Affiliated Teaching Hospitals Research Articles

Should Obtaining Informed Consent Be Considered an Entrustable Professional Activity? Insights From Whether and How Attendings Entrust Surgical Trainees.

Because residents are frequently delegated the task of obtaining consent early in their training, the American Association of Medical Colleges describes "obtaining informed consent" as a core entrustable professional activity (EPA) for medical school graduates. However, prior studies demonstrated that residents frequently perform this task without receiving formal instruction or assessment of competency. This study sought to understand how attending physicians decide to delegate obtaining informed consent for surgical procedures to trainees. The authors conducted a survey of attending surgeons at a university-based health care system of 6 affiliated teaching hospitals (October-December 2020) to collect data about current entrustment practices and attendings' knowledge, experience, and attitudes surrounding the informed consent process. Summary statistics and bivariate analyses were applied. Eighty-five attending surgeons participated (response rate, 49.4%) from diverse specialties, practice types, and years in practice. Fifty-eight of 85 (68.2%) stated they "never" granted responsibility for the consent conversation to a trainee and 74/81 (91.4%) reported they typically repeated their own consent conversation whenever a trainee already obtained consent. The most common reasons they retained responsibility for consent were ethical duty (69/82, 84.1%) and the patient relationship (65/82, 79.3%), while less than half (40/82, 48.8%) described concerns about trainee competency. Reflecting on hypothetical clinical scenarios, increased resident competency did not correspond with increased entrustment (P = 0.27 - 0.62). Nearly all respondents (83/85, 97.7%) believed residents should receive formal training, however, only 41/85 (48.2%) felt additional training and assessment of residents might change their current entrustment practices. Attendings view informed consent as an ethical and professional obligation that typically cannot be entrusted to trainees. This practice is discordant with previous literature studying residents' perspectives. Furthermore, resident competency does not play a predominant role in this decision, calling into question whether informed consent can be considered an EPA.

Delay to Surgical Treatment in Geriatric Hip Fracture Patients.

Hip fractures in the geriatric population are frequently encountered. There is increasing focus on minimizing the delay to surgery in these patients. This study was designed to evaluate factors responsible for a delay to surgery in a geriatric hip fracture population and how time to surgery affects mortality. A retrospective cohort of patients sustaining low energy geriatric hip fractures in either an American College of Surgeons (ACS) verified Level 1 trauma center or a local university affiliated community teaching hospital were reviewed. The following variables were evaluated as independent risk factors for delay to surgery: demographic data, surgical details, use of cardiology resources, treatment center, and comorbidities. As a secondary objective, the effect of time to surgery on 1year mortality was analyzed. 1157 patients met inclusion criteria. The following factors increased the risk of delay to surgery greater than 48hours: male sex, treatment in a community hospital (versus trauma center), older age, multiple comorbidities (eg, cardiovascular-related conditions or other fractures), cardiology consultation, and an American Society of Anesthesiologists physical status score of 3 or 4. Cardiology consultation was the strongest independent predictor of risk for delay to surgery of >48hours (odds ratio, 6.68; 95% confidence interval, 4.40 to 10.14; P < .001). The 1-year mortality of patients did not differ when surgical treatment occurred before 48hours or after 48hours (Log-rank test P = .109). The presence of cardiovascular comorbidities and cardiology consultations can delay surgical treatments for hip fractures in patients greater than 65years old, but the delay did not influence 1-year all-cause mortality. Level IV.

Predicting risk of blastocyst aneuploidy among women with previous aneuploid pregnancy loss: a multicenter-data-based multivariable model.

