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1.
J Infect Dis ; 222(Suppl 6): S528-S534, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32926743

RESUMO

BACKGROUND: The drivers of the gap in advancement between men and women faculty in academic Infectious Diseases (ID) remain poorly understood. This study sought to identify key barriers to academic advancement among faculty in ID and offer policy suggestions to narrow this gap. METHODS: During the 2019 IDWeek, we conducted focus groups with women faculty members at all ranks and men Full Professors, then we administered a brief survey regarding work-related barriers to advancement to the Infectious Disease Society of America (IDSA) membership. We report themes from the 4 focus group discussions that are most closely linked to policy changes and descriptive analyses of the complementary survey domains. RESULTS: Policy change suggestions fell into 3 major categories: (1) Policy changes for IDSA to implement; (2) Future IDWeek Program Recommendations; and (3) Policy Changes for IDSA to Endorse as Best Practices for ID Divisions. Among 790 faculty respondents, fewer women reported that their institutional promotion process was transparent and women Full Professors were significantly more likely to have been sponsored. CONCLUSIONS: Sponsorship and informed advising about institutional promotions tracks may help to narrow the advancement gap. The Infectious Disease Society of America should consider ambitious policy changes within the society and setting expectations for best practices among ID divisions across the United States.


Assuntos
Mobilidade Ocupacional , Docentes de Medicina/estatística & dados numéricos , Infectologia/estatística & dados numéricos , Logro , Feminino , Grupos Focais , Equidade de Gênero , Humanos , Infectologia/organização & administração , Masculino , Fatores Sexuais , Inquéritos e Questionários , Estados Unidos
2.
Clin Infect Dis ; 70(2): 290-296, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30873556

RESUMO

BACKGROUND: This study assesses differences in faculty rank between female and male infectious diseases (ID) faculty with academic appointments at US medical schools. METHODS: We analyzed a complete database of US physicians with medical school faculty appointments in 2014. This database consists of a linkage between the American Association of Medical Colleges faculty roster and a physician database from Doximity, and includes physician age, sex, years since residency completion, publications, National Institutes of Health grants, and registered clinical trials for all academic physicians by specialty. We used multivariable logistic regression models with medical school-specific fixed effects to assess sex differences in full professorship by specialty and the relationship between these factors and achieving the rank of full professor within ID. We compared this adjusted difference in ID to that of peer subspecialties. RESULTS: Among a total of 2016 academic ID physicians, there were 742 (37%) women who together accounted for 48.1% of assistant professors, 39.7% of associate professors, and 19.2% of full professors. Women faculty had fewer total (16.3 vs 28.3, P < .001) and first/last author publications (9.8 vs 20.4, P < .001). In adjusted models, the rate of full professorship (vs assistant or associate) among female compared to male ID physicians was large and significant (absolute adjusted difference, -8.0% [95% confidence interval, -11.9% to -4.1%]). This difference was greater in ID than in cardiology. CONCLUSIONS: Significant sex differences in achieving the rank of full professor exist in academic ID, after adjustment for multiple factors known to influence these outcomes. Greater efforts should be made to address equity in academic ID.


Assuntos
Doenças Transmissíveis , Medicina , Doenças Transmissíveis/epidemiologia , Docentes de Medicina , Feminino , Humanos , Masculino , Faculdades de Medicina , Caracteres Sexuais , Fatores Sexuais , Estados Unidos
3.
Clin Infect Dis ; 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38843037
4.
Subst Abus ; 39(3): 371-376, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29432074

