Cohort Of Physicians Research Articles

Liver-Directed Therapy for Neuroendocrine Tumor Liver Metastases in the Era of Peptide Receptor Radionuclide Therapy.

Neuroendocrine tumor liver metastases are treated by a multidisciplinary cohort of physicians that work together to achieve optimal clinical results for their patients. This review addresses critical concepts in diagnosis and workup of such patients followed by medical, surgical, and liver-directed arterial and ablative therapies. Specific perioperative care for these patients is crucial in avoiding dreaded complications related to Carcinoid Crisis. The recent introduction of Peptide Receptor Radionuclide Therapy as a therapeutic option has impacted some of the algorithms for timing and selection of arterial embolotherapies.

The effect of patient satisfaction scores on physician job satisfaction and burnout.

Physician burnout is recognized as reversible with the potential to negatively influence quality of care and patient outcomes. The study objective was to evaluate associations between patient satisfaction scores (PSS) and physicians’ perceptions of job satisfaction and burnout via a physician survey. Eighty two out of 107 report PSS are institutionally tracked, with 23/107 and 39/107 reporting PSS utilization in financial compensation or performance review, respectively. Fifty four out of 107, report pressure to emphasize PSS; 63/107, report PSS having negative effect on job satisfaction; 31/107 considered leaving their job or career due to PSS and 84/107 report PSS contribute to burnout. In the cohort of physicians treating patients with spine pain who responded to this survey, PSS are associated with decreased job satisfaction and increased burnout.

Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study.

Effective management of metastatic disease requires multidisciplinary input and entails high risk of disease-related and treatment-related morbidity and mortality. The factors that influence clinician decision-making around spinal metastases are not well understood. We conducted a qualitative study that included a multidisciplinary cohort of physicians to evaluate the decision-making process for treatment of spinal metastases from the clinician's perspective. We recruited operative and nonoperative clinicians, including orthopaedic spine surgeons, neurosurgeons, radiation oncologists, and physiatrists, from across North America to participate in either a focus group or a semistructured interview. All interviews were audiorecorded and transcribed verbatim. We then performed a thematic analysis using all of the available transcript data. Investigators sequentially coded transcripts and identified recurring themes that encompass overarching patterns in the data and directly bear on the guiding study question. This was followed by the development of a thematic map that visually portrays the themes, the subthemes, and their interrelatedness, as well as their influence on treatment decision-making. The thematic analysis revealed that numerous factors influence provider-based decision-making for patients with spinal metastases, including clinical elements of the disease process, treatment guidelines, patient preferences, and the dynamics of the multidisciplinary care team. The most prominent feature that resonated across all of the interviews was the importance of multidisciplinary care and the necessity of cohesion among a team of diverse health-care providers. Respondents emphasized aspects of care-team dynamics, including effective communication and intimate knowledge of team-member preferences, as necessary for the development of appropriate treatment strategies. Participants maintained that the primary role in decision-making should remain with the patient. Numerous factors influence provider-based decision-making for patients with spinal metastases, including multidisciplinary team dynamics, business pressure, and clinician experience. Participants maintained a focus on shared decision-making with patients, which contrasts with patient preferences to defer decisions to the physician, as described in prior work. The results of this thematic analysis document the numerous factors that influence provider-based decision-making for patients with spinal metastases. Our results indicate that provider decisions regarding treatment are influenced by a combination of clinical characteristics, perceptions of patient quality of life, and the patient's preferences for care.

