Local and National Trends in General Surgery Residents’ Operative Experience: Do Work Hour Limitations Negatively Affect Case Volume in Small Community-Based Programs?

2011 ◽  
Vol 77 (12) ◽  
pp. 1675-1680 ◽  
Author(s):  
Alexey Markelov ◽  
Aniket Sakharpe ◽  
Harjeet Kohli ◽  
David Livert
Keyword(s):  
General Surgery ◽  
Alimentary Tract ◽  
Community Hospital ◽  
National Level ◽  
Small Community ◽  
Case Volume ◽  
Community Based ◽  
Significant Difference ◽  
Work Hour ◽  
The Impact

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was —1.20 ( P = 0.52) vs 1.78 ( P = 0.07) for the national program average with statistically significant difference on comparison ( P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 ( P < 0.01) vs -1.08 ( P = 0.54)], abdomen [8.48 ( P < 0.01) vs -6.29 ( P < 0.01)], breast [1.91 ( P = 0.89) vs -3.6 ( P = 0.02)], and vascular [4.03 ( P = 0.02) vs -3.98 ( P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs.

Operative Experience in the Era of Duty Hour Restrictions: Is Broad-Based General Surgery Training Coming to an End?

2010 ◽  
Vol 76 (6) ◽  
pp. 578-582 ◽  
Author(s):  
Lindsay M. Fairfax ◽  
A. Britton Christmas ◽  
John M. Green ◽  
William S. Miles ◽  
Ronald F. Sing
Keyword(s):  
General Surgery ◽  
Alimentary Tract ◽  
Gynecologic Surgery ◽  
Case Volume ◽  
Surgery Training ◽  
Resident Work ◽  
The Mean ◽  
Operative Experience ◽  
The Impact ◽  
General Surgery Training

Since the institution of Accreditation Council for Graduate Medical Education (ACGME) resident work hour restrictions, conflicting evidence exists regarding the impact on resident case volume with most data from single-institution studies. We examined the effect of restrictions on national resident operative experience. After permission from the ACGME, we reviewed the publicly available national resident case log data (1999 through 2008) maintained on the ACGME web site ( www.acgme.org ), including total major cases with subanalysis of the ACGME-specified categories. The mean cases per resident were compared before (1999 to 2003) and after (2003 to 2008) restrictions. After the implementation of duty hour restrictions, the mean number of total cases per resident significantly decreased (949 ± 18 vs 911 ± 14, P = 0.004). Subanalysis showed a significant increase in alimentary tract (217 ± 7 vs 229 ± 3, P = 0.004), skin/soft tissue (31 ± 3 vs 36 ± 1, P = 0.01), and endocrine (26 ± 2 vs 31 ± 2, P = 0.006) cases. However, we observed a significant decrease in head and neck (21 ± 0.3 vs 20 ± 0.3, P = 0.01), vascular (164 ± 29 vs 126 ± 5, P = 0.01), pediatric (41 ± 1 vs 37 ± 2, P = 0.006), genitourinary (10 ± 2 vs 7 ± 1, P = 0.004), gynecologic surgery (5 ± 1 vs 3 ± 0.6, P = 0.002), plastics (16 ± 0.3 vs 15 ± 0.7, P = 0.03), and endoscopy (91 ± 3 vs 82 ± 2, P < 0.001) procedures. Analysis of the ACGME-compiled national data confirms that duty hour restrictions have significantly impacted resident operative experience. Importantly, experience in specialty areas, including vascular and endoscopy, appears to have been sacrificed for consolidation of resources into general surgery services as indicated by the increase in alimentary tract and endocrine cases. These findings raise the following question: Is the era of truly broad-based general surgery training coming to an end?

Evaluating the Impact and Effectiveness of Community-Based Health Insurance Policy Among Informal Sector in Lagos State Using Donabedian Model

2021 ◽  
Vol 5 (2) ◽  
pp. 65-80
Author(s):  
Afeez Kolawole Shittu ◽  
Kikelomo Aboyowa Mbada ◽  
Temitayo Isaac Odeyemi
Keyword(s):  
Health Insurance ◽  
Informal Sector ◽  
Urban Areas ◽  
National Level ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Healthcare Needs ◽  
Lagos State ◽  
Donabedian Model ◽  
The Impact

The study used the Donabedian model (process, structure, and outcome) to evaluate the impact and effectiveness of the Community Based Health Insurance Scheme (CBHIS) among informal sector population in rural and semi-urban areas of Lagos State, and the respondents were drawn among the market men and women, motorist, among others. Three hundred and eighty-four (384) respondents were sampled based on the research advisor's sampling size. Lagos State is stratified along with its three senatorial districts and a local government each is purposively selected based on the full implementation of CBHIS. Data were analysed using descriptive and interferential statistics and the result revealed that 55% of respondents attested to the effectiveness of CBHIS in drastically reducing the cost of medical services and enhancing equal accessibility for healthcare needs. On the other hand, the implementation of CBHIS has no significant impact on healthcare service delivery due to the unfriendly attitude of healthcare providers towards the beneficiaries. The study concluded by providing information on the outcomes of CBHIS implementation at the sub-national level of government in Nigeria and suggest ways of improvement.

