Interactions with the pharmaceutical industry and the practice, knowledge and beliefs of medical oncologists and clinical haematologists: a systematic review.

BACKGROUND: No previous review has assessed the extent and effect of industry interactions on medical oncologists and haematologists specifically. METHODS: A systematic review investigated interactions with the pharmaceutical industry and how these might affect the clinical practice, knowledge and beliefs of cancer physicians. MEDLINE, Embase, PsycINFO and Web of Science Core Collection databases were searched from inception to February 2021. RESULTS: Twenty-nine cross-sectional and two cohort studies met the inclusion criteria. These were classified into three categories of investigation: (1) extent of exposure to industry for cancer physicians as whole (n = 11); (2) financial ties among influential cancer physicians specifically (n = 11) and (3) associations between industry exposure and prescribing (n = 9). Cancer physicians frequently receive payments from or maintain financial ties with industry, at a prevalence of up to 63% in the United States (US) and 70.6% in Japan. Among influential clinicians, 86% of US and 78% of Japanese oncology guidelines authors receive payments. Payments were associated with either a neutral or negative influence on the quality of prescribing practice. Limited evidence suggests oncologists believe education by industry could lead to unconscious bias. CONCLUSIONS: There is substantial evidence of frequent relationships between cancer physicians and the pharmaceutical industry in a range of high-income countries. More research is needed on clinical implications for patients and better management of these relationships. REGISTRATION: PROSPERO identification number CRD42020143353.

Trust-Based Partnerships Are Essential - and Achievable - in Health Care Service.

When people think about trust in the context of health care, they typically focus on whether patients trust the competence of doctors and other health professionals. But for health care to reach its full potential as a service, trust must also include the notion of partnership, whereby patients see their clinicians as reliable, caring, shared decision-makers who provide ongoing "healing" in its broadest sense. Four interrelated service-quality concepts are central to fostering trust-based partnerships in health care: empathetic creativity, discretionary effort, seamless service, and fear mitigation. Health systems and institutions that prioritize trust-based partnerships with patients have put these concepts into practice using several concrete approaches: investing in organizational culture; hiring health professionals for their values, not just their skills; promoting continuous learning; attending to the power of language in all care interactions; offering patients "go-to" sources for timely assistance; and creating systems and structures that have trust built into their very design. It is in the real-world implementation of trust-based partnership that health care can reclaim its core mission.

Effect of interprofessional collaboration among nursing home professionals on end-of-life care in nursing homes.

As end-of-life (EOL) care in nursing homes is gradually increasing, interprofessional collaboration in EOL care in nursing homes is becoming important. However, a method for measuring interprofessional collaboration has not been established. Therefore, this study aimed to clarify the effect of interprofessional collaboration on EOL care in nursing homes. Questionnaires were mailed to the facility directors of 378 nursing homes in Kanagawa Prefecture, Japan, and distributed to nurses, care managers, and professional caregivers. Three professionals from each nursing home completed the same questionnaire, which included 9 items on EOL care: shared facility policy, residents' wishes, each professional's roles, person in charge of the facility, residents' conditions, mental status of residents' families, emergency codes, residents' key people, and sufficient discussion among professionals. Based on the professionals' responses, interprofessional collaboration was assessed. We used multivariable analysis, with interprofessional collaboration as an independent factor. The outcome was the amount of EOL care in the nursing home. A total of 180 (47.6%) nursing homes participated. Multivariable analysis showed that interprofessional collaboration (beta [ß] coefficient 2.5, 95% confidence interval [CI] 0.45-4.48; p = 0.017), availability of EOL care bonuses (ß coefficient 4.4, 95% CI 1.41-7.38; p = 0.004), physician support for emergency care during off time (ß coefficient 5.4, 95% CI 1.86-8.94; p = 0.003), and EOL care conferences (ß coefficient 4.1, 95% CI 1.19-6.99; p = 0.006) were significant factors associated with the amount of EOL care in the nursing homes. We found evidence in the adjusted model that interprofessional collaboration among facility professionals is effective for EOL care in nursing homes.