Understanding Osteoporosis Screening Practices in Men: A Nationwide Physician Survey

To understand osteoporosis screening practices, particularly in men, by a diverse cohort of physicians, including primary care physicians, endocrinologists, and geriatricians. We surveyed randomly selected members of the American Academy of Family Practice, Endocrine Society, and American Geriatrics Society. Respondents were asked to rate how often they would screen for osteoporosis in four different clinical scenarios by ordering a bone density scan. Multivariable logistic regression analyses were conducted to determine factors associated with offering osteoporosis screening in men in each clinical scenario. Physicians were also asked to note factors that would lead to osteoporosis screening in men. Response rate was 63% (359/566). While 90% respondents reported that they would always or frequently screen for osteoporosis in a 65-year-old post-menopausal woman, only 22% reported they would screen a 74-year-old man with no significant past medical history. Endocrinologists were more likely to screen a 74-year-old man compared to primary care physicians (odds ratio, 2.32; 95% confidence interval, 1.10 to 4.88). In addition to chronic steroid use (94%), history of nontraumatic fractures (88%), and androgen-deprivation therapy for prostate cancer (82%), more than half the physicians reported suppressive doses of thyroid hormone (64%) and history of falls (52%) as factors leading to screening for osteoporosis in men. Our survey results highlight heterogeneity in osteoporosis screening in men, with underscreening in some scenarios compared to women, and identify factors that lead to screening in men. These findings can help design interventions to improve osteoporosis screening in men.

Engaging Primary Care Physicians to Refer Patients to Home-Based Palliative Is Challenging and Complicated.

Background: Before the Affordable Care Act (ACA), the financing landscape for fee-for-service health care lacked broad structure and incentives to provide palliative care outside hospitals. Since the ACA, several payers have taken the opportunity to offer home-based palliative care (HBPC) to their members.Objective: To evaluate the impact of outreach efforts by a physician champion among a cohort of primary care physicians (PCPs) to introduce a new HBPC program and benefit, obtain buy-in, and motivate referrals for Blue Shield patients.Design: Secondary qualitative analysis of detailed field notes from a HBPC physician champion from in-person meetings with a cohort of PCPs and their office staff.Subjects: PCPs were from a physicians group in northern California that met with the physician champion during a 12-month study period.Results: During the 12-month study period, the physician champion met with clinicians at 27 distinct primary care offices. Qualitative analyses revealed three independent themes relating to receptivity and perception of the new HBPC program: (1) physician-level factors (overburdened, lack of palliative care knowledge, misconceptions around palliative care, and patient control), (2) practice-level factors (practice structure and role/integration of advance practice providers), and (3) first impression of the HBPC program (receptivity, “dirty data,” and communication).Conclusion: Results hold important implications for practice and new approaches to engaging PCPs in HBPC, obtaining buy-in, and generating patient referrals. PCPs need better support in caring for patients with serious illness and HBPC can likely fill that role if PCPs are willing to refer and HBPC programs adapt.

The Association Between High and Unnecessary Antibiotic Prescribing: A Cohort Study Using Family Physician Electronic Medical Records.

Approximately 25% of outpatient antibiotic prescriptions are unnecessary among family physicians in Canada. Minimizing unnecessary antibiotics is key for community antibiotic stewardship. However, unnecessary antibiotic prescribing is much harder to measure than total antibiotic prescribing. We investigated the association between total and unnecessary antibiotic use by family physicians and evaluated inter-physician variability in unnecessary antibiotic prescribing. This was a cohort study based on electronic medical records of family physicians in Ontario, Canada, between April 2011 and March 2016. We used predefined expected antibiotic prescribing rates for 23 common primary care conditions to calculate unnecessary antibiotic prescribing rates. We used multilevel Poisson regression models to evaluate the association between total antibiotic volume (number of antibiotic prescriptions per patient visit), adjusted for multiple practice- and physician-level covariates, and unnecessary antibiotic prescribing. There were 499 570 physician-patient encounters resulting in 152 853 antibiotic prescriptions from 341 physicians. Substantial inter-physician variability was observed. In the fully adjusted model, we observed a significant association between total antibiotic volume and unnecessary prescribing rate (adjusted rate ratio 2.11 per 10% increase in total use; 95% CI 2.05-2.17), and none of the practice- and physician-level variables were associated with unnecessary prescribing rate. We demonstrated substantial inter-physician variability in unnecessary antibiotic prescribing in this cohort of family physicians. Total antibiotic use was strongly correlated with unnecessary antibiotic prescribing. Total antibiotic volume is a reasonable surrogate for unnecessary antibiotic use. These results can inform community antimicrobial stewardship efforts.