No Implementation Without Representation: Real-Time Pharmacist Intervention Optimizes Rapid Diagnostic Tests for Bacteremia at a Small Community Hospital

2021 ◽  
pp. 001857872110375
Author(s):  
Brandon J. Tritle ◽  
Robert Watteyne ◽  
Abby Hickman ◽  
Todd J. Vento ◽  
Bert K. Lopansri ◽  
...  
Keyword(s):  
Real Time ◽  
Diagnostic Tests ◽  
Community Hospital ◽  
Statistical Significance ◽  
Pharmacist Intervention ◽  
Rapid Diagnostic Tests ◽  
Control Group ◽  
Small Community ◽  
The Impact ◽  
Small Community Hospital

Background: Rapid diagnostic tests (RDTs) for bacteremia allow for early antimicrobial therapy modification based on organism and resistance gene identification. Studies suggest patient outcomes are optimized when infectious disease (ID)-trained antimicrobial stewardship personnel intervene on RDT results. However, data are limited regarding RDT implementation at small community hospitals, which often lack access to on-site ID clinicians. Methods: This study evaluated the impact of RDTs with and without real-time pharmacist intervention (RTPI) at a small community hospital with local pharmacist training and asynchronous support from a remote ID Telehealth pharmacist. Time to targeted therapy (TTT) in patients with bacteremia was compared retrospectively across 3 different time periods: a control without RDT, RDT-only, and RDT with RTPI. Results: Median TTT was significantly faster in both the RDT with RTPI and RDT-only groups compared with the control group (2 vs 25 vs 51 hours respectively; P < .001). TTT was numerically faster for RDT with RTPI compared with RDT-only but did not reach statistical significance ( P = .078). Median time to any de-escalation was significantly shorter for RDT with RTPI compared with both RDT-only (14 vs 33 hours; P = .012) and the control group (14 vs 45 hours; P < .001). Median length of stay was also significantly shorter in both RDT groups compared with the control group (4.0 vs 4.1 vs 5.5 hours; P = .013). Conclusion: This study supports RDT use for bacteremia in a small community hospital with ID Telehealth support, suggesting additional benefit with RTPI.

Are Resident Work-Hour Limitations Beneficial to the Trauma Profession?

2006 ◽  
Vol 72 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Tara Abraham ◽  
Marilee Freitas ◽  
Spiros Frangos ◽  
Heidi L. Frankel ◽  
Reuven Rabinovici
Keyword(s):  
General Surgery ◽  
National Level ◽  
Work Hours ◽  
Emergency General Surgery ◽  
Duty Hours ◽  
Likert Score ◽  
Resident Work ◽  
Work Hour ◽  
Resident Duty ◽  
Level I

In July 2003, work-hour restrictions were implemented by the Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty hours. Attending surgeon work-hours have not been similarly reduced, and many trauma services have added emergency general surgery responsibilities. We hypothesized that trauma attending/resident work-hour disparity may disincentivize residents from selecting trauma careers and that trauma directors would view ACGME regulations negatively. We conducted a 6-month study of resident and in-house trauma attending self-reported hours at a level I trauma center and sent a questionnaire to 172 national level I trauma directors (TDs) regarding work-hours restrictions. TD survey response rate was 48 per cent; 100 per cent of 15 residents and 6 trauma faculty completed work-hour logs. Attending mean hours (87.1/ wk), monthly calls (5), and shifts >30 hours exceeded that of all resident groups. Case volume was similar. Residents viewed their lifestyle more favorably than the lifestyle of the trauma attending (Likert score 3.6 ± 0.5 vs Likert score 2.5 ± 0.8, P = 0.0003). Seventy-one per cent cited attending work hours and lifestyle as a reason not to pursue a trauma career. Nationally, 80 per cent of trauma surgeons cover emergency general surgery; 40 per cent work greater than 80 hours weekly, compared with <1 per cent of surgical trainees (P < 0.0001). Most TDs feel that residents do not spend more time reading (89%) or operating (96%); 68 per cent feel patient care has suffered as a result of duty-hours restrictions. Seventy-one per cent feel residents will not select trauma surgery as a career as a result of changes in duty hours. Perceived trauma attending/resident work-hour disparity may disincentive trainees from trauma career selection. TDs view resident duty-hour restrictions negatively.

