Drug Enforcement Agency to prescribe it outside of licensed narcotics treatment programs until the opioid bill of 2016. That bill granted nurse practitioners (NPs) and physician assistants (PAs) the ability to apply for waivers. However, in states that require NPs and/or PAs to be supervised by or collaborate with a physician, there are additional requirements regarding the training of the physician before the NP or PA can apply for a waiver. This affects nearly half of states for NPs, and all states for PAs.

We found that the average percentage of NPs with waivers was 5.6% in states that do not require physician supervision, but only 2.4% in more restrictive states. Even after adjusting for other factors, we found that the percentage of NPs with waivers was 75% higher when physician oversight is not required. We didn’t find a similar result for PAs, probably because they must have physician oversight in all states.  Continue reading

Shorter Individuals at Greater Risk of Heart Disease

MedicalResearch.com Interview with:

Eirini MarouliWilliam Harvey Research InstituteBarts and The London School of Medicine and Dentistry, Queen Mary University of London, London

Eirini Marouli

Eirini Marouli
William Harvey Research Institute
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London

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

Response: Epidemiological studies suggest that shorter stature is associated with increased risk of coronary artery disease (CAD) or type 2 diabetes (T2D). It is not clear though whether these associations are causal or there are other factors mediating these effects. When randomized trials are inappropriate or impossible, we can use Mendelian Randomisation as a good alternative to study the causal relationship between a trait and a disease. Here, we examined over 800 places in the human genome known to be associated with adult height and evaluated how genetically predicted height can affect the risk of CAD or T2D. Furthermore, we evaluated the role of several risk factors including, cholesterol, triglycerides, blood pressure, body mass index, fat percentage, socio-economic parameters including education and income as well as lung function. Lung function was assessed by spirometry measures including FEV1: forced expiratory volume in 1 second, FVC: forced vital capacity.

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Cancer Drug Trials: Does Changing the Endpoint from Overall Survival Hasten the Approval Process?

MedicalResearch.com Interview with:

Emerson Chen, MDChief Fellow, Hematology-Oncology, PGY-6Oregon Health & Science University

Dr. Chen

Emerson Chen, MD
Chief Fellow, Hematology-Oncology, PGY-6
Oregon Health & Science University

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

Response: Many cancer drugs are approved annually giving the appearance of innovation; however, some drugs may have been approved because of a lower bar. Use of lesser endpoints like response rate (how tumor shrinks) and progression-free survival (how tumor has delayed growth) have been proposed to speed trials when compared against traditional endpoints like overall survival (how long patients might live).

Using published trials that led to cancer drug approval from 2006 to 2017, we estimated how long it would take to get each of these three endpoints across all cancer drugs and indications to see how much time we could save by using these weaker but faster endpoints.

We see that many trials using overall survival used less time than anticipated, and many trials using response rate or progression-free survival actually took quite a bit of time.  In part that is due to researchers needing to document the duration of the response. But, whatever the reason, the time to get each of the three endpoints is actually more similar than different, and we estimate that our current use of  these faster endpoints are saving us only 11 months compared to using only overall survival.

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Cancer Patients Use THC and CBD Differently Than Other Medical Marijuana Patients

MedicalResearch.com Interview with:

Arum Kim, MDAssistant professor of Medicine and Rehabilitation MedicineNYU School of MedicineDirector of the Supportive Oncology ProgramPerlmutter Cancer Center

Dr. Kim

Arum Kim, MD
Assistant Professor
Medicine and Rehabilitation Medicine
NYU School of Medicine
Director of the Supportive Oncology Program
Perlmutter Cancer Center

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

Response: There is increasing interest in medical marijuana and its applications for patients with cancers. Despite increasing access, little is known regarding doses of cannabinoids – specifically tetrahydrocannabinol (THC)  and cannabidiol (CBD), methods of drug delivery, and differences in patterns of use between cancer and non-cancer patients.

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Tooth Loss Linked To Greater Risk of Pancreatic Cancer Among African American Women

MedicalResearch.com Interview with:

Dr. Julie Palmer

Dr. Palmer

Julie R. Palmer, ScD
Professor, Boston University School of Medicine
Associate Director, Slone Epidemiology Center at Boston University
Boston, MA 02118 

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

Response: Since 1995, 59,000 African American women from all regions of the U.S. have participated in a Boston University research study of the health of Black women.  Study participants complete mailed or online questionnaires every two years.

