scholarly journals Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

2015 ◽  
Vol 7 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Maureen D. Francis ◽  
Mark L. Wieland ◽  
Sean Drake ◽  
Keri Lyn Gwisdalla ◽  
Katherine A. Julian ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Linear Regression Analysis ◽  
Internal Medicine Resident ◽  
Cross Sectional Study ◽  
Analysis Of Covariance ◽  
Block Model ◽  
Cross Sectional ◽  
Educational Innovations ◽  
Medicine Resident ◽  
Multivariable Linear Regression Analysis

Abstract Background Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear. Methods This multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity. Results UPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY. Conclusions Clinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model.

scholarly journals 980. Drexel Medicine Resident Knowledge, Practices and Attitudes Regarding Pre-exposure prophylaxis (PrEP)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S518-S518
Author(s):  
Jen E Mainville ◽  
Ed Gracely ◽  
Zsofia Szep
Keyword(s):  
Internal Medicine ◽  
Male Partner ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Major Barrier ◽  
Medicine Resident ◽  
Highly Effective ◽  
Prevention Method ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) is a highly effective daily oral antiretroviral medication that was approved by the FDA in 2012 and has been shown to reduce the risk of HIV by 95% in real-world studies. Despite this, many healthcare providers are not offering PrEP to their patients who are at risk for HIV. Methods We performed a cross-sectional study among Drexel Internal Medicine, Family Medicine, and Obstetrics and Gynecology residents. The survey included questions about experience, knowledge, attitudes toward and barriers to using PrEP. The survey was adapted from previous studies regarding medical providers’ attitudes and knowledge about PrEP (Petroll, 2016; Seifman, 2016; Blumenthal, 2105). A Likert 5-point scale was used for attitude and barriers questions. Results Among 143 participants, 80% specialized in Internal Medicine. 43% of participants were in their first year of training and the mean age (+ SD) was 28.8 + 2. 76% reported never initiating a conversation about PrEP with a patient and only 18% reported ever prescribing PrEP to their patients. 92% reported being very or extremely willing to prescribe PrEP to a male with a current male partner known to be HIV positive. Only 43% of residents reported being moderately likely to prescribe PrEP to a patient coming in for a STI exposure. 68% of residents reported their knowledge about PrEP was a major barrier to prescribing PrEP. Conclusion We found that most residents have minimal experience with prescribing PrEP, and knowledge was identified as the largest barrier. Additional education and a better understanding of PrEP indications is necessary to ensure eligible PrEP patients have access to this highly effective HIV prevention method. Disclosures All Authors: No reported disclosures

scholarly journals Food Waste and Its Association with Diet Quality of Foods Purchased in South Florida

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2535
Author(s):  
Vanessa Mijares ◽  
Jair Alcivar ◽  
Cristina Palacios
Keyword(s):  
Food Waste ◽  
Diet Quality ◽  
Linear Regression Analysis ◽  
Cross Sectional Study ◽  
South Florida ◽  
Analysis Of Covariance ◽  
Grocery Stores ◽  
Cross Sectional ◽  
Grocery Purchase

The objective of this study was to explore the associations between food waste and the diet quality of foods purchased and with grocery purchasing behaviors. This was a cross-sectional study among 109 primary household food providers conducting primary shopping. Participants were recruited outside of local grocery stores and were asked to complete a survey assessing amounts of avoidable food waste and grocery purchasing behaviors. The diet quality of the foods purchased was assessed from grocery receipts using the Grocery Purchase Quality Index-2016 (GPQI-2016). Variables were associated using linear regression, analysis of covariance, and point biserial correlations. We found that fresh fruits (63%) and leafy greens (70%) were the foods that were the most wasted. The GPQI-2016 total score was significantly inversely associated with the total amount of food wasted (β  =  −0.63; 95% CI: −1.14,−0.12) after adjusting for important confounders. The reason “food past the date printed on the package” was directly correlated with food wasted (r = 0.40; p < 0.01) but inversely correlated with GPQI-2016 score (r = −0.21; p = 0.04). Food wasted, but not the GPQI-2016 score, was significantly higher among those who grocery shop 2–4 times per week compared to 1 time every 1–2 weeks (p = 0.02). In conclusion, food waste is inversely associated with diet quality and directly associated with grocery purchasing frequency.

