Financial conflicts of interest among presenters, panellists and moderators at haematology and oncology FDA workshops.

OBJECTIVE: To assess the characteristics and financial conflicts of interest of presenters, panellists and moderators at haematology and oncology workshops held jointly with or hosted by the US FDA. SETTING: We included information on all publicly available haematology or oncology FDA workshop agendas held between 1 January 2018 and 31 December 2022. EXPOSURE: General and research payments reported on Open Payments, industry funding to patient advocacy organizations reported on their webpages or 990 tax forms and employment in both pharmaceutical and regulatory settings. RESULTS: Among physicians eligible for payments, 78% received at least one payment from the industry between 2017 and 2021. The mean general payment amount was $82,170 for all years ($16,434 per year) and the median was $14,906 for all years ($2981 per year). Sixty-nine per cent of patient advocacy speakers were representing organizations that received financial support from the pharmaceutical industry. Among those representing regulatory agencies or pharmaceutical companies, 16% had worked in both settings during their careers. CONCLUSIONS AND RELEVANCE: Our findings in this cross-sectional study show a majority of US-based physician presenters at haematology and oncology workshops held jointly with members of the US FDA have some financial conflict of interest with the pharmaceutical industry. These findings support the need for clear disclosures and suggest that a more balanced selection of presenters with fewer conflicts may help to limit bias in discussions between multiple stakeholders.

Systematic Review and Meta-Analysis of Randomized Trials Testing Interventions to Reduce Physician Burnout.

BACKGROUND: Physicians deal with intense professional pressures, which may contribute to increasing burnout. We sought to evaluate the efficacy of interventions designed to reduce burnout in physicians, physicians-in-training, and other health care professionals. METHODS: We searched PubMed and Embase (through January 6, 2023) and reference lists. We included all randomized studies assessing an intervention designed to reduce professional burnout in physicians and other health care personnel. We adhered to the PRISMA reporting guidelines. We abstracted data on study and participant characteristics, study outcomes, and study quality. We used a random-effects model to pool mean differences in burnout change (pre- and post-intervention) between intervention and control arms. RESULTS: Thirty-one of the 38 eligible studies (81.6%) used the Maslach Burnout Inventory (MBI) questionnaire to assess burnout. When comparing the intervention and control groups, the mean difference in the emotional exhaustion component of the MBI was -1.11 (95% confidence interval [CI], -2.14 to -0.09; I2: 74.5%; 20 studies); the mean difference in the depersonalization component of the MBI was -0.32 (95% CI, -0.63 to -0.01; I2: 54.2%; 17 studies); and the mean difference in the personal accomplishment component of the MBI was 1.11 (95% CI, -0.21 to 2.43; I2: 94.3%; 16 studies). CONCLUSIONS: Studies testing interventions to decrease physician burnout led to significant numerical improvements in some domains of burnout, but it is unlikely that these changes result in meaningful changes in clinical burnout. Further, the limited follow-up time, biased assessments, and heterogeneity in intervention efficacy suggest that a more nuanced understanding of the causes of burnout is needed to develop more effective interventions.

Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System.

BACKGROUND: Many critically ill children are initially evaluated in front-line settings by clinicians with variable pediatric training before they are transferred to a pediatric intensive care unit (PICU). Because clinicians learn from past performance, communicating outcomes of patients back to front-line clinicians who provide pediatric emergency care could be valuable; however, referring clinicians do not consistently receive this important feedback. OBJECTIVES: Our aim was to determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system developed at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians. METHODS: Guided by the Health Information Technology Safety Framework, we iteratively designed, implemented, and evaluated a semiautomated electronic feedback system leveraging the EHR in one institution. After conducting interviews and focus groups with stakeholders to understand the PICU-ED health care work system, we designed the EHR-supported feedback system by translating stakeholder, organizational, and usability objectives into feedback process and report requirements. Over 6 months, we completed three cycles of implementation and evaluation, wherein we analyzed EHR access logs, reviewed feedback reports sent, performed usability testing, and conducted physician interviews to determine the system's feasibility, usability, and clinical relevance. RESULTS: The EHR-supported feedback process is feasible with timely delivery and receipt of feedback reports. Usability testing revealed excellent Systems Usability Scale scores. According to physicians, the process was well-integrated into their clinical workflows and conferred minimal additional workload. Physicians also indicated that delivering and receiving consistent feedback was relevant to their clinical practice. CONCLUSION: An EHR-supported system to deliver timely and relevant PICU patient outcome feedback to referring ED physicians was feasible, usable, and important to physicians. Future work is needed to evaluate impact on clinical practice and patient outcomes and to investigate applicability to other clinical settings involved in similar care transitions.

Discovery of Novel Quinoline-Based Proteasome Inhibitors for Human African Trypanosomiasis (HAT).