WhatsApp-propriate? A retrospective content analysis of WhatsApp use and potential breaches in confidentiality among a team of doctors at a district hospital, South Africa.

BACKGROUND: There has been a steady increase in the use of electronic media and instant messaging among healthcare professionals, where it has been almost universally adopted in the workplace. The use of WhatsApp and its perceived benefits in healthcare have been extensively studied; however, there are concerns regarding the potential for ethical breaches in confidentiality through shared electronic patient information. OBJECTIVES: To identify the usage characteristics and incidence of shared patient information with WhatsApp use in a team of medical doctors in an unobserved and unregulated setting. METHODS: We conducted a retrospective cross-sectional content analysis of WhatsApp messages (n=3 340) among a team of 20 doctors in a South African district hospital over 6 months. All messages found within this time period were allocated unique identifiers. The text and image messages were thematically grouped into four categories, i.e. clinical care, resource allocation, social and administrative. Messages that contained patient-identifying information were included in the analysis. RESULTS: Of a total of 3 340 messages sent, 220 (6.6%) contained patient-identifying information. Of these, 109 (3.3%) contained non-anonymised patient information, while in 111 (3.3%) messages, the information was anonymised. The likelihood of sharing patient identifiers was proportionally much higher in shared images (odds ratio (OR) 5.1; 95% confidence interval (CI) 3.2 - 8.2; p<0.0001) compared with text messages, and in messages that related to clinical care (OR 9.3; 95% CI 2.2 - 38.8; p=0.0023) compared with those sent for resource allocation, and social or administrative purposes. CONCLUSIONS: Non-anonymised patient identifiers were found in 3.3% of messages, constituting the potential for breaching patient confidentiality. While WhatsApp groups have significant utility in co-ordinating aspects of clinical care, resource allocation, as well as social and administrative functions, the safe use of WhatsApp should be promoted to ensure that patient confidentiality is maintained.

Design of a Situational Judgment Test for Preclinical Interprofessional Collaboration.

PROBLEM: There is an unmet need for economically feasible, valid, reliable, and contextually relevant assessments of interprofessional collaborative knowledge and skills, particularly at the early stages of health professions education. This study sought to develop and gather content and internal structure validity for an Interprofessional Situational Judgement Test (IPSJT), a tool for the measurement of students' interprofessional collaborative intentions during the early stages of their professional development. APPROACH: After engaging in an item development and refinement process (January-June 2018), an 18-question IPSJT was administered to 953 first-year students enrolled in 10 health professions degree programs at the University of Florida Health Science Center in October 2018. The IPSJT's performance was evaluated using item-level analyses, item difficulty, test-retest reliability, and exploratory factor analysis. OUTCOMES: Seven hundred thirty-seven (77.3%) students consented to the use of their data. Student IPSJT scores ranged from 0 to 69, averaging 42.68 (standard deviation = 12.28), with some statistically significant differences in student performance by health professions degree program. IPSJT item difficulties ranged from 0.13 to 0.92. Once one item with poor properties was excluded from analysis, the IPSJT demonstrated an overall reliability of 0.62. Students were more successful at identifying the least effective than the most effective responses. Test-retest reliability provided evidence of consistency (r = 0.50, P < .001) and similar item difficulty across administrations. An exploratory factor analysis indicated a 3-factor model with multiple cross-factor loadings. NEXT STEPS: This work represents the first step toward the development of a valid, reliable IPSJT for early learners. The emergent 3-factor model provides evidence that multiple competencies can be assessed in early learners via this tool. Additional research is necessary to build a more robust question bank, explore different scoring and response methods, and gather additional sources of validity evidence, including relations to other variables.

The RCA ReCAst: A Root Cause Analysis Simulation for the Interprofessional Clinical Learning Environment.