RESUMO

BACKGROUND: Despite escalating opioid overdose death rates, addiction medicine is underrepresented in residency curricula. Providing naloxone to at-risk patients, relatives, and first responders reduces overdose deaths, but rates of naloxone prescribing remain low. The goal of this study is to examine the impact of a brief curricular intervention for internal medicine residents on naloxone prescribing rates, knowledge, and attitudes. METHODS: Internal medicine residents (N = 160) at an urban, tertiary care medical center received two 1-hour didactic sessions addressing overdose prevention, including intranasal naloxone. The number of naloxone prescriptions generated by residents was compared to faculty, who received no similar intervention, in the 3-month periods before and after the curriculum. Resident knowledge and attitudes, as assessed by pre- and post-intervention surveys, were compared. RESULTS: The resident naloxone prescribing rate increased from 420 to 1270 per 100,000 inpatient discharges (P = .01) and from 0 to 370 per 100,000 ambulatory visits (P < .001) post-intervention. Similar increases were not observed among inpatient faculty, whose prescribing rate decreased from 1150 to 880 per 100,000 discharges (P = .08), or among outpatient faculty, whose rate increased from 30 to 180 per 100,000 ambulatory visits (P < .001) but was lower than the post-intervention resident rate (P = .01). Residents demonstrated high baseline knowledge about naloxone, but just 13% agreed that they were adequately trained to prescribe pre-intervention. Post-intervention, residents were more likely to agree that they were adequately trained to prescribe (Likert mean 2.5 vs. 3.9, P < .001), to agree that treating addiction is rewarding (Likert mean 2.9 vs. 3.3, P = .03), and to attain a perfect score on the knowledge composite (57% vs. 33%, P = .05). CONCLUSIONS: A brief curricular intervention improved resident knowledge and attitudes regarding intranasal naloxone for opioid overdose reversal and significantly increased prescribing rates.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Currículo , Overdose de Drogas/tratamento farmacológico , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Naloxona/uso terapêutico , Administração Intranasal , Analgésicos Opioides/efeitos adversos , Humanos , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos
5.
JAMA ; 327(12): 1131-1132, 2022 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-35315881
7.
Open Forum Infect Dis ; 11(4): ofae124, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38560610

RESUMO

Background: Febrile is an infectious diseases (ID) podcast and learning platform with the aim of providing high-quality and accessible ID content for learners. We describe the use of Febrile as a resource for learning and teaching ID as well as learner satisfaction and perceived impact on clinical practice. Methods: The Febrile platform was launched in December 2020 and includes audio podcast episodes, infographics, and detailed online summaries of adult and pediatric ID topics. Production and contributor information is summarized. Podcast, website, and social media engagement is reported from available quantitative analytics. An online anonymous survey was conducted to assess educational impact. Results: After 3 years of operation, Febrile has produced 90 episodes and has been downloaded >460 000 times in 196 countries, with the majority of its audience (58.9%) listening from within the United States. A total of 230 participants from 30 countries and 38 US states completed the survey, of whom 79 (34.5%) were ID fellows in training and 78 (34.2%) were ID faculty physicians. Seventy-two percent of survey respondents reported visiting the website, and 82% had seen an infographic. Enhancing core ID knowledge was the primary driver for listening. Two-thirds of respondents indicated that information learned from Febrile has changed their practice, and 50% have used Febrile as a way to teach others. Febrile also led to favorable impressions of ID for those considering ID as a career. Conclusions: Febrile is an engaging platform for ID medical education and provides a unique resource within the global ID community.

8.
Open Forum Infect Dis ; 11(2): ofad685, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38390462

RESUMO

Background: Many physician trainees plan pregnancy during residency and fellowship. A study of internal medicine program directors (PDs) demonstrated frequent misinterpretation of American Board of Internal Medicine (ABIM) leave policies applied to parental leave. The primary aim was to investigate how infectious disease (ID) PDs interpret current ABIM leave policies. Methods: We surveyed 155 ID PDs in an online anonymous questionnaire about knowledge of ABIM leave policies and application toward trainee leaves. Results: Of 155 PDs, 56 (36%) responded to the survey. Nearly 70% incorrectly identified leave limits permitted. A majority mistakenly chose to extend training when a competent fellow was within the allowed duration of leave. PDs reported that the majority of ID trainee maternity/birth parent leaves (60%) were ≤7 weeks and only 7% were ≥12 weeks; 50% of paternity/nonbirth parent leaves were ≤3 weeks. Conclusions: Surveyed ID fellowship PDs often misinterpret ABIM leave policies and apply policies incorrectly when given sample scenarios..

9.
Infect Dis Clin North Am ; 37(1): 139-151, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36805010

RESUMO

Antibiotic administration is often a part of end-of-life (EOL) care, including among patients who are not critically ill. Guideline-issuing bodies recommend that antimicrobial stewardship providers (ASPs) provide support to prescribers making decisions about whether or not to treat infections in this population. Relatively little is known about the rationale for antimicrobial prescribing during the EOL period in noncritical care settings, although patient and family preferences are often an influencing factor. The effectiveness of antimicrobials in improving quantity or quality of life in this population is unclear and likely context-specific.