Our major goal is to identify modifiable risk factors for cancers and nonmalignant conditions that disproportionately affect African Americans (e.g., pancreatic cancer, early-onset breast cancer, type 2 diabetes, uterine fibroids).  The reasons for the higher incidence of pancreatic cancer in African Americans relative to non-Hispanic White women in the U.S. are unknown.

I was aware that several recent studies in predominantly White populations had observed a higher incidence of pancreatic cancer in those who had reported poor oral health and wondered whether the higher prevalence of poor oral health among African Americans could play a role in their higher incidence of pancreatic cancer.  We had already asked about gum disease, periodontal disease, and adult tooth loss in several rounds of data collection.

After rigorous analysis, we found that women who reported any adult tooth loss had about two times the risk of future development of pancreatic cancer compared with those who had no tooth loss and had never reported periodontal disease.

The estimated risk was even greater for those who had lost five or more teeth. A similar association was observed for reports of periodontal disease, but the association was not statistically significant.

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Criminal and Socially Inappropriate Behaviors Could Be Signs of Dementia

MedicalResearch.com Interview with:

Dr. Madeleine Liljegren

Dr. Madeleine Liljegren
Photo: Ingemar Walldén

Madeleine Liljegren, MD
Division of Oncology and Pathology
Department of Clinical Sciences
Lund University Lund, Sweden

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

Response: We know from former studies including patients with a clinical diagnosis of dementia, that criminal and socially inappropriate behaviors can be signs of dementia, sometimes even the first signs of a neurodegenerative disorder.

We wanted to study this relatively large (n=220) cohort of neuropathologically verified Alzheimer disease (AD) and frontotemporal dementia (FTD) patients, who had been followed clinically by specialists in cognitive medicine or geriatric psychiatry during their disease period, to see if we could confirm results from previous studies.

In this paper, we further wanted to study potential differences regarding protein pathology and criminal behavior in frontotemporal dementia patients. This has, to our knowledge, never been done before.

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Gene Transfer Improved Cardiac Function in Diabetic Mouse Model

MedicalResearch.com Interview with:

H. Kirk Hammond, MDProfessor of Medicine at University of California, San DiegoBasic research scientist and cardiologistSan Diego Veterans' Affairs Healthcare System

Dr. Hammond

H. Kirk Hammond, MD
Professor of Medicine at University of California
San Diego
Basic research scientist and cardiologist
San Diego Veterans’ Affairs Healthcare System

Dr. Hammond is winner of the 2017 William S. Middleton Award – the highest research honor in the U.S. Department of Veterans Affairs 

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

Response: Worldwide, 9% of adults have diabetes, predominantly due to insulin resistance, known as Type 2 diabetes. It is associated with obesity and diets high in fat and carbohydrates. In this gene transfer study we showed that a single injection of a vector encoding a natural hormone (urocortin 2, Ucn2) increased glucose disposal and improved heart function in a model of diet-induced Type 2 diabetes in mice. 

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Predicting Death is Difficult, Making it Difficult To Save Money on End of Life Care

MedicalResearch.com Interview with:

Amy Finkelstein PhD John & Jennie S. MacDonald Professor of Economics MIT Department of Economics National Bureau of Economic Research Cambridge MA 02139 

Dr. Finkelstein

Amy Finkelstein PhD
John & Jennie S. MacDonald Professor of Economics
MIT Department of Economics
National Bureau of Economic Research
Cambridge MA 02139 

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

Response: Although only 5% of Medicare beneficiaries die in a given year, they account for almost 25% of Medciare spending.

This fact about high end of life spending has been constantly used to refer to inefficiency of the US healthcare system. A natural observation is that the fact is retrospective, and it motivated us to explore a prospective analog, which would take as an input the probability of someone dying in a given year rather than her realized outcome. We therefore used machine learning techniques to predict death, and somewhat to our surprise we found that at least using standardized and detailed claims-level data, predicting death is difficult, and there are only a tiny fraction of Medicare beneficiaries for whom we can predict death (within a year) with near certainty.

Those who end up dying are obviously sicker, and our study finds that up to half of the higher spending on those who die could be attributed to the fact that those who die are sicker and sick individuals are associated with higher spending.   Continue reading

Is More Supervision of Medical Residents Always Better for Patient Care?

