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1.
BMC Med Educ ; 21(1): 468, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34474670

RESUMO

BACKGROUND: Academic medical centers invest considerably in faculty development efforts to support the career success and promotion of their faculty, and to minimize faculty attrition. This study evaluated the impact of a faculty development program called the Leadership in Academic Medicine Program (LAMP) on participants' (1) self-ratings of efficacy, (2) promotion in academic rank, and (3) institutional retention. METHOD: Participants from the 2013-2020 LAMP cohorts were surveyed pre and post program to assess their level of agreement with statements that spanned domains of self-awareness, self-efficacy, satisfaction with work and work environment. Pre and post responses were compared using McNemar's tests. Changes in scores across gender were compared using Wilcoxon Rank Sum/Mann-Whitney tests. LAMP participants were matched to nonparticipant controls by gender, rank, department, and time of hire to compare promotions in academic rank and departures from the organization. Kaplan Meier curves and Cox proportional hazards models were used to examine differences. RESULTS: There were significant improvements in almost all self-ratings on program surveys (p < 0.05). Greatest improvements were seen in "understand the promotions process" (36% vs. 94%), "comfortable negotiating" (35% vs. 74%), and "time management" (55% vs. 92%). There were no statistically significant differences in improvements by gender, however women faculty rated themselves lower on all pre-program items compared to men. There was significant difference found in time-to-next promotion (p = 0.003) between LAMP participants and controls. Kaplan-Meier analysis demonstrated that LAMP faculty achieved next promotion more often and faster than controls. Cox-proportional-hazards analyses found that LAMP faculty were 61% more likely to be promoted than controls (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.16-2.23, p-value = 0.004). There was significant difference found in time-to-departure (p < 0.0001) with LAMP faculty retained more often and for longer periods. LAMP faculty were 77% less likely to leave compared to controls (HR 0.23, 95% CI 0.16-0.34, p < 0.0001). CONCLUSIONS: LAMP is an effective faculty development program as measured subjectively by participant self-ratings and objectively through comparative improvements in academic promotions and institutional retention.


Assuntos
Liderança , Autoeficácia , Centros Médicos Acadêmicos , Mobilidade Ocupacional , Docentes de Medicina , Feminino , Humanos , Masculino
2.
J Rheumatol ; 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34470795

RESUMO

OBJECTIVE: Frailty is associated with mortality in systemic lupus erythematosus (SLE), but how best to measure frailty is unclear. We aimed to compare two frailty metrics, the self-reported FRAIL scale (FS) and the Fried phenotype (FP), in SLE to evaluate differences between frail and nonfrail women and whether frailty is associated with self-reported disability. METHODS: Adult women <70 years old with validated SLE and mild/moderate disease enrolled in this cross-sectional study between August 2018 and October 2019. Correlation and agreement between the FS and the FP were determined. Differences in sociodemographic and disease characteristics, patient-reported outcome measures (PROMs), and biomarkers between frail and non-frail participants were evaluated, as well as association of frailty with Valued Life Activities disability. RESULTS: Of 67 participants, 27% and 18% were frail according to the FS and the FP, respectively. Correlation (r=0.51; p<0.0001) and agreement (k=0.4627; p=0.0004) between the FS and the FP were significant. Frail women had greater disease damage, high-sensitivity C-reactive protein, and interleukin 6 and worse PROMs according to both frailty definitions. Both frailty measures were associated with self-reported disability after adjustment for age, comorbidity, and disease activity and damage; this relationship was attenuated for the FP. CONCLUSION: Frailty prevalence was high in this cohort of women with SLE using both frailty definitions, suggesting that frailty may be accelerated in women with SLE, particularly when based exclusively on self-report. Frailty remained associated with self-reported disability in adjusted analyses. The FS may be an informative point-of-care tool to identify frail women with SLE.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34355298

RESUMO

To assess the feasibility and early efficacy of a combined lifestyle and acceptance-based therapy (ABT) intervention on weight loss at 16 weeks among Black breast cancer (BC) survivors with obesity. Thirty black breast cancer survivors with a BMI ≥ 30 kg/m2 at least 6 months post-treatment were enrolled. Outcomes included feasibility process measures, physical well-being assessed using the subscale of QOL-Breast Cancer (QOL-BC), physical activity assessed by Global Physical Activity Questionnaire (GPAQ), and weight. Fisher's Exact/Chi-Squared tests and Wilcoxon rank-sum tests were used to explore differences between responders and non-responders, as well as within-group changes during the intervention. Within the first 4 weeks, responders (participants who lost any weight) lost a median of 2.6 lbs. compared to non-responders (no weight loss) who gained a median of 2.6 lbs. At 16 weeks, participants reported greater physical well-being (p < 0.0001), increased time in recreational activities (p = 0.03), and a median weight loss of 5.6 pounds in responders vs. 0.7 pounds in non-responders (p ≤ 0.001). Non-responders were more likely to have developed a new health condition compared to responders (44% vs. 0%; p = 0.014). In this study, weight loss at 4 weeks and new-onset health conditions were significant factors associated with non-response to the combined intervention. Black BC with obesity are at high risk for recurrent cancer and secondary health conditions. ABT may be a suitable adjunct therapeutic option to lifestyle interventions implemented soon after a cancer diagnosis to improve physical well-being, increase physical activity, and promote weight loss.

