US Health Care Professionals Research Articles

Continuing medical and dental education on the global stage: the nexus of supporting international Christian healthcare workers and developing educators

One of the challenges facing international healthcare missionaries is that of maintaining up-to-date knowledge and staying current with professional certification. Since 1978, annual programs by the Christian Medical and Dental Associations have offered professional continuing education to thousands of US healthcare professionals serving as missionaries in the regions of Africa, Asia, and, in more recent years, globally. In addition, conference programming is designed to prepare, train, and support healthcare missionaries to, in turn, serve as educators in their places of ministry. The program is designed for both professional education and personal encouragement. Utilizing historical documents from program facilitation and interviews from those involved with its implementation, this paper describes the history, vision, and favorable quantitative growth and qualitative impact on participants. The program continues to grow as healthcare missionaries are educated near their places of service, while reinforcing their own roles as educators.

Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality.

Defining what represents a macronutritionally balanced diet remains an open question and a high priority in nutrition research. Although the amount of protein may have specific effects, from a broader dietary perspective, the choice of protein sources will inevitably influence other components of diet and may be a critical determinant for the health outcome. To examine the associations of animal and plant protein intake with the risk for mortality. This prospective cohort study of US health care professionals included 131 342 participants from the Nurses' Health Study (1980 to end of follow-up on June 1, 2012) and Health Professionals Follow-up Study (1986 to end of follow-up on January 31, 2012). Animal and plant protein intake was assessed by regularly updated validated food frequency questionnaires. Data were analyzed from June 20, 2014, to January 18, 2016. Hazard ratios (HRs) for all-cause and cause-specific mortality. Of the 131 342 participants, 85 013 were women (64.7%) and 46 329 were men (35.3%) (mean [SD] age, 49 [9] years). The median protein intake, as assessed by percentage of energy, was 14% for animal protein (5th-95th percentile, 9%-22%) and 4% for plant protein (5th-95th percentile, 2%-6%). After adjusting for major lifestyle and dietary risk factors, animal protein intake was not associated with all-cause mortality (HR, 1.02 per 10% energy increment; 95% CI, 0.98-1.05; P for trend = .33) but was associated with higher cardiovascular mortality (HR, 1.08 per 10% energy increment; 95% CI, 1.01-1.16; P for trend = .04). Plant protein was associated with lower all-cause mortality (HR, 0.90 per 3% energy increment; 95% CI, 0.86-0.95; P for trend < .001) and cardiovascular mortality (HR, 0.88 per 3% energy increment; 95% CI, 0.80-0.97; P for trend = .007). These associations were confined to participants with at least 1 unhealthy lifestyle factor based on smoking, heavy alcohol intake, overweight or obesity, and physical inactivity, but not evident among those without any of these risk factors. Replacing animal protein of various origins with plant protein was associated with lower mortality. In particular, the HRs for all-cause mortality were 0.66 (95% CI, 0.59-0.75) when 3% of energy from plant protein was substituted for an equivalent amount of protein from processed red meat, 0.88 (95% CI, 0.84-0.92) from unprocessed red meat, and 0.81 (95% CI, 0.75-0.88) from egg. High animal protein intake was positively associated with cardiovascular mortality and high plant protein intake was inversely associated with all-cause and cardiovascular mortality, especially among individuals with at least 1 lifestyle risk factor. Substitution of plant protein for animal protein, especially that from processed red meat, was associated with lower mortality, suggesting the importance of protein source.

A Survey of Adverse Event Reporting Practices Among US Healthcare Professionals

IntroductionThe under-reporting of adverse drug events (ADEs) is an international health concern. A number of studies have assessed the root causes but, to our knowledge, little information exists relating under-reporting to practices and systems used for the recording and tracking of drug‐related adverse event observations in ambulatory settings, institutional settings, and retail pharmacies.ObjectivesOur objective was to explore the process for reporting ADEs in US hospitals, ambulatory settings, and retail pharmacies; to explore gaps and inconsistencies in the reporting process; and to identify the causes of under-reporting ADEs in these settings.MethodsThe Tufts Center for the Study of Drug Development (Tufts CSDD) interviewed 11 thought leaders and conducted a survey between May and August 2014 among US-based healthcare providers (HCPs) in diverse settings to assess their experiences with, and processes for, reporting ADEs.ResultsA total of 123 individuals completed the survey (42 % were pharmacists; 27 % were nurses; 15 % were physicians; and 16 % were classified as ‘other’). HCPs indicated that the main reasons for under-reporting were difficulty in determining the cause of the ADE, given that most patients receive multiple therapies simultaneously (66 % of respondents); that HCPs lack sufficient time to report ADEs (63 % of respondents); poor integration of ADE-reporting systems (53 % of respondents); and uncertainty about reporting procedures (52 % of respondents).DiscussionThe results of this pilot study identify that key factors contributing to the under-reporting of ADEs relate to a lack of standardized process, a lack of training and education, and a lack of integrated health information technologies.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-016-0455-4) contains supplementary material, which is available to authorized users.