MedicalResearch.com Interview with:
Kathleen M. Finn MD, MPhil
Christiana Iyasere MD, MBA
Division of General Internal Medicine
Department of Medicine
Massachusetts General Hospital, Boston

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

Response: While the relationship between resident work hours and patient safety has been extensively studied, little research evaluates the role of attending supervision on patient safety. Beginning with the Bell Commission there have been increased calls for enhanced resident supervision due to patient safety concerns. At the same time, with the growth of the hospitalist movement more faculty physicians join daily resident work rounds under the assumption that increased supervision is better for patient safety and resident education. However, we know that supervision is a complex balancing act, so we wanted to study whether these assumptions were true. On the one hand patient safety is important, but on the other adult learning theory argues residents need to be challenged to work beyond their comfort level. Importantly, being pushed beyond your comfort level often requires appropriate space between teacher and learner. To investigate the role of attending supervision on patient safety and resident learning we studied the impact of two levels of physician supervision on an inpatient general medical team.

Twenty-two teaching faculty were randomized to either direct supervision of resident teams for patients previously known to the team vs usual care where they did not join rounds but rather discussed the patients later with the team. Faculty participated in both arms of the study, after completing the first arm they then crossed over to the other arm; each faculty member participated in the study for a total of 4 weeks.

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Female Residents Do Not Perceive Cardiology As Conducive To Work-Family Balance

MedicalResearch.com Interview with:

Pamela S. Douglas, MD, MACC, FASE, FAHA Ursula Geller Professor of Research in Cardiovascular Disease Duke University School of Medicine  Durham, NC 27715   

Dr. Douglas

Pamela S. Douglas, MD, MACC, FASE, FAHA
Ursula Geller Professor of Research in Cardiovascular Disease
Duke University School of Medicine
Durham, NC 27715    

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

Response: For any profession to succeed, it needs to attract top talent. We surveyed internal medicine residents to find out what they valued most in their professional development, how they perceived cardiology as field and how these two areas are associated with  their choosing a career in cardiology or another specialty.

We found that trainees were seeking careers that had stable hours, were family friendly and female friendly, while they perceived cardiology to  have adverse work conditions, interfere with family life and to not be diverse. We were able to predict career choice with 89-97% accuracy from these responses; the predictors are mix of things that attract to cardiology and those that are deterrents.

For men, the attractors outnumber the deterrents, for women its just the opposite.

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Male Physicians Receive More Money From Industry Than Women Doctors

MedicalResearch.com Interview with:
“Doctors” by Tele Jane is licensed under CC BY 2.0
Kathryn R. Tringale, MAS
Department of Radiation Medicine and Applied Sciences
University of California San Diego, La Jolla

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

Response: Financial relationships between biomedical industry and physicians are common, and previous work has investigated the potential conflicts of interest that can arise from these interactions.

Data show that even small payments in the form of industry sponsored lunches can influence physician prescribing patterns. Given the concern for the potential influence of biomedical industry over practice patterns and potentially patient care, the Open Payments program was implemented under the Affordable Care Act to shed light on these interactions and make reports of these financial transactions publicly available. We recently published a paper in JAMA on industry payments to physicians that found that men received a higher value and greater number of payments than women physicians and were more likely to receive royalty or licensing payments when grouped by type of specialty (surgeons, primary care, specialists, interventionalists).

The purpose of the Research Letter discussed here was to further examine differences in the value of payments received by male and female physicians within each individual specialty. The main takeaway from this study is that male physicians, across almost every specialty, are receive more money from biomedical industry compared to female physicians. At first glance, this finding can be interpreted as merely another example of gender disparities in the workplace, which we have seen before with gender gaps in physician salaries and research funding. Indeed, this gender gap may be a product of industry bias leading to unequal opportunity for women to engage in these profitable relationships. Alternatively, these data may be more representative of gender differences in physician decision-making. Previous data has shown that industry engagement can lead to changes in practice patterns, so maybe female physicians acknowledge these conflicts of interest and actively choose not to engage with industry. Unfortunately, we cannot tease out these subtleties from our results, but our paper does reveal a remarkable gender difference among physician engagement with industry. With this being said, whether male or female, everyone needs a bit of help sometimes. The use of loans is a possibility for many people who need a little financial assistance. Regardless of whether men are getting paid a little more than women, they may all need help just as equally. The type of loans that would be worth looking into if this is your current situation is physician loans, which basically allows medical professionals to purchase a home with a low/little down payment while avoiding mortgage insurance. A little bit of help goes a long way, especially when it involves your future.

