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1.
Neurosurg Focus ; 51(5): E11, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34724645

RESUMO

OBJECTIVE: Accurate clinical documentation is foundational to any quality improvement endeavor as it is ultimately the medical record that is measured in assessing change. Literature on high-yield interventions to improve the accuracy and completeness of clinical documentation by neurosurgical providers is limited. Therefore, the authors sought to share a single-institution experience of a two-part intervention to enhance clinical documentation by a neurosurgery inpatient service. METHODS: At an urban, level I trauma, academic teaching hospital, a two-part intervention was implemented to enhance the accuracy of clinical documentation of neurosurgery inpatients by residents and advanced practice providers (APPs). Residents and APPs were instructed on the most common neurosurgical complications or comorbidities (CCs) and major complications or comorbidities (MCCs), as defined by Medicare. Additionally, a "system-based" progress note template was changed to a "problem-based" progress note template. Prepost analysis was performed to compare the CC/MCC capture rates for the 12 months prior to the intervention with those for the 3 months after the intervention. RESULTS: The CC/MCC capture rate for the neurosurgery service line rose from 62% in the 12 months preintervention to 74% in the 3 months after intervention, representing a significant change (p = 0.00002). CONCLUSIONS: Existing clinical documentation habits by neurosurgical residents and APPs may fail to capture the extent of neurosurgical inpatients with CC/MCCs. An intervention that focuses on the most common CC/MCCs and utilizes a problem-based progress note template may lead to more accurate appraisals of neurosurgical patient acuity.


Assuntos
Documentação , Medicare , Centros Médicos Acadêmicos , Idoso , Comorbidade , Humanos , Melhoria de Qualidade , Estados Unidos
2.
Artigo em Inglês | MEDLINE | ID: mdl-34736297

RESUMO

This study aimed to investigate the degree to which newly appointed medical faculty members at the Catholic University of Korea are aware of Harden and Crosby's 12 educational roles and to identify their preferred educational roles. A 12-item survey questionnaire was distributed to 110 participants, and 100 responses were included in the analysis. The respondents gave the highest score to "clinical or practical teacher" and the lowest score to "curriculum planner" for their current personal competencies. For their preferred personal future competencies, they assigned the highest score to "on the job role model" and the lowest score to "student assessor." They gave almost equally high values to all 12 roles. However, individual faculty members had different preferences for educational roles. Accordingly, medical schools need to plan and implement customized faculty development programs, and efforts to provide appropriate educational roles according to individual faculty members' preferences are needed.


Assuntos
Centros Médicos Acadêmicos , Docentes de Medicina , Papel do Médico , Estudos Transversais , Docentes de Medicina/educação , Humanos , República da Coreia , Inquéritos e Questionários
3.
Adv Health Care Manag ; 202021 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-34779186

RESUMO

Women in medicine face barriers that hinder progress toward top leadership roles, and the industry remains plagued by the grand challenge of gender inequality. The purpose of this study was to explore how subtle and overt gender biases affect women physicians, physician leaders, researchers, and faculty working in academic health sciences environments and to further examine the association of these biases with workplace satisfaction. The study used a convergent mixed methods approach. Sampling from a list of medical schools in the United States, in conjunction with a list of each state's medical society, the authors analyzed the quantitative survey responses of 293 women in medicine. The authors conducted ordinary least squares multiple regression to assess the relationship of gender barriers on workplace satisfaction. Additionally, 132 of the 293 participants provided written open-ended responses that were explored using a qualitative content analysis methodology. The survey results showed that male culture, lack of sponsorship, lack of mentoring, and queen bee syndrome were associated with lower workplace satisfaction. The qualitative results provided illustrations of how participants experienced these biases. These results emphasize the obstacles that women face and highlight the detrimental nature of gender bias in medicine. The authors conclude by presenting concrete recommendations for managers endeavoring to improve the culture of gender equity and inclusivity.


