Mean Composite Score Research Articles

The Relationship Between Residents' Perceptions of Residency Program Leadership Team Behaviors and Resident Burnout and Satisfaction.

To explore the relationship between residents' perceptions of residency program leadership team behaviors and resident burnout and satisfaction. In February 2019, the authors surveyed all residents across the 77 graduate medical education training programs at Mayo Clinic's multiple sites. Survey items measured residents' perceptions of program director and associate program director behaviors (using a composite residency program leadership team score), resident burnout, and resident satisfaction with the program and organization. Multivariable logistic regression was performed to evaluate relationships between these variables at the individual resident (adjusting for age, sex, postgraduate training year, program location, and specialty) and program (including only programs with at least 5 respondents) levels. Of the 1,146 residents surveyed, 762 (66.5%) responded. At the individual resident level, higher composite leadership team scores were associated with lower emotional exhaustion and depersonalization and higher overall satisfaction with the residency program and organization (all P < .001). In adjusted logistic regression models, each 1-point gain in composite leadership team score was associated with 9% lower odds of burnout, 20% higher odds of program satisfaction, and 19% higher odds of satisfaction with the organization (all P < .001). At the residency program level, higher mean composite leadership team scores were associated with a lower rate of burnout (r = -0.35, P = .03) and higher program and organization satisfaction (r = 0.67 and 0.74, respectively, both P < .001). The behaviors of residency program leadership teams influence residents' burnout and satisfaction. Additional studies are needed to determine if leadership training results in improved resident well-being and satisfaction.

Facility readiness for basic emergency obstetric and neonatal care at PHC centres in Nigeria

Abstract Background Functionality of essential delivery services at primary health care (PHC) centres is crucial to achieving targeted improvements in maternal and neonatal outcomes in Nigeria. However, evidence suggests that PHC centres are often unable to adequately render basic emergency obstetric and neonatal care (BEmONC) services. This study assessed BEmONC availability and facility readiness at PHC centres in Edo State, Nigeria. Methods This facility-based cross-sectional survey was conducted in Edo State, Nigeria among 36 public primary health care centres selected by multistage sampling. The WHO service availability and readiness assessment tool was adapted to obtain data from PHC centres. BEmONC availability index was derived using 6 indicators (intravenous oxytotics, intravenous anticonvulsants, intravenous antibiotics, assisted deliveries, removal of retained products of conception and neonatal resuscitation). A composite readiness index was developed based on 26 indicators across five domains (trained staff, basic amenities, basic equipment, diagnostic tests and essential medicines). Indices were summarized as mean percentages and 95% confidence intervals. Results Among 36 facilities assessed, the mean BEmONC availability index score was 48.6% (CI = 41.7 - 55.5%) while the mean composite readiness index score was 58.9% (CI = 54.5 - 63.2%). Domain specific readiness indices showed marked variations with low mean scores for basic amenities (45.8%, CI = 38.4 - 55.3%) and trained staff (43.5%, CI = 33.1 - 53.9%), moderate score for basic equipment (53.5%, CI = 48.6 - 58.5%) and high scores for diagnostic tests (71.2%, CI = 60.5 - 82.1%) and essential medicines (80.1%, CI = 72.4 - 87.8%). Conclusions BEmONC availability and readiness at PHC centres in Edo State was suboptimal. Current efforts to improve services at PHC centres should strategically target availability of emergency obstetric functions, enhancing staff capacity and upgrading basic amenities. Key messages There are crucial gaps in the provision of BEmONC at primary health care level in Edo State, Nigeria that may negatively impact the quality of maternal and neonatal care. This study highlights the need for stakeholders to intensify PHC strengthening initiatives geared towards better pregnancy outcomes.

Quality of life in patients with uveitis: data from the ULISSE study (Uveitis: cLInical and medico-economic evaluation of a Standardised Strategy for the Etiological diagnosis)

AimsTo assess vision-related (VR-QOL) and health-related quality of life (HR-QOL) in a large series of patients with de novo uveitis at baseline and 6-month follow-up.MethodsNon-inferiority, prospective, multicentre, cluster randomised controlled...