Can blastocyst aneuploidy be predicted for patients with previous aneuploid pregnancy loss (PAPL) and receiving preimplantation genetic testing for aneuploidy (PGT-A)? Multivariable logistic regression models were established to predict high risk of blastocyst aneuploidy using four identified factors, presenting good predictive performance. Aneuploidy is the most common embryonic chromosomal abnormality leading to pregnancy loss. Several studies have demonstrated a higher embryo aneuploidy rate in patients with PAPL, which has suggested that PGT-A should have benefits in PAPL patients intending to improve their pregnancy outcomes. However, recent studies have failed to demonstrate the efficacy of PGT-A for PAPL patients. One possible way to improve the efficacy is to predict the risk of blastocyst aneuploidy risk in order to identify the specific PAPL population who may benefit from PGT-A. We conducted a multicenter retrospective cohort study based on data analysis of 1119 patients receiving PGT-A in three reproductive medical centers of university affiliated teaching hospitals during January 2014 to June 2020. A cohort of 550 patients who had one to three PAPL(s) were included in the PAPL group. In addition, 569 patients with monogenic diseases without pregnancy loss were taken as the non-PAPL group. PGT-A was conducted using single nucleotide polymorphism microarrays and next-generation sequencing. Aneuploidy rates in Day 5 blastocysts of each patient were calculated and high-risk aneuploidy was defined as a rate of ≥50%. Candidate risk factors for high-risk aneuploidy were selected using the Akaike information criterion and were subsequently included in multivariable logistic regression models. Overall predictive accuracy was assessed using the confusion matrix, discrimination by area under the receiver operating characteristic curve (AUC), and calibration by plotting the predicted probabilities versus the observed probabilities. Statistical significance was set at P < 0.05. Blastocyst aneuploidy rates were 30 ± 25% and 21 ± 19% for PAPL and non-PAPL groups, respectively. Maternal age (odds ratio (OR) = 1.31, 95% CI 1.24-1.39, P < 0.001), number of PAPLs (OR = 1.40, 95% CI 1.05-1.86, P = 0.02), estradiol level on the ovulation trigger day (OR = 0.47, 95% CI 0.30-0.73, P < 0.001), and blastocyst formation rate (OR = 0.13, 95% CI 0.03-0.50, P = 0.003) were associated with high-risk of blastocyst aneuploidy. The predictive model based on the above four variables yielded AUCs of 0.80 using the training dataset and 0.83 using the test dataset, with average and maximal discrepancies of 2.89% and 12.76% for the training dataset, and 0.98% and 5.49% for the test dataset, respectively. Our conclusions might not be compatible with those having fewer than four biopsied blastocysts and diminished ovarian reserves, since all of the included patients had four or more biopsied blastocysts and had exhibited good ovarian reserves. The developed predictive model is critical for counseling PAPL patients before PGT-A by considering maternal age, number of PAPLs, estradiol levels on the ovulation trigger day, and the blastocyst formation rate. This prediction model achieves good risk stratification and so may be useful for identifying PAPL patients who may have higher risk of blastocyst aneuploidy and can therefore acquire better pregnancy outcomes by PGT-A. This work was supported by the National Natural Science Foundation of China under Grant (81871159). No competing interest existed in the study. N/A.

Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?

During the second wave of the coronavirus disease 2019 (COVID-19) pandemic, a subset of critically ill patients developed delayed respiratory deterioration in the absence of new infection, fluid overload or extra-pulmonary organ dysfunction. To describe the clinical and laboratory characteristics, outcomes, and management of these patients, and to contrast this entity with other post COVID-19 immune dysregulation related inflammatory disorders. This was a retrospective observational study of adult patients admitted to the medical intensive care unit of a 2200-bed university affiliated teaching hospital, between May and August 2021, who fulfilled clearly defined inclusion and exclusion criteria. Outcome was assessed by a change in PaO2/FiO2 ratio and levels of inflammatory markers before and after immunomodulation, duration of mechanical ventilation after starting treatment, and survival to discharge. Five patients developed delayed respiratory deterioration in the absence of new infection, fluid overload or extra-pulmonary organ dysfunction at a median interquartile range (IQR) duration of 32 (23-35) d after the onset of symptoms. These patients had elevated inflammatory markers, required mechanical ventilation for 13 (IQR 10-23) d, and responded to glucocorticoids and/or intravenous immunoglobulin. One patient died (20%). This delayed respiratory worsening with elevated inflammatory markers and clinical response to immunomodulation appears to contrast the well described Multisystem Inflammatory Syndrome - Adults by the paucity of extrapulmonary organ involvement. The diagnosis can be considered in patients presenting with delayed respiratory worsening, that is not attributable to cardiac dysfunction, fluid overload or ongoing infections, and associated with an increase in systemic inflammatory markers like C-reactive protein, inteleukin-6 and ferritin. A good response to immunomodulation can be expected. This delayed inflammatory pulmonary syndrome may represent a distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection.