Causes, Burden, and Prevention of Clostridium difficile Infection.

Clostridium difficile infection (CDI) is a potentially deadly cause of diarrhea that is virtually always connected to healthcare system exposures, both inpatient and outpatient. Once a disease mainly of hospitals, 75% of CDI cases are now diagnosed outside of hospitals. However, the diagnosis location may not reflect where C. difficile spores were acquired or antibiotic exposure occurred. Changing epidemiology and increasing awareness about the role of every segment of the healthcare system in mediating this disease makes it clear that reducing its burden will also require active participation from all US healthcare professionals.

Chronic Disease Prevalence and Healthy Lifestyle Behaviors Among US Health Care Professionals

Although health care professionals may be assumed to make healthier lifestyle choices and have better health outcomes than others because of their greater health literacy, little is known about how actual health outcomes of health care professionals compare with those of the overall population. We analyzed how trends in obesity, diabetes, hypertension, and coronary artery disease prevalence as well as several health behaviors (smoking, alcohol use, and exercise) varied between health care professionals and the general US population from 2002 to 2013, using nationally representative data collected by the National Health Interview Survey. We estimated multivariate logistic regressions of each disease and behavior adjusted for age, race, sex, geographic region, and year. Although rates of obesity, diabetes, and hypertension were lower among health care professionals compared with the overall population, disease was still common among health care professionals and increased over time at a rate similar to that of the overall population. For example, obesity prevalence was lower among health care professionals but increased similarly from 2002 to 2013 (health care professionals, 20.5% in 2002 to 22.1% in 2013; other occupations, 28.4% to 31.7%; P=.64 for difference in trend). Diabetes prevalence was modestly lower among health care professionals but increased at a similar rate (health care professionals, 7.4% in 2005 to 8.6% in 2013; other occupations, 8.7% to 9.9%; P=.67 for difference in trend). Similar patterns were noted in hypertension. Coronary artery disease prevalence declined over time among health care professionals but increased for others. Health care professionals reported better health behaviors than others in smoking and physical activity but not in moderate to heavy alcohol use.

Job Crafting and Performance of Dutch and American Health Care Professionals

Abstract. We explore how job demands and job resources are related to job crafting, and how this, in turn, is related to performance in two samples of American (US; N = 70) and Dutch (NL; N = 144) health care professionals (HCP). A cross-sectional, cross-cultural design revealed that US HCP have higher job demands and reduce them more than NL HCP, who have higher and seek more job resources. Specifically, job demands positively related to seeking resources; job resources positively related to seeking challenges and seeking resources but negatively to reducing demands. While reducing demands negatively related to task and contextual performance, seeking resources positively related to task and creative performance. This study expands scientific and practical knowledge on employee proactive organizational behavior.

Communication Practice Patterns of US Healthcare Professionals with CML Patients Undergoing Oral Tyrosine Kinase Inhibitor Treatment

