Nonphysician Health Care Providers Research Articles

A Content Analysis of Multidimensional Support Needs Regarding Fertility Among Cancer Patients: How Can Nonphysician Health Care Providers Support?

This study aimed to identify support needs among young cancer patients regarding fertility-related issues to describe multidimensional support provided by nonphysician health care providers. Participants were cancer patients and their families who contacted the Hotline for Cancer Treatment and Reproduction at National Cancer Center Hospital in Japan. Medical charts were analyzed through content analysis. A total of 51 participants met the inclusion criteria, of which 32 cases (63%) involved patients themselves, 13 (25%) patients' family members, and 6 (12%) both patients and their families. About patients' demographic status, 40% of the patients were female and 28% were in their thirties. Gynecological and breast cancer patients were the majority, and 24 patients (47%) had not yet started cancer treatment. As a result of content analysis regarding support needs, 9 categories and 55 codes were extracted. The categories included information about risk of infertility, information about means to maintain reproductive function, referral to specialists, support for economic burden, support for worry about cancer progression, support for psychological distress upon facing the risk of infertility, support for communication with oncologists, support for family relationships, and decisional aid. This study suggests that nonphysician health care providers should acquire knowledge about fertility preservation and provide psychological support within their specialties.

Knowledge, Practice Behaviors, and Perceived Barriers to Fertility Care Among Providers of Transgender Healthcare

PurposeTransgender individuals may experience impaired fertility due to gender-affirming hormonal interventions (e.g., pubertal suppression treatment and/or exogenous hormones). Clinical practice guidelines recommend providers discuss fertility implications and options for fertility preservation. The goal of this study was to examine fertility knowledge, practice behaviors, and perceived barriers to fertility care among multidisciplinary providers who care for transgender pediatric and/or adult patients. MethodsA 46-item survey was distributed to relevant listservs and at conferences with a focus on transgender health. ResultsTwo hundred two providers completed the survey: (1) physicians (n = 87), (2) psychologists (n = 51), (3) Master (MA)-level mental health providers (n = 39), and (4) nonphysician healthcare providers, comprising advanced practice nurses, registered nurses, and physician assistants (n = 25). Overall knowledge was high (M = 3.64, SD = 1.61). Significant differences were identified in knowledge by provider type (p <.001) but not patient age group (p = .693). Physicians had significantly greater knowledge than MA-level mental health providers (p = .005). Variables associated with fertility discussion included provider-related barriers [b = –.42, p < .001], and perceived patient-related barriers, including perceptions that patients are unwilling to delay treatment [b = .12, p = .011] or are unable to afford fertility preservation (FP) [b = .12, p = .029]. ConclusionsWhile overall fertility-related knowledge was high, there was variability in domains of knowledge, as well as provider practice behaviors related to fertility counseling and referral for FP. Findings related to perceived barriers to fertility counseling and fertility preservation warrant further investigation; qualitative studies may be particularly helpful in understanding how specific provider- and patient-related barriers impact counseling and referral for fertility-related care.

Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest-posttest study.