Impact of Health Education on Mothers' Knowledge of Preventive Health Practices

1997 ◽  
Vol 27 (4) ◽  
pp. 199-202 ◽  
Author(s):  
Mubina Agboatwalla ◽  
Dure Samin Akram
Keyword(s):  
Health Education ◽  
Breast Feeding ◽  
Intervention Study ◽  
Intervention Group ◽  
Preventive Health ◽  
Slum Area ◽  
Post Intervention ◽  
Community Based ◽  
Significant Difference ◽  
The Impact

A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The post intervention knowledge scores of the mothers showed a significant difference of P < 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group ( P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group ( P < 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 ( P > 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 ( P < 0.05).

scholarly journals Effect of Residents-as-Teachers in Rural Community-Based Medical Education on the Learning of Medical Students and Residents: A Thematic Analysis

2021 ◽  
Vol 18 (23) ◽  
pp. 12410
Author(s):  
Nozomi Nishikura ◽  
Ryuichi Ohta ◽  
Chiaki Sano
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Family Medicine ◽  
Rural Community ◽  
Community Hospital ◽  
Community Based ◽  
Approach To Teaching ◽  
Medical Teams ◽  
The Impact ◽  
Residents As Teachers

Residents-as-teachers (RaT) is a theoretical framework emphasizing the significance of the similar learning background of teachers and learners. In Japan, community-based medical education (CBME) is a practical approach to teaching family medicine. This study aimed to investigate the impact and challenges of RaT on the learning of medical students and residents in CBME at a rural community hospital in Japan. Over the course of a year, the researchers conducted one-on-one interviews with three residents and ten medical students participating in family medicine training at the hospital. The interviews were recorded and transcribed verbatim. Grounded theory was used in the data analysis to clarify the findings. Three key themes emerged from the research: lack of educational experience with RaT, effectiveness of RaT, and challenges of RaT. Although participants were prejudiced against RaT, they felt its implementation could facilitate the establishment of beneficial relationships between learners and teachers. They were also able to participate in medical teams effectively. The findings suggest that the increased participation of senior doctors in RaT could strengthen its learning effects. RaT in rural CBME should be applied in various contexts, and its effectiveness should be further investigated both qualitatively and quantitatively.

scholarly journals The Impact of Surgery Resident Participation on the Outcome of Carotid Endarterectomy

2020 ◽  
Vol 13 (1) ◽  
pp. 6-8
Author(s):  
Alex Ammar
Keyword(s):  
Hospital Stay ◽  
Carotid Endarterectomy ◽  
General Surgery ◽  
Death Rate ◽  
Stroke Rate ◽  
Vascular Surgeon ◽  
Resident Participation ◽  
Significant Difference ◽  
Surgery Resident ◽  
The Impact

Introduction. The purpose of this study was to determine whether the in-hospital stroke rate plus deaths (SD) was adversely impacted by the participation of surgery residents during carotid endarterectomy. Methods. A single board-certified vascular surgeon performed 5,663 carotid endarterectomies (CEAs) from September 1982 through December 2016. The surgeon prospectively recorded the data used in this report during the patient’s hospital stay. These cases were done at five hospitals, three of which had general surgery residents participating in procedures and two that did not. Results. Of the 5,663 CEAs, residents participated at three hospitals in 4,974 CEAs. In the two hospitals that did not have surgery residents participating, 689 CEAs were performed. Fifty-seven strokes and 12 deaths occurred in hospitals with resident participation (SD 1.39%). Six strokes (0.9%) and no deaths occurred in hospitals without resident participation. No significant difference in stroke rate, death rate, or combined stroke plus death rate (SD) were identified in comparing hospitals with or without resident participation. Conclusion. This report corroborates others that senior general surgery residents did not have a significant impact on SD in patients undergoing CEA.

scholarly journals The impact of consanguinity on women's attitudes toward molecular testing of breast cancer in Saudi Arabia

2021 ◽  
pp. BMT57
Author(s):  
Bandar A Suliman
Keyword(s):  
Breast Cancer ◽  
Saudi Arabia ◽  
Sociodemographic Factors ◽  
Molecular Testing ◽  
Adult Women ◽  
Community Based ◽  
Cross Sectional ◽  
Saudi Women ◽  
Significant Difference ◽  
The Impact

Background: Breast cancer is the most common cancer in adult women in Saudi Arabia; however, awareness about molecular testing for breast cancer is insufficient. The authors aimed to assess knowledge and attitudes to determine sociodemographic factors that correlate with perceptions of genetic testing among Saudi women. Materials & methods: This cross-sectional community-based study used a questionnaire to investigate the relationships between various social and economic factors. Results: There was a significant difference in interest in undergoing molecular testing between women in consanguineous and non-consanguineous marriages. Conclusion: The data show that consanguinity adds an extra layer of complexity to other sociodemographic barriers that hinder the efficacy of early breast cancer detection and prevention programs in Saudi Arabia.