Compare the Effectiveness of Mulligan (Nags &amp; Snags) and McKenzie (Self-Stretching) On Improving the Pain and Functional Ability in Patient with Chronic Neck Pain

Neck pain is Consider the major problems and the prevalence of this musculoskeletal disorders are very common in people. Objective: To compare the effectiveness of mulligan and McKenzie on improving pain and functional ability in chronic neck patient. Methods: This trial was registered with Iranian trail registry with reference no: IRCT20220414054537N4. It’s a Double-Blind Randomized Clinical Trial that was conducted in DHQ Hospital Shadrah a affiliated teaching hospital attached with Afro-Asia University Lahore from 1 May 2022 to 30 June 2022.The sample size was calculated and total 26 patients were divided into two groups. The ages of the patients were around 20-55 years old. The entire patient having the mechanical neck pain was included in this study. Patients were selected from DHQ hospital in May to June 2022 duration. In group A we applied the mulligan technique of manual therapy treatment that included the Natural apophyseal glides, sustained natural apophyseal glides and Self SNAGs in sitting position of the patient. The second group of 13 patients had applied the Mackenzie exercises in seven motions like 4 movement of neck extension,2 movements in lateral flexion and rotation and one movement in flexion direction. Results: Overall the post Numeric pain rating scale and Neck Disability index was significantly improved in group A which received the NAGs &amp; SNAGs Mobilization technique. Conclusion: Mulligan (NAGs SNAGS) is effective than Mackenzie (self-stretching) treatment technique to improve the functional ability and reducing pain in chronic neck patient.

Utility and performance of cell blocks in urine cytology: Experience at three teaching hospitals.

The use of cell block (CB) preparation is underused in urine cytology (UC) and varies among hospitals. In addition to confirming a diagnosis, CBs can be useful in cases of metastatic disease, diagnoses requiring immunohistochemical (IHC) staining, and for ancillary studies. The role of this study is to examine the performance of CBs for UC at three affiliated teaching hospitals. A retrospective review of UC cases with a CB was conducted at a county hospital, Veterans Affairs hospital, and tertiary university-based hospital. For each specimen, patient demographics, specimen type, volume, original diagnosis, and IHC stains were recorded. Each case was reviewed for diagnosis based on ThinPrep alone, diagnosis based on ThinPrep and CB, utility of CB for diagnosis, and CB cellularity. A total of 250 UC specimens with CB from 186 patients was identified. Bladder washes were the most common (72.1%). IHC stains were performed on 17.2% of cases. On blinded review, CB preparation was deemed useful in 61.2% of cases, with the highest rate for suspicious for high-grade urothelial carcinoma (SHGUC) cases (87.0%). The diagnosis based on ThinPrep review changed with incorporation of CB in 13.2% of cases, with the highest rate for SHGUC cases (43.5%). The results demonstrate that use of CB in UC confirms the final diagnosis in more than one-half of cases and changes the diagnosis in a subset of cases. Use of CB was most helpful in the SHGUC category. Further evaluation of the types of cases in which CB are prepared is warranted.

Toward improvement of knowledge of financial conflicts of interest in a large medical school in France.

Conflict of interests (COIs) adversely affect the integrity of science and public health. The role of medical schools in the teaching and management of COIs has been highlighted by the publication of an annual evaluation of American medical schools based on their COIs policies by the American Medical Student Association (AMSA). A deontological charter was adopted by French medical schools in 2018 but its impact on COI comprehension by students and its effects on COI prevention were not evaluated. A 10-item direct survey was conducted among about 1000 students in Paris-Cité University in order to investigate the respect of the charter regarding COIs both in the medical school and in affiliated teaching hospitals. Cumulative results show a satisfying respect of prevention policies regarding COIs in the medical school and hospitals despite the fact that the existence of the charter and its major aspects were insufficiently known. Disclosure of COIs by teachers was insufficient. This first direct study among students shows better results than expected according to current non-academic surveys. Moreover, this study demonstrates the feasibility of this kind of survey whose repetition should be an appropriate tool to improve the implementation of the charter within medical schools and teaching hospitals, in particular mandatory disclosure of COIs by teachers.