The association between Asian patient race/ethnicity and lower satisfaction scores

BackgroundPatient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings.MethodsPatient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California – a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) – was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N = 216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box (“very good”) compared to all other categories (“very poor,” “poor,” “fair,” and “good”). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex.ResultsAsian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question “likelihood of recommending this practice to others” (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675–0.685 compared to NHW PP 0.820, 95% CI: 0.818–0.822; Site B: Asian PP 0.734, 95% CI: 0.733–0.736 compared to NHW PP 0.859, 95% CI: 0.859–0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking.ConclusionsPatient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.

Trifocal diffractive intraocular lens implantation in patients after previous corneal refractive laser surgery for myopia

BackgroundWith the difficulties in IOL power calculation and the potential side effects occurring postoperatively, multifocal IOL implantation after previous corneal refractive surgery are rarely reported especially for the trifocal IOL. Herein we report the clinical observation of trifocal IOL implantation in patients with previous myopia excimer laser correction. In this study, a multi-formula average method was performed for the IOLs power calculation to improve the accuracy. Visual and refractive outcomes were analyzed, and the subjective quality of patients’ life was evaluated by questionnaires survey.MethodsThis retrospective case series included patients with previous myopia excimer laser correction who underwent femtosecond laser assisted phacoemulsification and trifocal IOL (AT LISA tri 839 MP) implantation. Follow-up was done at 1-day, 1-month and 3-month to assess the visual outcomes. Outcome measures were uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction, defocus curve, and subjective quality of vision.ResultsTwenty-one Eyes from sixteen patients (14 eyes with previous laser in situ keratomileusis and 7 eyes with previous photorefractive keratectomy) were included. Mean postoperative spherical equivalent (SE) at 3-month was − 0.56 D ± 0.49 SD, wherein, 10 eyes (47.6%) were within ±0.50 D of the desired emmetropia and 19 eyes (90.5%) were within ±1.0 D. Mean monocular UDVA, UIVA and UNVA (logMAR) at last visit were 0.02 ± 0.07, 0.10 ± 0.10, and 0.15 ± 0.11 respectively. Three patients (19%) reported halos and glare in postoperative 3 months, two of them needed to use spectacles to improve the intermediate visual acuity. Fifteen patients (94%) reported a satisfaction score of ≥3.5 out of 4.0, without any difficulty in daily activity. Thirteen patients (81%) did not need spectacles at all distances, while the other 3 patients (19%) used spectacles for near-distance related visual activity. Mean composite score of the VF-14 questionnaire was 95.00 ± 7.29 out of 100.ConclusionsTrifocal IOL implantation after myopia excimer laser correction could restore good distance, intermediate visual acuity and acceptable near visual acuity, and provide accurate refractive outcomes as well as high spectacles independence rate.

Comparing Students' Clinical Grades to Scores on a Standardized Patient Note-Writing Task.

Few assessments capture the diagnostic impressions medical students form immediately following patient encounters. However, notes written for objective structured clinical examinations (OSCEs) allow learners to document their clinical reasoning in real time. The University of Illinois at Chicago College of Medicine (UIC-COM) has developed a rubric for scoring patient notes (PNs) in their OSCE for senior students. To validate the UIC-COM PN Scoring Rubric as a measure of clinical reasoning by comparing PN scores from a similar exam at the Columbia University Vagelos College of Physicians and Surgeons (VP&S) to clinical rotation performance. Cross-sectional analysis. From a total of 146 third-year medical students who completed the OSCE at VP&S in spring 2017, we selected 60 at random, 20 from each tertile of clinical rotation performance. We scored these students' PNs using the rubric's four sections-Documentation, Differential Diagnosis, Justification, and Workup, each scored from 1 to 4-and calculated a composite score (maximum 100). We used one-way ANOVA to examine differences in scores between clinical rotation performance tertiles. Students in the bottom, middle, and top clinical rotation performance tertiles had mean Documentation scores of 2.54, 2.63, and 2.88, respectively (p = 0.02, bottom vs. top tertile). Mean composite scores were 61.98, 64.05, and 67.86, respectively (p = 0.02, bottom vs. top tertile). We showed an association between PN scores and clinical rotation performance. Since clinical rotation grades incorporate multiple types of assessments of students' clinical reasoning skills, we believe that this correlation lends validity evidence to using the note-writing task as a measure of clinical reasoning. Future directions include expanding the task to different stages of learners, to real life patient encounters, and to formative rather than summative assessments of note-writing skills.