Patient adherence to oral tyrosine kinase inhibitor (TKI) treatment remains a significant challenge for the hematology healthcare professional treating patients with chronic myeloid leukemia (CML). Current data suggests that only a minority of CML patients are perfectly adherent to TKI treatment. Moreover, patients with less than 90% adherence have significantly lower molecular response rates and, ultimately, outcomes. Therefore, guidelines currently recommend evaluating adherence whenever a therapeutic milestone is not achieved. Given the importance of adherence to optimal CML treatment, communication patterns of US healthcare professionals and the impact of education on those practice patterns were evaluated.From December 2012 to April 2014, 38 live 1-hour educational interventions were implemented in accordance with the essential areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) and Accreditation Council for Pharmacy Education (ACPE). The programs educated 631 healthcare professionals practicing in the community setting. Participants were asked a series of questions on communication and follow-up with CML patients prior to and following an educational intervention. Practice pattern, knowledge, and competence were assessed via case vignettes prior to and immediately following each educational activity via an audience response system. Surveys completed 6 weeks following each activity assessed practitioner performance and long-term incorporation of the educational content.Prior to the education less than 50% of practitioners evaluated adherence for a CML patient missing major response milestones. The majority of practitioners instead opted to switch to a different TKI or increase TKI dose. Education profoundly increased the proportion of practitioners choosing to evaluate adherence in both the short- and long-term. Furthermore, prior to the education, only 60% of healthcare professionals reported always discussing the impact of non-adherence to oral TKI treatment on clinical outcomes. Immediately following the education 86% reported intent to always discuss the impact with patients. However, preliminarily, this intent did not appear to be incorporated into clinical practice for those physicians responding to the long-term follow-up survey. Most practitioners (85% prior to the education and 94% following the education) reported using a tool to facilitate dose management for patients on an oral TKI. A pillbox was the most commonly used tool (41% prior to the education, 38% following the education). Education resulted in an increase (+13%) in those practitioners incorporating technology (text, email, or cell phone application) as a dose management or patient adherence tool. In the long-term, 64% of survey respondents agreed or strongly agreed that participation in the educational activity increased their likelihood to use a tool to aid dose management and adherence (no participants disagreed).Overall, these data suggest that among community practitioners, discussion of adherence to oral TKI treatment for CML is limited. Education positively improves the percentage of practitioners who recognize when adherence should be evaluated, the importance of patient-practitioner discussion on non-adherence, and incorporate tools to facilitate patient dose management and adherence to oral TKI treatment. DisclosuresFagerlie:Novartis: Unrestricted Educational Grant Other. Heintz:Novartis: unrestricted educational grant Other. Haas:Novartis: unrestricted educational grant Other.

Medication Safety

Medication Safety

Health Care Provider Management of Patients With Type 2 Diabetes Mellitus: Analysis of Trends in Attitudes and Practices

Objective: To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes mellitus (T2DM) management; to compare current study data with results from a similar 2011 study. Methods: A nominal group technique focus group identified barriers to optimal management of patients with T2DM. Five case-vignette surveys were created, 1 for each group of health care professionals (HCPs): ENDOs; FPs and IMs; NPs and PAs; CDEs; and R-PHs and H-PHs. Surveys were tailored to each group. Versions were as similar as possible to each other and to the 2011 surveys to facilitate comparisons. Questions assessed guideline familiarity; knowledge of insulin formulations, glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors; patterns of referral to ENDOs and CDEs; as well as cultural barriers and communication barriers. Surveys were distributed by e-mail/fax to a nationally representative, random sample of US HCPs during January and February 2013. Results and Conclusions: Notable shifts from 2011 included NPs' increased familiarity with American Diabetes Association (ADA) guidelines; FPs, IMs, NPs, and PAs continued comfort with prescribing long-acting basal insulin but less with basal-bolus, Neutral Protamine Hagedorn insulin alone, or human premixed insulin; increased pharmacists' comfort in discussing long-acting basal insulin; increased likelihood that FPs will refer patients with recurrent hypoglycemia unable to achieve target glycated hemoglobin level to an ENDO; and continued incorporation of insulin and incretins into treatment regimens. The trends suggest gaps in perception, knowledge, and management practices to be addressed by education. Most HCPs lack confidence in using insulin regimens more complex than long-acting insulin alone. All providers need education on T2DM management guidelines, differences between GLP-1 agonists and DPP-4 inhibitors, and how to intensify therapy for patients not reaching goal blood glycemic level with use of multiple agents. Pharmacists might benefit from education on glycemic treatment goals.

Digital house calls: US healthcare professionals and online media communication

The popularity and increased use of online interaction and social media websites is certain to impact the healthcare profession. As 80% of Americans with Internet access search for health information, it is important for healthcare professionals (HCP) to adapt to the needs of their clients. Through the use of an online survey of HCP, this study offers insight into their current interest and use of online media. The findings indicate that many HCP have little interest in participating in online interaction with patients and are deterred by issues of privacy and liability. Applying a theoretical framework of uses and gratifications, our study addresses HCP motivations for interacting online, both professionally and personally. Analysis reveals that HCPs have three dominant motivations for using online social media: professional self-expression, social entertainment, and convenience. Relationships are noted between motivations for use and frequency of social media activity. Findings inform best practices in communication via online platforms for HCP as they forge relationships with patients in a digital age.