Preventing Postoperative Urinary Retention (POUR) in Patients Undergoing Elective Lumbar Surgery: A Quality Improvement Project.

Postoperative urinary retention (POUR) is associated with significant morbidity. Our institution's POUR rate was elevated among patients undergoing elective lumbar spinal surgery. We sought to demonstrate that our quality improvement (QI) intervention would significantly lower our POUR rate and length of stay (LOS). A resident-led QI intervention was implemented from October 2017 to 2018 on 422 patients in an academically affiliated community teaching hospital. This consisted of standardized intraoperative indwelling catheter utilization, postoperative catheterization protocol, prophylactic tamsulosin, and early ambulation after surgery. Baseline data on 277 patients were collected retrospectively from October 2015 to September 2016. Primary outcomes were POUR and LOS. The focus, analyze, develop, execute, and evaluate (FADE) model was used. Multivariable analyses were used. P value <.05 was considered significant. We analyzed 699 patients (277 pre-intervention vs 422 post-intervention). The POUR rate (6.9% vs 2.6%, Δ confidence interval [CI] 1.15-8.08, P = .007) and mean LOS (2.94 ± 1.87 days vs 2.56 ± 2.2 days, Δ CI 0.066-0.68, P = .017) were significantly improved following our intervention. Logistic regression demonstrated that the intervention was independently associated with significantly decreased odds for developing POUR (odds ratio [OR] = 0.38, CI 0.17-0.83, P = .015). Diabetes (OR = 2.25, CI 1.03-4.92, P = .04) and longer surgery duration (OR = 1.006, CI 1.002-1.01, P = .002) were independently associated with increased odds of developing POUR. After implementing our POUR QI project for patients undergoing elective lumbar spine surgery, the institutional POUR rate significantly decreased by 4.3% (62% reduction) and LOS, by 0.37 days. We demonstrated that a standardized POUR care bundle was independently associated with a significant decrease in the odds of developing POUR.

Considering the role of medical radiation technologists to mitigate the care delivery problems associated with nasogastric tube verification and improve patient care

IntroductionMisplaced nasogastric (NG) tubes can have deleterious consequences for patients, including death. Medical radiation technologists (MRTs) may be well-positioned to improve the NG tube verification process. The objective of this study was to identify the care delivery problems (CDPs) associated with verifying NG tube placement and to consider where MRTs may mitigate current challenges. MethodsThis study involved three sources of data; a data audit of NG tube chest x-rays (CXRs), a review of related incident reports, and a staff survey, all conducted in the general radiography departments at two large, affiliated teaching hospitals in Toronto, Ontario. ResultsOver a 36-month period, 9,655 NG tube examinations were performed. Just over half of all exams (55.5%) required a single image for verification, while 10.1% required four or more images. The median time an MRT spent for an NG tube examination was 13.5 minutes, with 45.4% of exams completed in 10 minutes or less, while 4.5% required over 30 minutes. 118 incident reports and 57 survey submissions suggested five key CDPs; delayed verification, lack of verification, incorrect verification, increased radiation exposure, and inefficient workflow. ConclusionsCDPs associated with verifying NG tube placement can lead to poor patient care and inefficient workflows. The results of this study suggest that there may be value in future exploration of additional responsibility for MRTs as a potential solution for improving the NG tube process and thus patient care.

Hormonal therapy is effective and safe for cryptorchidism caused by idiopathic hypogonadotropic hypogonadism in adult males.