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Conflicts of Interest In Medical Guideline Committees Underreported

MedicalResearch.com Interview with:

Akilah Jefferson, MD, MSc Postdoctoral Fellow, Clinical Center, Department of Bioethics Clinical Fellow, Allergy and Immunology National Institute of Allergy and Infectious Diseases National Institutes of Health

Dr. Akilah Jefferson

Akilah Jefferson, MD, MSc
Postdoctoral Fellow, Clinical Center, Department of Bioethics
Clinical Fellow, Allergy and Immunology
National Institute of Allergy and Infectious Diseases
National Institutes of Health

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

Response: The guidelines that we looked at in this study were two that resulted in large paradigm shifts. Given their impact, we thought the question of conflicts of interest, which has been problematic among specialty societies in the past, be looked into.

We found that the levels of conflicts of interest among both guideline committees was problematic, and that conflict of interest disclosures often did not match contemporaneous conflict of interest disclosures in published articles.

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

Response: We want to highlight the need for broader and more explicit adoption of Institute of Medicine (IOM)  standards for conflict of interest management.

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

Response: We recommend further research into how specialty societies are adopting Institute of Medicine standards, and barriers to adoption. Some work has highlighted how some specialty societies are successfully avoiding conflicts of interest among their guideline writing groups.

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

Response: We hope that our study leads to positive discussions about this topic, and adoption of more standard and transparent methods of conflict of interest disclosure among specialty societies.

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

Citation:

Jefferson AA, Pearson SD. Conflict of Interest in Seminal Hepatitis C Virus and Cholesterol Management Guidelines. JAMA Intern Med. Published online January 17, 2017. doi:10.1001/jamainternmed.2016.8439

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

MILESTONE Ratings of Medical Residents Better Able To Distinguish Competence

MedicalResearch.com Interview with:

Karen E. Hauer, MD, PhD Associate Dean, Competency Assessment and Professional Standards Professor of Medicine, UCSF San Francisco, CA 94143

Dr. Karen Hauer

Karen E. Hauer, MD, PhD
Associate Dean, Competency Assessment and Professional Standards
Professor of Medicine, UCSF
San Francisco, CA  94143

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

Response: As part of the Accreditation Council for Graduate Medical Education (ACGME)’s Next Accreditation System, residency programs are now required to rate residents using the Milestones. Evidence of validity of Milestone ratings is needed to show whether this rating system measures meaningful aspects of residents’ practice.

In the field of internal medicine, we compared ratings of residents using the old evaluation form, the pre-2015 Resident Annual Evaluation Summary (RAES), which has a non-developmental rating scale that rates residents from unsatisfactory to superior on a 9-point scale, with developmental Milestone ratings. This was a cross-sectional study of all United States internal medicine residency programs in 2013-14, including 21,284 internal medicine residents. Milestone ratings are submitted by residency program directors working with Clinical Competency Committees. We correlated RAES and Milestone ratings by training year; correlated ratings of Medical Knowledge milestones using the two systems with American Board of Internal Medicine (ABIM) certification examination scores; and examined ratings of unprofessional behavior using the two systems.

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What Interventions Can Reduce Epidemic Physician Burnout?

MedicalResearch.com Interview with:

Colin P. West, MD, PhD, FACP  Divisions of General Internal Medicine and Biomedical Statistics and Informatics Departments of Internal Medicine and Health Sciences Research Mayo Clinic

Dr. Colin West

Colin P. West, MD, PhD, FACP
Divisions of General Internal Medicine and Biomedical Statistics and Informatics
Departments of Internal Medicine and Health Sciences Research
Mayo Clinic

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

Response: Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practicing physicians demonstrating burnout rates in excess of 50%. Consequences include negative effects on patient care, professionalism, physicians’ own care and safety, and the viability of health-care systems. We conducted a systematic review and meta-analysis to better understand the quality and outcomes of the literature on approaches to prevent and reduce burnout.