PROBLEM: The Accreditation Council for Graduate Medical Education calls for resident participation in real or simulated interprofessional analysis of a patient safety event. There are far more residents who must participate in these investigations than available institutional root cause analyses (RCAs) to accommodate them. To correct this imbalance, the authors developed an institutionally sponsored, interprofessional RCA simulation program and implemented it across all graduate medical education (GME) residency programs at the Hospital of the University of Pennsylvania. APPROACH: The authors developed RCA simulations based upon authentic adverse events experienced at their institution. To provide relevance to all GME programs, RCA simulation cases varied widely and included examples of errors involving high-risk medications, communication, invasive procedures, and specimen labeling. Each simulation included residents and other health care professionals such as nurses or pharmacists whose disciplines were involved in the actual event. Participants adopted the role of RCA investigation team, and in small groups systematically progressed through the RCA process. OUTCOMES: A total of 289 individuals from 18 residency programs participated in an RCA simulation in 2019-2020. This included 84 interns (29%), 123 residents (43%), 20 attending physicians (7%), and 62 (21%) other health care professionals. There was an increase in ability of GME trainees to correctly identify factors required for an RCA investigation (62% pre vs 80% post, P = .02) and an increase in intent to "always report" for each adverse event category (3% pre vs 37% post, P < .001) following the simulation. NEXT STEPS: The authors plan to expand the RCA simulation program to other GME clinical sites while striving to involve all GME learners in this educational experience at least once during training. Additionally, by collaborating with health system patient safety leaders, they will annually review all new RCAs to identify cases suitable for simulation adaptation.

Examining the Educational Value of Student-Run Clinics for Health Care Students.

PURPOSE: Student-run clinics (SRCs) are increasingly recognized as an educational experience in many health professions' curricula. Several benefits have been documented, including students with SRC experience using patient-centered approaches to care, showing interest in working with marginalized populations, and more fully appreciating the care provided by interprofessional teams. Yet, few studies have explored student experiences within SRCs or examined how these experiences affect and shape these documented attitudes. This study explored the experiences of students at an SRC and the effect of these experiences on their learnings. METHOD: From November 2016 to July 2017, 23 students in the Community Health Initiative by University Students SRC at the University of British Columbia participated in 2 focus group interviews: the first after their first clinic day and the second on their final clinic day. Open- and closed-ended questions were used to explore participants' learnings from the SRC. Using a grounded theory approach, the authors iteratively analyzed the transcribed interviews, adjusting questions for subsequent focus groups as new themes evolved. Three investigators each separately coded the data; the full team then collectively consolidated the themes and developed explanatory models for each theme. RESULTS: Two themes were identified from the focus group input: (1) through managing real, complex patients-in situations unlike those offered in classroom and case-based learning environments-students gained insights into the intricacies of incorporating the patient's perspective into their definition and management of the patient's problem, and (2) by working as a team instead of focusing on delineating scopes of practice, students gained a meaningful understanding of the roles of practitioners from other health professions. CONCLUSIONS: This study provides insights into the unique opportunities SRCs offer health care students early in their training, enabling them to develop a richer understanding and appreciation of holistic and interprofessional approaches to patient care.

Surgical autonomy: A resident perspective and the balance of teacher development with operative independence.

BACKGROUND: This study aims to understand the perspectives of operative autonomy of surgical residents at various postgraduate levels. METHODS: Categorical general surgery residents at a single academic residency were invited to participate in focus groups to discuss their opinions and definitions of operative autonomy. Employing constructivist thematic analysis, focus groups were audio recorded, transcribed, and inductively analyzed using a constant comparative technique. RESULTS: Twenty clinical surgical residents participated in 6 focus groups. Overarching themes identified include autonomy as a dynamic, progressive path to operative independence and the complex interaction of resident-as-teacher development and operative autonomy. Four within operative case themes were intrinsic factors, extrinsic factors, autonomy promoting or inhibiting behaviors, and the relationship between residents and attendings. CONCLUSION: Residents define operative autonomy as a progressive and dynamic pathway to operative independence. Teacher development is viewed as both an extension beyond operative independence and potentially in conflict with their colleagues' development.