Hormonal therapy is a reasonable treatment for cryptorchidism caused by idiopathic hypogonadotropic hypogonadism (IHH). However, the clinical evidence on whether it is effective and safe for the treatment of cryptorchidism caused by IHH is lacking. To evaluate the effect of hormonal therapy in testicular descent, puberty development, and spermatogenesis in adult males with cryptorchidism caused by IHH. This retrospective study included 51 patients with cryptorchidism caused by IHH from the Andrology Clinic of University affiliated teaching hospital. Patients were divided into two groups: group A patients received hormonal therapy; group B patients received surgical treatment for cryptorchidism followed by hormonal therapy. The rate of successful testicular descent following hormonal therapy (19/32 in group A) or surgical treatment (11/19 in group B) shows no statistically significant difference. There was also no statistically significant difference in penile length, Tanner stage of pubic hair, testicular volume, and success rate of spermatogenesis between the two groups. Testicular atrophy was seen in a single patient in group B. Hormone therapy in adult males with cryptorchidism caused by IHH is effective and safe regarding testicular descent, puberty development, and spermatogenesis. This study provides new insight into the treatment of cryptorchidism caused by IHH and highlights that hormonal therapy could be an effective, safe, and economic treatment option for cryptorchidism in males caused by IHH.

A Gap in Mission: The Disparate Missions of Medical Schools and Teaching Hospitals

Objective The social contract mandates that in return for the government-funded labor of residents and fellows, the medical profession trains, to the best of its ability, the physicians of our future. This contract obligates graduate medical education (GME) to utilize all available information to create an optimal learning environment for its trainees. Business research has determined that a clearly defined mission statement is associated with improved employee engagement, retention, and wellness. Given that GME trainees are situated at the intersection of at least two institutions, each with its own separate mission, trainees could potentially be hindered by incongruent missions in the learning environment. The literature on mission statements has analyzed medical schools and hospitals separately; however, investigations comparing the statements of these affiliated institutions have not been conducted. Therefore, we plan to compare the content and assess the consistency of mission statements from affiliated medical schools and hospitals to determine if incongruencies exist. Methods In 2023, the mission statements from the Association of American Medical Colleges (AAMC) medical schools and affiliated teaching hospitals (n = 163) were aggregated from their public websites. The content of each mission statement was thematically analyzed to assess variation. Results According to content analysis of the mission statements from 163 AAMC medical school members and affiliated teaching hospitals, less than half of their top priorities are shared by their affiliated hospitals (45%). Additionally, themes of diversity, religion, and global care were found to be contrasting priorities between affiliated institutions. Conclusion Given the precedence within the business and the observed discrepancies in mission, further research is needed to determine whether collaborating medical schools and hospitals could provide a more favorable graduate training environment by uniting their priorities and identifying shared goals.

"Where You Feel Like a Family Instead of Co-workers": a Mixed Methods Study on Care Teams and Burnout.

BackgroundPhysicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions.ObjectiveTo explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout.DesignA mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland.ParticipantsParticipants included 724 physicians and 971 nurses providing direct clinical care to patients.Main Measures and ApproachMeasures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses.Key ResultsForty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing.ConclusionsMore team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07756-2.

An exploratory descriptive cohort study of 90-day prognosis after acute ischaemic stroke with mechanical thrombectomy.

Aim: To evaluate the relationship between nursing assessment findings at discharge and acute ischaemic stroke (AIS) patient prognosis after mechanical thrombectomy (MT). Methods: We analysed the characteristics of 144 AIS patients with MT treatment admitted to a university affiliated teaching hospital in Chengdu, Sichuan Province China, from January 2020 to December 2020. The modified Rankin Scale (mRS) score was used to assess outcomes 90-days after discharge. Exploratory analyses were undertaken using IBM SPSS Statistics (Version 26.0). Results: At 90-days, 47.9% (n = 69) had a good prognosis (mRS ≤ 2) including 22.2%(n = 32) fully recovered patients. There were 5 (3.5%) deceased patients and 48.6% (n =70) of patients had a poor prognosis (mRS ≥ 3). In univariate analysis, clinical prognosis correlated with the need for inpatient endotracheal intubation (p = 0.02), nasogastric tube (p＜0.001), indwelling urinary catheter (p＜0.001), central venous catheter (p = 0.03), health knowledge needs of pressure injury prevention (p = 0.03), National Institute of Health Stroke Scale (NIHSS) score (p＜0.001) and Activities of Daily Living (ADL) score (p＜0.001) at the time of discharge from hospital. The average hospitalisation time of the 144 patients was 12[IQR, 9–25] days, and the average cost of hospitalisation was $Y$21291.93 (SD 9165.01). Conclusion: Almost half of the surviving patients had a poor prognosis. In our country, this surgery and rehabilitation impose a significant financial burden that needs to be addressed. However, the longer length of hospital stay and higher costs at discharge may be contributing factors to worse outcomes. The outcomes of comprehensive nursing assessment of the patients, including nursing needs, activities of daily living, and neurological function, can predict their outcome. Impact Statement: We recommend a comprehensive nursing assessment at discharge that predicts patient outcomes and can be used for subsequent targeted interventions. The prognosis of patients with acute ischaemic stroke after mechanical thrombectomy is poor, and the financial burden needs to be considered.