Intimate partner violence (IPV) is prevalent among female patients at fracture clinics; however, previous research suggests health care providers (HCPs) are unprepared to identify victims and provide appropriate support. To address this gap in care, we developed an IPV educational program and conducted a study to measure the impact of this program on HCPs' IPV-related knowledge, attitudes, beliefs and self-reported behaviours. We enrolled 140 participants (orthopedic surgeons, surgical trainees, nonphysician HCPs and research and administrative staff) from 7 fracture clinics in North America who completed the 2-hour educational program. We used a pretest-posttest study design to assess knowledge, attitudes, beliefs and self-reported behaviours. We administered the Physician Readiness to Manage IPV Survey before, immediately after and 3 months after training and generated scores for each of the 10 subscales. Our primary outcome was change in score for the actual knowledge subscale from before training to 3 months after training. We used linear regression to conduct all analyses. We found significant improvement on the actual knowledge subscale 3 months after the training (mean difference [MD] 2.44, 95% confidence interval [CI] 1.79 to 3.09). We found statistically significant improvements on 7 additional subscales 3 months after training (perceived preparation [MD 1.96, 95% CI 1.79 to 2.13], perceived knowledge [MD 2.05, 95% CI 1.88 to 2.23], practice issues [MD 6.10, 95% CI 4.98 to 7.23], preparation [MD 1.06, 95% CI 0.89 to 1.22], legal requirements [MD 1.50, 95% CI 1.30 to 1.70], workplace issues [MD 1.11, 95% CI 0.97 to 1.26] and self-efficacy [MD 0.54, 95% CI 0.45 to 0.63]) and on all 10 subscales immediately after training (actual knowledge [MD 3.35, 95% CI 2.77 to 3.94], perceived preparation [MD 2.06, 95% CI 1.88 to 2.23], perceived knowledge [MD 2.14, 95% CI 1.98 to 2.30], practice issues [MD 4.08, 95% CI 3.35 to 4.82], preparation [MD 1.04, 95% CI 0.89 to 1.20], legal requirements [MD 1.66, 95% CI 1.47 to 1.85], workplace issues [MD 1.08, 95% CI 0.96 to 1.20], self-efficacy [MD 0.56, 95% CI 0.49 to 0.63], alcohol/drugs [MD 0.20, 95% CI 0.10 to 0.30] and victim understanding [MD 0.15, 95% CI 0.04 to 0.25]). Our educational program led to significant improvements in participants' readiness to manage IPV. This finding suggests HCPs are better prepared to help patients who experience IPV; however, future research should aim to investigate the impact of this program directly on patients.

Impact of patient-education on health related quality of life of diabetic foot ulcer patients: A randomized study

BackgroundDiabetic foot is the most serious and disabling long term complication of diabetes, adversely affecting the health related quality of life (HRQoL). ObjectivesTo evaluates the impact of patient-education (PE) on HRQoL of diabetic foot ulcer (DFU) patients. MethodsThis randomized controlled study on the effect of PE on improvement of HRQoL, conducted in Kasturba Hospital, Manipal, India consisted of 135 DFU patients with 65 subjects in the control group (CG) and 70 subjects in the intervention group (IG). RAND-36 questionnaire was employed for evaluating HRQoL scores of DFU patients in both groups at baseline and after six months of PE. ResultsSubjects in the both IG and CG reported poor HRQoL scores, on all the eight subscales at baseline. After six months of PE, HRQoL improved substantially in IG with respect to CG and IG at baseline (p < 0.05). Likewise, in both CG and IG, the physical component summary scale (PCS) scores (24.1 ± 6.6 vs 25.6 ± 7.3) and the mental component summary scale (MCS) scores (27.3 ± 5.4 vs 28.8 ± 7.1) were similar and poor before PE. However, six months post PE, in IG, the Both PCS and MCS scores increased dramatically from 25.6 ± 7.3 to 42.9 ± 9.7 and 28.8 ± 7.1 to 48.8 ± 8.4 (p < 0.05) respectively. ConclusionThe remarkable improvement in the HRQoL in IG at six months follow-up suggests that PE significantly improves HRQoL in DFU patients. Overworked physicians and paucity of trained doctors in resource-poor settings obligate task-sharing with non-physician healthcare providers.

Hypertension, knowledge, attitudes, and practices of primary care physicians in Ulaanbaatar, Mongolia.

We examined the knowledge, attitudes, and practices of primary care doctors in Ulaanbaatar, Mongolia using a recently developed World Hypertension League survey. The survey was administered as part of a quality assurance initiative to enhance hypertension control. A total of 577 surveys were distributed and 467 were completed (81% response rate). The respondents had an average age of 35years and 90.1% were female. Knowledge of hypertension epidemiology was low (13.5% of questions answered correctly); 31% of clinical practice questions had correct answers and confidence in performing specific tasks to improve hypertension control had 63.2% "desirable/correct" answers. Primary care doctors mostly had a positive attitude toward hypertension management (76.5% desirable/correct answers) and highly prioritized hypertension management activities (85.7% desirable/correct answers). Some important highlights included the majority (>80%) overestimating hypertension awareness, treatment, and control rates; 78.2% used aneroid blood pressure manometers; 15% systematically screened adults for hypertension in their clinics; 21.8% reported 2 or more drugs were required to control hypertension in most people; and 16.1% reported most people could be controlled by lifestyle changes alone. 55% of respondents were not comfortable prescribing more than 1 or 2 antihypertensive drugs in a patient and the percentage of desirable/correct responses to treating various high-risk patients was low. Most (53%-74%) supported task shifting to nonphysician health care providers except for drug prescribing, which only 13.9% supported. A hypertension clinical education program is currently being designed based on the specific needs identified in the survey.