Neurodiversity and deficit perspectives in The Washington Post’s coverage of autism

Media representations can perpetuate stereotypes about marginalized groups. Autism is often portrayed as a series of deficits needing correction. Many autistic self-advocates argue, however, that their neurological characteristics represent natural genetic variation—neurodiversity—and that they are not in need of a “cure.” The current study examined articles about autism on The Washington Post website from January 2007 through December 2016. It was hypothesized that articles would contain more elements of the neurodiversity perspective over time. Each article was coded for its overall valence, four measures of neurodiversity, and four deficit measures. Mean valence and mean composite neurodiversity scores significantly increased over time, while the mean composite deficit score significantly decreased over time. While the data suggest positive trends towards the neurodiversity perspective, they also reveal that some aspects of the deficit view of autism did not change over this time period in this news outlet. Points of interest Autism is often portrayed as entirely negative, but it has been argued that autism represents a form of diversity (neurodiversity) that should be recognized and respected. The current study examined how autism was portrayed in an influential US newspaper (The Washington Post) from 2007 to 2016. Later articles about autism were more likely to use words like neurodiversity, more likely to highlight strengths of autistic people, and more frequently described accommodations for autistic people. They also focused less on identifying causes of autism but continued to use negative terms and very few articles contained the perspectives of autistic individuals themselves. Although some progress seems to have been made in the portrayal of autism, there is still room for improvement.

Inadequate Knowledge, Attitude and Practices about Second-Hand Smoke among Non-Smoking Pregnant Women in Urban Vietnam: The Need for Health Literacy Reinforcement.

The rate of exposure to second-hand smoke (SHS) is relatively high in several countries, including Vietnam, and health issues related to SHS have worsened in recent years, especially for pregnant women and their infants. Enhancement of knowledge, attitude, and practice (KAP) scores of pregnant women in Vietnam could raise practical interventions to protect their health and reduce complications of SHS. A cross-sectional study of 432 pregnant women who came to the Obstetrics Department of Bach Mai Hospital, Hanoi, Vietnam for antenatal care was conducted in 2016 to collect information about their KAP related to SHS. Composite mean scores from survey questions assessing their KAP were calculated on a 10-point scale, finding mean scores of 4.19, 7.45, and 4.30, respectively. Higher scores indicated better knowledge, attitude, and practice. Generalized linear models identified that age, occupation, living place, and sources of information were associated with SHS-related KAP. Findings from this study indicate that suitable programs related to SHS should be implemented to improve and reinforce health literacy to both mothers and smokers to reduce the harmfulness of smoking on women and their infants’ health.

FUNCTIONAL MOVEMENT AND DYNAMIC BALANCE IN ENTRY LEVEL UNIVERSITY DANCERS

Dance requires integration and synergy between movement, postural stability, and body alignment to effectively execute the technical and aesthetic requirements of the performance. Evaluation of movement competency and dynamic balance provides opportunity to identify dysfunctional movement which may negatively impact both artistic and technical aspects of dance performance. Investigation of the relationships between movement competency and postural control may aid in technical development, performance improvement, and ultimately injury reduction. Although the Functional Movement Screen™ (FMS™) and Y-Balance Test (YBT) have assessed movement competency in athletes, they have not been used extensively in the performing arts. The purposes of this investigation were to examine movement competency in university dancers using the FMS™ and YBT and to determine the relationship between functional movement and dynamic balance. Cross sectional. Fifteen, injury-free, female members (19.1 ± 1.18 years old) of an introductory university ballet class volunteered to participate. Pearson product correlations were used to determine relationships between variables. The mean composite FMS™ score was 15.32 ± 2.30. Shoulder mobility (SM) (r = 0.63, p = 0.01), In-line lunge (ILL) (r = 0.64, p = 0.01), and Deep Squat (DS) (r = 0.62, p = 0.01) were correlated with composite FMS™ score. Overall composite YBT score was 86.62% ± 8.17%. Reach asymmetry was 3.25 cm ± 3.53 cm (anterior), 4.06 cm ± 3.59cm (posteromedial (PM)), and 3.28cm ± 2.61cm (posterolateral (PL)). Composite FMS™ score was not correlated with composite YBT composite score (r = 0.44, p = 0.10). A moderate to good correlation was found between the ILL and YBT composite score (r = 0.64, p = 0.01). Collectively the results indicate the FMS™ and YBT do not measure the same constructs. However, the associations between individual components of the FMS™ and YBT indicate a relationship between certain movements and dynamic balance, supporting their combined use in a dancer injury risk management program. 2b.