Comparing perspectives on medication treatment for opioid use disorder between national samples of primary care trainee physicians and attending physicians

BackgroundMost people with opioid use disorder (OUD) are not treated with FDA-approved medications methadone, buprenorphine, or naltrexone. Expanding capacity for evidence-based OUD medication in primary care is a national priority. No studies have examined primary care trainee physicians’ attitudes about these medications. This study surveyed a national sample of primary care trainee physicians and compared their views with those of primary care attending physicians (i.e., those who have completed training). MethodsRandom samples of 1,000 trainee physicians and 1,000 attending physicians specializing in family, internal, or general medicine were selected from the American Medical Association Masterfile. Surveys were mailed February-August 2019. 45 % of eligible trainee physicians and 54 % of eligible attending physicians responded. Chi-square tests were used to compare responses between the groups. ResultsTrainee physicians were more likely than attending physicians to agree that treating OUD with medication is more effective than treatment without medication (76 % versus 67 %, p = 0.03). Half of trainee physicians (51 %) expressed interest in treating patients with OUD compared to 20 % of attending physicians. Trainee physicians expressed greater support than attending physicians for policies that loosen restrictions on prescribing OUD medications. ConclusionsRelative to attending physicians, the emerging cohort of primary care physicians may be more receptive to working with patients with OUD and prescribing medication. Enhancing medical training on OUD and its treatment, exposing clinicians to individuals in recovery from OUD, and increasing support for clinicians that provide medication treatment for OUD may strengthen this group’s capacity to respond to the opioid crisis.

Can visual inspection of the electrical activity of the diaphragm improve the detection of patient-ventilator asynchronies by pediatric critical care physicians?

Patient-ventilator asynchronies are challenging during pediatric mechanical ventilation. We hypothesized that monitoring the electrical activity of the diaphragm (EAdi) together with the "standard" airway opening pressure (Pao) and flow-time waveforms during pressure support ventilation would improve the ability of a cohort of critical care physicians to detect asynchronies in ventilated children. We recorded the flow, Pao and EAdi waveforms in ten consecutive patients. The recordings were split in periods of 15 s, each reproducing a ventilator screenshot. From this pool, a team of four experts selected the most representative screenshots including at least one of the three most common asynchronies (missed efforts, auto-triggering and double triggering) and split them into two versions, respectively showing or not the EAdi waveforms. The screenshots were shown in random order in a questionnaire to sixty experienced pediatric intensivists that were asked to identify any episode of patient-ventilator asynchrony. Among the ten patients included in the study, only eight had EAdi tracings without artifacts and were analyzed. When the Eadi waveform was shown, the auto-triggering detection improved from 13% to 67% (P<0.0001) and the missed efforts detection improved from 43% to 95% (P<0.0001). The detection of double triggering, instead, did not improve (85% with the EAdi vs. 78% without the EAdi waveform; P=0.52). This single center study suggests that the EAdi waveform may improve the ability of pediatric intensivists to detect missed efforts and auto-triggering asynchronies. Further studies are required to determine the clinical implications of these findings.

Examine the Impact of Independent Freestanding Emergency Departments in Texas on Rural and Underserved Health Workforce