Assuntos
Medicina , Médicas , Centros Médicos Acadêmicos , Animais , Feminino , Humanos , Liderança , Masculino , Sexismo , Estados Unidos
4.
Appl Clin Inform ; 12(5): 1074-1081, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34788889

RESUMO

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) vaccine administration has faced distribution barriers across the United States. We sought to delineate our vaccine delivery experience in the first week of vaccine availability, and our effort to prioritize employees based on risk with a goal of providing an efficient infrastructure to optimize speed and efficiency of vaccine delivery while minimizing risk of infection during the immunization process. OBJECTIVE: This article aims to evaluate an employee prioritization/invitation/scheduling system, leveraging an integrated electronic health record patient portal framework for employee COVID-19 immunizations at an academic medical center. METHODS: We conducted an observational cross-sectional study during January 2021 at a single urban academic center. All employees who met COVID-19 allocation vaccine criteria for phase 1a.1 to 1a.4 were included. We implemented a prioritization/invitation/scheduling framework and evaluated time from invitation to scheduling as a proxy for vaccine interest and arrival to vaccine administration to measure operational throughput. RESULTS: We allotted vaccines for 13,753 employees but only 10,662 employees with an active patient portal account received an invitation. Of those with an active account, 6,483 (61%) scheduled an appointment and 6,251 (59%) were immunized in the first 7 days. About 66% of invited providers were vaccinated in the first 7 days. In contrast, only 41% of invited facility/food service employees received the first dose of the vaccine in the first 7 days (p < 0.001). At the vaccination site, employees waited 5.6 minutes (interquartile range [IQR]: 3.9-8.3) from arrival to vaccination. CONCLUSION: We developed a system of early COVID-19 vaccine prioritization and administration in our health care system. We saw strong early acceptance in those with proximal exposure to COVID-19 but noticed significant difference in the willingness of different employee groups to receive the vaccine.


Assuntos
COVID-19 , Vacinação em Massa , Centros Médicos Acadêmicos , Vacinas contra COVID-19 , Estudos Transversais , Humanos , SARS-CoV-2 , Estados Unidos
5.
BMJ Open ; 11(11): e054746, 2021 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-34799364

RESUMO

OBJECTIVES: To develop and evaluate a simulation-based mastery learning (SBML) curriculum for cricothyrotomy using wet towels to suppress aerosolisation during a pandemic. DESIGN: Quasi-experimental, pre-post study. SETTING: Tertiary care, academic medical centre in Chicago. PARTICIPANTS: Ear, nose and throat and general surgery residents, fellows and attendings. INTERVENTION: Cricothyroidotomy simulation-based mastery learning curriculum. OUTCOMES MEASURE: Pretest to posttest simulated cricothyrotomy skills checklist performance. RESULTS: 37 of 41 eligible surgeons participated in the curriculum. Median pretest score was 72.5 (IQR 55.0-80.0) and 100.0 (IQR 98.8-100.0) for the posttest p<0.001. All participants scored at or above a minimum passing standard (93% checklist items correct) at posttest. CONCLUSIONS: Using SBML is effective to quickly train clinicians to competently perform simulated cricothyrotomy during a pandemic.


Assuntos
Internato e Residência , Pandemias , Centros Médicos Acadêmicos , Competência Clínica , Estudos de Coortes , Currículo , Humanos
6.
J Emerg Manag ; 18(7): 91-98, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34723350

RESUMO

PURPOSE: This study measured the degree of COVID-19-related fear among academic medical center employees, identified subsections with high COVID-19 fear, and validated the Fear of COVID-19 Scale with medical professionals in the United States. METHODS: This study is a cross-sectional, internet-based survey delivered by Qualtrics. The survey was conducted at the Oklahoma University Health Sciences Center between May 21 and June 18, 2020. The medical center is composed of seven healthcare colleges, child and adult hospitals, a Veterans Hospital, and outpatient services clinics across the Oklahoma city area. Faculty, staff, and students (N = 1,761) from the Oklahoma University Health Sciences Center completed the survey. RESULTS: COVID-19 fear is highest among nonclinical employees, smokers, and those with pre-existing conditions. Males and females, both clinicians and nonclinicians, appear to express their COVID-19 fears differently. Employees worried most about their families contracting the virus. The Fear of COVID-19 Scale is a valid and reliable assessment instrument among US healthcare workers. Responses were compared based on pre-existing medical condition(s), patient care or nonpatient care, sex, and occupational specialization. Analyses reveal a strong Cronbach's α measure of internal consistency (α = 0.87). Significant differences were observed among employees with a nonclinical emphasis (p = 0.02), with a predisposing medical health condition (p < 0.001), and with a nonacademic occupational specialization (p < 0.01), and by sex (p < 0.001). CONCLUSIONS AND DISCUSSION: COVID-19 fear significantly impacts academic medical center employees. Medical centers should address both healthcare and nonhealthcare workers' COVID-19-related fears. It is important to recognize that men and women may have different types of fears and express them differently, necessitating a gender-specific approach to managing COVID-19 fears. Employees with pre-existing conditions or who have vulnerable family members require additional support to remain fully functional and on the job.