Pediatric Readiness in the Emergency Department and Its Association With Patient Outcomes in Critical Care: A Prospective Cohort Study.

Pediatric mortality in Latvia remains one of the highest among Europe. The purpose of this study was to assess the quality of pediatric acute care and pediatric readiness and determine their association with patient outcomes using a patient registry. This was a prospective cohort study. Pediatric readiness was measured using the weighted pediatric readiness score based on a 100-point scale. The processes of care were measured using in situ simulations to generate a composite quality score. Clinical outcome data-including PICU and hospital length of stay as well as 6-month mortality-were collected from the Pediatric Intensive Care Audit Network registry. The associations between composite quality score and weighted pediatric readiness score on patient outcomes were explored with mixed-effects regressions. This study was conducted in all Latvian Emergency Departments and in the national PICU. All patients who were transferred into the national PICU were included. None. All (16/16) Latvian Emergency Departments participated with a mean composite quality score of 35.3 of 100 and a median weighted pediatric readiness score of 31 of 100. A total of 254 patients were included in the study and followed up for a mean of 436 days, of which nine died (3.5%). Higher weighted pediatric readiness score was associated significantly with lower length of stay in both the PICU and hospital (adjusted ß, -0.06; p = 0.021 and -0.36; p = 0.011, respectively) and lower 6-month mortality (adjusted odds ratio, 0.93; 95% CI, 0.88-0.98). These data provide a national assessment of pediatric emergency care in a European country. Pediatric readiness in the emergency department was associated with patient outcomes in this population of pediatric patients transferred to the national PICU.

The influence of multiple sclerosis-related symptoms on health-related quality of life

Multiple sclerosis (MS) is a chronic disease that is associated with a variety of MS-specific symptoms. Many of these symptoms have a negative impact on health-related quality of life (HRQoL). Until now it is unclear which MS-specific symptoms have the highest impact on the HRQoL. The study is based on the data of a member survey of the German MS Society (DMSG) in 2015 (n = 424). Considering socio-demographic variables and general medical variables, the influence of MS-specific symptoms on HRQoL was examined. The HRQoL was collected using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) instrument. In a pretest, all influencing variables were tested for a significant mean difference (p = 0.05), or a mean correlation (Pearson's r ≥ 0.3). Subsequently, the influence of the variables identified in the pretest on the HRQoL was investigated by multiple linear regression analysis. We calculated a mean physical health composite score (PHCS) of 48.3 (sd = 17.7) and a mean mental health composite score (MHCS) of 56.0 (sd = 20.1). The most fundamental factors influencing HRQoL were the MS-specific symptoms of depression, pain and cognitive impairment. MS-related symptoms with a mobility context showed declining PHCS. Speech disorder and dizziness were associated with a decreasing MHCS. Employment status was the only socio-economic factor that significantly affected HRQoL in multiple regression. The general medical factors showed no significant influence on HRQoL. MS-specific symptoms have a major impact on the HRQoL of people with MS. Our study show that especially the so-called 'hidden symptoms' such as the symptoms of depression, pain and cognitive impairment have a significant influence on the HRQoL. Greater attention should be paid to these in the care of people with MS.

Are Obstetrics and Gynecology Residents Equipped to Care for Transgender Patients? A National Survey Study [04G