Research ObjectiveIn recent years, more and more emergency departments (EDs) are located and operated away from hospital campuses. A MedPAC report found at least 556 stand‐alone EDs around the country, comprising of 363 hospital‐affiliated off‐campus emergency departments and 203 independent freestanding emergency departments (IFEDs) in 2017. Five Metropolitan Statistical Areas (MSAs) in Texas accounted for over 72 percent of all IFEDs in the country. The rapid proliferation of IFEDs brings into question, who and where are the workforce coming from for these IFEDs. This study explores the origin and composition of health workforce of IFEDs in Texas and the implications of IFEDs on rural and underserved workforce.Study DesignWe compiled a list of current IFED physicians using the freestanding emergency department list released by Texas Department of State Health Services (July 2019 version) in conjunction with a search of Texas Medical Board Licensing and IFED organization web searches. We identified 545 physicians from 211 IFEDs. We were not able to find staffing information for 11 IFEDs (5.2% of IFEDs). We tracked the IFED physicians prior practice locations using the Medicare Physician Shared Patient Patterns data (2009‐2013) and CareSet DocGraph Hop Teaming data (2014‐2017). We identified those physician’s self‐reported specialty in National Provider and Plan Enumeration System (NPPES) and Medicare Provider Enrollment, Chain, and Ownership System (PECOS). We further examined the historical volume of Medicare services provided by these IFED physicians over time using Medicare Part B Public Use Files (2012‐2017).Population StudiedAll 545 physicians who we can identify worked at Texas IFEDs at the time of data collection (September 2019).Principal FindingsOf the 545 IFED physicians, NPPES data indicate 481 physicians are Emergency Medicine physicians, 38 Family Medicine, 11 Internal Medicine and 15 other. PECOS data differed slightly. We were able to identify at least 1 previous practice location for 533 of the 545 physicians currently working at IFEDs. In any year, physicians may have practiced in up to seven hospitals. In 2012, we can identify the practice hospitals for 442 IFED physicians, of whom 95 practiced at rural hospitals and 417 practiced at Disproportionate Share Hospitals (hospitals may be both rural and DSH). In 2017, we can identify the practice hospitals for 267 IFED physicians, of whom 48 practiced at rural hospitals and 207 practiced at Disproportionate Share Hospitals. The reduction of IFED physicians who we can identify from Medicare databases represented the movement of physicians from hospital EDs to IFEDs. We observed a 64.7% decline in total volume of Medicare services provided by this cohort of physicians from 2012 to 2017.ConclusionsOur findings suggest IFEDs are recruiting physicians largely from rural and underserved settings.Implications for Policy or PracticeThe recruitment of IFED physicians from rural and underserved settings taken in combination with evidence that freestanding emergency departments locate in areas with higher incomes and lower proportions of Medicaid patients; our findings raise concerns about the potential negative workforce and access side effects of these newer, entrepreneurial health care organization models.Primary Funding SourceHealth Resources and Services Administration.

An Exploratory Assessment of Sleep Patterns, Burnout and Perceived Stress of a Cohort of Active Duty Military Physicians.

This article was migrated. The article was marked as recommended. Introduction: Physician well-being is crucial and has the potential to impact patient safety. Many physicians across different stages of their careers experience stress, burnout, and/or decreased sleep. These factors can negatively affect physician well-being and performance and contribute to medical errors. The purpose of this study is to further understand physician well-being by examining a single cohort for patterns of sleep, burnout, and perceived stress across gender, training level, and specialty. Materials and methods: A cohort of 32 practicing military physicians ranging from first-year residents to experienced attendings continuously wore an actigraphy watch for a duration of at least 5 days to capture baseline sleep patterns. On the last day of data collection, participants completed a self-reported assessment of their daytime sleepiness using the Epworth Sleepiness Scale (ESS), a two-item burnout scale adapted from the Maslach Burnout Inventory, and a 10-item perceived stress questionnaire. Data for the entire cohort were descriptively analyzed. Results: The cohort had a mean sleep duration of 6.69 hours across the 5 days, with a maximum mean sleep duration of 7.90 hours, and a minimum mean sleep duration of 5.69 hours per day. Analysis stratified by gender and level of training revealed an average sleep duration of at least 6 hours across these groups. Overall, the cohort reported low perceived stress levels, low daytime sleepiness, and low burnout. Conclusion: The cohort of physicians examined in the present study did not show signs of significant sleep deprivation, feelings of perceived stress, or burnout. This may be due to military culture and the structure of military training facilities that emphasize duty hour regulations. In addition, these findings may be related to the fact that military health professionals are salaried, as opposed to being on a fee-for-service schedule, and military facilities offer well-being programs.