Assuntos
COVID-19 , Centros Médicos Acadêmicos , Adulto , Criança , Estudos Transversais , Medo , Feminino , Humanos , Masculino , SARS-CoV-2 , Estados Unidos
7.
West J Emerg Med ; 22(6): 1227-1239, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34787545

RESUMO

INTRODUCTION: Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context. METHODS: We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method. RESULTS: From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow). CONCLUSIONS: Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.


Assuntos
Internato e Residência , Transferência da Responsabilidade pelo Paciente , Médicos , Centros Médicos Acadêmicos , Fricção , Humanos
8.
Ethiop J Health Sci ; 31(4): 907-910, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34703192

RESUMO

Background: Congenital pulmonary airway malformation is a very rare congenital cystic lung disease that presents in 0.004% of all pregnancies and constitutes <25% of all congenital pulmonary anomalies in children. Respiratory distress is a major concern in these patients. Case Details: Here in, we report an 8 month old girl presenting with exacerbation of fast breathing of three days duration. Chest X-ray showed hyper lucent right lung with significant shift of mediastinum to the left side, flattening of the diaphragm on the right side and compression of the left lung. Computed tomography scan of the chest revealed multiseptated cystic mass on the right lung measuring 8.9cm by 6.9cm. After receiving treatment for pneumonia, surgical excision of the mass was performed and biopsy showed congenital pulmonary airway malformation type1. The infant died on 40th postoperative day from uncontrolled hospital acquired infection. Conclusion: When a child has respiratory distress, congenital pulmonary airway malformation could be considered after common pathologies are ruled out. Surgical excision, which is the treatment of choice, is recommended to make a definite diagnosis and exclude hidden malignancies.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão , Centros Médicos Acadêmicos , Criança , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico por imagem , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Etiópia , Feminino , Humanos , Lactente , Pulmão/diagnóstico por imagem , Gravidez , Tomografia Computadorizada por Raios X
10.
Glob Health Sci Pract ; 9(3): 690-697, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593591

RESUMO

Emergency medicine (EM) is rapidly being recognized as a specialty around the globe. This has particular promise for low- and middle-income countries (LMICs) that experience the largest burden of disease for emergency conditions. Specialty education and training in EM remain essentially an apprenticeship model. Finding the required expertise to educate graduate learners can be challenging in regions where there are low densities of specialty providers.We describe an initiative to implement a sustainable, bidirectional partnership between the Emergency Medicine Departments of Weill Cornell Medicine (WCM) in New York, NY, USA, and Bugando Medical Center (BMC) in Mwanza, Tanzania. We used synchronous and asynchronous telecommunication technology to enhance an ongoing emergency medicine education collaboration.The Internet infrastructure for this collaboration was created by bolstering 4G services available in Mwanza, Tanzania. By maximizing the 4G signal, sufficient bandwidth could be created to allow for live 2-way audio/video communication. Using synchronous and asynchronous applications such as Zoom and WhatsApp, providers at WCM and BMC can attend real-time didactic lectures, participate in discussion forums on clinical topics, and collaborate on the development of clinical protocols. Proof of concept exercises demonstrated that this system can be used for real-time mentoring in EKG interpretation and ultrasound technique, for example. This system was also used to share information and develop operations flows during the COVID-19 pandemic. The use of telecommunication technology and e-learning in a format that promotes long-term, sustainable interaction is practical and innovative, provides benefit to all partners, and should be considered as a mechanism by which global partnerships can assist with training in emergency medicine in LMICs.