INTRODUCTION: Obstetricians and gynecologists (OB-GYNs) play an important role in the medical and surgical management of transgender and gender nonconforming (TGNC) patients. Our study aims to assess three self-reported outcomes: (1) comfort, (2) competency, and (3) curricular satisfaction of OB-GYN residents in TGNC care topics. METHODS: Our survey tool consisted of thirty questions on a 4-point Likert scale and was distributed electronically by program coordinators. The survey tool was deemed exempt by the Northwell Health Institutional Review Board. Descriptive statistics and Kruskal-Wallis test by ranks were performed using SPSS 26.0. RESULTS: One-hundred and six surveys were completed by OB-GYN residents (response rate=12.0%). Composite mean scores were calculated in the three self-reported outcome domains: comfort (2.8±0.7), competency (2.7±0.6), and satisfaction (2.4±0.7). No statistically significant difference in comfort, competency, and satisfaction scores between residency training level was observed. Male residents were more likely (χ2(1)=5.285, P=.022) to have higher self-reported competency scores than female residents (3.0±0.7 versus 2.5±0.6, respectively). LGBTQ residents were more likely (χ2(1)=5.509, P=.019) to have higher self-reported comfort scores than those who identified as heterosexual (3.1±0.6 versus 2.7±0.7, respectively). CONCLUSION: To our knowledge, this is the first study to assess the comfort, competency, and satisfaction of OB-GYN residents in TGNC care topics. Residents reported being more competent and comfortable than satisfied, which suggests that further curricular and clinical exposure is necessary to address the unique healthcare needs of this underserved patient population and to meet the educational needs of residents. LGBTQ residents may be able to share knowledge with peers to increase heterosexual residents’ comfort.

Prospective longitudinal patient-reported outcomes of swallowing following intensity modulated proton therapy for oropharyngeal cancer

Background and purposeWith an enlarging population of long-term oropharyngeal cancer survivors, dysphagia is an increasingly important toxicity following oropharynx cancer treatment. While lower doses to normal surrounding structures may be achieved with intensity modulated proton therapy (IMPT) compared to photon-based radiation, the clinical benefit is uncertain. Methods and materialsSeventy-one patients with stage III/IV oropharyngeal cancer (AJCC 7th edition) undergoing definitive IMPT on a longitudinal prospective cohort study who had completed the MD Anderson Dysphagia Inventory (MDADI) at pre-specified time points were included. ResultsThe majority of patients had HPV-positive tumors (85.9%) and received bilateral neck radiation (81.4%) with concurrent systemic therapy (61.8%). Mean composite MDADI scores decreased from 88.2 at baseline to 59.6 at treatment week 6, and then increased to 74.4 by follow up week 10, 77.0 by 6 months follow up, 80.5 by 12 months follow up, and 80.1 by 24 months follow up. At baseline, only 5.6% of patients recording a poor composite score (lower than 60), compared to 61.2% at treatment week 6, 19.1% at follow up week 10, 13.0% at 6 months follow up, 13.5% at 1 year follow up, and 11.1% at 2 years follow up. ConclusionsPatient reported outcomes following IMPT for oropharyngeal cancer demonstrates decreased swallowing function at completion of treatment with relatively rapid recovery by 10 weeks follow up and steady improvement through 2 years. The results are comparable to similar longitudinal studies of photon-based radiotherapy for oropharynx cancer, and suggest that IMPT confers no additional excess toxicity related to swallowing.

Quality of life after total laryngectomy: impact of different vocal rehabilitation methods in a middle income country

IntroductionThe impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Total laryngectomy impacts essential functions such as breathing, communication and swallowing, and may influence the quality of life as well as affecting the social life of laryngeal cancer patients.ObjectiveDescribe the quality of life and analyze the factors associated with the reduced quality of life in patients who have undergone total laryngectomy.MethodObservational cross-sectional study was carried out to evaluate the quality of life of patients who had undergone total laryngectomy due to laryngeal cancer. The fourth version of the UW-QOL Quality of Life Assessment Questionnaire from Washington University, validated for Portuguese, was used.ResultsThe study population was 95 patients, and the mean composite score of the QOL was 80.4. In the subjective domains the majority of the patients (38.9%) reported they felt much better at present compared to the month before being diagnosed with cancer. When questioned about how they evaluated their health-related quality of life, there was a predominance of those who considered it good (43.2%), and most considered they had a good quality of life (46.3%) considering personal well-being. The overall quality of life was considered good to excellent by 83.2% of the patients. Patients with tracheoesophageal prosthesis reported a better quality of life, compared to patients using an electrolarynx or esophageal voice.ConclusionThe high mean value of the composite score for quality of life revealed that the patients assessed their quality of life positively. The absence of vocal emission was the only variable associated with a lower quality of life within the composite score according to the UW-QOL questionnaire.