Assuntos
Anti-Infecciosos , Gestão de Antimicrobianos , Humanos , Qualidade de Vida , Objetivos , Motivação , Morte
10.
Open Forum Infect Dis ; 10(1): ofac692, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36686640

RESUMO

Background: Little is known about antimicrobial prescribing when patient care is transitioned to comfort measures only (CMO). We used a multidisciplinary survey and retrospective cohort study to gain insight into antimicrobial prescribing in this population at an academic medical center to inform future antimicrobial stewardship interventions. Methods: A survey focusing on antimicrobial prescribing during the transition to CMO was electronically distributed to providers in medical subspecialities and responses were compared across specialties. A retrospective chart review was performed of patients admitted to an academic medical center in 2020 who were on antimicrobials in the 48 hours prior to CMO. We investigated the percentage of patients who remained on antimicrobials after the transition to CMO and rationale for continuing antimicrobials. Results: We received 113 survey responses (35% response rate). Forty-one percent of respondents indicated that they "sometimes" or "often" continued antimicrobials during the transition to CMO. Patient/family preference and symptom palliation were the most common factors cited by respondents when deciding whether to continue antimicrobials in this population. Of the 546 patient charts reviewed, 140 (26%) patients were alive 48 hours after CMO order, and 19 (14%) of those patients remained on antimicrobials. Five of 19 (26%) patients had documentation that antimicrobials were continued due to patient/family preference and 5 of 19 (26%) patients had documentation that antimicrobials were continued for palliation of symptoms. Conclusions: Patient/family preference and symptom palliation are important factors in prescribing antimicrobials when patient care is transitioned to CMO. More evidence is needed regarding palliative benefits of antibiotics to inform provider discussions of benefits and harms of antimicrobial use in this setting.

11.
Open Forum Infect Dis ; 10(1): ofac660, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36686641

RESUMO

Background: Gender inequities in academic advancement persist in many specialties, including Infectious Diseases (ID). Prior studies of advancement disparities have been predominantly quantitative, utilizing large physician databases or surveys. We used qualitative methods to explore ID physicians' experiences and beliefs about causes and ways to mitigate gender inequities in advancement. Methods: We conducted semistructured focus group discussions with academic ID physicians in the United States at IDWeek 2019 to explore perceived barriers and facilitators to academic advancement. Participants were assigned to focus groups based on their academic rank and gender. We analyzed focus group transcripts using content analysis to summarize emergent themes. Results: We convened 3 women-only focus groups (1 for instructors/assistant professors, 1 for associate professors, and 1 for full professors) and 1 men-only focus group of full professors (total N = 50). Our analyses identified several major themes on barriers to equitable academic advancement, including (1) interpersonal and institutional gender bias, (2) difficulty balancing the demands of family life with work life, and (3) gender differences in negotiation strategies. Conclusions: Barriers to gender equity in academic advancement are myriad and enduring and span the professional and personal lives of ID physicians. In addition to swift enactment of policy changes directed at critical issues such as ending workplace harassment and ensuring adequate parental leaves for birth and nonbirth parents, leaders in academic medicine must shine a bright light on biases within the system at large and within themselves to correct these disparities with the urgency required.

13.
J Contin Educ Health Prof ; 42(1): e27-e31, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34393185

RESUMO

INTRODUCTION: Antimicrobial Stewardship programs promote appropriate antimicrobial use through different avenues, including education. Advanced Practice Providers (APPs) provide inpatient care in a wide-range of settings. Little is known about the educational needs of APPs at academic medical centers or the effect of educational interventions directed at inpatient APPs on clinical care. Our study looked at the effect of an educational intervention on antimicrobial prescribing by APPs for asymptomatic bacteriuria (ASB) and candiduria (ASC). We also conducted a needs assessment on the opportunities and barriers to continuing medical education. METHODS: The educational intervention consisted of in-person interactive learning accompanied by an online video. Pre-intervention and postintervention surveys included an educational needs assessment and knowledge acquisition assessment. A retrospective chart review of adult inpatients admitted to the APP services with bacteriuria or candiduria during the 3 months pre-intervention and postintervention was performed. RESULTS: Our needs assessment revealed several barriers to APP-focused education including no protected time for learning, and curricula predominantly directed at the Graduate Medical Education level. Engaged APPs had improved knowledge scores, but the proportion of treated ASB or ASC episodes did not differ between the pre-intervention and postintervention. DISCUSSION: Although our educational intervention did not change prescribing patterns, the intervention increased knowledge around ASB and ASC. The potential hierarchical structure of interprofessional care teams may be a barrier to changing antimicrobial prescribing. Our study identified the possibility of a hidden curriculum at academic medical centers that does not prioritize APP educational needs.


