Estimating patient-reported outcomes for glaucoma management: A cross-sectional study.

AIM: To identify important explanatory variables of four patient-reported outcomes (PROs): vision-related quality of life (VRQoL), preference-based health-related quality of life (HRQoL), social support and community integration and depressive symptoms. METHODS: Cross-sectional study conducted at one ophthalmic practice in a hospital setting. Patients with a diagnosis of glaucoma or glaucoma suspect (n = 250) were sequentially recruited. Patients with language restrictions were excluded. Data were collected through medical chart reviews and face-to-face interviews. The PROs were measured using validated tools. Candidate models for predicting PROs from explanatory variables were constructed using linear and logistic regression, as well as classification and regression trees. Through leave-one-out cross-validation, the performance of each model was assessed in terms of mean absolute error. RESULTS: Use of mobility aids, best corrected visual acuity (BCVA), income, and living arrangements were most predictive of VRQoL, social support, and community integration. Use of mobility aids was also most predictive of the presence of depressive symptoms, and BCVA with preference-based HRQoL. CONCLUSION: Although promising associations were discovered, the models based on commonly collected clinical variables had limited ability to accurately predict individual patient PROs. Thus, although this study identifies clinical and demographic variables that are most predictive of PROs, routine collection of PROs in clinical practice may be necessary to obtain a complete picture of the quality of life of glaucoma patients.

Mentoring needs of distributed medical education faculty at a Canadian medical school: a mixed-methods descriptive study.

INTRODUCTION: The Schulich School of Medicine & Dentistry in London, Ontario, has a mentorship program for all full-time faculty. The school would like to expand its outreach to physician faculty located in distributed medical education sites. The purpose of this study was to determine what, if any, mentorship distributed physician faculty currently have, to gauge their interest in expanding the mentorship program to distributed physician faculty and to determine their vision of the most appropriate design of a mentorship program that would address their needs. METHODS: We conducted a mixed-methods study. The quantitative phase consisted of surveys sent to all distributed faculty members that elicited information on basic demographic characteristics and mentorship experiences/needs. The qualitative phase consisted of 4 focus groups of distributed faculty administered in 2 large and 2 small centres in both regions of the school's distributed education network: Sarnia, Leamington, Stratford and Hanover. Interviews were 90 minutes long and involved standardized semistructured questions. RESULTS: Of the 678 surveys sent, 210 (31.0%) were returned. Most respondents (136 [64.8%]) were men, and almost half (96 [45.7%]) were family physicians. Most respondents (197 [93.8%]) were not formal mentors to Schulich faculty, and 178 (84.8%) were not currently being formally mentored. Qualitative analysis suggested that many respondents were involved in informal mentoring. In addition, about half of the respondents (96 [45.7%]) wished to be formally mentored in the future, but they may be inhibited owing to time constraints and geographical isolation. Consistently, respondents wished to have mentoring by a colleague in a similar practice, with the most practical being one-on-one mentoring. CONCLUSION: Our analysis suggests that the school's current formal mentoring program may not be applicable and will require modification to address the needs of distributed faculty.