Relationship Between Organizational Leadership and Health Care Employee Burnout and Satisfaction

ObjectiveTo explore the relationship between immediate supervisor leadership behaviors and burnout and professional satisfaction of health care employees. Participants and MethodsFrom October 2 to 20, 2017, we surveyed nonphysician health care employees. The survey included 2 items from the Maslach Burnout Inventory and items on their immediate supervisor leadership behaviors. Logistic regression was performed to evaluate the relationship between the leadership score and the prevalence of burnout and satisfaction after adjusting for age, sex, duration of employment, and job category. Sensitivity analysis was performed using mixed models with a random intercept for work unit to assess the impact of the correlation within work units on burnout and satisfaction with the organization. ResultsOf the 57,414 employees surveyed, 39,896 (69.5%) responded and answered the leadership questions. Supervisor scores in each dimension and composite leadership scores correlated with burnout and satisfaction of employees (P<.001 for all). In logistic regression, each 1-point increase in leadership score was associated with a 7% decrease in odds of burnout and an 11% increase in odds of satisfaction (P<.001 for both) of employees. The mean composite leadership score rating of each immediate supervisor correlated with rate of burnout (r=−0.247; P<.001) and the satisfaction with the organization (r=0.416; P<.001) at the work unit level. ConclusionLeadership qualities of immediate supervisors relate to burnout and satisfaction of nonphysician health care employees working in a large organization. Further studies are needed to determine whether strategies to monitor and improve supervisor leadership scores result in reduction in burnout and improved satisfaction among health care employees.

What Do Adult Surgical Patients Speaking Primarily Cantonese, Italian, or Portuguese Really Want to Know About Pain and Pain Management?

BackgroundSurgical patients consider information about pain and pain management to be highly important (Apfelbaum, 2003). At the same time, evidence indicates that members of racial and ethnic minorities are more likely to experience inadequate pain management (Green, Anderson, Baker, Campbell, Decker, Fillingim, & Todd, 2003; Mossey, 2011). AimsThis study investigated the needs of general day surgery patients who spoke primarily Cantonese, Italian, or Portuguese at home for information about postoperative pain. DesignThis was a mixed methods, descriptive study. SettingThe day surgery unit of a large, quaternary care hospital in downtown Toronto. Partipants/SubjectsInclusion criteria were day patients who were at least 18 years of age or older and spoke primariy Cantonese, Italian or Portugues at home. and were able to read and write in their primary language. MethodsParticipants who had undergone a day surgery procedure completed a telephone information needs survey in their primary language (Cantonese, Italian, Portuguese) within 72 hours after discharge. Composite mean scores were calculated for each item. Chi-squared analyses were used to probe for intergroup differences and compare with English-fluent participants from phase 1 of this study (Kastanias, Denny, Robinson, Sabo, & Snaith, 2009). ResultsSixty-three participants in total completed the survey: 21% Cantonese, 41% Italian, and 38% Portuguese. The mean age of the sample was 70 years old; 89% were born outside of Canada, and 52% were male. For the combined group, the average importance rating score range for the information items was 6.2-8.9 out of a possible score of 10. All items were rated as moderate (5-6 out of 10) to high (≥7out of 10) importance. Surgical subtype, health status, and age had no effect on the importance of any information item. There were no significant differences between the three language groups on any of the information items. This lack of difference may have been a result of a lack of power due to the small sample size of the individual language groupings. Overall, the top-ranked information items were “the plan for which drugs to take and when,” “what I can do if I still have pain or side effects,” and “side effects I was most likely to get.” ConclusionsSimilar to English-fluent participants (Kastanias et al., 2009), participants who primarily spoke either Cantonese, Italian, or Portuguese at home placed moderate to high importance on all of the information items. and neither surgical subtype, health status nor age had any effect on the importance of any item. The multilingual sample in this study placed more importance than English-fluent participants on information regarding help with paying for pain medication (p = .001) and the side effects they were most likely to experience (p < .05). Due to a paucity of literature in this area, further research is warranted. Results may assist with evaluating and improving current approaches to surgical patient pain management education.

Association of Patient-reported Experiences and Surgical Outcomes Among Group Practices: Retrospective Cohort Study.