Assuntos
Gestão de Antimicrobianos , Bacteriúria , Doenças Transmissíveis , Centros Médicos Acadêmicos , Adulto , Antibacterianos/uso terapêutico , Bacteriúria/tratamento farmacológico , Doenças Transmissíveis/tratamento farmacológico , Feminino , Humanos , Masculino , Estudos Retrospectivos
14.
Artigo em Inglês | MEDLINE | ID: mdl-33630067

RESUMO

BACKGROUND: Diabetic foot osteomyelitis is a common infection where treatment involves multiple services, including infectious diseases, podiatry, and pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking. METHODS: Representatives from infectious diseases, podiatry, and pathology interested in quality improvement developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to diabetic foot osteomyelitis (DFO). Knowledge acquisition was assessed by preintervention and postintervention surveys. Inpatients with forefoot DFO were retrospectively reviewed before and after intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses. RESULTS: A postintervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the preintervention cohort (April 1, 2018, to April 1, 2019) and 32 patients in the postintervention cohort (November 5, 2019, to March 1, 2020), the latter truncated by changes in hospital practice during the coronavirus disease 2019 pandemic. Noncategorizable or equivocal disease reports decreased from before intervention to after intervention (27.0% versus 3.3%, respectively; P = .006). We observed nonsignificant improvement in correct bone margin definition (74.0% versus 87.5%; P = .11), unnecessary peripherally inserted central catheter line placement (18.3% versus 9.4%; P = .23), and unnecessary prolonged antibiotics (21.9% versus 5.0%; P = .10). In addition, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients. CONCLUSIONS: This quality improvement initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and nonsignificant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.


Assuntos
COVID-19 , Diabetes Mellitus , Pé Diabético , Osteomielite , Podiatria , Humanos , Pé Diabético/cirurgia , Estudos Retrospectivos , Osteomielite/complicações , Osteomielite/terapia , Osteomielite/diagnóstico , Antibacterianos/uso terapêutico
15.
Open Forum Infect Dis ; 8(3): ofab084, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33796597

RESUMO

Social media is an increasingly popular forum for medical education. Many educators, including those in infectious diseases, are now creating and sharing unique and educational patient cases online. Unfortunately, some educators unknowingly threaten patient privacy and open themselves to legal liability. Further, the use of published figures or tables creates risk of copyright infringement. As more and more infectious diseases physicians engage in social media, it is imperative to create best practices to protect both patients and physicians. This summary will define the legal requirements of patient de-identification as well as other practical recommendations as they relate to use of clinical case information, patient images, and attribution of primary references on social media.

16.
Open Forum Infect Dis ; 8(2): ofaa583, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33553468

RESUMO

One of the many challenges that has befallen the Infectious Diseases and Graduate Medical Education communities during the coronavirus disease 2019 (COVID-19) pandemic is the maintenance of continued effective education and training of the future leaders of our field. With the remarkable speed and innovation that has characterized the responses to this pandemic, educators everywhere have adapted existing robust and safe learning environments to meet the needs of our learners. This paper will review distinct aspects of education and training of the Infectious Diseases fellows we believe the COVID-19 pandemic has impacted most, including mentoring, didactics, and wellness. We anticipate that several strategies developed in this context and described herein will help to inform training and best practices during the pandemic and beyond.

18.
J Gen Intern Med ; 22(6): 877-8, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17384979

RESUMO

Parvovirus B19 is a common infection in adults and children. There are reports of secondary parvovirus infection in immunocompromised persons, but no reports of symptomatic secondary infection in healthy persons. We describe a healthy 39-year-old woman who presented with fever, rash, and arthralgia. Her symptoms were thought most compatible with parvovirus B19 infection, but she reported prior positive parvovirus antibody 2 years earlier during prenatal care. Tests were therefore also sent for HIV, streptococcal infection, hepatitis C, and Lyme disease. Testing revealed both elevated IgG and IgM antibodies for parvovirus B19; previously, the patient was positive only for IgG. On a subsequent visit she related that a community outbreak of parvovirus developed in her town and church group. We believe this case demonstrates that a symptomatic secondary infection with parvovirus can occur in healthy persons, and that prior positive antibody test does not preclude the development of acute infection.


Assuntos
Surtos de Doenças , Infecções por Parvoviridae , Parvovirus B19 Humano , Adulto , Anticorpos Antivirais/sangue , Infecções Comunitárias Adquiridas/epidemiologia , Feminino , Humanos , Infecções por Parvoviridae/sangue , Recidiva
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