scholarly journals Continuity Clinic Model and Diabetic Outcomes in Internal Medicine Residencies: Findings of the Educational Innovations Project Ambulatory Collaborative

2016 ◽  
Vol 8 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Maureen D. Francis ◽  
Katherine A. Julian ◽  
David A. Wininger ◽  
Sean Drake ◽  
KeriLyn Bollman ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Blood Pressure ◽  
Glycemic Control ◽  
Quality Measures ◽  
Analysis Of Covariance ◽  
Diabetic Patients ◽  
Block Model ◽  
Cross Sectional ◽  
Continuity Clinic ◽  
Process Measures

ABSTRACT Background Efforts to improve diabetes care in residency programs are ongoing and in the midst of continuity clinic redesign at many institutions. While there appears to be a link between resident continuity and improvement in glycemic control for diabetic patients, it is uncertain whether clinic structure affects quality measures and patient outcomes. Methods This multi-institutional, cross-sectional study included 12 internal medicine programs. Three outcomes (glycemic control, blood pressure control, and achievement of target low-density lipoprotein [LDL]) and 2 process measures (A1C and LDL measurement) were reported for diabetic patients. Traditional, block, and combination clinic models were compared using analysis of covariance (ANCOVA). Analysis was adjusted for continuity, utilization, workload, and panel size. Results No significant differences were found in glycemic control across clinic models (P = .06). The percentage of diabetic patients with LDL &lt; 100 mg/dL was 60% in block, compared to 54.9% and 55% in traditional and combination models (P = .006). The percentage of diabetic patients with blood pressure &lt; 130/80 mmHg was 48.4% in block, compared to 36.7% and 36.9% in other models (P &lt; .001). The percentage of diabetic patients with HbA1C measured was 92.1% in block compared to 75.2% and 82.1% in other models (P &lt; .001). Also, the percentage of diabetic patients with LDL measured was significantly different across all groups, with 91.2% in traditional, 70.4% in combination, and 83.3% in block model programs (P &lt; .001). Conclusions While high scores on diabetic quality measures are achievable in any clinic model, the block model design was associated with better performance.

scholarly journals Clinic Design, Key Practice Metrics, and Resident Satisfaction in Internal Medicine Continuity Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

2014 ◽  
Vol 6 (2) ◽  
pp. 249-255 ◽  
Author(s):  
Maureen D. Francis ◽  
Kris Thomas ◽  
Michael Langan ◽  
Amy Smith ◽  
Sean Drake ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Cross Sectional Study ◽  
Satisfaction Survey ◽  
Resident Satisfaction ◽  
Cross Sectional ◽  
Educational Innovations ◽  
Healing Relationship ◽  
Ambulatory Training ◽  
Resident Perception ◽  
Block Models

Abstract Background Internal medicine programs are redesigning ambulatory training to improve the resident experience and answer the challenges of conflicting clinical responsibilities. However, little is known about the effect of clinic redesign on residents' satisfaction. Objective We assessed residents' satisfaction with different resident continuity clinic models in programs participating in the Educational Innovations Project Ambulatory Collaborative (EPAC). Methods A total of 713 internal medicine residents from 12 institutions in the EPAC participated in this cross-sectional study. Each program completed a detailed curriculum questionnaire and tracked practice metrics for participating residents. Residents completed a 3-part satisfaction survey based on the Veterans Affairs Learners' Perception Survey, with additional questions addressing residents' perceptions of the continuous healing relationship and conflicting duties across care settings. Results Three clinic models were identified: traditional weekly experience, combination model with weekly experience plus concentrated ambulatory rotations, and a block model with distinct inpatient and ambulatory blocks. The satisfaction survey showed block models had less conflict between inpatient and outpatient duties than traditional and combination models. Residents' perceptions of the continuous healing relationship was higher in combination models. In secondary analyses, the continuity for physician measure was correlated with residents' perceptions of the continuous healing relationship. Panel size and workload did not have an effect on residents' overall personal experience. Conclusions Block models successfully minimize conflict across care settings without sacrificing overall resident satisfaction or resident perception of the continuous healing relationship. However, resident perception of the continuous healing relationship was higher in combination models.

