Majority Of Residents Research Articles

Developing and Implementing a Systems-Based Residents as Teachers Initiative

This article was migrated. The article was not marked as recommended. PurposeUsing a systems-based approach for developing and implementing a residents as teachers (RaT) initiative follows the trend of systems thinking in health care and medical education, and assures positive outcomes and sustainability. This paper outlines the steps for a systematic, program-wide RaT initiative, using the University of British Columbia (UBC) as a case example. Project period was 2013-2015.Study DesignThe initiative team surveyed 65 of UBC's then 72 residency programs on their level of involvement and comprehensiveness in teaching residents to teach, which they used to create a 0-4 classification system. A six-topic RaT core curriculum was developed and train-the-trainer sessions were offered to build capacity within programs to customize and deliver the topics. An online scheduling system was used to schedule RaT sessions, track resident attendance, and disseminate evaluation surveys.ResultsA portion of the programs (n=21, 34%) were classified at Level 0, indicating few to no teaching competencies were taught. After the implementation of RaT in four programs, the majority of residents (n=61, 88%) indicated the overall quality of the educational experience was good or excellent. Most responses (n=2-93, 89-100%) agreed or strongly agreed that learning objectives were met for each RaT topic. ConclusionsImplementing a systems-based approach for RaT allows for centralized curriculum, administration, and evaluation, but also allows individual programs to have ownership and responsibility over curriculum adaptation, delivery methods, and faculty and resident engagement. Furthermore, the classification system provides a way to identify program needs and track improvements across all postgraduate residency training.

Supervision and autonomy of ophthalmology residents in the outpatient clinic in the United States II: a survey of senior residents

BackgroundA balance between autonomy and supervision can be difficult to obtain in medical education. In this study, we sought to determine whether the presence and level of supervision of ophthalmology resident outpatient clinic correlates with metrics of resident success, professionalism and stress.MethodsA survey was emailed to all US ophthalmology program directors requesting it be forwarded to PGY4 residents. Questions included whether their program provided a resident-hosted outpatient clinic, and if so, whether residents were mandated to discuss every patient with faculty. Residents were assigned to three categories based on this question (0: no clinic, 1: mandated faculty input, 2: discretionary faculty input). Success metrics included numbers of manuscripts submitted, OKAP scores and success in obtaining fellowships. Professionalism metrics included rating comfort obtaining informed consent, breaking bad news, managing time in clinic, and confidence in providing care in various settings. Residents affirming participation in a continuity clinic also provided perceptions of the level of supervision and how the clinic affected stress.ResultsCategory 1 residents perceived somewhat too much supervision, while category 2 residents felt that they had somewhat insufficient supervision. The majority of residents in either category did not feel that the continuity clinic affected their overall stress, although those who reported a change in stress usually indicated that the presence of the clinic increased stress. There were no other statistically significant differences between the responses from any category.ConclusionsThe presence of a resident-hosted continuity clinic neither adds nor detracts from the success or sense of professionalism of ophthalmology residents. However, when such a clinic is present, the degree of supervision appears to correlate inversely with resident perception of autonomy. These results suggest that the decision of a training program to offer a clinic hosted by residents offering comprehensive continuity care can be informed primarily by faculty and trainee philosophy and personal preferences without comprising education quality, clinical efficiency, residents’ perception of stress or their success in fellowship matching.

Conceptualizing sexual and gender-based violence in European asylum reception centers

