scholarly journals The Text Effect: Stress Management and Resiliency Training Pilot for Resident Physicians

2021 ◽  
Vol 53 (2) ◽  
pp. 139-144
Author(s):  
Jane Nathan ◽  
Laura McCray ◽  
Nathalie Feldman
Keyword(s):  
Stress Management ◽  
Perceived Stress ◽  
Positive Impact ◽  
Medical Center ◽  
Academic Medical Center ◽  
Stress Management Training ◽  
Resiliency Training ◽  
Resident Physicians ◽  
Mindful Attention ◽  
Over Time

Background and Objectives: Burnout is common among resident physicians. Studies show that those who engage in stress management and mindful practice have improved empathy and lower rates of mood disturbance. This study piloted a program entitled Stress Management and Resiliency Training for Residents (SMART-R) with Family Medicine (FM) and Ob-Gyn residents at an academic medical center. Methods: The 6-hour SMART-R program, which teaches relaxation strategies, stress awareness, and adaptive coping, was mandatory for all years of residency and delivered in three 2-hour sessions during protected didactic time. Interested residents received a weekly phone text message with mindfulness and resiliency reminders to enhance practice between sessions. We measured burnout, empathy, perceived stress, mindful attention awareness, mind body practices, and program satisfaction. Results: There were 14 matched pre/post surveys (six FM, eight Ob-Gyn), of which 10 (five FM; five Ob-Gyn) opted to receive weekly texts. Empathy, stress, and burnout remained stable over time. Those who received the weekly texts showed a significant increase in mindful attention awareness and trended toward lower perceived stress compared to those who did not receive texts. Half of those surveyed felt the training should be mandatory and 71% would recommend it to colleagues. While 93% thought it was important to know the current research on mind-body medicine to guide patients, only 29% felt they knew much about this. Conclusions: This study demonstrated the positive impact a 6-hour stress management and resiliency intervention can have on resident physicians. Unlike other studies that have shown decreased empathy and increased stress and burnout over time, these features remained stable over the academic year. Weekly text reminders supported the training and suggest potential benefit to enhance stress management training for medical professionals.

Complementary and Integrative Medicine at Mayo Clinic

2015 ◽  
Vol 43 (08) ◽  
pp. 1503-1513 ◽  
Author(s):  
Ran Pang ◽  
Shihan Wang ◽  
Lin Tian ◽  
Mark C. Lee ◽  
Alexander Do ◽  
...  
Keyword(s):  
Back Pain ◽  
Stress Management ◽  
Mayo Clinic ◽  
Medical Center ◽  
Academic Medical Center ◽  
Psychological Disorders ◽  
Management Training ◽  
Stress Management Training ◽  
Academic Medical ◽  
The Us

Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.

scholarly journals COVID-19 vaccine impact on rates of SARS-CoV-2 cases and post vaccination strain sequences among healthcare workers at an urban academic medical center: a prospective cohort study

2021 ◽  
Author(s):  
Tara C. Bouton ◽  
Sara Lodi ◽  
Jacquelyn Turcinovic ◽  
Sarah E. Weber ◽  
Emily Quinn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Healthcare Workers ◽  
Positive Impact ◽  
Medical Center ◽  
Academic Medical Center ◽  
Post Vaccination ◽  
Unvaccinated Control ◽  
Rate Ratios