An investigation of knowledge, attitude and practice towards simulation among clinical nursing teachers in China: A cross-sectional study

AimThis study aimed to investigate the knowledge, attitude and practice towards simulation among CNTs in China and analyze the influencing factors. BackgroundIn China, simulation is now increasingly used by Clinical Nursing Teachers (CNTs) who are mainly responsible for nurses’ continuing education, novice nurses training and nursing students practice in clinical settings. Over the past 20 years, enrolment scale of nursing education was expanded greatly, and the number of registered nurses increased from 1.22 to 4.10 million in China. To contribute to nurses’ or nursing students’ professional development and successful transition to competent practitioners, CNTs are now being challenged to use simulation to develop more learner-centered educational programs, which could better facilitate learner engagement. As faculty preparation is a prerequisite for conducting quality simulation, it is critical that CNTs have the requisite knowledge and skills to use simulation to its full potential. However, data on CNTs’ knowledge, attitude and practice towards simulation is limited. DesignA cross-sectional study. MethodsA total of 342 CNTs from six tertiary affiliated teaching hospitals of a medical university in Beijing, China, participated in the study. Electronic questionnaire of Nurse Educators’ Knowledge, Attitude and Practice towards Simulation (NEKAPS) was delivered to CNTs. Analysis of variance, t-test were used to analyze data. ResultsThe mean score of knowledge and attitude for all participants was 60.01 ± 13.42 and 81.40 ± 19.99, respectively. The mean practice score was 70.65 ± 22.05 for 162 participants (47.4 %) who had conducted simulation in their hospitals. Participants with higher educational level (F=3.476, p = 0.032) and nursing career length≤ 15 years (t = 2.676, p = 0.008) had higher knowledge scores. However, there were no significant differences among different groups for attitudes. Participants with age ≤ 35 years old (t = 3.355, p = 0.001), nursing teaching length ≤ 10 years (t = 2.073, p = 0.041) and advanced beginner nurses (t = 3.212, p = 0.002) presented higher practice scores. ConclusionsCNTs had a low level of knowledge on simulation. Their attitudes towards simulation were positive, whereas their practices were still lacking. It is highlighted an urgent need for standardized training of CNTs to improve their knowledge and practice towards simulation, so that they can optimize the simulation programs they provide for nurses or nursing students.

Identifying Risks Associated With Workplace Health and Employee Wellness

Background: Well-being at the workplace influences health and productivity and a negative work environment may lead to physical and mental health problems. Objectives: The current study aimed to measure the attitude and perception of the workforce towards work place environment and to identify key factors affecting workplace health and employee engagement and wellness. Methods: A survey study was conducted over a period of three months at Ras Al Khaimah Medical and Health Science University, United Arab Emirates. The Mental health America’s Workplace Mental Health Survey was used to collect data from a random sample of employees in the study settings. The objective of the study was adequately explained to participants and their informed consent was obtained with assured confidentiality. Results: The overall mean score of respondents satisfaction was 61.0 ± 8.1 SD. Employees responses towards workplace was significantly lower among full time university personnel than those at affiliated teaching hospitals (59.3±6.9 vs. 62,3±8.7, p=0.01). Work insecurity was the only item which was negatively correlated with the overall score (r= -0.72; p=0.02). The rate of absenteeism, Engaging in unhealthy behavior due to workplace stress and Speaking poorly about the workplace were strongly correlated with overall workplace health score (r=0.5;P=0.001). Support from colleagues and supervisor were correlated with overall job satisfaction (r=0.3 and r= 0.2; p=0.01 respectively). Conclusion: Respondents were generally happy with the state of their workplace. However, workplace perquisites such as open door policies, flexible time arrangement; opportunities for professional development promote more positive attitude and perceptions.