Mental Health of Young Physicians in China During the Novel Coronavirus Disease 2019 Outbreak

This cohort study assesses anxiety, depression, mood, and fear of workplace violence in a cohort of young physicians in China before and during the coronavirus disease 2019 outbreak.

Intimate Partner Violence: Using Standardized Patients to Improve Trauma-Informed Care in the era of the Covid-19 Pandemic.

This article was migrated. The article was marked as recommended. Intimate partner violence (IPV) is a global public health problem that has been exacerbated by the social isolation measures currently in place in countries around the world. The authors appreciate the importance of teaching medical students the skill sets to cope with the recognition and diagnosis and medical management of IPV. This is because physicians are most often the first point of contact for victims of IPV. It is also essential to ensure medical students become self-aware of the emotional triggers which may be associated with caring for victims of IPV. This opinion piece explains how medical educators can make a difference in training future physicians in caring for victims of IPV. With the current COVID-19 pandemic bringing the issue of IPV sharply into focus, this paper outlines why medical educators should ensure that medical students are equipped to deal with the societal consequences emanating from the COVID-19 pandemic which will reverberate into the future. Therefore, there is no more time to waste. We are facing a critical juncture, with the current cohort of medical students and physicians exposed to the disproportionately high levels of personal, professional, and emotional trauma that have resulted from the COVID-19 pandemic. Training is imperative; it is of paramount importance for our future medical professionals to be self-aware of their emotional triggers.

Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? A Systematic Review and Meta-analysis.

Dizziness is a common complaint presented in the emergency department (ED). A subset of these patients will present with acute vestibular syndrome (AVS). AVS is a clinical syndrome defined by the presence of vertigo, nystagmus, head motion intolerance, ataxia, and nausea/vomiting. These symptoms are most often due to benign vestibular neuritis; however, they can be a sign of a dangerous central cause, i.e., vertebrobasilar stroke. The Head Impulse test, Nystagmus, Test of Skew (HINTS) examination has been proposed as a bedside test for frontline clinicians to rule out stroke in those presenting with AVS. Our objective was to assess the diagnostic accuracy of the HINTS examination to rule out a central cause of vertigo in an adult population presenting to the ED with AVS. Our aim was to assess the diagnostic accuracy when performed by emergency physicians versus neurologists. We searched PubMed, Medline, Embase, the Cochrane database, and relevant conference abstracts from 2009 to September 2019 and performed hand searches. No restrictions for language or study type were imposed. Prospective studies with patients presenting with AVS using criterion standard of computed tomography and/or magnetic resonance imaging were selected for review. Two independent reviewers extracted data from relevant studies. Studies were combined if low clinical and statistical heterogeneity was present. Study quality was assessed using the QUADAS-2 tool. Random effects meta-analysis was performed using RevMan 5 and SAS 9.3. A total of five studies with 617 participants met the inclusion criteria. The mean (±SD) study length was 5.3(±3.3)years. Prevalence of vertebrobasilar stroke ranged 9.3% to 44% (mean±SD=39.1%±17.1%). The most common diagnoses were vertebrobasilar stroke (mean±SD=34.8%± 17.1%), peripheral cause (mean±SD=30.9%±16%), and intracerebral hemorrhage (mean±SD=2.2%±0.5%). The HINTS examination, when performed by neurologists, had a sensitivity of 96.7% (95% CI=93.1% to 98.5%, I2 =0%) and specificity of 94.8% (95% CI=91% to 97.1%, I2 =0%). When performed by a cohort of physicians including both emergency physicians (board certified) and neurologists (fellowship trained in neurootology or vascular neurology) the sensitivity was 83% (95% CI=63% to 95%) and specificity was 44% (95% CI=36% to 51%). The HINTS examination, when used in isolation by emergency physicians, has not been shown to be sufficiently accurate to rule out a stroke in those presenting with AVS.