INTRODUCTION: L'École de médecine et de dentisterie Schulich, à London en Ontario, offre un programme de mentorat à tout le personnel enseignant à temps plein. L'École aimerait étendre son programme aux médecins enseignants des établissements de formation médicale décentralisée. Le but de cette étude était de déterminer à quel mentorat, le cas échéant, ces médecins ont accès actuellement et d'établir leur intérêt pour le programme de mentorat de l'École et leur vision du programme le plus approprié pour répondre à leurs besoins. METHODS: Nous avons mené une étude en méthodologie mixte. Lors de la phase quantitative, nous avons envoyé des questionnaires à tous les médecins des établissements de formation médicale décentralisée afin d'obtenir des renseignements sur les caractéristiques démographiques de base ainsi que les expériences et besoins de mentorat. La phase qualitative comprenait quatre groupes de discussion composés de médecins enseignants décentralisés dans deux grands et deux petits centres des deux régions du réseau de formation décentralisée de l'École, soit Sarnia, Leamington, Stratford et Hanover. Les entrevues étaient d'une durée de 90 minutes et se composaient de questions semi-structurées normalisées. RESULTS: Sur les 678 questionnaires distribués, 210 (31 %) ont été retournés. La plupart des répondants (136 [64,8 %]) étaient des hommes et presque la moitié (96 [45,7 %]) étaient des médecins de famille. La plupart des répondants (197 [93,8 %]) n'agissaient pas comme mentors officiels auprès du personnel enseignant de l'École de médecine et de dentisterie Schulich et 178 (84,8 %) ne recevaient pas de mentorat officiel actuellement. L'analyse qualitative suggère que plusieurs répondants participaient à une forme quelconque de mentorat informel. De plus, environ la moitié des répondants (96 [45,7 %]) souhaitaient recevoir un mentorat officiel à l'avenir, mais avaient possiblement des contraintes liées au manque de temps et à l'isolement géographique. Les répondants ont systématiquement exprimé le désir d'obtenir un mentorat d'un collègue dans une pratique similaire et un mentorat individualisé, de façon pratique. CONCLUSION: Notre analyse suggère que le programme actuel de mentorat de l'École n'est peut-être pas applicable et nécessitera des modifications pour répondre aux besoins du personnel enseignant décentralisé.

Fibrinogen Concentrate in Cardiovascular Surgery: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Postoperative bleeding remains a frequent complication after cardiovascular surgery and may contribute to serious morbidity and mortality. Observational studies have suggested a relationship between low endogenous plasma fibrinogen concentration and increased risk of postoperative blood loss in cardiac surgery. Although the transfusion of fibrinogen concentrate has been increasing, potential benefits and risks associated with perioperative fibrinogen supplementation in cardiovascular surgery are not fully understood. METHODS: PubMed, Cochrane Library, Ovid MEDLINE, Embase, Web of Science, and China National Knowledge Infrastructure were searched on January 15, 2017, with automated updates searched until February 15, 2018, to identify all randomized controlled trials (RCTs) of fibrinogen concentrate, whether for prophylaxis or treatment of bleeding, in adults undergoing cardiovascular surgery. All RCTs comparing fibrinogen infusion versus any other comparator (placebo/standard of care or another active comparator) in adult cardiovascular surgery and reporting at least 1 predefined clinical outcome were included. The random-effects model was used to calculate risk ratios and weighted mean differences (95% confidence interval [CI]) for dichotomous and continuous variables, respectively. Subgroup analyses by fibrinogen dose and by baseline risk for bleeding were preplanned. RESULTS: A total of 8 RCTs of fibrinogen concentrate in adults (n = 597) of mixed risk or high risk undergoing cardiovascular surgery were included. Compared to placebo or inactive control, perioperative fibrinogen concentrate did not significantly impact risk of all-cause mortality (risk ratio, 0.41; 95% CI, 0.12-1.38; I = 10%; P = .15). Fibrinogen significantly reduced incidence of allogeneic red blood cell transfusion (risk ratio, 0.64; 95% CI, 0.49-0.83; I = 0%; P = .001). No significant differences were found for other clinical outcomes. Subgroup analyses were unremarkable when analyzed according to fibrinogen dose, time of infusion initiation, mean cardiopulmonary bypass time, and rotational thromboelastometry/fibrinogen temogram use (all P values for subgroup interaction were nonsignificant). CONCLUSIONS: Current evidence remains insufficient to support or refute routine perioperative administration of fibrinogen concentrate in patients undergoing cardiovascular surgery. Fibrinogen concentrate may reduce the need for additional allogeneic blood product transfusion in cardiovascular surgery patients at high risk or with evidence of bleeding. However, no definitive advantage was found for reduction in risk of mortality or other clinically relevant outcomes. The small number of clinical events within existing randomized trials suggests that further well-designed studies of adequate power and duration to measure all-cause mortality, stroke, myocardial infarction, reoperation, and thromboembolic events should be conducted. Future studies should also address cost-effectiveness relative to standard of care.