scholarly journals A Disclosure About Death Disclosure: Variability in Circulatory Death Determination

2021 ◽  
Vol 14 ◽  
pp. 277-281
Author(s):  
Christopher Robinson ◽  
Suzanne Hunt ◽  
Gary Gronseth ◽  
Sara Hocker ◽  
Eelco Wijdicks ◽  
...  
Keyword(s):  
Online Survey ◽  
Practice Patterns ◽  
Formal Training ◽  
Physician Competence ◽  
Examination Methods ◽  
Examination Techniques ◽  
Attending Physicians ◽  
Death Determination ◽  
Death Data ◽  
Respiratory Death

Introduction. Circulatory-respiratory death declaration is a common duty of physicians, but little is known about the amount of education and physician practice patterns in completing this examination. Methods. We conducted an online survey of physicians evaluating the rate of formal training and specific examination techniques used in the pronouncement of circulatory-respiratory death. Data, including level of practice, training received in formal death declaration, and examination components were collected. Results. Respondents were attending physicians (52.4%), residents (30.2%), fellows (10.7%), and interns (6.7%). The majority of respondents indicated they had received no formal training in death pronouncement, however, most reported self-perceived competence. When comparing examination components used by our cohort, 95 different examination combinations were used for death pronouncement. Conclusions. Formal training in death pronouncement is uncommon and clinical practice varies. Implementation of formal training and standardization of the examination are necessary to improve physician competence and reliability in death declarations.

scholarly journals Assessing the utility and attitudes toward molecular testing in neuro-oncology: a survey of the Society for Neuro-Oncology members

2021 ◽  
Author(s):  
Shannon Fortin Ensign ◽  
Maya Hrachova ◽  
Susan Chang ◽  
Maciej M Mrugala
Keyword(s):  
Online Survey ◽  
Clinical Decision Making ◽  
Unmet Needs ◽  
Practice Patterns ◽  
Response Rate ◽  
Clinical Decision ◽  
Molecular Testing ◽  
Newly Diagnosed ◽  
Tumor Boards ◽  
Oncology Practice

Abstract Background Molecular testing (MT) is utilized in neuro-oncology with increasing frequency. The aim of this study was to determine clinical practice patterns to acquire this information, interpret and utilize MT for patient care, and identify unmet needs in the practical clinical application of MT. Methods We conducted a voluntary online survey of providers within the Society for Neuro-Oncology (SNO) membership database between March and April 2019. Results We received 152 responses out of 2022 SNO members (7.5% of membership). 88.8% of respondents routinely order MT for newly diagnosed gliomas. Of those who do not, testing is preferentially performed in younger patients or those with midline tumors. 82.8% use MT in recurrent gliomas. Other common indications included: metastatic tumors, meningioma, and medulloblastoma. Many providers utilize more than one resource (36.0%), most frequently using in-house (41.8%) over commercially available panels. 78.1% used the results for clinical decision-making, with BRAF, EGFR, ALK, and H3K27 mutations most commonly directing treatment decisions. Approximately, half (48.5%) of respondents have molecular tumor boards at their institutions. Respondents would like to see SNO-endorsed guidelines on MT, organized lists of targeted agents available for specific mutations, a database of targetable mutations and clinical trials, and more educational programs on MT. Conclusion This survey was marked by several limitations including response rate and interpretation of MT. Among respondents, there is routine use of MT in Neuro-Oncology, however, there remains a need for increased guidance for providers to effectively incorporate the expanding genomic data resulting from MT into daily Neuro-Oncology practice.