Disparity in Transplant Referral Patterns for Alcohol-Related Liver Disease Based on Physician-Dependent Variables

IntroductionDistance from a liver transplant (LT) center does not affect post-transplant outcomes. Rural areas have lower rates of listing and receiving solid organ transplants. The aim of this study was to investigate trends in referral for LT based on physician-dependent variables. MethodsAn online survey was distributed to a cohort of physicians. Questions pertained to physician demographics, including age, specialty, practice location, and training at an LT center. Distances to the nearest transplant center was calculated based on zip code. Variables studied included length of sobriety, patient age, and body mass index required for transplant evaluation. Responses were analyzed using univariate ordinal logistic regression models and multivariable analyses. ResultsIn the study, 299 physician respondents were analyzed. Physicians without LT center training were 2.05 (confidence interval [CI] 1.33-3.17) times more likely to require longer duration of sobriety. As distance increased from a transplant center, the odds of requiring longer sobriety increased by 1.43 (CI 1.11-1.83) times. Gastroenterologists (GIs) and transplant hepatologists (THs) showed significant differences in referral candidacy for patients with alcohol-related liver disease (P < .0001). When compared to GIs/THs, primary care physicians were 2.11 times (CI 0.97-4.58) more likely to require a longer duration of sobriety. No significant physician-dependent variables were found in respect to patient age or body mass index. DiscussionOur study demonstrates that physician-dependent variables exist in referral for transplant evaluation. GIs and THs were more likely to refer higher-risk patients, which suggests a disparity in referral of patients with alcohol-related liver disease to transplantation depending on access to subspecialty care.

Setting the Standards: Examining Research Productivity Among Academic Urologists in the USA and Canada in 2019

BackgroundResearch productivity among academic urologists is strongly encouraged, but little data are available on productivity metrics within the field. ObjectiveTo provide the first comprehensive survey of research productivity among academic urologists in the USA and Canada. Design, setting, and participantsUsing the Accreditation Council for Graduate Medical Education, the Canadian Resident Matching Service, and individual program websites, all active accredited urology faculties were identified. For each individual, we collected data on American Urological Association section, title, gender, fellowship training, Scopus H-index, and citations. Comprehensive searches were completed during March–May 2019. Outcome measurements and statistical analysisDescriptive statistics for demographic comparisons were performed using analysis of variance for continuous variables and chi‐square test for categorical variables. Multivariable logistic regressions were used to identify the predictors of H-index greater than the median. Results and limitationsA total of 2214 academic urology faculties (2015 in USA and 199 in Canada) were identified. The median and mean H-indices for the entire cohort of physicians were 11 and 16.1, respectively. On multivariable analysis, physicians in the North Central and Western Sections (vs mid-Atlantic), who were fellowship trained (vs no fellowship training), and of higher academic rank (professor and associate professor vs clinical instructor) were more likely to have H-index values greater than the median. Additionally, female physicians (vs male) were more likely to have H-index values less than the median. ConclusionsThis study represents the first comprehensive assessment of research productivity metrics among academic urologists. These represent key benchmarks for trainees considering careers in academics and for practicing physicians gauging their own productivity in relation to their peers. Patient summaryIn this study, we provide the first comprehensive assessment of research productivity among academic urologists in the USA and Canada. Our results help provide key benchmarks for trainees considering careers in academics and for practicing physicians gauging their own productivity in relation to peers.

Diagnostic Likelihood Thresholds That Define a Working Diagnosis of Idiopathic Pulmonary Fibrosis.