Asthma in the USA: the good, the bad, and the disparity

Asthma in the USA: the good, the bad, and the disparity

Abstract IS-3: Breast Imaging in Resource Constrained Regions: Lessons from Uganda

Abstract Breast cancer is the leading cause of cancer death in women and the most common cancer among women world-wide. Five-year survival rates in patients with breast cancer in the United States, Australia and Canada approach 90%, while in parts of Africa survival rates are less than 15%. In October 2013 the international New York Times front page reported on “Uganda's Neglected Epidemic of Breast Cancer.” In December 2013 the WHO International Agency for Research on Cancer (IARC) issued an update on the world's cancer statistics with the headline including the alarm that “marked increase in breast cancers must be addressed.” In Uganda, resources for surgical intervention (mastectomy) and medical oncology (hormonal therapy and limited chemotherapy) are available. Strong recent efforts by the National Cancer Institute, American Cancer Society, and global partners will increase the availability of affordable chemotherapy. In parallel, there is a growing community of breast cancer survivors in Uganda who are sharing their stories and emphasizing the importance of early detection and prompt treatment. Women with palpable breast lumps, identified by themselves or their healthcare providers, are encouraged to seek treatment. But with so many women having palpable breast lumps, and no efficient way to sort the majority of lumps that are benign from the minority of lumps that are malignant, systems are overwhelmed. Clinics do not have the capacity to detect the cancers amongst all the women who present with palpable lumps, and breast cancers remain undiagnosed and untreated, and mortality rates continue to rise. The delays in diagnosis can be significantly reduced with ultrasound (US) technology placed in the hands of non-physician healthcare providers, to streamline the diagnostic process and separate women with lumps that have features warranting biopsy from lumps that can be safely followed clinically in the patient's local, healthcare clinic. Mammography has little added value in countries with limited resources. With so many women who have clear symptoms of breast cancer, and with a significantly higher pre-test probability of cancer in women with (rather than without) symptoms, interventions targeted to asymptomatic women are neither logical nor feasible. The need is not to screen for breast cancers in asymptomatic women but rather to detect the breast cancers in women with symptoms, most notably palpable lumps. Innovative, effective, affordable strategies that emphasize prompt and accurate diagnostic methods in women with palpable breast lumps are needed to improve breast cancer survival in LMICs. These programs can be based on inexpensive, portable ultrasound machines that support triage of patients with palpable lumps to those that need biopsy and those that don't. These technologies are already being used by local health care personnel in developing countries for other prenatal and urgent care purposes. Going forward, novel ultrasound techniques for automated sonogram acquisition and machine learning and deep learning methods can combine to extend the impact of ultrasound imaging in breast cancer diagnosis by reducing the need for highly specialized breast imagers in both acquisition and interpretation. Citation Format: Lehman CD. Breast Imaging in Resource Constrained Regions: Lessons from Uganda [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr IS-3.

(294) - Measuring pain management values in clinicians: development and psychometric analysis of a new instrument

The personal values of clinicians play a critical role in pain management decision-making. Values identified in the literature as important to pain management decision-making are open-mindedness, respect, trust, consistency, and honesty but no instrument exists to measure these values among clinicians. The aim of this study was to develop and test the psychometric properties of a new instrument that strives to measure the pain management values of clinicians using a prospective survey design. Based on the literature and the style of the Schwartz Value Inventory Short Form, an 18-item multiple-choice instrument with continuous measures was developed. Content validity by eight clinical pain/ethics experts was high (CVI = 91.2%). The instrument, along with a matching 18-item version designed to measure inter-rater reliability, was emailed to 9,580 non-physician clinical healthcare providers in the United States. Total analyzable data returned, N = 289(3%). Nurses/nurse practitioners: n = 258(89%); physician assistants/other: n = 31(11%). All correlations between individual items and total score were significant, r = .37–.66, P < .01. Internal consistency high: α = .87. Inter-rater reliability fair between instrument items and matched version: (weighted k = .27, 95%CI: .04–.43). Exploratory factor analysis using orthogonal varimax rotation was done and multiple decision rules revealed a three factor solution: respect, trust, and open-mindedness. Two items were eliminated based on low factor loading and low correlations with total score, leaving a final 16-item instrument with three subscales that demonstrates high decision consistency and acceptable reliability and validity in non-physician clinical healthcare providers. This instrument will be useful to assess and provide introspection on the pain management values of non-physician clinicians, inform pain management education, and assist with investigating clinician-based values that contribute to pain management outcomes. This investigation will need to be repeated to further test reliability and criterion-related validity in other clinical healthcare provider populations including physicians and surgeons.