Fourth-Year Podiatric Medical Student Perspectives on Clerkships and Residency Selection

2018 ◽  
Vol 108 (4) ◽  
pp. 311-319 ◽  
Author(s):  
David W. Shofler ◽  
Kathryn Bosia ◽  
Lawrence Harkless
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Medical School ◽  
Online Survey ◽  
Learning Experiences ◽  
Residency Programs ◽  
Forefoot Surgery ◽  
Quality Of Learning ◽  
Attending Physicians

Background: The fourth year of podiatric medical school is an important period in the education of the podiatric medical student, a period that consists largely of month-long clerkships. Nonetheless, there has been limited formal study of the quality of learning experiences during this period. Furthermore, there is limited knowledge of how podiatric medical students evaluate residency programs during clerkships. Methods: An online survey was developed and distributed electronically to fourth-year podiatric medical school students. The focus of the survey was the quality of learning experiences during externships, and decision making in ranking residency programs. Results: The most valuable learning experiences during clerkships were interactions with attending physicians, interactions with residents, and general feedback in surgery. Students self-identified that they most improved in the following areas during clerkships: forefoot surgery, clinical podiatry skills, and rearfoot surgery. The areas in which students improved the least were research, pediatrics, and practice management. The three most important factors students considered as they created their rank list were hands-on resident participation in surgical training, the attitude and personality of the residents, and the attitude and personality of the attending physicians. A range of surgical interest was identified among students, and students lacking in surgical interest self-reported less improvement in various surgical topics. Conclusions: The perspectives of fourth-year podiatric medical students are currently an underused resource. Improved understanding can help residency programs improve the quality of associated learning experiences and can make their programs more appealing to potential residency candidates.

scholarly journals Clinical practice patterns in indirect peroral cholangiopancreatoscopy: outcome of a European survey

2021 ◽  
Vol 09 (11) ◽  
pp. E1704-E1711
Author(s):  
Pauline M.C. Stassen ◽  
Pieter Jan F. de Jonge ◽  
George J.M. Webster ◽  
Mark Ellrichmann ◽  
Arno J. Dormann ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Bile Duct ◽  
Online Survey ◽  
Practice Patterns ◽  
International Consensus ◽  
Clinical Practice Patterns ◽  
European Survey ◽  
Standardized Protocol ◽  
Pancreatic Duct Stones

Abstract Background and aims Indirect peroral cholangiopancreatoscopy (IPOC) is a relatively new diagnostic and therapeutic tool for biliopancreatic diseases. This international survey aimed to evaluate clinical practice patterns in IPOC among endoscopists in Europe. Methods An online survey was developed comprising 66 questions on the use of IPOC. Questions were grouped into four domains. The survey was sent to 369 endoscopists who perform IPOC. Results 86 respondents (23.3 %) from 21 different countries across Europe completed the survey. The main indications for cholangioscopy were determination of biliary strictures (85 [98.8 %]) and removal of common bile duct or intrahepatic duct stones (79 [91.9 %]), accounting for an estimated use of 40 % (interquartile range [IQR] 25–50) and 40 % (IQR 30–60), respectively, of all cases undergoing cholangioscopy. Pancreatoscopy was mainly used for removal of pancreatic duct stones (68/76 [89.5 %]), accounting for an estimated use of 76.5 % (IQR 50–95) of all cases undergoing pancreatoscopy. Only 13/85 respondents (15.3 %) had an institutional standardized protocol for targeted cholangioscopy-guided biopsy sampling. IPOC with lithotripsy was used as first-line treatment in selected patients with bile duct stones or pancreatic stones by 24/79 (30.4 %) and 53/68 (77.9 %) respondents, respectively. Conclusions This first European survey on the clinical practice of IPOC demonstrated wide variation in experience, indications, and techniques. These results emphasize the need for prospective studies and development of an international consensus guideline to standardize the practice and quality of IPOC.

scholarly journals Delivering bad news in the perspective of patient rights

2020 ◽  
Vol 66 (3) ◽  
Author(s):  
Krzysztof Sobczak ◽  
Katarzyna Leoniuk ◽  
Agata Janaszczyk
Keyword(s):  
Online Survey ◽  
Patient Rights ◽  
Moderate Level ◽  
Bad News ◽  
Computer Assisted ◽  
Full Information ◽  
Patient Organisations ◽  
National Patient ◽  
Level Of Knowledge ◽  
Attending Physicians