Human African Trypanosomiasis (HAT) is a vector-borne disease caused by kinetoplastid parasites of the Trypanosoma genus. The disease proceeds in two stages, with a hemolymphatic blood stage and a meningo-encephalic brain stage. In the latter stage, the parasite causes irreversible damage to the brain leading to sleep cycle disruption and is fatal if untreated. An orally bioavailable treatment is highly desirable. In this study, we present a brain-penetrant, parasite-selective 20S proteasome inhibitor that was rapidly optimized from an HTS singleton hit to drug candidate compound 7 that showed cure in a stage II mouse efficacy model. Here, we describe hit expansion and lead optimization campaign guided by cryo-electron microscopy and an in silico model to predict the brain-to-plasma partition coefficient Kp as an important parameter to prioritize compounds for synthesis. The model combined with in vitro and in vivo experiments allowed us to advance compounds with favorable unbound brain-to-plasma ratios (Kp,uu) to cure a CNS disease such as HAT.

Transgender inmates: A systems-based model for assessment and treatment planning.

Concepts of gender, gender roles, and gender norms have continuously adapted with the increased acceptance of diversity throughout the United States in recent decades. Although guidelines exist regarding competent assessment and treatment of transgender individuals, correctional environments place substantial restrictions and complications on this process. Recent legal cases have increased public awareness of such cases, including challenges to the status quo of which responsibilities fall under the purview of correctional systems. This paper describes one model for the assessment and treatment-planning process for transgender inmates. This model follows sequential procedures and involves multidisciplinary collaboration to reach conclusions regarding diagnostic impressions and associated recommendations for treatment and correctional management. Case examples are presented to highlight relevant aspects of the model and identify potential pitfalls. Recommendations are offered for how psychologists can contribute to the success of such programs by using a holistic, multidimensional, systems-based approach to the assessment and treatment-planning process. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey.

Background Front-line clinicians are expected to make accurate and timely diagnostic decisions before transferring patients to the pediatric intensive care unit (PICU) but may not always learn their patients' outcomes. We evaluated the characteristics of post-transfer updates received by referring clinicians regarding PICU patients and determined preferences regarding content, delivery, and timing of such updates. Methods We administered an electronic cross-sectional survey to Iowa clinicians who billed for ≥5 pediatric patients or referred ≥1 patient to the University of Iowa (UI) PICU in the year before survey administration. Results One hundred and one clinicians (51 non-UI, 50 UI-affiliated) responded. Clinicians estimated that, on average, 8% of pediatric patients they saw over 1 year required PICU admission; clinicians received updates on 40% of patients. Seventy percent of UI clinicians obtained updates via self-initiated electronic record review, while 37% of non-UI clinicians relied on PICU communication (p = 0.013). Clinicians indicated that updates regarding diagnoses/outcomes will be most relevant to their practice. Among clinicians who received updates, 13% received unexpected information; 40% changed their practice as a result. Conclusions Clinicians received updates on less than half of the patients they referred to a PICU, although such updates could potentially influence clinical practice. Study findings will inform the development of a formal feedback system from the PICU to referring clinicians.

Key High-efficiency Practices of Emergency Department Providers: A Mixed-methods Study.

OBJECTIVE: The objective of this study was to determine specific provider practices associated with high provider efficiency in community emergency departments (EDs). METHODS: A mixed-methods study design was utilized to identify key behaviors associated with efficiency. Stage 1 was a convenience sample of 16 participants (ED medical directors, nurses, advanced practice providers, and physicians) identified provider efficiency behaviors during semistructured interviews. Ninety-nine behaviors were identified and distilled by a group of three ED clinicians into 18 themes. Stage 2 was an observational study of 35 providers was performed in four (30,000- to 55,000-visit) community EDs during two 4-hour periods and recorded in minute-by-minute observation logs. In Stage 3, each behavior or practice from Stage 1 was assigned a score within each observation period. Behaviors were tested for association with provider efficiency (relative value units/hour) using linear univariate generalized estimating equations with an identity link, clustered on ED site. RESULTS: Five ED provider practices were found to be positively associated with efficiency: average patient load, using name of team member, conversations with health care team, visits to patient rooms, and running the board. Two behaviors, "inefficiency practices," demonstrated significant negative correlations: non-work-related tasks and documentation on patients no longer in the ED. CONCLUSIONS: Average patient load, running the board, conversations with team member, and using names of team members are associated with enhanced provider productivity. Identification of behaviors associated with efficiency can be utilized by medical directors, clinicians, and trainees to improve personal efficiency or counsel team members.

Suicide Prevention in Correctional Settings: Current Standards and Recommendations for Research, Prevention, and Training.