AbstractBackgroundCOVID-19 vaccine trials and post-implementation data suggest vaccination decreases SARS-CoV-2 infections. We examine COVID-19 vaccination’s impact on SARS-CoV-2 case rates and viral diversity among healthcare workers (HCW) during a high community prevalence period.MethodsA prospective cohort study from Boston Medical Center (BMC)’s HCW vaccination program, where staff received two doses of BNT162b2 or mRNA-1273. We included PCR-confirmed SARS-CoV-2 cases among HCWs from December 09, 2020 to February 23, 2021. Weekly SARS-CoV-2 rates per 100,000 person-day overall and by time from first injection (1-14 and >14 days) were compared with surrounding community rates. Viral genomes were sequenced from SARS CoV-2 positive samples.ResultsSARS-CoV-2 cases occurred in 1.4% (96/7109) of HCWs given at least a first dose and 0.3% (17/5913) of HCWs given both vaccine doses. Adjusted SARS-CoV-2 infection rate ratios were 0.73 (95% CI 0.53-1.00) 1-14 days and 0.18 (0.10-0.32) >14 days from first dose. HCW SARS-CoV-2 cases >14 days from initial dose compared to within 14 days were more often older (46 versus 38 years, p=0.007), Latinx (10% versus 8%, p=0.03), and asymptomatic (48% versus 11%, p=0.0002). SARS-CoV-2 rates among HCWs fell below those of the surrounding community, with a 18% versus 11% weekly decrease respectively (p=0.14). Comparison of 48 SARS-CoV-2 genomes sequenced from post-first dose cases did not indicate selection pressure towards known spike-antibody escape mutations.ConclusionsOur results indicate a positive impact of COVID-19 vaccines on SARS-CoV-2 case rates. Post-vaccination isolates did not show unusual genetic diversity or selection for mutations of concern.Main PointCases of SARS-CoV-2 among health care workers dropped rapidly with COVID-19 vaccination. Sequencing 48 breakthrough infections (overwhelmingly in 14 days after 1st dose) showed no clear sign of any differences in spike protein compared with time-matched, unvaccinated control sequences.

Engaging Housestaff as Informatics Collaborators: Educational and Operational Opportunities

2021 ◽  
Vol 12 (05) ◽  
pp. 1150-1156
Author(s):  
Jared A. Shenson ◽  
Ivana Jankovic ◽  
Hyo Jung Hong ◽  
Benjamin Weia ◽  
Lee White ◽  
...  
Keyword(s):  
Positive Impact ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Information ◽  
Lessons Learned ◽  
First Year ◽  
Hospital Governance ◽  
Staff Members ◽  
It Systems

Abstract Background In academic hospitals, housestaff (interns, residents, and fellows) are a core user group of clinical information technology (IT) systems, yet are often relegated to being recipients of change, rather than active partners in system improvement. These information systems are an integral part of health care delivery and formal efforts to involve and educate housestaff are nascent. Objective This article develops a sustainable forum for effective engagement of housestaff in hospital informatics initiatives and creates opportunities for professional development. Methods A housestaff-led IT council was created within an academic medical center and integrated with informatics and graduate medical education leadership. The Council was designed to provide a venue for hands-on clinical informatics educational experiences to housestaff across all specialties. Results In the first year, five housestaff co-chairs and 50 members were recruited. More than 15 projects were completed with substantial improvements made to clinical systems impacting more than 1,300 housestaff and with touchpoints to nearly 3,000 staff members. Council leadership was integrally involved in hospital governance committees and became the go-to source for housestaff input on informatics efforts. Positive experiences informed members' career development toward informatics roles. Key lessons learned in building for success are discussed. Conclusion The council model has effectively engaged housestaff as learners, local champions, and key informatics collaborators, with positive impact for the participating members and the institution. Requiring few resources for implementation, the model should be replicable at other institutions.

Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty

2019 ◽  
Vol 161 (1) ◽  
pp. 164-170 ◽  
Author(s):  
Lyndy J. Wilcox ◽  
Claudia Schweiger ◽  
Catherine K. Hart ◽  
Alessandro de Alarcon ◽  
Nithin S. Peddireddy ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Balloon Dilation ◽  
Case Series ◽  
Slide Tracheoplasty ◽  
Time Period ◽  
Academic Medical ◽  
Operative Notes ◽  
Over Time

ObjectiveThis study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic medical center.Subjects/MethodsMedical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented.ResultsOf 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings ( P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation.ConclusionsThis is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.