scholarly journals Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: a ‘Born in Wales’ mixed methods study using routine data

2021 ◽  
Author(s):  
Hope Jones ◽  
Mike Seaborne ◽  
Laura Cowley ◽  
David Odd ◽  
Shantini Paranjothy ◽  
...  
Keyword(s):  
Birth Weight ◽  
Birth Outcomes ◽  
Online Survey ◽  
Negative Impact ◽  
National Level ◽  
Population Level ◽  
Significant Difference ◽  
Expectant Mothers ◽  
The Impact ◽  
Mothers Experiences

AbstractBackgroundPregnancy can be a stressful time and the COVID-19 pandemic has affected all aspects of life. This study aims to investigate the impact of the pandemic on population birth outcomes in Wales, rates of primary immunisations and examine expectant mothers’ experiences of pregnancy including self-reported levels of stress and anxiety.MethodsPopulation-level birth outcomes in Wales: Stillbirths, prematurity, birth weight and Caesarean section births before (2016–2019) and during (2020) the pandemic were compared using national-level routine anonymised data held in the Secure Anonymised Information Linkage (SAIL) Databank. The first three scheduled primary immunisations were compared between 2019 and 2020. Self-reported pregnancy experience: 215 expectant mothers (aged 16+) in Wales completed an online survey about their experiences of pregnancy during the pandemic. The qualitative survey data was analysed using codebook thematic analysis.FindingsThere was no significant difference between annual outcomes including gestation and birth weight, stillbirths, and Caesarean sections for infants born in 2020 compared to 2016-2019. There was an increase in late term births (≥42 weeks gestation) during the first lockdown (OR: 1.28, p=0.019) and a decrease in moderate to late preterm births (32-36 weeks gestation) during the second lockdown (OR: 0.74, p=0.001). Fewer babies were born in 2020 (N=29,031) compared to 2016-2019 (average N=32,582). All babies received their immunisations in 2020, but there were minor delays in the timings of vaccines. Those due at 8-weeks were 8% less likely to be on time (within 28-days) and at 16-weeks, they were 19% less likely to be on time. The pandemic had a negative impact on the mental health of 71% of survey respondents, who reported anxiety, stress and loneliness; this was associated with attending scans without their partner, giving birth alone, and minimal contact with midwives.InterpretationThe pandemic had a negative impact on mothers’ experiences of pregnancy; however, population-level data suggests that this did not translate to adverse birth outcomes for babies born during the pandemic.

scholarly journals ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data

2021 ◽  
Vol 6 (Suppl 4) ◽  
pp. e004986
Author(s):  
Melissa Neuman ◽  
Katherine L Fielding ◽  
Helen Ayles ◽  
Frances M Cowan ◽  
Bernadette Hensen ◽  
...  
Keyword(s):  
Meta Analysis ◽  
National Level ◽  
Population Level ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Community Based ◽  
Variable Effect ◽  
Standard Testing ◽  
Meta Regression ◽  
The Impact

IntroductionMeasuring linkage after community-based testing, particularly HIV self-testing (HIVST), is challenging. Here, we use data from studies of community-based HIVST distribution, conducted within the STAR Initiative, to assess initiation of antiretroviral therapy (ART) and factors driving differences in linkage rates.MethodsFive STAR studies evaluated HIVST implementation in Malawi, Zambia and Zimbabwe. New ART initiations during the months of intervention at clinics in HIVST and comparison areas were presented graphically, and study effects combined using meta-analysis. Meta-regression was used to estimate associations between the impact of community-based HIVST distribution and indicators of implementation context, intensity and reach. Effect size estimates used (1) prespecified trial definitions of ART timing and comparator facilities and (2) exploratory definitions accounting for unexpected diffusion of HIVST into comparison areas and periods with less distribution of HIVST than was expected.ResultsCompared with arms with standard testing only, ART initiations were higher in clinics in HIVST distribution areas in 4/5 studies. The prespecified meta-analysis found positive but variable effects of HIVST on facility ART initiations (RR: 1.14, 95% CI 0.93 to 1.40; p=0.21). The exploratory meta-analysis found a stronger impact of HIVST distribution on ART initiations (RR: 1.29, 95% CI 1.08 to 1.55, p=0.02).ART initiations were higher in studies with greater self-reported population-level intensity of HIVST use (RR: 1.12; 95% CI 1.04 to 1.21; p=0.02.), but did not differ by national-level indicators of ART use among people living with HIV, number of HIVST kits distributed per 1000 population, or self-reported knowledge of how to link to care after a reactive HIVST.ConclusionCommunity-based HIVST distribution has variable effect on ART initiations compared with standard testing service alone. Optimising both support for and approach to measurement of effective and timely linkage or relinkage to HIV care and prevention following HIVST is needed to maximise impact and guide implementation strategies.

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