BackgroundSexual and gender based violence (SGBV) is a major public health problem and a violation of human rights. Refugees, asylum seekers and migrants are exposed to a constant risk for both victimization and perpetration. Yet, in the context of European asylum reception centers (EARF) professionals are also considered to be at risk. Our study explores the conceptualization of SGBV that residents and professionals have in this specific context. Further, we intent to identify key socio-demographic characteristics that are associated with SGBV conceptualization for both groups.MethodsWe developed a cross-sectional study using the Senperforto project database. Semi-structured interviews were conducted with residents (n = 398) and professionals (n = 202) at EARF. A principal component analysis (PCA) was conducted to variables related with knowledge on SGBV. Chi-square test and Fisher’s exact test were applied to understand if significant statistical association exists with socio-demographic characteristics (significant level 0.5%).ResultsThe majority of residents were male (64.6%), aged from 19 to 29 years (41.4%) and single (66.8%); for professionals the majority were women (56.2%), aged from 30 to 39 years (42.3%) and married (56.8%). PCA for residents resulted in 14 dimensions of SGBV representing 83.56% of the total variance of the data, while for professionals it resulted in 17 dimensions that represent 86.92% of the total variance of the data. For both groups differences in SGBV conceptualization were found according to host country, sex, age and marital status. Specific for residents we found differences according to the time of arrival to Europe/host country and type of accommodation, while for professionals differences were found according to legal status and education skills.ConclusionResidents and professionals described different conceptualization of SGBV, with specific types of SGBV not being recognized as a violent act. Primary preventive strategies in EARF should focus on reducing SGBV conceptualization discrepancies, taking into account socio-demographic characteristics.

A protocol for measuring the impact of a smoke-free housing policy on indoor tobacco smoke exposure

BackgroundTobacco remains a leading cause of preventable death in the U.S., responsible for more than 440,000 deaths each year. Approximately 10% of these deaths are attributable to exposure of non-smokers to secondhand smoke (SHS). Residents living in public multi-unit housing (MUH) are at excess risk for SHS exposure compared to the general population. On November 30, 2016, the U.S. Department of Housing and Urban Development (HUD) passed a rule requiring all public housing agencies to implement smoke-free housing (SFH) policies in their housing developments by July 30, 2018.MethodsAs part of a larger natural experiment study, we designed a protocol to evaluate indoor SHS levels before and after policy implementation through collection of repeat indoor air samples in non-smoking apartments and common areas of select high-rise NYCHA buildings subject to the HUD SFH rule, and also from socio-demographically matched private-sector high-rise control buildings not subject to the rule. A baseline telephone survey was conducted in all selected buildings to facilitate rapid recruitment into the longitudinal study and assess smoking prevalence, behaviors, and attitudes regarding the SFH policy prior to implementation. Data collection began in early 2018 and will continue through 2021.DiscussionThe baseline survey was completed by 559 NYCHA residents and 471 comparison building residents (response rates, 35, and 32%, respectively). Smoking prevalence was comparable between study arms (15.7% among NYCHA residents and 15.2% among comparison residents). The majority of residents reported supporting a building-wide smoke-free policy (63.0 and 59.9%, respectively). We enrolled 157 NYCHA and 118 comparison non-smoking households into the longitudinal air monitoring study and performed air monitoring in common areas. Follow up surveys and air monitoring in participant households occur every 6 months for 2.5 years. Capitalizing on the opportunity of this federal policy rollout, the large and diverse public housing population in NYC, and robust municipal data sources, this study offers a unique opportunity to evaluate the policy’s direct impacts on SHS exposure. Methods in this protocol can inform similar SFH policy evaluations elsewhere.

PERSEPSI KENYAMANAN PARA PENGHUNI ASRAMA POLISI DI LEMBAGA PENDIDIKAN DAN PELATIHAN KEPOLISIAN REPUBLIK INDONESIA – AKADEMI KEPOLISIAN

As a primary need, shelter or boards are often to the top priority in human life which must be fulfilled after clothing and food. The Police Dormitory from Indonesian Republic Police Education And Training Institutions – Police Academy or abbreviated in Indonesian “Lemdiklat Polri – Akpol” is residential facility in the police dormitory provided for personnel and staff who teach or served in the Police Academy both members of the National Police or PNS (Goverment Employees). Not infrequently this dormitory are also inhabited more than two years by its members who serve in the Indonesian Republic Police Education And Training Instituitions – Police Academy. The majority of residents can be said to be decent enough to buy, or rent and inhabit outside the plice dormitory which has far better conditions than the police dormitory itself. This paper aims to determine the factors that make them stay at home to live there, even thought they can rent or buy more suitable home to live. The method used is mixing of qualitative methods and quantitative methods called mixed methods, and also look at the psychological and economic aspects of them. The results of the study reveal that there are a numbers of reasons for neighboring life that are safe, comfortable, economically affordable, the tranquility and natural silence in the surrounding area along with pollution – free air makes the residents still remain even though this location is far from the economic center in mainly.

