Twelve tips to improve medical teaching rounds.

The ward round is the bread and butter of internal medicine. It forms the basis of clinical decision making and reviewing patients' progress. It is fundamental to the role of the internal medical physician. It allows for the review of the patients' notes, signs and symptoms, physiological parameters and investigation results. Most importantly, it allows for an interaction with the patient and their relatives and is a means of relating medical information back, answer queries and plan future medical management strategies. These should be integrated into the teaching round by a senior clinician so that time away from the bedside is also used to enhance the teaching and learning experience. Here, I would like to draw on my experience as a learner as well as an educator, together with the available literature, to draw up a simple 12-step teaching strategy that should help the ward round serve the dual purpose of teaching medical students and junior doctors.

Using Systems Science for Strategic Planning of Obesity Prevention and Treatment: The Roundtable on Obesity Solutions Experience.

The sustained multi-decade increase in the prevalence of obesity calls for a new approach on addressing this public health concern. The Roundtable on Obesity Solutions (ROOS) (of the National Academies of Sciences, Engineering, and Medicine NASEM), a multisector group comprised of members from a variety of organizations and institutions, initiated a year-long effort to build a strategic plan and roadmap for action that would drive a paradigm shift for the ROOS in pursuing obesity solutions. Following a review of obesity prevention and treatment recommendations with sufficient actionable-evidence by authoritative organizations, the ROOS deployed systems science methods. Members engaged in group model building (GMB) exercises to develop an obesity systems map based on determinants and drivers from a multi-sector perspective and overlaid with aligned solutions. To expand the understanding of systems science approaches and methods, 3 public workshops were held in tandem with the development of the map. The causal map was refined, and solutions were ranked using a leverage-point framework to inform a strategic plan and narrative roadmap for action. For the ROOS, structural racism and social justice, biased mental models and social norms, and effective health communications were prioritized as the leverage points most likely to have a significant impact in addressing obesity. Complementary to the mission, vision, and guiding principles of the ROOS, the obesity systems map, and narrative roadmap will drive the ROOS activities over the next 3-6 years and serve as a resource for researchers, organizations, and institutions involved with policy, prevention, and treatment of obesity.

Primary Care and Public Health Collaboration Reports: A Qualitative Review of Integration Aims, Participants, and Success Determinants.

This qualitative review of 57 published case reports aimed to analyze primary care and public health integration efforts in 45 states to summarize collaboration aims, participants, and systemic, organizational, and interactional success determinants. Chronic disease management, maternal and child health, and wellness and health promotion were the most commonly reported aims of collaboration between primary care and public health entities in the United States. Typical participants were government public health structures, health delivery systems, communities, academia, state professional medical associations, and employers and businesses. Systemic, organizational, and interactional determinants included adequate funding, multiple stakeholder engagement, leadership, data and information sharing, capitalization on collaborator resources, community engagement, steering committees, effective communication, regular meetings, shared mission, vision, and goals, previous positive relationships, collaborations, and partnerships. The present study contributes to the body of knowledge of when, where, and under what contextual circumstances collaboration and integration have been perceived as effective. Future research could extrapolate which determinants are more essential than others and focus on how systemic, organizational, and interactional factors are interrelated. To advance the practice of successful integration between primary care and public health entities, longitudinal research is needed to examine the degree of integration and sustainability.

The aging farm population and rural aging research.

This article explores the potential and the promise of convergence between gerontological and occupational health researchers to better understand challenges faced by aging farmers including declining economic viability of family farms, the aging of the population of working farmers, and probability of work-related injury or disability among older farmers. Although the need for research seems obvious, the economic, demographic, and psychosocial dynamics of continued work among aging farmers is under-studied in the occupational health literature and absent in the gerontological literature. Following examination of studies of aging farmers drawn from the occupational health literature, we review studies of rural aging in the gerontological literature. First, we compare varying definitions of rural across federal agencies that impact the ability of researchers using these data to examine variability across rural places. Next, we review studies based upon primary data that include rural residence among their independent variables. We describe different definitions of rural residence across federal agencies with an eye toward their methodological and conceptual impact on the rural aging literature. Then we describe inadequate and incomplete definition and measurement of rural residence across published studies of primary data. Following discussion of the implications of these shortcomings for rural aging research including farmers and others engaged in extractive activities, we discuss the potential for joint work among gerontologists and occupational health researchers to better understand the significance of aging for transition in the agricultural economy and the viability of family farms. We recommend attention to the definition and measurement of rural residence to include variability in rural farm and non-farm populations and refocusing the occupational health literature on aging farmers to include a life course perspective from gerontological theory applied through longitudinal research designs.

Preventing workplace violence from negligent hiring in healthcare.

Negligent hiring is emerging as one of the prime causes of healthcare employer liability for workplace violence. Healthcare administrators have been found liable for violent acts of employees both within and outside their normal scope of employment. The authors discuss negligent hiring doctrine and what the US courts have decided on negligent hiring cases. The discussion shows how liability in healthcare institutions can occur, and how the respondeat superior doctrine may no longer serve to limit employer liability. The authors suggest how to develop screening practices to reduce work-place violence and minimize negligent hiring lawsuits.