Assuntos
Currículo , Educação à Distância/métodos , Educação de Pós-Graduação em Medicina/métodos , Medicina de Emergência/educação , Medicina de Emergência/métodos , Centros Médicos Acadêmicos , Serviço Hospitalar de Emergência , Humanos , Aplicativos Móveis , Cidade de Nova Iorque , Mídias Sociais , Tanzânia
11.
Acad Med ; 96(11): 1546-1552, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34705750

RESUMO

Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.


Assuntos
Centros Médicos Acadêmicos/organização & administração , COVID-19/etnologia , Desastres/prevenção & controle , Equidade em Saúde/normas , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Defesa Civil/organização & administração , Consenso , Diversidade Cultural , Grupos Étnicos/estatística & dados numéricos , Programas Governamentais/organização & administração , Programas Governamentais/normas , Disparidades em Assistência à Saúde/etnologia , Humanos , Grupos Minoritários/estatística & dados numéricos , Formulação de Políticas , Saúde Pública/normas , SARS-CoV-2/genética , Participação Social , Fatores Socioeconômicos , Estados Unidos/epidemiologia
13.
Indian Heart J ; 73(5): 588-593, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34627574

RESUMO

OBJECTIVE: In the United States, atrial fibrillation (AF) accounts for over 400,000 hospitalizations annually. Emergency Department (ED) physicians have few resources available to guide AF/AFL (atrial flutter) patient triage, and the majority of these patients are subsequently admitted. Our aim is to describe the characteristics and disposition of AF/AFL patients presenting to the University of North Carolina (UNC) ED with the goal of developing a protocol to prevent unnecessary hospitalizations. METHODS: We performed a retrospective electronic medical chart review of AF/AFL patients presenting to the UNC ED over a 15-month period from January 2015 to March 2016. Demographic and ED visit variables were collected. Additionally, patients were designated as either having primary or secondary AF/AFL where primary AF/AFL patients were those in whom AF/AFL was the primary reason for ED presentation. These primary AF/AFL patients were categorized by AF symptom severity score according to the Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF) Scale. RESULTS: A total of 935 patients presented to the ED during the study period with 202 (21.5%) having primary AF/AFL. Of the primary AF/AFL patients, 189 (93.6%) had mild-moderate symptom severity (CCS-SAF ≤ 3). The majority of primary AF/AFL patients were hemodynamically stable, with a mean (SD) SBP of 123.8 (21.3), DBP of 76.6 (14.1), and ventricular rate of 93 (21.9). Patients with secondary AF/AFL were older 76 (13.1), p < 0.001 with a longer mean length of stay 6.1 (7.7), p = 0.31. Despite their mild-moderate symptom severity and hemodynamic stability, nearly 2/3 of primary AF/AFL patients were admitted. CONCLUSION: Developing a protocol to triage and discharge hemodynamically stable AF/AFL patients without severe AF/AFL symptoms to a dedicated AF/AFL clinic may help to conserve healthcare resources and potentially deliver more effective care.


Assuntos
Fibrilação Atrial , Flutter Atrial , Ablação por Cateter , Centros Médicos Acadêmicos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Flutter Atrial/terapia , Canadá , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , Fatores de Risco
14.
Appl Clin Inform ; 12(5): 996-1001, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34706394