Comparative Study of the Impact of Biomass and Clean Fuels Burning as Cooking Energy on Rural Indoor Air Quality in Heilongjiang, China

In rural areas of the northeast China, the majority of residents use traditional Chinese Kang-stoves for heating and cooking by burning biomass fuels. However, this method is associated with serious indoor air pollution problems. The purpose of this study is to evaluate indoor air quality impacts from biomass combustion and indoor air quality improvements derived from using clean fuel. A comparative study was conducted in three rural households of Heilongjiang to determine indoor air pollution extent during burning biomass (rice straw, cornstalk and corncob) and liquefied petroleum gas (LPG) fuels for cooking. The results indicated that the concentration of CO from the combustion of four kinds of fuels was almost below the guidelines prescribed in Chinese In-door Air Quality Standard. On the contrary, PM2.5 concentrations exceeded the limiting value regardless of which fuel was used, and the lowest PM2.5 concentration values, which were obtained during burning LPG, were about 2.4-7.5 times of 24-h mean PM2.5 concentration limit. The mean values of formaldehyde concentrations during using four types of cooking energy were totally higher than the standard limit, and the lowest formaldehyde concentrations were detected when corncob was used as cooking energy. Compared with LPG fuel, biomass fuels combustion in traditional Kang-stove with chimney increased the concentrations of TVOC and BTEX. To conclude, the pollutants generated from using LPG are relatively less harmful. Among the three biomass fuels, the minimal pollution derives from the combustion of corncob.

How Federal Tax Law Rewards Segregation

Residual, de facto segregation is among the most enduring barriers to equal opportunity in America. Nearly five decades after the Fair Housing Act of 1968, Blacks and Latinos still tend to live in neighborhoods where the majority of residents are people of color. Such racial segregation is often accompanied by economic segregation. Meanwhile, sociologists, housing law scholars, and poverty law experts have stressed the importance of residential location to the impact of poverty and the potential for upward economic mobility. But an unlikely source of federal housing law—the tax code—may interfere with efforts to promote more integrated communities. This Article argues that federal tax law rewards White-flight and economic segregation and, as a result, may exacerbate the enduring effects of past policies like redlining and exclusionary zoning, while also limiting the effectiveness of non-tax federal programs intended to promote housing choice, such as the Section 8 tenant voucher program. The Article begins by using publicly available data from the Internal Revenue Service and the Department of Housing and Urban Development to map the flow of mortgage interest deduction benefits and the location of low-income housing tax credit properties in a representative city, Philadelphia. Next, the Article uses thought experiments to demonstrate how features of the tax law create monetary incentives to reinforce the segregation patterns reflected in the spatial distribution of these tax-subsidies. Finally, the Article sets forth recommendations for tax policy reforms that would better promote integrated communities.

Residency training in Ghana: the residents' perspective.

Prior to 1973, West African citizens completed postgraduate medical and surgical training abroad, particularly in the United Kingdom. In 2003, the Ghana College of Physicians and Surgeons were established respectively and began to offer specialized training locally. The aim of this study was to obtain and evaluate the views of Medical and Surgical Residents of the GCPS on their training in Ghana. A descriptive cross-sectional study was undertaken whereby a 25 item, self-administered questionnaire, was distributed to 170 residents of Korle Bu and Komfo Anokye Teaching Hospitals in Ghana. Information regarding the residents' sociodemographic characteristics, level of residency, and satisfaction with the programs in terms of clinical supervision, didactic teaching, program duration and research training was collected. 117 residents completed the survey, yielding a response rate of 68.8%. 59.8% were males and 40.2% females. The age of the residents ranged from 25 to 40 years with a mean age of 32.7+1.4 years. Majority of residents (92.3%) were satisfied with the duration of the programs . Slightly more than half of the residents (50.4%) were satisfied with the clinical supervision, however only a third of the respondents (33.3%) were satisfied with the didactic teaching and an even smaller percentage (17.1%) with research training. Whilst majority of residents were satisfied with the duration of the residency program, the perspective of the respondents was that trainees would benefit from additional didactic teaching and increased research exposure. None.