A Comprehensive Review of the Sternal Foramina and its Clinical Significance.

A sternal foramen (SF), which arises from the incomplete fusion of the cartilaginous neonatal sternum, is a relatively common anatomical variation found in 2.5% to 13.8 % of all individuals. SFs are usually located at the lower third of the sternal body and their average diameter is 6.5 mm. An SF is subclinical; however, its close proximity to the thoracic organs, i.e., the heart and lungs, entails a risk of serious complications from blinded sternal interventions. Moreover, its presence can lead to misinterpretation of radiological and postmortem findings. The SF is ignored by many physicians and non-physician healthcare providers who must understand its clinical significance in order to optimize patient care. Our aim in this review is to highlight the potential clinical consequences for SF patients, discuss recommendations for performing sternal procedures safely when this anatomical variation is present, and preclude radiological and pathological misinterpretations so that patient care can be improved.

Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care.

There is increasing concern about the extent to which narrow-network plans, generally defined as those including fewer than 25percent of providers in a given health insurance market, affect consumers' choice of and access to specialty providers-particularly in mental health care. Using data for 2016 from 531 unique provider networks in the Affordable Care Act Marketplaces, we evaluated how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers. Compared to primary care networks, participation in mental health networks was low, with only 42.7percent of psychiatrists and 19.3percent of nonphysician mental health care providers participating in any network. On average, plan networks included 24.3percent of all primary care providers and 11.3percent of all mental health care providers practicing in a given state-level market. These findings raise important questions about provider-side barriers to meeting the goal of mental health parity regulations: that insurers cover mental health services on a par with general medical and surgical services. Concerted efforts to increase network participation by mental health care providers, along with greater regulatory attention to network size and composition, could improve consumer choice and complement efforts to achieve mental health parity.

Brief educational interventions to improve performance on novel quality metrics in ambulatory settings in Kenya: A multi-site pre-post effectiveness trial

BackgroundThe quality of primary care delivered in resource-limited settings is low. While some progress has been made using educational interventions, it is not yet clear how to sustainably improve care for common acute illnesses in the outpatient setting. Management of urinary tract infection is particularly important in resource-limited settings, where it is commonly diagnosed and associated with high levels of antimicrobial resistance. We describe an educational programme targeting non-physician health care providers and its effects on various clinical quality metrics for urinary tract infection.MethodsWe used a series of educational interventions including 1) formal introduction of a clinical practice guideline, 2) peer-to-peer chart review, and 3) peer-reviewed literature describing local antimicrobial resistance patterns. Interventions were conducted for clinical officers (N = 24) at two outpatient centers near Nairobi, Kenya over a one-year period. The medical records of 474 patients with urinary tract infections were scored on five clinical quality metrics, with the primary outcome being the proportion of cases in which the guideline-recommended antibiotic was prescribed. The results at baseline and following each intervention were compared using chi-squared tests and unpaired two-tailed T-tests for significance. Logistic regression analysis was used to assess for possible confounders.FindingsClinician adherence to the guideline-recommended antibiotic improved significantly during the study period, from 19% at baseline to 68% following all interventions (Χ2 = 150.7, p < 0.001). The secondary outcome of composite quality score also improved significantly from an average of 2.16 to 3.00 on a five-point scale (t = 6.58, p < 0.001). Interventions had different effects at different clinical sites; the primary outcome of appropriate antibiotic prescription was met 83% of the time at Penda Health, and 50% of the time at AICKH, possibly reflecting differences in onboarding and management of clinical officers. Logistic regression analysis showed that intervention stage and clinical site were independent predictors of the primary outcome (p < 0.0001), while all other features, including provider and patient age, were not significant at a conservative threshold of p < 0.05.ConclusionThis study shows that brief educational interventions can dramatically improve the quality of care for routine acute illnesses in the outpatient setting. Measurement of quality metrics allows for further targeting of educational interventions depending on the needs of the providers and the community. Further study is needed to expand routine measurement of quality metrics and to identify the interventions that are most effective in improving quality of care.