Patients' attitude towards medical students at Combined Military Hospital, Dhaka

Introduction: Patient is the best resource and most important component in medical education. One of the vital parts of clinical education is patients’ cooperation and acceptance of medical students in their care. Aim: To assess patients’ attitude towards medical students at Combined Military Hospital (CMH) Dhaka, and to determine factors that may affect those attitudes. Methods: This cross-sectional study was conducted at CMH Dhaka, an affiliated teaching hospital to Armed Forces Medical College (AFMC). One hundred and eighteen patients were interviewed face to face from January to June 2021 using a predesigned questionnaire. Results: All study participants had responded to the questionnaire. Majority of the patients (98%) thought that students should examine patients as part of their medical training. All participants accepted students’ presence during the medical consultation. 86.4% and 69.5% of the patients agreed students’ involvement in general physical examination in presence and absence of a doctor respectively. In case of genital examination by students 33.9% and 30.5% patients were agreed to allow them in presence and absence of supervising doctor respectively. Conclusion: Patients of this study show some overall positive attitudes. Patients like less number of students' involvement in their physical examination; however, majority of the patients realized the importance of patient examination by students as a part of their medical training. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 12-16

Institution Origin and Medical School Rank Impact the Citation Frequency and Publication Rate in Orthopaedic Sports Medicine Journals

PurposeTo examine the trends between various categories of institutions with their respective published orthopaedic sports medicine content and to determine the publication output and citation rate from the 25 highest-ranked medical schools compared with lower-ranked institutions.MethodsPublications between 2015 and 2019 from the American Journal of Sports Medicine, Journal of Bone and Joint Surgery, Journal of Shoulder and Elbow Surgery, Clinical Orthopaedics and Related Research, and Arthroscopy were categorized into university/university affiliated hospitals, non-university affiliated teaching hospitals, public/semi-government research institutes, nonprofit research institutes, private sector institutions, government institutions, and other institutions. Citation rates were collected from PubMed for the first and corresponding author. Similarly, corresponding authors were stratified by U.S. News and World Report 2021 medical school research rankings.ResultsOf the 12,152 publications identified, 5,044 publications met the inclusion criteria. Nonprofit research institutions garnered the greatest number of citations on average (6.44 based on first author, SD 8.83, n = 214; 6.62 based on corresponding author, SD 9.65, n = 208; P < .001), while university/university-affiliated hospitals produced the majority of published articles (77.0% based on first author, 76.8% based on corresponding author), but had lower average citation rates (4.48 based on first author, SD 6.67, n = 3,886; 4.44 based on corresponding author, SD 6.55, n = 3,873; P < .001). Furthermore, of 1953 medical school publications, the top 25 accounted for 53.1% of publications; however, there was no statistical difference between their citation rates and those of lower rankings (P = 0.47).ConclusionsPublications are cited at different rates, depending on their institution of origin. In addition, high-ranking medical schools produce a disproportionately greater output of publications than lower-ranking schools, but there is no statistically significant difference in citation rates on an individual publication basis.Clinical RelevanceKnowing how an institution’s ranking influences publication and citation rates can help us understand bias in the scientific literature.

Residents' transformational changes through self-regulated, experiential learning for professionalism.