Influence of Continuing Medical Education On the Utilization of Combined Proteasome Inhibitor/Immunomodulatory Agent Induction Therapy and Cytogenetic Information for Multiple Myeloma by US Healthcare Professionals

AbstractAbstract 4707Over the past 15 years, optimal treatment for multiple myeloma (MM) has undergone dramatic changes. Novel therapies have led to unprecedented response rates and improved survival. Active therapies are now being combined with good efficacy; however, combination therapy often alters the toxicity profile as well as therapy options at relapse. Because there are a number of active regimens for newly diagnosed MM, healthcare professionals must stay abreast of the most current information in order to make optimal patient care decisions. An interactive, case-based education series focusing on MM treatment was conducted at hospitals, medical centers, cancer centers, medical practices, and community dinner venues throughout the United States. The target audience for this program was hematologists, hematologist-oncologists, medical oncologists, oncology specialty pharmacists, and allied healthcare professionals charged with the care of patients with MM. From April 2010 to November 2011, 94 live 1-hour education activities were implemented in accordance with the essential areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) and Accreditation Council for Pharmacy Education (ACPE). After the initial 69 activities, which educated 1360 healthcare professionals including 809 physicians, outcomes assessments were expanded. The remaining 25 activities reached 440 healthcare providers including 256 physicians. Practice pattern, knowledge, and competence were assessed via case vignettes prior to and immediately following each educational activity using an audience response system. Case vignette surveys completed 6 weeks following each activity evaluated practitioner performance. The median number of responses per question for the first 69 activities was 413 at baseline, 223 immediately following each activity, and 44 at 6 weeks. For a young ISS stage III patient with few comorbidities and normal cytogenetics, practitioners favored induction therapy combining a proteasome inhibitor and immunomodulatory agent, with 56% of practitioners selecting either a thalidomide/bortezomib- or lenalidomide/bortezomib-based regimen at baseline. Preference for combination therapy increased after the educational activity to 75% (+19% shift). The majority favored a bortezomib/lenalidomide-based treatment plan (45% at baseline and 67% post-education). Subgroup analysis found a similar trend for the physician target audience with 45% of physicians at baseline and 67% immediately following the education selecting a lenalidomide/bortezomib-based regimen. Follow-up at 6 weeks found 68% of respondents opted for a combined regimen. For the final 25 activities, the case vignette was altered from normal cytogenetics to t(4;14), and participants were asked a series of questions on cytogenetics and MM treatment. For the t(4;14) patient, baseline use of a combined lenalidomide/bortezomib regimen was similar to the first 69 activities (48% for total audience, 49% for physicians). Upon education 84% of the total audience and 76% of physician opted for a lenalidomide/bortezomib-based regimen. The majority of practitioners (81% of the total audience and 82% of physicians) reported that cytogenetic information affected their treatment approach, and 94% were able to identify high-risk cytogenetics. When asked to select induction therapy for an elderly transplant-ineligible MM patient with comorbidities, there was little consensus and education did not result in a significant change in practice pattern. The most commonly identified barrier to applying activity content into clinical practice was treatment side effects. Overall, these data suggest that among community practitioners, combination induction therapy with a proteasome inhibitor and immunomodulatory agent is preferred for a young transplant eligible patient and cytogenetic information is being incorporated into treatment selection. Education of current data impacts treatment selection, increasing the number of practitioners selecting combination therapy. Treatment of frail elderly patients remains a challenge. Practice patterns varied for elderly MM before and after the educational activity. Participants identified treatment side effects as the most common barrier, and further education on the management of these side effects, especially in elderly MM, is needed. Disclosures:Fagerlie:Onyx Pharmaceuticals, Inc: Research Funding; Celgene Corporation: Research Funding; Millennium: The Takeda Oncology Company: Research Funding. Heintz:Onyx Pharmaceuticals, Inc: Research Funding; Celgene Corporation: Research Funding; Millennium: The Takeda Oncology Company: Research Funding. Haas:Onyx Pharmaceuticals, Inc: Research Funding; Celgene Corporation: Research Funding; Millennium: The Takeda Oncology Company: Research Funding. Stacy:Onyx Pharmaceuticals, Inc: Research Funding; Celgene Corporation: Research Funding; Millennium: The Takeda Oncology Company: Research Funding.

Can Chaplains Survive and Thrive with P4P?

In the near future, almost all US health care professionals—doctors, nurses and members of the ancillary disciplines, including chaplains—likely will be paid based on quality of performance, i.e., pay for performance (P4P), by achieving evidence based, best practice, desired outcomes that have a positive impact on institutional bottom lines. This article describes the context, implications for chaplaincy, progress to date and next steps for professional chaplaincy to survive and thrive with P4P.