The Role of e-Health in Optimizing Task-Shifting in the Delivery of Antiviral Therapy for Chronic Hepatitis C.

Recently, we reported the successful application of task-shifting to improve the management of patients with chronic hepatitis C virus (HCV) infection receiving treatment with direct-acting antiviral (DAA) agents in underserved areas of California. We assessed the impact of e-health on task-shifting in our treatment model. In a retrospective analysis, we reviewed the impact of e-health on optimizing the delivery of DAA-based regimen to HCV-infected patients in outreach clinics in medically underserved areas of California. A nonphysician healthcare provider worked in close conjunction with a hepatologist to monitor the patients during the course of antiviral therapy. We exclusively used our institution-based, secured e-health portal as the means of communication with the local staff and patients in outreach clinics. From January 2015 to June 2016, we treated over 100 HCV-infected patients with DAA-based regimens using the task-shifting model. During the study period, we did not experience any delay in the care of our patients undergoing treatment with DAA agents. Communication with the patient and staff using e-health was prompt, secured, and documented in electronic medical records. Due to the optimization of task-shifting by e-health and safety/tolerability of DAA, 95% patients did not need a follow-up clinic visit during the treatment. Return clinic visits during the treatment were unrelated to DAA use or associated with ribavirin-related anemia. In addition, we noted improvement in access and capacity of our outreach clinic. We report a positive impact of e-health in optimizing task-shifting for DAA in HCV-infected patients in underserved outreach clinics. More importantly, a secondary improvement in access and capacity of our clinic was noted.

Working Together: Evaluating Interprofessional Experiences on a Pediatric Clerkship

This article was migrated. The article was not marked as recommended. Background:Medical schools offer interprofessional education (IPE) opportunities during preclinical years; however, the literature holds fewer descriptions of projects designed to promote IPE for medical students in clinical settings. Our project seeks to evaluate if students on a 6-week pediatric clerkship can establish working relationships with other health care providers (HCP). Methods: We instructed 167 pediatric clerkship students to interact with two different non-physician HCPs and then to ask the providers to complete comments-only evaluations of the student's professionalism. Encounters were to occur as part of normal patient care interactions. A dataset was created to record time-of-year, setting (wards, nursery, emergency department, clinic/offices), evaluator's profession and status (trainee or staff/faculty), and student's career interests. Descriptive statistics were generated for this cross-sectional study. Results: 304 evaluations were submitted, demonstrating a 91% completion rate at an average of 1.8 evaluations per student (range 1-2). Pharmacists completed the most evaluations (46%, n= 140), which were all completed on general wards where pharmacists are well-integrated into clinical teams on which students rotate. Nurses completed the next highest amount (29%, n=87). Conclusion: Clerkship students are able to establish working relationships with other HCPs in clinical settings. However, clerkship directors may have to guide students to reach out more broadly to providers outside structured teams.

Patients' Attitudes Toward Nonphysician Screening of Low Back and Low Back Related Leg Pain Complaints Referred for Surgical Assessment.

A questionnaire survey. The aim of this study was to explore patient attitudes toward screening to assess suitability for low back surgery by nonphysician health care providers. Canadian spine surgeons have shown support for nonphysician screening to assess and triage patients with low back pain and low back related leg pain. However, patients' attitudes toward this proposed model are largely unknown. We administered a 19-item cross-sectional survey to adults with low back and/or low back related leg pain who were referred for elective surgical assessment at one of five spine surgeons' clinics in Hamilton, Ontario, Canada. The survey inquired about demographics, expectations regarding wait time for surgical consultation, as well as willingness to pay, travel, and be screened by nonphysician health care providers. Eighty low back patients completed our survey, for a response rate of 86.0% (80 of 93). Most respondents (72.5%; 58 of 80) expected to be seen by a surgeon within 3 months of referral, and 88.8% (71 of 80) indicated willingness to undergo screening with a nonphysician health care provider to establish whether they were potentially a surgical candidate. Half of respondents (40 of 80) were willing to travel >50 km for assessment by a nonphysician health care provider, and 46.2% were willing to pay out-of-pocket (25.6% were unsure). However, most respondents (70.0%; 56 of 80) would still want to see a surgeon if they were ruled out as a surgical candidate, and written comments from respondents revealed concern regarding agreement between surgeons' and nonphysicians' determination of surgical candidates. Patients referred for surgical consultation for low back or low back related leg pain are largely willing to accept screening by nonphysician health care providers. Future research should explore the concordance of screening results between surgeon and nonphysician health care providers. 3.