RESUMO

BACKGROUND: Overuse of cardiac telemetry monitoring (telemetry) can lead to alarm fatigue, discomfort for patients, and unnecessary medical costs. Currently there are evidence-based recommendations describing appropriate telemetry use, but many providers are unaware of these guidelines. OBJECTIVES: At our multihospital health system, our goal was to support providers in ordering telemetry on acute care in accordance with evidence-based guidelines and discontinuing telemetry when it was no longer medically indicated. METHODS: We implemented a multipronged electronic health record (EHR) intervention at two academic medical centers, including: (1) an order set requiring providers to choose an indication for telemetry with a recommended duration based on American Heart Association guidelines; (2) an EHR-generated reminder page to the primary provider recommending telemetry discontinuation once the guideline-recommended duration for telemetry is exceeded; and (3) documentation of telemetry interpretation by telemetry technicians in the notes section of the EHR. To determine the impact of the intervention, we compared number of telemetry orders actively discontinued prior to discharge and telemetry duration 1 year pre- to 1 year post-intervention on acute care medicine services. We evaluated sustainability at years 2 and 3. RESULTS: Implementation of the EHR initiative resulted in a statistically significant increase in active discontinuation of telemetry orders prior to discharge: 15% (63.4-78.7%) at one site and 13% at the other (64.1-77.4%) with greater improvements on resident teams. Fewer acute care medicine telemetry orders were placed on medicine services across the system (1,503-1,305) despite an increase in admissions and the average duration of telemetry decreased at both sites (62 to 47 hours, p < 0.001 and 73 to 60, p < 0.001, respectively). Improvements were sustained 2 and 3 years after intervention. CONCLUSION: Our study showed that a low-cost, multipart, EHR-based intervention with active provider engagement and no additional education can decrease telemetry usage on acute care medicine services.


Assuntos
Registros Eletrônicos de Saúde , Telemetria , Centros Médicos Acadêmicos , Documentação , Humanos , Monitorização Fisiológica , Estados Unidos
15.
Am J Manag Care ; 27(10): e343-e348, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34668676

RESUMO

OBJECTIVES: Hospital mergers and acquisitions are increasingly used as a strategy to facilitate value-based care. However, no studies have assessed health care utilization (HCU) and patient flow across merged institutions. We aim to evaluate patient population distribution, HCU, and patient flow across a recent hospital merger of an academic medical center (AMC), a primary and specialty care alliance (PSC), and a community-based medical center (CMC). STUDY DESIGN: This was a retrospective observational study. METHODS: The study used 2018 adult demographic and encounter data from electronic health records. Patients' parent health care institution was determined by the most frequently visited site of face-to-face visits. Differences in patient demographics and HCU (ie, emergency department [ED] visits, hospitalizations, primary care visits) were compared. Independent factors associated with utilization were identified using adjusted logistic regression models. RESULTS: A total of 406,303 adult patients were identified in the cohort. The PSC setting, compared with the AMC and the CMC, had significantly more female (62.7% vs 54.4% and 58.5%, respectively), older (mean [SD] age, 52.0 [18.1] vs 51.1 [17.8] and 49.2 [17.8] years), and privately insured (63.6% vs 51.3% and 56.0%) patients. A higher proportion of patients at the CMC (27.5%) visited the ED compared with patients at the AMC (10.8%). Approximately 1645 primary care patients (7%) at the CMC setting went to the AMC for specialized care such as oncology, surgery, and neurology. CONCLUSIONS: Hospital mergers are increasing across the United States, allowing AMCs to expand their reach. These findings suggest that patients mainly sought care at their parent health care institution, yet appropriately received specialized care at the AMC. These results provide insights for future mergers and guide resource allocation and opportunities for improving care delivery.


Assuntos
Instituições Associadas de Saúde , Centros Médicos Acadêmicos , Adulto , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
16.
Best Pract Res Clin Anaesthesiol ; 35(3): 425-435, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34511230

RESUMO

The novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.


Assuntos
Centros Médicos Acadêmicos/tendências , Anestesiologia/tendências , COVID-19/epidemiologia , Cuidados Críticos/tendências , Reestruturação Hospitalar/tendências , Admissão e Escalonamento de Pessoal/tendências , Centros Médicos Acadêmicos/normas , Anestesiologia/normas , COVID-19/terapia , Cuidados Críticos/normas , Pessoal de Saúde/normas , Pessoal de Saúde/tendências , Reestruturação Hospitalar/normas , Humanos , Cidade de Nova Iorque , Pandemias , Admissão e Escalonamento de Pessoal/normas
17.
J Am Board Fam Med ; 34(5): 1003-1009, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34535525

RESUMO

The Coronavirus disease 2019 (COVID-19) pandemic forced not only rapid changes in how clinical care and educational programs are delivered but also challenged academic medical centers (AMCs) like never before. The pandemic made clear the need to have coordinated action based on shared data and shared resources to meet the needs of patients, learners, and communities. Family medicine departments across the country have been key partners in AMCs' responses. The Duke Department of Family Medicine and Community Health (FMCH) was involved in many aspects of Duke University's and Health System's responses, including leadership contributions in delivering employee health and student health services. The pandemic also surfaced the biological and social interactions that reveal underlying socioeconomic inequalities, for which family medicine has advocated since its inception. Key to success was the department's ability to integrate "horizontally" with the broader community, thereby accelerating the institution's response to the pandemic.