Barreiras e facilitadores para construção de um ambiente ético em um serviço de traumatologia / Barreras y facilitadores para la construcción de un entorno ético en un servicio de traumatología / Barriers and facilitators to the implementation of an ethical environment in a traumatology service

RESUMO Objetivo identificar as principais barreiras e facilitadores do trabalho multiprofissional, com vistas à construção de um ambiente ético em um serviço de traumatologia. Método estudo exploratório-descritivo com abordagem qualitativa realizado com dez profissionais de uma equipe multiprofissional de uma unidade de traumatologia de um Hospital Universitário localizado no Sul do Brasil. Participaram três médicos, três médicos residentes, dois enfermeiros e dois técnicos em enfermagem. A coleta de dados ocorreu no período de setembro a outubro de 2019, por meio de Grupo Focal e foram submetidos à Análise Textual Discursiva. Resultados os dados permitiram a construção de duas categorias principais: as barreiras e os facilitadores encontrados para construção de um ambiente ético em um serviço de traumatologia. Conclusão e implicações para a prática como principais barreiras para a construção de um ambiente ético de trabalho foram identificadas a presença de diferentes vínculos empregatícios, a limitação de espaço físico e a burocracia e como facilitadores, foram destacados a presença de protocolos e comunicação efetiva que juntos podem resultar em uma direção para a construção de um ambiente ético de trabalho, de modo a ir ao encontro com a meta do serviço, no qual se constitui na humanização da assistência e a segurança do paciente.

RESUMEN Objetivo Identificar las principales barreras y facilitadores del trabajo multiprofesional, con miras a la construcción de un ambiente ético en un servicio de traumatología. Método estudio exploratorio-descriptivo con abordaje cualitativo, realizado con 10 profesionales de un equipo multidisciplinario de una unidad de traumatología en un Hospital Universitario ubicado en el sur de Brasil. Participaron tres médicos, tres médicos residentes, dos enfermeras y dos técnicos de enfermería. La recolección de datos se llevó a cabo de septiembre a octubre de 2019, a través del Focus Group, sometidos al Análisis Textual Discursivo. Resultados Los datos permitieron la construcción de dos categorías principales: barreras y facilitadores encontrados para la construcción de un ambiente ético en un servicio de traumatología. Conclusión e implicaciones para la práctica Las principales barreras para la construcción de un ambiente de trabajo ético fueron la presencia de diferentes vínculos laborales, la limitación del espacio físico y la burocracia. Como facilitadores, se destacaron la presencia de protocolos y una comunicación efectiva, que en conjunto pueden resultar en un rumbo para la construcción de un ambiente de trabajo ético, a fin de cumplir con el objetivo del servicio, que constituye la humanización del cuidado y la seguridad del paciente.

ABSTRACT Objective Identify the main barriers and facilitators to multi-professional practice to promote an ethical environment in a traumatology service. Method this exploratory-descriptive study with a qualitative approach addressed ten professionals from the multidisciplinary team of a traumatology service at a University Hospital located in southern Brazil. Three doctors, three resident doctors, two nurses, and two nursing technicians participated in the study. Data were collected from September to October 2019 through a Focus Group and analyzed through Discursive Textual Analysis. Results Two main categories emerged: barriers and facilitators to building an ethical environment in a traumatology service. Conclusion and implications for practic e: The main barriers hindering the construction of an ethical workplace environment included the presence of different employment contracts, restricted physical space, and bureaucracy, while facilitators included existing protocols and effective communication, which have the potential to promote an ethical workplace environment to fulfill the service's goals, i.e., the humanization of care and patient safety.

About mentees and mentors: what kind of advanced training should young scientists receive? - A personal reflection.

Comprehensive training of talented MD or PhD students and postdoctoral fellows is one of the essential requirements for a future career as an established investigator or even an outstanding scientist. Here, from personal experience, several relevant aspects are summarized including the high responsibility of the academic mentor. Specifically, the interaction of the mentor with fellows, the choice of the research project, and the impact of the mentor's personality on mentees are discussed.

Moral distress in pediatric otolaryngology: A pilot study.