Standing Posture at Work Does Not Increase the Risk of Varicose Veins among Health Care Providers in Taiwan

Objective: This study compared the risk of varicose veins (VV) among physicians, nonphysician health care providers (HCP), and the general population. Subjects and Methods: The Taiwan National Health Insurance Research Database was used to identify 28,844 physicians and 26,099 nonphysician HCP and an identical number of age- and sex-matched patients from the general population. Using logistic regression analyses, VV risks between physicians and the general population, nonphysician HCP and the general population, and physicians and nonphysician HCP, and among physician specialists were compared by tracing their medical histories between 2007 and 2011. Results: Physicians and nonphysician HCP had cumulative VV incidences of 0.12% (34/28,844) and 0.13% (33/26,099), respectively, during the 5-year period, compared to that of the general population within the same 5-year period. Physicians and nonphysician HCP did not have a higher VV risk than the general population after adjusting for deep vein thrombosis (DVT) history (adjusted odds ratio [AOR] 0.86; 95% confidence interval [CI] 0.53-1.40, and AOR 1.43; 95% CI 0.82-2.50, respectively). Physicians did not a have higher VV risk than nonphysician HCP (AOR 0.80; 95% CI 0.43-1.51) after adjusting for age, sex, and DVT history. Surgery had the highest incidence (0.22%) while pediatrics and emergency medicine had the lowest incidence (0%) of VV risk among physician specialists; however, the difference was not significant (all p values >0.05). Conclusion: In this study, VV risk did not differ among physicians, nonphysician HCP, and the general population.

Physicians should not Shackle Non-physician Healthcare Providers

Physicians should not Shackle Non-physician Healthcare Providers

930: IMPROVING MULTIDISCIPLINARY INVOLVEMENT AT THE CRITICAL CARE CONGRESS THROUGH SOCIAL MEDIA

Learning Objectives: The Society of Critical Care Medicine promotes a collaborative multidisciplinary practice, with a team consisting of professionals in different fields. Participation in social media activities, such as live-tweeting a meeting provides a unique opportunity for members of all professions to participate, and may allow for inclusion of a more diverse group in discussions. We assessed participation using social media metrics by physicians and non-physicians in conversations at the annual Critical Care Congress (CCC). Methods: Symplur Analytics were used to compare the characteristics of those who tweeted using the 2015 and 2016 CCC hashtag (#CCC44 and #CCC45, respectively). Characteristics of the top 50 participants during the conference were compared. Allied health professionals (AHP) were defined as non-physician healthcare providers. Results: There was an increase in tweets and participants from 2015 (4,374 tweets, 625 participants) to 2016 (14,358 tweets, 1,693 participants). In 2015, 27 of the top 50 tweeters were physicians, 7 were AHP (2 nurses, 2 advanced practitioners, and 1 pharmacist), 10 were organizations, and 6 were other non-healthcare individuals. In 2016, 22 of the top 50 tweeters were physicians, 17 were AHP (2 nurses, 5 advanced practitioners, 5 pharmacists, 2 dietitians, and 3 other providers), 8 were organizations, and 3 were other non-healthcare individuals. There were significantly more AHP participating in social media during 2016 CCC compared to 2015 (34% vs 14% of the top 50 accounts; p=0.047). The number of followers of AHP accounts were significantly fewer than the number of followers of the physician accounts (800 ± 626 followers vs 1,608 ± 2,282 followers; p=0.02), but there was no significant difference in number of tweets (7,403 ± 8,993 vs 16,764 ± 36,230 tweets; p=0.1) or duration of time on Twitter (4.8 ± 2.3 vs 5.1 ± 2.1 yrs; p=0.6). Conclusions: Social media is another way to engage all heath care professionals in academic conversations that occur during CCC. More effort should be made to increase inclusion in this important venue for multidisciplinary conversation.