The aim of the study was to determine the association of patient-reported experiences (PREs) and risk-adjusted surgical outcomes among group practices. The Centers for Medicare and Medicaid Services required large group practices to submit PREs data for successful participation in the Physician Quality Reporting System (PQRS) using the Consumer Assessment of Healthcare Providers and Systems for PQRS survey. Whether these PREs data correlate with perioperative outcomes remains ill defined. Operations between January 1, 2014 and December 31, 2016 in the American College of Surgeons' National Surgical Quality Improvement Program registry were merged with 2015 Consumer Assessment of Healthcare Providers and Systems for PQRS survey data. Hierarchical logistic models were constructed to estimate associations between 7 subscales and 1 composite score of PREs and 30-day morbidity, unplanned readmission, and unplanned reoperation, separately, while adjusting for patient- and procedure mix. Among 328 group practices identified, patients reported their experiences with clinician communication the highest (mean ± standard deviation, 82.66 ± 3.10), and with attention to medication cost the lowest (25.96 ± 5.14). The mean composite score was 61.08 (±6.66). On multivariable analyses, better PREs scores regarding medication cost, between-visit communication, and the composite score of experience were each associated with 4% decreased odds of morbidity [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-0.99], readmission (OR 0.96, 95% CI 0.93-0.99), and reoperation (OR 0.96, 95% CI 0.93-0.99), respectively. In sensitivity analyses, better between-visit communication remained significantly associated with fewer readmissions. In these data, patients' report of better between-visit communication was associated with fewer readmissions. More sensitive, surgery-specific PRE assessments may reveal additional unique insights for improving the quality of surgical care.

A Study of the Validity of the New MCAT Exam.

To conduct a study of the validity of the new Medical College Admission Test (MCAT). Deidentified data for first- and second-year medical students (185 women, 54.3%; 156 men, 45.7%) who matriculated in 2016 and 2017 to the University of Minnesota Medical School-Twin Cities were included. Of those students, 220 (64.5%) had taken the new MCAT exam and 182 (53.4%) had taken the old MCAT exam (61 [17.9%] had taken both). The authors calculated descriptive statistics and Pearson product moment correlations (r) between new and old MCAT section scores. They conducteda regression analysis of MCAT section scores with Step 1 scores and with preclerkship course performance. They also conducted an exploratory factor analysis (principal component analysis with varimax rotation) of MCAT scores, undergraduate grade point average, Step 1 scores, and course performance. The new MCAT exam section mean score percentiles ranged from 72 to 78 (mean composite score percentile of 80). The old MCAT exam section mean score percentiles ranged from 84 to 88 (mean composite score percentile of 83). The pattern of correlations among and between new and old MCAT exam section scores (range of r: 0.03-0.67; P < .01) provided evidence of both divergent and convergent validities. Backward multiple regression of new MCAT exam section scores and Step 1 scores resulted in a multiple R of .440; the same analysis with Human Behavior course performance as the dependent variable provided a similar solution with the expected sections of the new MCAT exam (multiple R = .502). The factor analysis resulted in 4 cohesive, theoretically meaningful factors: biomedical knowledge, basic science concepts, cognitive reasoning, and general achievement. This study provided empirical evidence of multiple types of validity for the new MCAT exam.

English

Distance learners in some studies have reported feelings of isolation and lack of direction in developing effective study habits. The purpose of this study is to establish the extent to which social guidance and counselling influence study habits of learners in Bachelor of Educational programmes by distance learning of the University of Nairobi. Data were collected using structured questionnaire. Simple random and stratified random sampling methods adopted to select the 327 participants from a target population of 2199. Cronbach&rsquo;s alpha of &alpha; =0.76 zero was attained as the reliability coefficient of the pre-test instruments. Simple and multiple linear regression and Pearson Correlation Coefficient models determine the predictor variable. Results show that social guidance and counselling mean score of 3.29 and standard deviation of 1.297 were similar to composite mean score of 3.29 and standard deviation of 1.297. Therefore, the results of the study demonstrate that social guidance and counselling is critical in enhancing study habits of distance learners. The study recommends that education policy makers and universities should integrate social guidance and counselling in the curriculum to address myriad challenges facing distance learners in connection to their study habits. Key words: Social guidance, counselling, study habits, support services, distance learners. &nbsp

Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians

Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged. This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures. A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis. A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician's diagnosis, and (5) likelihood to request additional tests. Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants' race, gender, racial prejudice, or sexism. No significant differences were observed for simulated patients' evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction. ClinicalTrials.gov Identifier: NCT04190901.