Introduction: The necessity to deliver bad news to patients is one of the classic challenges of medical communication. The applicable patient rights oblige doctors to communicate full information concerning adverse condition tactfully and cautiously.The purpose of the study was to determine the level of knowledge of the rights and responsibilities of the patient in people who had received bad news, to identify the fields in which knowledge is lacking and to check if the level of knowledge affected the patient’s behaviour.Materials and methods: The study was conducted with 314 people who had been given bad news. An original Computer-Assisted Web Interview (CAWI) online survey questionnaire was used. Reaching the respondents was possible thanks to our cooperation with national patient organisations and electronic media.Results: One in 5 respondents (21%) was characterised by little knowledge concerning patient rights and responsibilities; 67% had a moderate level of knowledge or were almost fully aware of their rights. A vast majority of the respondents knew that they were entitled to full information about their condition, prognosis and treatment, as well as an inspection of their medical documentation.Conclusions: The knowledge of patient rights seems to be at an unsatisfactory level. Respondents with a higher education and those suffering from cancer had more knowledge. Patients with little or a moderate level of knowledge of patient rights and responsibilities were more likely to change their attending physicians or discontinue their treatments.

How Residents MET their training: Resident’s perception of Medical Emergency Team and its contribution to their Training

2020 ◽  
Author(s):  
Kangqi Ng ◽  
Daryl Jones ◽  
Augustine Tee
Keyword(s):  
Internal Medicine ◽  
Online Survey ◽  
Improve Patient Safety ◽  
Core Competencies ◽  
Medical Emergency Team ◽  
Learning Goals ◽  
Medical Emergency ◽  
Formal Training ◽  
Emergency Team ◽  
Medical Emergencies

Abstract Background Medical Emergency Teams (MET) have been implemented in many hospitals to improve patient safety. Few studies examined how residents perceive the MET as part of training. Objective We aimed to evaluate residents’ perceptions of how MET rotation affected training in the core competencies specified by Accreditation Council for Graduate Medical Education (ACGME). Methods We conducted an online survey of 106 residents. They are either junior residents who are in training in internal medicine, non-trainee registrars or senior residents who are training in respiratory or advanced internal medicine. Results We achieved a response rate of 62.3%. More than 90% of residents agreed or strongly agreed that MET contributed positively to their training, made resuscitation of patients safer and more efficient, and disagreed or strongly disagreed that MET made resuscitation of patients more time-consuming or cumbersome. More than 80% agreed or strongly agreed that the MET improved their clinical judgement in medical emergencies, helped achieve their learning goals and exposed them to a wide variety of cases. At least two-thirds thought that the MET posting improved their procedural skills and communication in end of life care discussions. In contrast, 26.6% of respondents agreed or strongly agreed that the MET decreased autonomy of the primary team. One-third felt they needed formal training for the MET posting. Conclusion Our findings suggest that residents perceive participation in MET was beneficial in training and improved patient care. We also found that formal training and consultant oversight may be needed for junior team leaders of MET.

scholarly journals Attitudes and Approaches to Use of Meal Replacement Products among Healthcare Professionals in Management of Excess Weight

2020 ◽  
Vol 10 (9) ◽  
pp. 136
Author(s):  
Gabrielle Maston ◽  
Janet Franklin ◽  
Alice A. Gibson ◽  
Elisa Manson ◽  
Samantha Hocking ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Overweight And Obesity ◽  
Prescribing Patterns ◽  
Formal Training ◽  
Meal Replacement ◽  
Potential Barriers ◽  
Safety Concerns

Meal replacement product-based diets are an effective weight loss intervention used in the management of obesity. Historically, these diets have been underutilised by HealthCare Professionals (HCPs). An online survey of mixed methods design was distributed to HCPs to capture current perceptions and prescribing patterns of meal replacement products (MRPs) in the management of overweight and obesity. A total of 303 HCPs working in weight management across Australia began the survey and 197 (65%) completed it. While over 70% of HCPs have prescribed MRP currently or in the past, MRPs are only prescribed to a median 7% of patients seeking weight management treatment. Qualitative analysis identified potential barriers to MRP prescription, which include experience with patient non-compliance, perceived poor long-term weight loss durability and safety concerns regarding the product and its use as a total meal replacement program. Safety concerns are centred on the perceived risk of weight cycling and its potential negative psychological impact. MRP prescription is 66% more likely to occur if HCPs had formal training in the use of MRPs relative to those who did not, with a relative risk (RR) of 1.7 (95% CI 1.4, 2.0). This study highlights the potential barriers to the prescription of MRPs, which are centred around safety concerns. This also indicates that formal training may enhance the likelihood of prescribing MRPs, suggesting that once HCPs have a comprehensive understanding of the products and the evidence behind their use, their prescription is likely to be increased.