7.
BMC Health Serv Res ; 18(1): 894, 2018 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-30477576

RESUMO

BACKGROUND: Successfully transitioning patients from hospital to home is a complex, often uncertain task. Despite significant efforts to improve the effectiveness of care transitions, they remain a challenge across health care systems. The lens of complex adaptive systems (CAS) provides a theoretical approach for studying care transition interventions, with potential implications for intervention effectiveness. The aim of this study is to examine whether care transition interventions that are congruent with the complexity of the processes and conditions they are trying to improve will have better outcomes. METHODS: We identified a convenience sample of high-quality care transition intervention studies included in a care transition synthesis report by Kansagara and colleagues. After excluding studies that did not meet our criteria, we scored each study based on (1) the presence or absence of 5 CAS characteristics (learning, interconnections, self-organization, co-evolution, and emergence), as well as system-level interdependencies (resources and processes) in the intervention design, and (2) scored study readmission-related outcomes for effectiveness. RESULTS: Forty-four of the 154 reviewed articles met our inclusion criteria; these studies reported on 46 interventions. Nearly all the interventions involved a change in interconnections between people compared with care as usual (96% of interventions), and added resources (98%) and processes (98%). Most contained elements impacting learning (67%) and self-organization (69%). No intervention reflected either co-evolution or emergence. Almost 40% of interventions were rated as effective in terms of impact on hospital readmissions. Chi square testing for an association between outcomes and CAS characteristics was not significant for learning or self-organization, however interventions rated as effective were significantly more likely to have both of these characteristics (78%) than interventions rated as having no effect (32%, p = 0.005). CONCLUSIONS: Interventions with components that influenced learning and self-organization were associated with a significant improvement in hospital readmissions-related outcomes. Learning alone might be necessary but not be sufficient for improving transitions. However, building self-organization into the intervention might help people effectively respond to problems and adapt in uncertain situations to reduce the likelihood of readmission.


Assuntos
Atenção à Saúde/organização & administração , Readmissão do Paciente , Transferência de Pacientes/organização & administração , Humanos , Relações Interpessoais , Avaliação de Resultados em Cuidados de Saúde , Qualidade da Assistência à Saúde , Teoria de Sistemas
8.
Int J Audiol ; 51 Suppl 1: S43-50, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22264062

RESUMO

OBJECTIVE: Noise is probably the most ubiquitous of occupational hazards. While many jurisdictions require hearing conservation programs (HCP), the most effective intervention-engineered noise controls (ENC)-is rarely implemented. We used a qualitative study design to investigate barriers to the implementation of ENC. DESIGN & STUDY SAMPLE: Fifty-five individuals at eight food and beverage manufacturers participated. In-depth interviews were conducted and analysed using grounded theory techniques. HCP audits provided contextual information. RESULTS: None of the companies had fully implemented HCP as required by regulation. Many factors emerged as possible barriers to the implementation of engineered noise control, including: poor knowledge of relevant regulations, noise reduction options and the health impacts of noise; weak technical skills and experience; low ranking of noise as a hazard by stakeholders; issues around job insecurity, weak language skills; lack of 'quiet' machine options and information from equipment manufacturers; poor employer-regulator relationships; barriers to employee-employer reporting; informal valuation of ENC costs; and feasibility issues. CONCLUSIONS: Potential barriers to the implementation of ENC were identified, and classified at three levels at which they operated. Many barriers could be addressed by a more rigorous application of existing HCP regulation and improvements in education, technical support, and regulatory enforcement.


Assuntos
Indústria de Processamento de Alimentos , Perda Auditiva Provocada por Ruído/prevenção & controle , Ruído Ocupacional/prevenção & controle , Adulto , Colúmbia Britânica , Meio Ambiente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Adulto Jovem
9.
J Acoust Soc Am ; 129(4): 2005-14, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21476656

RESUMO

This paper discusses the prediction of verbal-communication quality in eating establishments (EEs). EEs contain talkers and listeners who require high speech intelligibility at their tables, and high speech privacy between tables. Using catt-Acoustic, verbal-communication quality--quantified by speech transmission index (STI)--in models of three existing EEs was predicted. Talker voice-output levels were predicted using an existing empirical model accounting for the Lombard effect. With these, catt-Acoustic predicted impulse responses, speech levels and noise levels at primary and secondary listener positions, and the corresponding STIs. The untreated EEs were first modeled for various talker and listener positions, and occupancies. Then various treated configurations, involving reduced volume, increased absorption and barriers were studied to determine the effectiveness of the treatments. The results suggest that placing barriers around tables can be an effective way to achieve good verbal-communication quality. Increasing the absorption of the room surfaces or decreasing the ceiling height to control reverberation may not be effective. However, increasing the surface absorption and putting barriers around tables may achieve optimal speech conditions in EEs. Subdividing large EEs into smaller ones can also be effective.


Assuntos
Acústica , Planejamento Ambiental , Ruído/prevenção & controle , Restaurantes , Percepção da Fala , Comunicação , Comportamento do Consumidor , Humanos , Modelos Teóricos , Valor Preditivo dos Testes
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