Rationale: The level of diagnostic likelihood at which physicians prescribe antifibrotic therapy without requesting surgical lung biopsy (SLB) in patients suspected of idiopathic pulmonary fibrosis (IPF) is unknown.Objectives: To determine how often physicians advocate SLB in patient subgroups defined by IPF likelihood and risk associated with SLB, and to identify the level of diagnostic likelihood at which physicians prescribe antifibrotic therapy with requesting SLB.Methods: An international cohort of respiratory physicians evaluated 60 cases of interstitial lung disease, giving: 1) differential diagnoses with diagnostic likelihood; 2) a decision on the need for SLB; and 3) initial management. Diagnoses were stratified according to diagnostic likelihood bands described by Ryerson and colleagues.Measurements and Main Results: A total of 404 physicians evaluated the 60 cases (24,240 physician-patient evaluations). IPF was part of the differential diagnosis in 9,958/24,240 (41.1%) of all physician-patient evaluations. SLB was requested in 8.1%, 29.6%, and 48.4% of definite, provisional high-confidence and provisional low-confidence diagnoses of IPF, respectively. In 63.0% of provisional high-confidence IPF diagnoses, antifibrotic therapy was prescribed without requesting SLB. No significant mortality difference was observed between cases given a definite diagnosis of IPF (90-100% diagnostic likelihood) and cases given a provisional high-confidence IPF diagnosis (hazard ratio, 0.97; P = 0.65; 95% confidence interval, 0.90-1.04).Conclusions: Most respiratory physicians prescribe antifibrotic therapy without requesting an SLB if a provisional high-confidence diagnosis or "working diagnosis" of IPF can be made (likelihood ≥ 70%). SLB is recommended in only a minority of patients with suspected, but not definite, IPF.

Primary Care Physicians' Perceptions of Bariatric Surgery and Major Barriers to Referral.

Each year from 2011 to 2017, fewer than 1% of eligible Americans underwent bariatric surgery to treat obesity and obesity-related comorbidities. Recent studies have suggested that a lack of knowledge within the primary care specialty about the safety and efficacy of bariatric surgery greatly affects referral. This study aimed to analyze a large cohort of primary care physicians' (PCPs) clinical perceptions regarding bariatric surgery and to identify major barriers to referral that could inform the implementation of a future educational strategy to address underutilization of bariatric surgery. A prospective anonymous electronic survey was sent to all primary care physicians at a multicenter community-based academic hospital system between March and June of 2018, with 150 respondents, a response rate of 28%. The survey was composed of eleven questions in total, the first eight utilizing a five-point Likert scale, with answers including strongly disagree, disagree, neutral, agree, and strongly agree. The final three questions utilized freeform answers of numbers or text where appropriate. Between 83 and 88% of PCPs responded favorably, either agree or strongly agree, to questions regarding the utility of bariatric surgery as an efficacious and valuable tool for the treatment of obesity and related comorbidities. PCPs reported an average body mass index (BMI) of 40.4 ± 5.0 kg/m2 at which bariatric surgery is a patient's best option for weight loss and an average BMI of 38.0 ± 5.6 kg/m2 at which surgery is the best option for management of comorbidities. Eighty-six percent of PCPs agree that having a BMI over 40 kg/m2 is a greater risk to a patient's long-term health than undergoing bariatric surgery. However, only 46.6% of PCPs claimed any familiarity with the NIH eligibility criteria for bariatric surgery and only 59.5% responded affirmatively that they were comfortable participating in the long-term care of a postoperative bariatric patient. The two highest reported barriers to referral for bariatric surgery together account for 40% of PCPs responses: 21.5% of PCPs report concern regarding surgical complications and/or long-term side effects as the primary barrier for referral, and 18.5% report concern for ineffective weight loss after bariatric surgery as a primary barrier to referral. Results of this study indicate that despite largely positive attitudes toward the use of bariatric surgery in a patient population with obesity, primary care physicians report significant barriers to confidently referring their own patients. Further, bariatric surgery is overlooked in a large group of patients with BMIs between 35 and 40 kg/m2. Educational strategies to address these barriers should target rates of specific surgical complications and weight loss outcomes.

Associations Between Dietary Patterns and Sleep-Related Impairment in a Cohort of Community Physicians: A Cross-sectional Study.