What are the top five essential features of a high quality eating disorder service? A comparison of the views of US and UK eating disorder sufferers, carers and health professionals.

The aim of the present study was to identify what are the main features of a high quality eating disorders service and to triangulate the views of patients, carers and health professionals in a cross-national (USA, UK) survey. Data from an internet survey were subjected to content analysis and common themes were identified. All six stakeholder groups (US and UK patients, carers and health professionals) included the professional qualities of staff amongst their top five quality features. Personal qualities of staff, support for carers and psychological interventions were mentioned by four of the six groups, Support for service users and nutritional assistance was mentioned by three groups. Availability/access and Rapid access to care were mentioned by UK Carers and UK health care personnel. Medical assistance was only mentioned by US health care professionals and flexible care only by UK sufferers. This study suggests many similarities and some differences between different stakeholders from two countries with different health care systems in their views on quality of care.

Breastfeeding Mothers Returning to Work: Possibilities for Information, Anticipatory Guidance and Support from US Health Care Professionals

Today, more mothers in the United States are in the labor force, and returning to the workforce presents numerous challenges for the breastfeeding mother. Although it as been demonstrated that maternal employment is associated with a decrease in the length of time a mother continues to breastfeed, health care providers are in a unique position to enhance a mother's breastfeeding success as she transitions back into the workplace. This article describes various commonly perceived obstacles to combining breastfeeding and working and provides examples of information, anticipatory guidance, and support that health care providers can use to assist a breastfeeding mother with a successful return to the workforce.

Health careers for Native American students: Challenges and opportunities for enrichment program design

Native Americans are severely underrepresented among US health care professionals, medical researchers, and public health officials. This low representation presents a substantial challenge to addressing the urgent need to improve health care in Native communities. Increasing the number of Native American clinicians and scientists can help to improve the health of these communities through direct provision of health care and by driving a targeted research and policy agenda. Low enrollment of Native American students in medical school and other health-related degree tracks has numerous root causes, ranging from financial constraints to the lack of appropriate mentorship. Academic institutions can play a vital role in reaching out to provide the appropriate experiences and resources that will engage Native students and help them take the next step towards a career in health care. These programs should always be accompanied by an appropriate evaluation structure that ensures continued improvement and facilitation of particular student needs.

Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study

Objective To examine the association between intake of total fat, specific types of fat, and cholesterol and risk of stroke in men.Design and setting Health professional follow up study with...

Practitioner attitudes in the United States and United Kingdom toward decisions at the end of life: are medical ethicists out of touch?

Objective To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing or withholding treatment, ordinary or extraordinary interventions, and the doctrine of double effect. Design, subjects, and setting Answers to a 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” were compared with those of a similar questionnaire administered to 759 US nurses and 687 US physicians taking the Hastings Center course on “Decisions Near the End of Life.” Results Practitioners accept the relevance of concepts widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic and ordinary interventions and withholding and withdrawing treatment. Within the UK nurses' group, the responses of a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment. Conclusions Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners.

Are medical ethicists out of touch? Practitioner attitudes in the US and UK towards decisions at the end of life

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect Design, subjects...

National Adverse Drug Reaction Surveillance 1986

• The collection of adverse drug reaction (ADR) reports by the Food and Drug Administration serves to provide additional information on the toxic reactions of drugs that often cannot be known before a drug is marketed. In 1986, a total of 53 547 ADR reports were received; 56% of these were made by US health care professionals based on observations made during usual clinical practice. The 1986 total represents an increase of 14% in ADR reporting over 1985, continuing a trend begun in 1981. While these increases are encouraging, US reporting rates are far below many other countries, and further encouragement of reporting must be done. Of these ADR reports, 24% involved serious reactions and 20% involved new drugs. An ADR report should be seen as a professional responsibility; reports are carefully analyzed and used. ( Arch Intern Med 1988;148:785-787)

National Adverse Drug Reaction Surveillance

The collection of adverse drug reaction (ADR) reports by the Food and Drug Administration serves to provide additional information on the toxic reactions of drugs that often cannot be known before a drug is marketed. In 1986, a total of 53,547 ADR reports were received; 56% of these were made by US health care professionals based on observations made during usual clinical practice. The 1986 total represents an increase of 14% in ADR reporting over 1985, continuing a trend begun in 1981. While these increases are encouraging, US reporting rates are far below many other countries, and further encouragement of reporting must be done. Of these ADR reports, 24% involved serious reactions and 20% involved new drugs. An ADR report should be seen as a professional responsibility; reports are carefully analyzed and used.