We identified 2617 articles, of which 15 randomized trials including 716 physicians and 37 cohort studies including 2914 physicians met inclusion criteria. Across interventions, overall burnout rates decreased from 54% to 44%, emotional exhaustion score decreased from 23.82 points to 21.17 points, and depersonalization score decreased from 9.05 to 8.41. High emotional exhaustion rates decreased from 38% to 24% and high depersonalization rates decreased from 38% to 34%.

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COPD: Benefits of high dose N-acetylcysteine

Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB Associate Consultant, Kwong Wah Hospital, Hong Kong Life member and Council member of Hong Kong Thoracic SocietyMedicalResearch.com Interview with:
Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB
Associate Consultant, Kwong Wah Hospital, Hong Kong
Life member and Council member of Hong Kong Thoracic Society

MedicalResearch: What are the main findings of the study?

Dr. Hoi Nam Tse: N-acetylcysteine (NAC) is an oral mucolytic containing anti-oxidative and anti-inflammatory property. Our study demonstrated that long term use of high-dose : N-acetylcysteine (600 mg twice daily for 1 year) was a well-tolerated treatment, and it reduced exacerbations and prolonged time to first exacerbation in ‘high-risk’ COPD patients–which was defined as patients who had 2 or more exacerbations per year, FEV1<50% or both. Such beneficial effect was not obvious in the ‘low-risk’ COPD patients.

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Pulmonary Embolism: Evaluation of Age-Adjusted Threshold of D-Dimer Blood Test

Scott C. Woller, MD Co-Director Thrombosis Program Intermountain Medical Center Associate Professor of Internal Medicine University of Utah School of Medicine Murray, UT 84157-7000MedicalResearch.com Interview with
Scott C. Woller, MD
Co-Director Thrombosis Program
Intermountain Medical Center
Associate Professor of Internal Medicine
University of Utah School of Medicine
Murray, UT 84157-7000

Dr. Woller: By way of background, D-dimer, a simple blood test that is used to investigate the diagnosis of suspected pulmonary embolism (PE), and it increases with age.  Recent research suggests that the use of an age-adjusted d-dimer threshold may improve diagnostic efficiency without compromising safety. We wished to assess the safety of using an age-adjusted d-dimer threshold in the work-up of patients with suspected pulmonary embolism.

MedicalResearch:  What are the main findings of the study?

Dr. Woller: In this retrospective cohort study we identified 923 patients age > 50 years who presented to our emergency department with suspected pulmonary embolism, and had their pretest probability of PE calculated along with a d-dimer performed. All patients underwent computed tomography pulmonary angiography (CTPA). We observed that among patients unlikely to have PE, adoption of an age-adjusted D-dimer cut-off (compared with a conventional D-dimer cut-off) reduced the need for CTPA in an additional 18.3% of patients, and was associated with a low 90-day rate of failure to diagnose PE.
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Male Circumcision: Rate of Adverse Events

Charbel El Bcheraoui, PhD, MSc Acting Assistant Professor, Global Health Institute for Health Metrics and Evaluation University of Washington Seattle, WA 98121MedicalResearch Interview with:
Charbel El Bcheraoui, PhD, MSc
Acting Assistant Professor, Global Health
Institute for Health Metrics and Evaluation
University of Washington
Seattle, WA 98121

MedicalResearch: What are the main findings of the study?

Dr. El Bcheraoui: We found a low rate of adverse events associated with male circumcision from U.S. hospital settings, especially if the procedure is performed within the first year of life. The rate of adverse events increased about 10 – 20 times if the procedure was performed later in life.
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Chronic Hepatitis C: Clinical Outcome Tool

Dr. Adriaan J van der Meer Department of Gastroenterology and Hepatology Erasmus MC, University Medical Center Rotterdam, The NetherlandsMedicalResearch.com Interview with:
Dr. Adriaan J van der Meer
Department of Gastroenterology and Hepatology
Erasmus MC, University Medical Center
Rotterdam, The Netherlands


MedicalResearch: What are the main findings of the study?

Dr. J van der Meer: The main finding of our study is that the prognosis of patients with compensated HCV-induced advanced liver disease can be adequately assessed by risk scores which merely include objective variables that are readily available in daily practice. Our analyses resulted in two separate prognostic scores by which the individual patient’s risk of mortality or clinical disease progression (defined as occurence of Hepatitis C Cirrhosis (HCC), liver failure, liver transplantation or death) can be assessed.
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