There is increasing evidence that diet can mitigate fatigue. The objective of this study was to assess the associations between dietary habits and sleep-related impairment (SRI) in a cohort of community physicians. In this cross-sectional study, we analyzed data from 245 physicians who had completed a wellness survey in March 2016 (98% response rate). Three dietary patterns were derived using principal component analysis: plant based, high protein, and high saturated fat and sugar. In the adjusted analysis, every SD increase in the plant-based dietary pattern score was associated with a 0.71-point decrease (β = -0.72; SE = 0.32; P = .027; 95% CI = -1.35 to -0.08) in the SRI score, and every SD increase in the high saturated fat and sugar dietary pattern score was associated with a 0.77-point increase (β = 0.77; SE = 0.32; P = .015; 95% CI = 0.15 to 1.39) in the SRI score. There were no associations between high protein diets and SRI scores. Physicians adhering to diets that are high in plant-based foods and low in saturated fat and added sugars had less SRI. Physicians currently face significant barriers to maintaining a healthy diet. This study highlights the potential role of workplace nutrition on SRI and work performance of physicians.

Advanced visualizations to interpret prescription drug monitoring program information

ObjectivesPrescription drug monitoring programs (PDMPs) are state-based databases that contain information about controlled substance prescriptions dispensed by pharmacies. Many states now mandate PDMP use by prescribers, despite unclear effectiveness. We hypothesize that it is possible to improve the interpretability, and hence effectiveness, of PDMPs by enhancing them. MethodsThis was a real-time simulation of an enhanced PDMP. Fifty practicing physicians (25 primary care, 25 emergency medicine) were randomized to see three cases with a standard profile or an enhanced profile that included graphical representation of prescriptions and identified risky prescribing patterns. After a two-month washout period, participants were placed in the opposite group. ResultsPhysicians presented with the enhanced profile were more likely to correctly identify patients with multiple providers (97.0% vs. 85.8%, p = 0.002), overlapping opioid and benzodiazepine prescriptions (94.7% vs. 87.5%, p = 0.03), overlapping opioid prescriptions (89.5% vs. 70.8%, p < 0.01), high daily dosages of opioids (99.2% vs. 25.0%, p = 0.02), and traveling to distant pharmacies (79.7% vs. 2.5%, p < 0.01). There was no difference in interpretation time for the three cases (standard profile 657.3 s vs. enhanced profile 686.3 s, p = 0.31). ConclusionsA simulated PDMP with graphical displays and interpretation of findings was, for this cohort of emergency physicians and primary care physicians, associated with an increased ability to determine high-risk features on PDMP profiles.

Construction and preliminary evaluation of the inpatient glycemic control questionnaire (IGCQ): a survey tool assessing perceptions and knowledge of resident physicians

BackgroundUncontrolled hyperglycemia in hospitalized patients, with or without diabetes mellitus, is associated with many adverse outcomes. Resident physicians are the primary managers of inpatient glycemic control (IGC) in many academic and community medical centers; however, no validated survey tools related to their perceptions and knowledge of IGC are currently available. As identification of common barriers to successful IGC amongst resident physicians may help foster better educational interventions (ultimately leading to improvements in IGC and patient care), we sought to construct and preliminarily evaluate such a survey tool.MethodsWe developed the IGC questionnaire (IGCQ) by using previously published but unvalidated survey tools related to physician perspectives on inpatient glycemic control as a framework. We administered the IGCQ to a cohort of resident physicians from the University of Mississippi Medical Center, University of Louisville, Emory University, and the University of Virginia. We then used classical test theory and Rasch Partial Credit Model analyses to preliminarily evaluate and revise the IGCQ. The final survey tool contains 16 total items and three answer-choice categories for most items.ResultsTwo hundred forty-six of 438 (56.2%) eligible resident physicians completed the IGCQ during various phases of development.ConclusionsWe constructed and preliminarily evaluated the IGCQ, a survey tool that may be useful for future research into resident physician perceptions and knowledge of IGC. Future studies could seek to externally validate the IGCQ and then utilize the survey tool in pre- and post-intervention assessments.