Village development movement together with lecturers and students through Abdi Desa activities in Lebak Pendeuy Village, Banten [Gerakan Membangun Desa melalui Kegiatan Abdi Desa Dosen dan Mahasiswa di Dusun Lebak Pendeuy, Banten

Kabupaten Lebak is one part of Banten Province, Indonesia. The habit of residents who carry out toilet wash (MCK) activities and dispose of garbage in the river should be a matter of concern. Because this habit is the cause of river pollution. Water becomes dirty and is also a major cause of disease. Because all activities of the villagers use water from the river. The majority of residents in this hamlet do not yet recognize the existence of a National Health Insurance (JKN) program, only a small number have a BPJS health card (Social Security Organizing Agency). Residents get health services from the Puskesmas Midwives who come once a month, and once every 6 months there is a service from the Puskesmas Doctors who visit the Village. The service is carried out free of charge by the Puskesmas. Techniques used in finding problems in this activity are Direct Observation and Semi-Structured Interviewing techniques. The results of this activity are the provision of education to school students, health checks, basic food giving, and the making of MCK.

Abstract P5-09-17: Risk reducing interventions among BRCA 1 and 2 female carriers in Newfoundland and Labrador: A provincial analysis

Abstract Introduction Germline mutations in the tumour suppressor genes BRCA 1 and 2 result in a significant increase in cancer predisposition. Female carriers can have up to a 50-70% chance of developing a breast malignancy in their life time and a risk of 20-40% for ovarian cancer. Management options for women with a BRCA mutation include screening with annual mammography and magnetic resonance imaging (MRI), prophylactic surgery and chemoprevention. There is substantial evidence that preventative strategies may reduce the risk of developing breast and ovarian cancer and in some cases improve survival. Newfoundland and Labrador (NL) is the most easterly province in Canada with a population of 525 983. It is geographically and genetically isolated with the majority of residents from English and Irish ancestry. While no one single founder effect has been identified, geographically distinct mutations for both BRCA 1 and 2 have been described. The objective of this study is to characterize the population of BRCA mutation carriers in NL and to evaluate their uptake of risk reducing interventions. Methods All BRCA 1 and 2 carriers tested through the Provincial Medical Genetics program between 1996 - 2018 were captured. Inclusion criteria for this study were females ≥ 18 years of age residing in the province. Demographic, clinical history and information on uptake of risk reducing interventions were abstracted from the electronic medical record. Descriptive statistical analysis was performed. Results One hundred and sixty one women were identified that met inclusion criteria (38% of patients had BRCA1 and 62% had BRCA 2 mutations). Of those unaffected carriers eligible for mammography and MRI screening, only 58% were adherent in the last 18 months. Consultation with a medical or gynecological oncologist increased mammogram screening within the last 18 months to 71% compared with 29% of women who did not see an oncologist. MRI screening increased to 80% for those assessed by oncology versus 20% who did not. For those women who underwent prophylactic surgeries, 27% had bilateral mastectomies with the majority having breast reconstruction (>70%). Fifty two percent of carriers had bilateral salpingo-oophorectomies (BSO) at a median age of 45 years in BRCA 1 and 51 years in BRCA 2. Fifty-three women had a diagnosis of breast cancer and 8 had ovarian cancer. In this cohort, most underwent genetic testing after their diagnosis of cancer (>80%). Median age at presentation of breast cancer was 44 years versus 54 years for ovarian cancer. Conclusion This study demonstrates that women with BRCA 1 and 2 mutations are not adequately availing of risk reducing interventions for breast and ovarian cancer. Furthermore, most patients with malignancy did not undergo genetic testing until after they were diagnosed with cancer. Patient focused research designed to explore factors which may contribute is planned. Consultation with an oncologist increased the likelihood of adherence to breast cancer screening. This highlights the importance of specialty care for patients with a hereditary predisposition to breast and ovarian cancer. Citation Format: Seal MD, Roebothan A, Gabriel A, Dawson L. Risk reducing interventions among BRCA 1 and 2 female carriers in Newfoundland and Labrador: A provincial analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-17.