Anxiety and Depression in an Internal Medicine Resident Continuity Clinic: Difficult Diagnoses

2001 ◽  
Vol 31 (2) ◽  
pp. 155-167 ◽  
Author(s):  
David G. Didden ◽  
John T. Philbrick ◽  
John B. Schorling
Keyword(s):  
Internal Medicine ◽  
Anxiety Disorder ◽  
Major Depression ◽  
Mental Disorders ◽  
Depressive Disorders ◽  
Internal Medicine Resident ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Cross Sectional ◽  
General Internal

Objective: To determine the prevalence of anxiety and depression in a residents' clinic and if these diagnoses are associated with patients being perceived as difficult, as well as how often these diagnoses are documented in the patients' charts. Methods: This was a cross-sectional study conducted in a general internal medicine residents' clinic. A total of 135 patients were given the Primary Care Evaluation of Mental Disorders questionnaire (DSM-IIIR version) and their physicians filled out the Difficult Doctor-Patient Relationship Questionnaire after the visit. Charts were reviewed for documentation of a diagnosis of anxiety or depression. Results: Major depression was present in 26 percent, dysthymia 16 percent, major depression in partial remission 9 percent, generalized anxiety disorder 13 percent, and panic disorder 7 percent. Overall, 38 percent had at least one and 21 percent had more than one diagnosis. Of patients with one psychiatric diagnosis, 9 percent were classified as difficult versus 100 percent of patients with four diagnoses. Documentation of depression was noted for 43 percent of patients with major depression but only 9 percent with an anxiety disorder. Conclusions: Anxiety and depression were very common among the patients in this clinic, and increasing numbers of diagnoses were associated with patients being classified as difficult. Residents diagnosed depressive disorders as often as practicing physicians in other studies, but anxiety less well. The high prevalence of mental disorders has implications for resident education in that they need to be prepared to care for these patients, but residents also may benefit from exposure to sites with more typical prevalences of these illnesses.

scholarly journals High Levels of Psychological Resilience Are Associated With Decreased Anxiety in Inflammatory Bowel Disease

2021 ◽  
Author(s):  
Alicia Philippou ◽  
Priya Sehgal ◽  
Ryan C Ungaro ◽  
Kelly Wang ◽  
Emilia Bagiella ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Linear Regression Analysis ◽  
Multivariable Analysis ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Psychological Resilience ◽  
Comorbid Disorders ◽  
Cross Sectional ◽  
Multivariable Linear Regression Analysis

Abstract Background Anxiety and depression are comorbid disorders with IBD and are associated with poor outcomes. Resilience is an innate but modifiable trait that may improve the symptoms of psychological disorders. Increasing resilience may decrease the severity of these comorbid disorders, which may improve IBD outcomes. The aim of this study was to describe the association between resilience, anxiety, and depression in IBD patients. Methods We performed a cross-sectional study of IBD patients. Patients completed a questionnaire consisting of the Connor-Davidson Resilience Scale (CD-RISC), a measure of resilience, the Generalized Anxiety Disorder 7 (GAD-7), and the Patient Health Questionnaire-9. Primary outcome was severity of anxiety and depression in patients with high resilience. Multivariable linear regression analysis evaluated the association between severity of anxiety and depression and level of resilience. Results A sample of 288 patients was analyzed. Bivariable linear regression analysis showed a negative association between resilience and anxiety (Pearson rho = −0.47; P &lt; .0001) and between resilience and depression (Pearson rho = −0.53; P &lt; .0001). Multivariable linear regression indicated that high resilience is independently associated with lower anxiety and that for every 1-unit increase in CD-RISC, the GAD-7 score decreased by 0.04 units (P = .0003). Unlike anxiety, the association between resilience and depression did not remain statistically significant on multivariable analysis. Conclusions High resilience is independently associated with lower anxiety in IBD patients, and we report a quantifiable decrease in anxiety score severity for every point of increase in resilience score. These findings suggest that IBD patients with higher resilience may have better coping mechanisms that buffer against the development of anxiety.