scholarly journals Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services

2021 ◽  
Author(s):  
Maylyn Martinez ◽  
Matthew Cerasale ◽  
Mahnoor Baig ◽  
Claire Dugan ◽  
Marla Robinson ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Positive Impact ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Medicine ◽  
High Mobility ◽  
Academic Medical ◽  
Risk Patients ◽  
Therapy Services ◽  
Activity Measure

Appropriate use of inpatient physical therapy services is important for preventing hospital-associated disability (HAD). We assessed potential overutilization of physical therapy consults on hospital medicine services using the Activity Measure-Post Acute Care (AM-PAC) score. Our sample included 3592 unique admissions (mean age, 66 years; 48% women) at a large academic medical center. Based on an AM-PAC cutoff of >43.63 (raw score, 18) in patients who were discharged to home, 38% of physical therapy consults were considered “potential overutilization.” Combined with age <65 years, 18% of consults remained “potential overutilization.” After adjustment for age, sex, and length of stay, patients admitted with high mobility scores were 5.38 times more likely to be discharged to home (95% CI, 4.36-2.89) compared with those with low mobility scores. Being more judicious with physical therapy consults and reserving skilled therapy for at-risk patients could help prevent HAD while also having a positive impact on healthcare systems.

scholarly journals Treatment of Asymptomatic Bacteriuria after Implementation of an Inpatient Urine Culture Algorithm in the Electronic Medical Record

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 138
Author(s):  
Dianne Osiemo ◽  
Danny K. Schroeder ◽  
Donald G. Klepser ◽  
Trevor C. Van Schooneveld ◽  
Andrew B. Watkins ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Asymptomatic Bacteriuria ◽  
Provider Education ◽  
Quasi Experimental ◽  
Culture Algorithm ◽  
Over Time

Ordering urine cultures in patients without pyuria is associated with the inappropriate treatment of asymptomatic bacteriuria (ASB). In 2015, our institution implemented recommendations based on practice guidelines for the management of ASB and revised the urine culture ordering process to limit cultures in immunocompetent patients without pyuria. The purpose of this study was to determine how the treatment of ASB has changed over time since altering the urine culture ordering process to reduce unnecessary cultures at an academic medical center. A quasi-experimental study was conducted for inpatients with urine cultures from January to March of 2014, 2015, 2016 and 2020. The primary outcome was the antibiotic treatment of asymptomatic bacteriuria for over 24 h. The secondary outcomes were the total days of antibiotic therapy, type of antibiotic prescribed and overall urine culture rates at the hospital. A total of 200 inpatients with ASB were included, 50 at random from each year. In both 2014 and 2015, 70% of the patients with ASB received antibiotic treatment. Antibiotics were prescribed to 68% and 54% of patients with ASB in 2016 and 2020, respectively. The average duration of therapy decreased from 5.12 days in 2014 to 3.46 days in 2020. Although the urine cultures were reduced, there was no immediate impact in the prescribing rates for patients with ASB after implementing this institutional guidance and an altered urine culture ordering process. Over time, there was an observed improvement in prescribing and the total days of antibiotic therapy. This could be attributed to increased familiarity with the guidelines, culture ordering practices or improved documentation. Based on these findings, additional provider education is needed to reinforce the guideline recommendations on the management of ASB.

scholarly journals The German Version of the Perceived Stress Scale (PSS-10): Evaluation of Dimensionality, Validity, and Measurement Invariance With Exploratory and Confirmatory Bifactor Modeling

Assessment ◽  
2017 ◽  
Vol 26 (7) ◽  
pp. 1246-1259 ◽  
Author(s):  
Dorota Reis ◽  
Dirk Lehr ◽  
Elena Heber ◽  
David Daniel Ebert
Keyword(s):  
Stress Management ◽  
Measurement Invariance ◽  
Perceived Stress ◽  
Reliability And Validity ◽  
Management Training ◽  
Bifactor Model ◽  
Perceived Stress Scale ◽  
Stress Management Training ◽  
Stress Scale ◽  
Bifactor Modeling