Higher risk for cervical herniated intervertebral disc in physicians: A retrospective nationwide population-based cohort study with claims analysis.

There is no study about cervical herniated intervertebral disc (cervical HIVD) in physicians in the literature; therefore, we conceived a retrospective nationwide, population-based cohort study to elucidate the topic. We identified 26,038 physicians, 33,057 non-physician healthcare providers (HCPs), and identical numbers of non-HCP references (i.e., general population). All cohorts matched a 1:1 ratio with age and gender, and each were chosen from the Taiwan National Health Insurance Research Database (NHIRD). We compared cervical HIVD risk among physicians, nonphysician HCPs, and non-HCP references and performed a follow-up between 2007 and 2011. We also made comparisons among physician specialists. Both physicians and nonphysician HCPs had higher cervical HIVD risk than non-HCP references (odds ratio [OR]: 1.356; 95% confidence interval (CI): 1.162–1.582; OR: 1.383; 95% CI: 1.191–1.605, respectively). There was no significant difference of cervical HIVD risk between physicians and nonphysician HCPs. In the comparison among physician specialists, orthopedists had a higher cervical HIVD risk than other specialists, but the difference was not statistically significant (adjusted OR: 1.547; 95% CI: 0.782–3.061). Physicians are at higher cervical HIVD risk than the general population. Because unknown confounders could exist, further prospective studies are needed to identify possible causation.

A Modified Delphi Study to Identify Factors Associated With Clinical Deterioration in Hospitalized Children.

Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized children. We conducted a modified Delphi study with 3 iterations, administered electronically. The expert panel consisted of 11 physician and nonphysician health care providers from hospitals in Canada and the United States. Consensus was reached that 21 of the 57 factors presented are associated with clinical deterioration in hospitalized children. The final list of variables includes patient characteristics, signs and symptoms in the emergency department, emergency department management, and system factors. We generated a list of variables that can be used in future prospective studies to determine if they are predictors of clinical deterioration on the inpatient ward.

Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis

Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practising physicians. The consequences are negative effects on patient care, professionalism, physicians' own care and safety, and the viability of health-care systems. A more complete understanding than at present of the quality and outcomes of the literature on approaches to prevent and reduce burnout is necessary. In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Education Resources Information Center from inception to Jan 15, 2016, for studies of interventions to prevent and reduce physician burnout, including single-arm pre-post comparison studies. We required studies to provide physician-specific burnout data using burnout measures with validity support from commonly accepted sources of evidence. We excluded studies of medical students and non-physician health-care providers. We considered potential eligibility of the abstracts and extracted data from eligible studies using a standardised form. Outcomes were changes in overall burnout, emotional exhaustion score (and high emotional exhaustion), and depersonalisation score (and high depersonalisation). We used random-effects models to calculate pooled mean difference estimates for changes in each outcome. We identified 2617 articles, of which 15 randomised trials including 716 physicians and 37 cohort studies including 2914 physicians met inclusion criteria. Overall burnout decreased from 54% to 44% (difference 10% [95% CI 5-14]; p<0·0001; I2=15%; 14 studies), emotional exhaustion score decreased from 23·82 points to 21·17 points (2·65 points [1·67-3·64]; p<0·0001; I2=82%; 40 studies), and depersonalisation score decreased from 9·05 to 8·41 (0·64 points [0·15-1·14]; p=0·01; I2=58%; 36 studies). High emotional exhaustion decreased from 38% to 24% (14% [11-18]; p<0·0001; I2=0%; 21 studies) and high depersonalisation decreased from 38% to 34% (4% [0-8]; p=0·04; I2=0%; 16 studies). The literature indicates that both individual-focused and structural or organisational strategies can result in clinically meaningful reductions in burnout among physicians. Further research is needed to establish which interventions are most effective in specific populations, as well as how individual and organisational solutions might be combined to deliver even greater improvements in physician wellbeing than those achieved with individual solutions. Arnold P Gold Foundation Research Institute.