Needs Assessment of Emergency Department Residents in Examining and Managing Patients with Ophthalmologic Complaints

Purpose Emergency medicine residents are trained to deal with a variety of emergency conditions; eye emergencies represent only a small portion of their clinical experience. This study was a targeted needs assessment of the comfort level of emergency medicine residents in diagnosing and managing patients who present with an ophthalmic chief complaint, with the goal of targeting future educational interventions. Methods This was a cross sectional survey conducted at a large tertiary-care hospital between June 2016 and August 2016. Participants were 1st, 2nd, or 3rd year emergency medicine residents in an Accreditation Council for Graduate Medical Education (ACGME)-approved emergency medicine residency. Results The total response rate was 67.4% (29/43). The majority of residents did not expect equivalent availability of ophthalmology consultation services post-graduation. They generally believed ophthalmology and examination skills to be important to their future career and became more comfortable with the slit lamp exam through residency, although the average level of comfort was only 6.9 on a 1 to 10 scale for 3rd year residents (standard deviation [SD] = 2.6). A majority of residents were not confident with their diagnostic, examination, or management skills when queried about specific ophthalmic conditions or presenting symptoms. They indicated a variety of reasons why their comfort with ophthalmologic patients was limited. Conclusion There is both need and desire for increased ophthalmic skills training for emergency medicine residents. Given time constraints in residency training, possible solutions will need to be innovative and multifaceted in order to target this goal.

Personal, Social, and Environmental Factors Associated with the Behavior of Plastic Bag Use among Urban Residents: A Study with Socioecological Approach.

Background:Disposal and release of plastic bags in the environment can cause environmental, economic, and social problems. The aim of this study was to explore the determinants of the behavior of plastic bag use (BPBU) among residents using socioecological approach (SEA).Methods:In this cross-sectional study, multistage random sampling was employed to enroll 400 residents in Hadishahr County, North West of Iran. A valid and reliable instrument based on SEA variables was used.Results:Hierarchical multiple linear regressions were performed with SEA and BPBU as outcome variables. Predictors of outcome variables were classified into four different blocks. Demographic characteristics and SEA constructs explained 50% of the observed variance in BPBU. In the first block, age (P = 0.03) and purchase frequency (P = 0.902) were significant predictors of BPBU (R2 = 0.34), and in the third block, access to alternatives in environment (P = 0.01) was significant predictor for BPBU (R2 = 0.49). The majority of residents (47%) were taking home 6 to 10 plastic bags and more than 10 freezer bags after their shopping per week.Conclusions:Health-care providers may consider purchase frequency and SEA as a framework for developing educational, environmental, and social interventions aiming at reducing the consumption of plastic bags.

An Extension of the Theory of Planned Behaviour to Predict Willingness to Pay for the Conservation of Urban Lakes for Mitigating the Urban Heat Island Effect

Urban heat island effect has become a serious environmental problem of Beijing and urban lakes are proved to be effective in mitigating this phenomenon. Urban lakes are proved to be effective in mitigating urban heat island effect, while this effect has long been overlooked. One important reason is that its economic value cannot be easily measured. This paper empirically investigates the Beijing residents' willingness of pay for the benefit of urban lakes in mitigating the urban heat island effects. In addition, the government also willing to promote public participation in environmental issues. To explore the influencing factors of residents' willingness to pay, this study applied an extended framework of the theory of planned behavior by introducing the concept of environmental concern. The estimated mean willingness to pay was 24.44 US dollars per year. In order to improve the prediction power of respondents' pro-environmental behavior, the original framework of the Theory of Planned behavior were extended by adding the factor of environmental concern. The new relation of components show that environmental concern influence respondents’ willingness to pay both directly and indirectly, and the explanatory power of the original prediction model is improved. This research reveal that a majority of residents in Beijing are willing to contribute for the conservation of urban lakes for mitigating urban heat island effect, while environment related information disclosure is necessary for promoting public participation in urban environment management.