Inmates remain a vulnerable group at elevated risk for suicide, especially in light of stresses associated with incarceration. Despite the elevated risk for inmates, suicide prevention practices in corrections remain tenuous at best. The present article reviews literature on risk and protective factors for suicide among inmates as well as current recommended best practices. It then provides directions for suicide prevention provision, training, and research in correctional settings. These include adaptations for security staff of current empirically supported models of suicide risk training and intervention.

Potentially Avoidable Pediatric Interfacility Transfer Is a Costly Burden for Rural Families: A Cohort Study.

OBJECTIVES: Interhospital transfer is a common strategy to provide high-quality regionalized care in rural emergency departments (EDs), but several reports have highlighted problems with selection of children for transfer. The purpose of this study is to characterize the burden of potentially avoidable transfer (PAT) and to estimate the medical and family-oriented costs associated with PAT. METHODS: This study was a cohort study of all children treated in Iowa EDs between 2004 and 2013. PAT was defined as a child who was transferred and then either discharged from the receiving ED or admitted for ≤ 1 day, without having any separately billed procedures performed. Costs of care were estimated from 1) medical costs, 2) ambulance transfer, and 3) family costs (travel and lodging). RESULTS: Over 10 years, 2,117,317 children were included (1% transferred to another hospital). Only 63% were transferred to a designated children's hospital, and PATs were identified in 39% of all transfers. PAT was associated with $909 in additional cost. The conditions most strongly associated with PAT were seizure (additional cost $1,138), fracture ($814), isolated traumatic brain injury without extra-axial bleeding ($1,455), respiratory infection ($556), and wheezing ($804). Few of these charges are attributable to nonmedical family costs ($21). CONCLUSIONS: Potentially avoidable pediatric interhospital transfer is common and is responsible for significant healthcare-related costs. Future work should focus on improving selection of children who benefit from interhospital transfer for high-yield conditions, to reduce the costly and distressing burden that PAT places on rural patients and their families.

Risky business: Addressing the consequences of predicting violence.

Despite major advances in the prediction of violence and risk management, risk evaluations are necessarily imperfect. This article focuses on the role of the evaluator in such assessments and addresses the consequences incurred by clinicians involved in conducting risk assessments. We discuss the risks of overpredicting and underpredicting violence with respect to how these risks can influence an evaluator's opinion. Then, we review how law and psychology inform the clinician's work. Finally, in response to the compelling tendency toward overprediction of violence, we propose a preliminary self-assessment guide as a method of examining influences on the evaluator in assessing violence risk.

Behavioral signs of schizoidia and schizotypy in the biological parents of social anhedonics.

A community sample of 88 putative schizotypes (48 social anhedonics, 40 controls), aged 18 to 19 years, and their biological parents (42 mothers of social anhedonics, 37 mothers of controls; 24 fathers of social anhedonics, 20 fathers of controls) receive videotaped diagnostic evaluations that serve as the basis for ratings of behavioral signs of schizoidia and schizotypy. Proband social anhedonics exhibit more atypical interpersonal behaviors characteristic of schizoid and schizotypal personality disorders than controls. Mothers of social anhedonics display more atypical interpersonal behaviors characteristic of schizotypal personality disorder than mothers of controls. In contrast, clinical symptom ratings of schizotypy do not differentiate mothers of social anhedonics from mothers of controls. Meaningful, though not statistically significant, effects are observed for behavioral sign ratings in the smaller sample of fathers of social anhedonics. Results provide preliminary support for the familiality of atypical interpersonal behavior in social anhedonics.

Chemical composition of the leaf essential oil of Casimiroa edulis La Llave & Lex. (Rutaceae) from Monteverde, Costa Rica.

The leaf essential oil of Casimiroa edulis (Rutaceae), collected from Monteverde, Costa Rica, has been obtained by hydrodistillation and analyzed by GC-MS. The leaf oil was dominated by sesquiterpene hydrocarbons, predominately germacrene D (16-22%) and (E)-caryophyllene (16-17%), consistent with the traditional use of this plant as a sedative, sleep inducer and hypotensive.

Seasonal variation and bioactivity in the leaf oil of Liriodendron tulipifera growing in Huntsville, Alabama.

The seasonal variation in the chemical composition of the leaf essential oil of Liriodendron tulipifera has been analyzed by GC-MS. Two individual trees were sampled five times during the course of the growing season. Twenty components were identified in the leaf oils, which were dominated by sesquiterpene hydrocarbons, principally germacrene D and beta-elemene, in the early part of the season (42-44% and 18-23%, respectively,) but monoterpene hydrocarbons, largely (Z)-beta-ocimene, dominated the later season leaf oils (40-60%). The leaf oils exhibited in-vitro antibacterial activity against Bacillus cereus and Staphylococcus aureus as well as cytotoxic activity on MDA-MB-231 and Hs 578T human breast tumor cells.