No consensus exists for use of anticoagulation for calf vein thrombosis

Vascular ◽  
2013 ◽  
Vol 22 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Michael J Anstadt ◽  
T Calloway Robertson ◽  
Ross Milner
Keyword(s):  
Online Survey ◽  
Practice Patterns ◽  
Low Molecular Weight ◽  
Multiple Choice Questions ◽  
Single Institution ◽  
Vein Thrombosis ◽  
Ivc Filters ◽  
Calf Vein ◽  
The Ideal

The ideal treatment of calf vein thrombosis (CVT) remains undefined. We assessed practice patterns at a single institution for CVT. Physicians were sent an online survey with 8 multiple choice questions about management of CVT. A total of 99 physicians of varying specialties participated in the survey. A total of 48.5% anticoagulate patients with CVT and 51.5% do not. Of those who anticoagulate, 62.3% use low molecular weight heparin and 11% use IV heparin. Treatment duration is 3 months for 58% and 6 months for 30% of responders. Of those who do not anticoagulate, 71.2% reassess for clot propagation or resolution with a duplex exam. IVC filters are used by 46% when there is a contraindication to anticoagulation and 13.7% when clot propagation is noted on follow-up scan. These results suggest that there is no consensus treatment of CVT. There is a higher than expected rate of IVC filters placed for CVT.

Educational Impact of a Podcast Covering Vitreoretinal Topics: 1-Year Survey Results

2019 ◽  
Vol 3 (5) ◽  
pp. 358-362 ◽  
Author(s):  
Michael J. Venincasa ◽  
Louis Z. Cai ◽  
Angela Chang ◽  
Ajay E. Kuriyan ◽  
Jayanth Sridhar
Keyword(s):  
Medical Education ◽  
Continuing Medical Education ◽  
Online Survey ◽  
Perceived Usefulness ◽  
Educational Impact ◽  
Cross Sectional ◽  
Educational Methods ◽  
Survey Results ◽  
Attending Physicians ◽  
Relevant Material

Purpose: This article aims to determine preferences and demographics for listeners of an ophthalmology podcast, since podcasts are gaining favor for medical education. Methods: The present study used a cross-sectional, online survey as well as Podtrac, Inc and Squarespace, Inc platform analytics to examine perceived educational usefulness of podcasts for listeners. Results: Quarterly episode downloads increased from 684 in first-quarter 2017 to 16 016 in third-quarter 2018. A total of 102 participants completed the survey: 82 (80.4%) men and 68 (66.7%) retina attending physicians or fellows. Most respondents listened to “stay up to date” or “learn more about the field of retina” (67; 65.7% each). Most respondents agreed that podcasts are useful for medical education and result in changes in practice, but not that podcasts have surpassed traditional educational methods. For respondents, there was no difference in perceived usefulness between podcasts and peer-reviewed journals, textbooks, continuing medical education lectures, or national conferences; these did not differ with respondent listening histories. Conclusions: Podcasts are valuable adjuncts for distributing clinically relevant material.

scholarly journals Pneumocystis jirovecii prophylaxis in patients treated for high-grade gliomas: a survey among neuro-oncologists

2018 ◽  
Vol 6 (4) ◽  
pp. 321-326
Author(s):  
Nebojša Skorupan ◽  
Surabhi Ranjan ◽  
Seema Mehta ◽  
Olga Yankulina ◽  
Nathan Nenortas ◽  
...  
Keyword(s):  
Online Survey ◽  
Practice Patterns ◽  
The United States ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
High Grade ◽  
Cancer Centers ◽  
Medical Oncologists ◽  
High Grade Gliomas ◽  
Cd4 Lymphocyte