Auto/Biography After Disaster: The Year in Puerto Rico

Auto/Biography After DisasterThe Year in Puerto Rico Ricia Anne Chansky (bio) How do I mark myself safe or ask if someone else is safe during a disaster? When you receive a notification from Facebook asking if you're safe, tap Tell Friends You're Safe. Facebook, Help Center On September 20, 2017, Hurricane María made landfall in Puerto Rico and ravaged the island. The rising temperatures in the Atlantic Ocean—created by a continued dedication to producing fossil fuels despite the severity of the environmental crisis in the Anthropocene Era—triggered several large-scale hurricanes in the 2017 and 2018 storm seasons. Puerto Rico's colonial status as a territory of the United States, however, has generated a second, human-made humanitarian crisis in the aftermath of the hurricane. In a series of moves by the US federal government that clearly positioned Puerto Ricans as second-class citizens, essential supplies and assistance did not appear in a timely manner (if at all), causing a staggeringly high number of deaths and prompting a second wave of the contemporary mass migration to the continental United States.1 In this year of natural and human-made disasters, a spate of e-memoirs, digital narratives, and online auto/biographical acts have emerged from Puerto Rico that speak to the sense of urgency in life stories crafted in the wake of disaster. In this essay, I will focus on hurricane narratives that were digitally self-published in Puerto Rico in the twelve-month period following María. I have previously used the term "ugly auto/biography" to refer to the fast, unrefined, and unrevised hurricane memoirs that were written by my students when our classes at the University of Puerto Rico at Mayagüez resumed on October 30, 2017. At this time, the majority of residents were still without electricity and access to telecommunications, while others were living in various states of precarity due to compromised housing, lack of food and/or potable water, and [End Page 124] inability to access medical care. In a recent essay on disaster pedagogy, I articulate that the term "ugly" in this usage does not enter into a binary signifying a story worth less than another, different sort of a narrative.2 Instead, I argue that the term denotes the rawness and urgency of these narratives—recorded in periods of great instability and voiced from spaces of crisis and danger—that manifest without time for reflection or editorial intervention from either the author or nonauthorial agent. Such narratives outline particular types of life stories, ones that we might recognize and engage with for different reasons and in different ways than those crafted with the benefit of a narrating "I" who has the luxury of time and the advantage of distance from the event or events that motivated the act of narration. Auto/biographers can be self-aware in these narratives that something different may be published as more time passes. "In the months and years to come," M. Kelley states in her hastily-produced disaster narrative, "I believe there will be an outpouring of stories" (2). The primary emphasis in these initial e-narratives may not necessarily be the craft of storytelling but the need for sharing the life story at this juncture. Rangely J. García Colón tells one of these life stories. Otherwise known as "Rad Rangy," García Colón is a self-proclaimed "Art Director/Illustrator/Writer/Comic Book Artist & crazy bird lady from Puerto Rico" (@radrangy), who has won three Emmy Awards for her animation and writing for children's shows (García Colón). Her work tends to revolve around anthropomorphic characters who have highly urbanized adventures. In her fictional comix, she uses a sophisticated visual style that blends action-oriented scenes with elements of classic noir aesthetics, and she typically produces full-color images. This sense of immediacy in post-disaster narratives is easily seen in the contrasting visual style adopted by García Colón in her webcomic, Ave María: A Comic Diary of a Category 5 Disaster. García Colón's visual diary of Hurricane María and its aftermath was posted on her...