The Perceived Stress Scale (PSS) is a popular instrument for measuring the degree to which individuals appraise situations in their lives as excessively uncontrollable and overloaded. Despite its widespread use (e.g., for evaluating intervention effects in stress management studies), there is still no agreement on its factor structure. Hence, the aim of the present study was to examine the dimensionality, measurement invariance (i.e., across gender, samples, and time), reliability, and validity of the PSS. Data from 11,939 German adults (73% women) were used to establish an exploratory bifactor model for the PSS with one general and two specific factors and to cross-validate this model in a confirmatory bifactor model. The model displayed strong measurement invariance across gender and was replicated in Study 2 in data derived from six randomized controlled trials investigating a web-based stress management training. In Study 2 (overall N = 1,862), we found strong temporal invariance. Also, our analyses of concurrent and predictive validity showed associations with depressive symptoms, anxiety, and insomnia severity for the three latent PSS factors. These results show the implications of the bifactor structure of the PSS that might be of consequence in empirical research.

scholarly journals Collaborative Comanagement Between Neurohospitalists and Internal Medicine Hospitalists Decreases Provider Costs and Enhances Satisfaction With Neurology Care at an Academic Medical Center

2017 ◽  
Vol 8 (2) ◽  
pp. 74-81
Author(s):  
James G. Greene
Keyword(s):  
Positive Impact ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Medicine ◽  
Professional Services ◽  
Care Model ◽  
Future Health ◽  
Medical Centers ◽  
Academic Medical ◽  
Potential Benefits

Background and Purpose: The majority of academic medical centers are moving to a neurohospitalist model of care for hospital neurology coverage. Potential benefits over a more traditional academic model of patient care include greater expertise in acute neurologic disease, increased efficiency, and improved availability to patients, providers, and learners. Despite these perceived advantages, switching to a neurohospitalist model can come at substantial financial cost, so finding ways to maximize the positive impact of a limited number of neurohospitalists is very important to the future health of academic neurology departments. Over the past 7 years, we have implemented a model for inpatient neurological care based on an intimate collaborative relationship between the neurology and hospital medicine services at our main academic hospital. Our goal was to optimize the value of care by decreasing cost while improving quality. Methods: Cost and revenue associated with professional services was evaluated on a yearly basis. As part of ongoing quality improvement efforts, yearly surveys were administered to referring providers during the transition to a collaborative care model in which NHs and medicine hospitalists comanage neurology inpatients. Results: Net operating loss was dramatically decreased upon transition to the new care model. Concomitantly, there was a robust positive impact on perception of overall quality, timeliness, and communication skills of neurology services. Conclusions: Collaborative comanagement is an effective strategy to improve overall satisfaction with neurology services at a tertiary academic medical center while maintaining financial viability.

scholarly journals Responsivity of Utilization Rates to the Intensity of Case Management over Time Among High-Utilizing Adults with Sickle Cell Disease

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5803-5803
Author(s):  
Wally R Smith ◽  
Daniel Sop ◽  
Shirley Johnson ◽  
Thokozeni Lipato ◽  
Sarah Hartigan
Keyword(s):  
Sickle Cell Disease ◽  
Case Management ◽  
Sickle Cell ◽  
Medical Center ◽  
Academic Medical Center ◽  
Fiscal Year ◽  
Cell Disease ◽  
Outpatient Visits ◽  
Academic Medical ◽  
Over Time