Abstract Background Pneumocystis jirovecii pneumonia (PJP) is a known complication in patients with high-grade gliomas (HGGs) who are treated with radiation and chemotherapy. PJP prophylaxis is commonly recommended, but there are currently no clear guidelines regarding duration of treatment and choice of drugs. This study aimed to assess current practice patterns of PJP prophylaxis among neuro-oncologists. Methods An online survey of 14 multiple choice questions was sent to 207 neuro-oncologists and medical oncologists treating brain cancers at all National Cancer Institute-designated cancer centers in the United States. Recipients were identified via a search of the cancer centers’ websites. Results Sixty-one invited experts completed the survey (response rate 29%; of these, 72% were neuro-oncologists, 18% were medical oncologists, and 10% were pediatric neuro- or medical oncologists). Seventy percent of respondents stated that they routinely prescribe PJP prophylaxis, while 7% do not provide prophylaxis. Eighty-one percent of respondents use absolute lymphocyte count (ALC) to assess lymphopenia and 13% also monitor CD4 lymphocyte counts during prophylaxis. The most commonly used first-line agent is trimethoprim-sulfamethoxazole (88% of respondents), followed by pentamidine (6%). Discontinuation of PJP prophylaxis is determined by the following: count recovery (33% by ALC; 18% by CD4 lymphocyte counts), radiation completion (23%), and chemotherapy completion (7%). Glucose-6-phosphate dehydrogenase levels were routinely checked by only 13% of respondents. Conclusions PJP prophylaxis is commonly used in HGG patients, but there are large variations in practice patterns, including the duration of prophylaxis. As consideration for PJP prophylaxis affects all patients with HGG, standardization of prophylaxis should be formally addressed.

scholarly journals Orthopaedic Resident Preparation and Confidence in Treating On-Field Injuries

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770828 ◽  
Author(s):  
Jonathan D. Hodax ◽  
Andrew D. Sobel ◽  
Steven DeFroda ◽  
Alison B. Chambers ◽  
Michael J. Hulstyn
Keyword(s):  
Orthopaedic Surgery ◽  
Resident Education ◽  
Comfort Level ◽  
Field Conditions ◽  
Formal Training ◽  
Residency Programs ◽  
Mandatory Training ◽  
Training Requirement ◽  
Life Saving ◽  
Attending Physicians

Background: Orthopaedic surgery residents may cover athletic events, although the training provided to prepare residents for this role and oversight from attending physicians during these activities is not well understood. Purpose: To survey orthopaedic residents about the training provided by their residency program for on-field athletic coverage and to understand their levels of preparation for this role and confidence in treating commonly encountered on-field conditions. Study Design: Descriptive epidemiology study. Methods: An anonymous survey was emailed to residents in all American College of Graduate Medical Education–accredited, allopathic, nonmilitary orthopaedic surgery residency programs. This survey queried residents about their demographics, the opportunities their residencies require or allow for athletic coverage, their level of preparation for serving an on-field physician, and their comfort level with treating a number of on-field conditions. Likert-type scales were used to assess resident comfort level for treating 13 orthopaedic and nonorthopaedic conditions as well as their perceived level of preparedness. Results: Of 148 residency programs contacted, 57 programs responded (39%). Of the 57 programs responding, 51 (89.5%) allowed or required residents to cover athletic events, and 27 of 51 (52.9%) reported that training to prepare for this role was provided. Only 6 of 24 programs without training available (25%) had direct attending supervision of residents at all athletic events. Residents who answered that their residency programs mandate training prior to their participation in athletic coverage activities reported a higher level of preparation for this role than those with no training, optional training, or those who were unsure of their training requirement ( P < .0001, P = .035, and P = .013, respectively). In addition, the more senior the resident was, the higher the level of confidence was in treating all orthopaedic and some nonorthopaedic conditions. Residents who had mandatory training displayed a higher comfort level in treating on-field orthopaedic and nonorthopaedic conditions than those without training. Conclusion: Formal training of orthopaedic residents prior to their covering athletic events can improve confidence in treating orthopaedic and nonorthopaedic conditions. Many programs do not ensure that residents are familiar with key and potentially life-saving equipment. An opportunity exists to improve resident education.

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