Feeling of Happiness in Self-Assessments of Ukrainians

Happiness shows as an important sociological category. Starting from Aristotle, happiness has traditionally been conceptualized in European reflection as the main goal of human life, as a result of human development (eudaimonic interpretation). At the same time, a simplified understanding of happiness as a subjective complex of sensations (hedonistic interpretation) has formed in the history of sociology. The article focuses on the relevance of the issue of happiness as a subject of sociological research. The concept of happiness has been interpreted as a particularly significant, key indicator that combines the subjective and objective characteristics of the humanˊs life-world as an integral part of society. Modern empirical techniques that allow us to reach a new level of understanding the role of happiness in human life are evaluated by us. The article contains the results of a secondary analysis of the sociological dimensions of happiness carried out in Ukraine in recent years, including in the context of the study of values and value orientations. According to research results, the negative events taking place in Ukraine in recent years did not directly affect on self-assessments of a feeling of happiness. This can be explained by the lack of formation of the “concept of happiness” among Ukrainians (Y. Golovakha), as well as the prevalence of family values in the general hierarchy of values. The results of a questionnaire conducted at the Department of Sociology of the Petro Mohyla Black Sea National University in May 2018 have been published and analyzed. According to our data, the vast majority of residents of the three centers of the Black Sea region (Mykolaiv, Odessa, Kherson) consider themselves happy people. At the same time, the feeling of happiness among the residents of the region is due to a greater extent to personal factors and is not directly related to the well-being of society. This can be regarded as a dangerous trend, one of the symptoms of the growing atomization of society.

Smart Home Users Perception on Sustainable Urban Living and Legal Challenges in Malaysia

Smart homes can improve life by providing comfort, leisure, safety, and healthcare to residents. Nevertheless, the smart home concept depends on the integration on human and non-human intelligence, which raises a host of questions concerning its implication on legal liability. The legal issues in relation to definition of smart home, data protection, privacy, liability and insurance coverage. The aims of this paper is to discuss the perception of smart home users on the sustainable urban living and its challenges. This is a qualitative study and involves a small survey among smart home users in Kuala Lumpur. The findings show that there is no legal specific definition of smart home, there is no specific standard or specification issued by any regulatory bodies to regulate the network or appliances being used in smart homes. Majority of residents agreed that there are threats of privacy to smart home users. And privacy is not guaranteed and majority of residents agreed that their smart home and devices is not covered by insurance policy. Hence, a policy and specific law or at least provisions regarding smart home must be drafted or inserted in the present statute initiated by the Ministry of Urban Wellbeing, Housing, and Local Government of Malaysia.

2210. An Online Survey of Hepatitis C Testing Attitudes and Practice Habits Among Residents at an Urban Medical Center

BackgroundThe hepatitis C virus (HCV) is the most common blood-borne infection; treatments are well tolerated, highly effective, and improve health outcomes. A recent blinded seroprevalence study of ED patients identified an undiagnosed HCV prevalence 0.8%. New York State recently highlighted a strategic plan to reduce the incidence and prevalence of HCV through aggressive testing, linkage, and treatment. To evaluate HCV screening practices, we conducted a survey of resident attitudes and practice habits surrounding HCV screening.MethodsFrom August 1, 2017 to April 30, 2018 we conducted an anonymous online survey to examine attitudes about sexual health screening among residents at an upper Manhattan academic medical center. Response rates were 22% (33) for internal medicine (IM), 45% (35) for pediatrics (Peds), and 21% (10) for emergency medicine (EM).ResultsA majority of IM residents (61%) agreed that HCV screening was one of their responsibilities as compared with Peds (23%, P = 0.002) and EM residents (20%). This differed from HIV testing where the majority of residents across disciplines (73, 71, 60%) considered HIV screening to be their responsibility. IM residents were more likely to agree that it is important to screen for HCV in all care settings. However, less than half of them considered HCV screening (42%) or successfully screened (45%) the majority of their eligible patients. Barriers to HCV screening were diverse across specialty groups with the majority of EM residents concerned about inadequate resources (90%) and issues surrounding minors (90%). IM residents were concerned about higher priority issues (85%) and time constraints (58%). Peds residents were concerned that HCV testing was outside their scope of practice (69%) and that the prevalence was too low (63%). When informed that one-third of individuals diagnosed with HCV were outside of the birth cohort both Peds and EM providers were more likely to consider screening their patients for HCV. ConclusionIM residents acknowledged the importance of HCV screening and felt it was appropriate to screen in all settings but identified challenges to screening. Barriers to HCV screening differed between IM, Peds, and EM residents highlighting opportunities for individualized targeted interventions.Disclosures All authors: No reported disclosures.

Reader response: Education research: The current state of neurophysiology education in selected neurology residency programs.