Relationships Between Serum α-Klotho Concentration and Inflammation-Related Cytokines in Hemodialysis Patients

2021 ◽  
Author(s):  
Katarzyna A. Lisowska ◽  
Hanna Storoniak ◽  
Monika Soroczyńska-Cybula ◽  
Mateusz Maziewski ◽  
Alicja Dębska-Ślizień
Keyword(s):  
Serum Concentration ◽  
Linear Regression Analysis ◽  
Significant Negative Correlation ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Multivariable Linear Regression Analysis ◽  
Positive Correlations ◽  
The Relationship

Abstract We investigated the relationship between α-Klotho and cytokines related to inflammation in HD patients. We analyzed levels of α-Klotho with ELISA and inflammatory cytokines with CBA in the serum of HD patients. There was a significant negative correlation between the concentration of serum α-Klotho and patients’ age and the serum concentration of PTH. No correlation has been found between α-Klotho and Ca or Pi. HD time, creatynine or eGFR. However, there were significant positive correlations between the concentration of α-Klotho and the serum concentration of IL-12p70, IL-10, and IL-1β. Furthermore, the concentration of IL-10 and IL-1β was significantly lower in HD patients with low α-Klotho concentrations compared with HD patients with high α-Klotho. However, in a multivariable linear regression analysis, only patients’ age was associated independently with α-Klotho level. While these results draw our attention to potential relationships between α-Klotho proteins and inflammatory markers in HD patients, our cross-sectional study could not fully explain the pathogenic link between α-Klotho and inflammation in these patients. Therefore, further studies are necessary to clarify these relationships. However, this observation aligns with previous studies that confirm a significant relationship between Klotho concentration and human aging.

Serum Asprosin Concentrations Are Increased and Associated with Insulin Resistance in Children with Obesity

2019 ◽  
Vol 75 (4) ◽  
pp. 205-212 ◽  
Author(s):  
Min Wang ◽  
Chunyan Yin ◽  
Ling Wang ◽  
Yusheng Liu ◽  
Honggang Li ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Linear Regression Analysis ◽  
Cross Sectional Study ◽  
Anthropometric Parameters ◽  
Cross Sectional ◽  
Tnf Α ◽  
Multivariable Linear Regression Analysis ◽  
Factor Α ◽  
Necrosis Factor

Objective: Asprosin, a novel peptide that has recently discovered as an important regulatory adipokine, is relevant to obesity in animals and adult humans. Little is known about its roles in children. The aim of the current study was to determine the potential role of asprosin and explore its relationship to various obesity-related markers in children with obesity. Methods: A cross-sectional study was conducted among 119 Chinese children, including 79 children with obesity and 40 lean controls. Anthropometric parameters, clinical data, and circulating tumor necrosis factor-α (TNF-α), adiponectin, leptin, and asprosin levels were measured. Results: Serum asprosin concentrations were significantly elevated in children with obesity compared with lean controls. Children with insulin resistance (IR) had higher asprosin levels than non-IR group. Asprosin was positively correlated with waist-to-hip ratio (WHR), diastolic blood pressure, homoeostasis model of IR (HOMA-IR), leptin-to-adiponectin ratio, TNF-α independent of their body mass index, SDs score, and age. In multivariable linear regression analysis, WHR and HOMA-IR were associated with the circulating level of asprosin. Conclusions: Circulating asprosins are increased in children with obesity and associated with IR. It may be proposed as a novel marker to predict advanced disease.

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