Background: Case management (CM) and community health workers (CHWs) are two evidence-based health management strategies that can help reduce health risks, reduce readmission rates, and improve patient-provider relationships, all of which may be suboptimal in adults with sickle cell disease (SCD). In Fiscal Year (FY) 2016, the actual average vs. expected average length of stay (ALOS) among SCD adults at Virginia Commonwealth University Medical Center (VCU), an urban academic medical center, was 6.7 days vs 4.2 days. The 30-day readmission rate was 33.7%. We have previously presented results of a year-long pilot CM and CHW intervention for five of VCU's highest adult SCD utilizers, measured by calendar year (CY) 2015 VCU charges (Sop, et al., Blood 2017). Comparing CYs 2015 and 2016, there were numeric improvements in inpatient discharges, 30-day readmissions, 3-Day Emergency Department (ED) returns, ED discharges, outpatient visits, inpatient days, and total VCU charges. Herein, we show results of an extension of the pilot to evaluate responsivity to change over time: whether these improvements were lost among these same patients in the subsequent year (CY 2017) with diminished CM due to loss of funding, and whether they recurred in CY 2018, when CM was more robust as a result of new, more stable funding. Methods: Using the VCU charge and utilization database, we compared the above utilization variables for the five highest CY 2015 utilizers in CYs 2018, 2017, 2016 and 2015. The five original patients included 2 males and 3 females aged between 25-31 years old. One of the females passed away in 2016. Results: There was a trend toward numerically lower utilization during the two CM and CHW years (2016 and 2018), compared to the two diminished CM years (2015 and 2017). Inpatient discharges, inpatient days, and total charges see-sawed according to the intensity of intervention, going down during the year of the initial intervention, rising during the year after intervention, and going down again with resumption of intervention. However, there were notable exceptions: 30-day re-admissions were the lowest in 2017 a diminished intervention year; 3-day ED returns were flat throughout; ED discharges declined throughout, and; outpatient visits rose throughout. Conclusions: These pilot results must be interpreted with caution, since the sample was very small, and interventions were not standardized or randomized, so that secondary trends could be excluded. We found that, after diminution in 2017 of an initial CM and CHW intervention in 2016, several of the initial 2015-to-2016 improvements in academic medical center utilization for five high-utilizing adult SCD patients deteriorated. Subsequently, these improvements recurred when CM and CHWs were reapplied in 2018. We also found that other utilization improvements were sustained despite diminution or resumption of the intervention. This pilot result lays the groundwork for larger, more rigorous CM and CHW Table Disclosures Smith: Novartis: Consultancy, Honoraria. Lipato:Novartis: Honoraria.

Clinical Outcomes of Student Pharmacist–Driven Medication Histories at an Academic Medical Center

2018 ◽  
Vol 32 (4) ◽  
pp. 404-411 ◽  
Author(s):  
Justine S. Gortney ◽  
Lynette R. Moser ◽  
Priyasha Patel ◽  
Joshua N. Raub
Keyword(s):  
Clinical Outcomes ◽  
Health Care Providers ◽  
Positive Impact ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Providers ◽  
Medication List ◽  
Discharge Medication ◽  
Ed Visits ◽  
The Impact

Background: Many studies have shown the positive impact that student pharmacists have on patients’ health; however, no studies have been published evaluating student pharmacists’ impact on direct patient outcomes (ie, readmission, emergency department [ED] visits, length of stay) related to the medication history process. Objective: To evaluate the impact of student pharmacist–obtained medication histories on identification of medication discrepancies and clinical outcomes. Methods: Student pharmacists obtained medication histories and then compared the history to that obtained by other health-care providers. Students documented discrepancies and interventions were completed. Control patients were identified and discharge medication list and 30-day readmissions were compared. Results: Seventeen students conducted 215 patient interviews, and 1848 modifications were made to documented home medications in the electronic medical record. Compared to controls (n = 148 student pharmacist, 149 controls), a nonsignificant improvement was found in discharge medication list completeness scores in patients seen by student pharmacists (3.94 vs 3.63; P = .06); but no difference was found in accuracy scores (0.92 vs 0.93; P = .41). Fewer ED visits at 30 days were found in the student pharmacist group (8 vs 18; P = .045), with no difference in readmissions. Conclusions: Student pharmacist–obtained medication histories improved the information available for identifying drug-related problems for inpatients, completeness of the discharge medication list, and ED visits within 30 days.

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