I read with interest the Resident & Fellow Education Research article by Daniello and Weber1 on the current state of neurophysiology education in neurology residency programs. The authors found that the majority of residents graduate without meeting level 4 Accreditation Council for Graduate Medical Education (ACGME) milestones in EEG and EMG (EMG > EEG). Inpatient service demands and time constraints on residents were reported as the major cause of resident failure to meet ACGME milestones. The last few decades have witnessed a knowledge explosion in neurology. Somehow, the knowledge explosion and knowledge divide needs to be bridged, especially by residents in training. The 80-hour work week restriction placed by ACGME needs to be relaxed so that residents can be exposed to various neurology subspecialties, or we risk having many of our patients with epilepsy and neuromuscular disorders receive suboptimal care from these doctors in the future.

Challenging Hazards Amidst Observational Simulation in the Emergency Department: Advancing Gamification in Simulation Education Through a Novel Resident-led Skills Competition.

Medical simulation competitions have become an increasingly popular method to provide a hands-on “gamified” approach to education and training in the health professions. The most well-known competition, SimWars, consists of well-coordinated teams that are tasked with completing a series of mind-bending clinical scenarios in front of a live audience through ‘bracket-style’ elimination rounds. Similarly, challenging hazards amidst observational simulation (CHAOS) in the emergency department (ED) is another novel approach to gamification in both its structure and feel. Conducted at the Council of Emergency Medicine Resident Directors (CORD) 2018 National Assembly in San Antonio, Texas, instead of assigning premeditated teams, it placed random Emergency Medicine (EM) faculty, residents, and medical students together in teams to test them on a variety of fundamental EM content areas. Additionally, the event incorporated multiple levels within each round, allowing the inclusion of additional information to be shared with participants to support “switching gears,” as is typical for teams working in the ED and augmenting the perceived level of “chaos.”To assess this pilot project, formal quantitative and qualitative feedback was solicited at the end of the session. Quantitative evaluation of the intervention was obtained through an eight-item questionnaire using a five-point Likert-type scale from 19 of the 20 enrolled participants (95% response rate). Responses were generally positive with an overall course rating score of 4.45 out of 5 (SD +/- 0.62). Qualitative feedback revealed that learners enjoyed performing procedures and networking with their EM colleagues. The majority of residents (95%) recommend the activity be integrated into subsequent conferences. Areas for improvement included shorter cases and minimizing technical malfunctions.CHAOS in the ED was a successful pilot study that incorporated gamification as a means to deploy simulation-based training at a national emergency medicine conference in a community of simulation educators. Future studies should focus on incorporating learners’ feedback into subsequent CHAOS iterations and reducing overhead costs to increase its adoption by both regional and national audiences.

PALLIATIVE AND HOSPICE SERVICES IN LONG TERM CARE

Our purpose is to explore perceived satisfaction with pain management among residents of long-term care (LTC) facilities, with hospice/palliative care (HPC) hypothesized to improve services. The 22 RNs used tablets to review charts; speak to facility administrators, and interview residents / family. Analyses included random-effects logistic model. We explored data from 815 LTC facilities using within facility, random selection of 1,412 residents. The results indicate that 147 or 10% of residents receive HPC. Regarding pain care satisfaction, 989 residents responded to the question and 159 (16%) were not satisfied; 830 were satisfied (84%). The estimated average probability of being satisfied with pain relief was .839 (se = .012, 95% CI: 0.816, 0.862). We also found no difference in the satisfaction with pain relief for HPC users and not. The estimated effect of HPC on the logit was -0.09225 (se=0.2980), p-value = 0.7570, 95% CI of the effect: (-0.6771 0.4926). For reported minutes taken to receive medication after the request, 570 residents responded to the question. Estimated variation in log-transformed time spent was attributed to facilities. The estimated proportion was 0.3673/(0.3673 + 0.7798) = .32 No differences found in reported time to receipt of medication after request for HPC and not. The estimated effect of HPC on reported time was 0.03862 (se=0.2086), p-value = 0.8532, 95% CI of the effect: (-0.3712, 0.4485)). Overall, the majority of residents are satisfied with their pain control; variation was due to individual facility differences. Hospice/palliative care had no effect on the satisfaction or time to medication.