PurposePostgraduate trainees (‘residents”) are required to convey professional behaviours as they navigate complex clinical environments. However, little is known about experiential learning for professionalism. Thus, we asked residents about professionalism challenges within the clinical learning environment: 1) how challenges were identified, 2) what supported successfully addressing challenges and 3) the impact of addressing challenges to further inform resident education.MethodFrom 2015-2016, twenty-five residents across specialties and multiple university affiliated teaching hospitals participated in appreciative inquiry informed audio-taped semi-structured interviews. Transcripts were categorized deductively for the 2015 CanMEDS Professional Role element addressed (commitment to patients, society, the profession, and physician health). A pragmatic research paradigm focussed descriptive data analysis on actions and outcomes.ResultsResidents actively identify opportunities for experiential learning of professionalism within the clinical workplace– addressing conflicting priorities with interprofessional clinicians to ensure excellent patient care, providing informal feedback regarding peers’ and other healthcare clinicians’ professionalism lapses and by gaining self-awareness and maintaining wellness. There were no descriptions of commitment to society. Values, relationships, and reflection supported professional behaviours. Many described transformative personal and professional growth as an outcome of addressing professionalism challenges.ConclusionsResidents self-regulated experiential learning for professionalism often results in transformational changes personally and professionally. Elucidation of how residents successfully navigate power dynamics and conflict to provide excellent patient care and feedback for professional regulatory behaviour will support professionalism education. An interprofessional research lens will be valuable to explore how best to incorporate commitment to society within clinical environments.

Study on Unnatural Death Pattern in Mardan, Pakistan.

Introduction: Medico-legal autopsy is a scientific examination of a dead body which is performed to determine the cause, mode, time since death, manner of death and in some cases the identification of the deceased where unknown; thus helping the law enforcement agencies and the society in providing justice to everybody even after death.Objective: To determine the spectrum of unnatural deaths during a study period of one year in Mardan, so that information may subsequently be used to develop pub-lic health and law enforcement work and statistics.Methodology: This retrospective study was conducted Mardan Medical Complex Hospital, an affiliated teaching hospital of Bacha Khan Medical College, Mardan from 1st January, 2017 to 31st December, 2017. Data of unnatural deaths (n=119) obtained from mortuary. The demographic variables age and gender, manner of death, weapon used and urban-rural variation in medico-legal deaths were noted. Data presented as numbers and percentages.Results: A total of 119 medico-legal autopsies were conducted during one year study period. Males were 97 (81.51%) and females 22 (18.48%). Accidental deaths significantly predominated 58 (48.73%) over homicidal 36 (30.25%) and suicidal 22 (18.48%) manners of death. Most of the deaths resulted from road traffic acci-dental deaths followed by firearms, blunt and sharp weapons. Most of the cases were urban inhabitants 72(60.50%) followed by those belonging to rural areas 47(39.49%).Conclusion: Majority of victims of unnatural deaths died from road traffic accidents followed by firearm deaths, and definitely deaths reported from urban areas was more compared to the rural areas.Keywords: Medico-legal autopsy, Unnatural death, Homicide, Suicide, Accident

Asherman's Care in a Covid-19 Pandemic

Study ObjectiveWe aimed to evaluate patient's satisfaction with Asherman's care in women who were referred to our center for a second opinion for Asherman's Syndrome (AS) in the Covid-19 pandemic.DesignObservational cohort study.SettingUniversity affiliated teaching hospital and tertiary referral center for Asherman's syndrome in The Netherlands from March 2020 to March 2021.Patients or ParticipantsWomen with AS, eligible for treatment were included.InterventionsThe first consult and pre-operative screening took place with a phone interview. The diagnosis, treatment and follow-up protocol were explained. Women were triaged on basis of their symptoms and infection exposure status and whether or not a face-to-face visit with the anesthesiologist was required. If eligible for treatment, they were given the opportunity to schedule a see and treat procedure with propofol sedation. All women who decide to proceed with surgery were treated with the standard AS protocol with special Covid-19 precaution measurements. At the recovery unit, women were asked to fill in a questionnaire.Measurements and Main Results137 women were operated in 32 sessions between March 2020 and March 2021. Patients were matched with a cohort prior to the Covid-19 pandemic. Baseline characteristics were reported. Patients rated their satisfaction with hearing the explanation about the disease and upcoming treatment by the practitioner over the phone, the assisting on-site nurse's capability, quality of care of the treatment, convenience, and overall understanding and explanation by the practitioner post operatively. Women with AS who were treated in our center during the Covid-pandemic were equally satisfied with the information at first visit, explanation, treatment and follow-up as women in their matched cohort prior to the pandemic.ConclusionPatients with AS who were referred to our center, were offered COVID-19 adjusted protocol to inform, diagnose, treat and follow-up on their condition. Women were equally satisfied with the care provided.