Assuntos
COVID-19 , Centros Médicos Acadêmicos , Medicina de Família e Comunidade , Humanos , Pandemias , SARS-CoV-2
18.
J Frailty Aging ; 10(4): 363-366, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34549253

RESUMO

BACKGROUND: Long-term residential care facilities and nursing homes are known to be particularly vulnerable to viral respiratory diseases and have expressed the need for multidisciplinary collaboration to help manage outbreaks when they occur. METHOD: In April 2020, Tours University Medical Center created a multidisciplinary mobile team to help local nursing homes deal with outbreaks of coronavirus disease 2019 (COVID-19). The team included a geriatrician, infectious disease experts, and palliative care specialists. RESULTS: On April 8th, 2020, the first intervention took place in a 100 residents nursing home with a total of 18 confirmed cases among 26 symptomatic residents and five deaths. The nursing home staffs' main requests were a multidisciplinary approach, consensus decision-making, and the dissemination of information on disease management. CONCLUSION: Three lessons emerged from this collaboration: (i) intensify collaborations between hospitals and nursing homes, (ii) limit disease transmission through the use of appropriate hygiene measures, broad screening, and the isolation of sick residents and sick employees, and (iii) provide sufficient human resources.


Assuntos
COVID-19 , Centros Médicos Acadêmicos , Humanos , Casas de Saúde , SARS-CoV-2
19.
Pediatrics ; 148(Suppl 2)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34470879

RESUMO

Women in medicine experience disparities in the workplace and in achieving leadership roles. They face challenges related to climate and culture, equitable compensation, work-life integration, opportunities for professional development and advancement, and occupational and systemic factors that can lead to burnout. Without specific resources to support women's development and advancement and promote conducive workplace climates, efforts to recruit, retain, and promote women physicians into leadership roles may be futile. This article is designed for 2 audiences: women physicians of all career stages, who are exploring factors that may adversely impact their advancement opportunities, and leaders in academic medicine and health care, who seek to achieve inclusive excellence by fully engaging talent. The need for greater representation of women leaders in medicine is both a moral and a business imperative that requires systemic changes. Individuals and institutional leaders can apply the practical strategies and solutions presented to catalyze successful recruitment, retention, and promotion of women leaders and widespread institutional reform.


Assuntos
Centros Médicos Acadêmicos/tendências , Mobilidade Ocupacional , Docentes de Medicina/tendências , Liderança , Médicas/tendências , Feminino , Humanos
20.
J Surg Orthop Adv ; 30(3): 131-135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34590999

RESUMO

Orthopaedic surgical trays contain unused instruments, but we do not know which specific instruments go unused nor do we know the savings from eliminating them from a given tray. This was a single-site, observational study conducted at an academic medical center. The primary outcome was type of unused instruments and percentage of instruments used in two commonly used surgical trays. The secondary outcome was cost savings in United States dollars (USD) that could be attained by eliminating these instruments. In the first tray, five instruments (10.6%) were unused in any of 37 observed cases. In the second tray, nineteen instruments (19.6%) were unused in 37 observed cases. The total annual savings from replacement cost analysis and reprocessing cost analysis was $6,597.00 USD. Unused instruments are common in surgical trays. Eliminating unused instruments can result in immediate cost savings. (Journal of Surgical Orthopaedic Advances 30(3):131-135, 2021).


Assuntos
Salas Cirúrgicas , Procedimentos Ortopédicos , Centros Médicos Acadêmicos , Redução de Custos , Estudos Transversais , Humanos , Estudos Prospectivos , Instrumentos Cirúrgicos
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