OBJECTIVES: SUBJECTS/METHODS: Moral distress is defined as "when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action". The Moral Distress Survey-Revised (MDS-R) is a validated 21-question survey measuring moral distress in pediatrics. The MDS-R was anonymously distributed to pediatric otolaryngology faculty and fellows at a tertiary institution. Descriptive statistics, bivariate and multivariate analysis were performed. RESULTS: Response rate was 89% (16/18). Overall MDS-R score was 40 (range 14-94), which is lower than that found in the literature for pediatric surgeons (reported mean 72), pediatric intensivists (reported means 57-86), and similar to pediatric oncologists (reported means 42-52). Fellows had a significantly higher level of moral distress than faculty (mean 69 vs. 26, p < 0.05). Factors leading to higher degrees of distress involved communication breakdowns and pressure from administration/insurance companies to reduce costs. CONCLUSION: Pediatric Otolaryngologists at our institution have lower degrees of moral distress compared to other pediatric subspecialists. Fellows had higher levels of distress compared to faculty. Further research is necessary to determine degrees of distress across institutions and to determine its impact on the wellness of pediatric otolaryngologists.

Pain Management in Patients with Serious Illness.

Managing pain in patients with serious illness can be complex. However, pain is often a prominent symptom in patients with malignant and nonmalignant serious illness and providers have to be adept at balancing effective pain management and safety. Clinicians should start with a standard pain assessment that lays important groundwork for developing a tailored multimodal approach to pain management. It is important to identify physical causes of pain and also existential causes. Opioids are not always appropriate but are still an important tool for managing pain. Basic opioid management and safe practices are essential when managing this population.

Leader sleep devaluation, employee sleep, and unethical behavior.

OBJECTIVES: The objectives of this study is to examine the effect of leader sleep devaluation (which we define as leader behaviors that signal to employees that sleep should be sacrificed for work) on the sleep and unethical behavior of subordinates. DESIGN: Across 2 studies (with 3 total samples of participants), we use a cross-sectional survey, a diary study completed by employees, and a diary study completed by employees and their leaders. SETTING: Study 1 - a convenience sample of working adults in Italy, including 575 subordinates nested under 140 leaders. Study 2A - 135 working adults recruited from Amazon's Mechanical Turk. Study 2B - 127 employee-supervisor dyads recruited from the Study Response project. MEASUREMENTS: Survey measures of leader behaviors, subordinates sleep, and subordinate unethical behavior. RESULTS: Sleep devaluing leader behavior has harmful effects on employee sleep, and that these effects occur above and beyond the effects of abusive supervision and other alternative explanations. Subordinate sleep quality has a mediating role between leader sleep devaluation and subordinate unethical behavior. Effects for sleep quantity were inconsistent. CONCLUSIONS: Leaders can adversely influence the sleep and work experience of their subordinates. Specifically, sleep devaluing leader behavior undermines subordinate sleep, which in turn is associated with higher levels of subordinate unethical behavior.

Medical, pharmacy and nursing students in the Baltic countries: interactions with the pharmaceutical and medical device industries.

BACKGROUND: Interactions between pharmaceutical and medical device industries and students can lead to commercial influences on educational messages, with a potential to bias future treatment choice. This is the first study in the Baltic countries describing exposure and attitudes of medical, pharmacy and nursing students towards cooperation with industry. METHODS: A cross-sectional on-line survey of current medical, pharmacy and nursing students (n = 918) in three Baltic countries was carried out. RESULTS: We found that most students participate in events organized or sponsored by industry and accept a range of gifts and benefits. Students in the Baltic countries consider cooperation with industry important; at the same time, most do not feel that they have sufficient training on how to ethically interact with pharmaceutical and medical device companies and believe that these interactions can influence their prescribing or dispensing patterns. There is a tendency to rationalize cooperation with industry by referring to the current economic situation and patient benefits. Pharmacy students have higher rates of participation and they accept gifts and other benefits more often than nursing or medical students; therefore, they are likely to be more vulnerable to potential industry influence. CONCLUSIONS: The findings highlight the need to include topics on ethics and conflicts of interests in cooperation with industry in curriculum of health care students in Baltic countries. Without proper training, students continue to be at risk to industry influence and may develop habits for their further practice differing from evidence-based practice in prescribing and dispensing of medicines, as well as use of medical devices.