Physical Restraint Usage in Hospitals Across the United States: 2011-2019.

Objective: To determine the change in rates of physical restraint (PR) use and associated outcomes among hospitalized adults. Patients and Methods: Using national inpatient sample databases, we analyzed years 2011-2014 and 2016-2019 to determine trends of PR usage. We also compared the years 2011-2012 and 2018-2019 to investigate rates of PR use, in-hospital mortality, length of stay, and total hospital charges. Results: There were 242,994,110 hospitalizations during the study period. 1,538,791 (0.63%) had coding to signify PRs, compared with 241,455,319 (99.3%), which did not. From 2011 to 2014, there was a significant increase in PR use (p-trend<.01) and a nonsignificant increase in PR rates from 2016-2019 (p-trend=.07). Over time, PR use increased (2011-2012: 0.52% vs 2018-2019: 0.73%; p<.01). Patients with PRs reported a higher adjusted odds for in-hospital mortality in 2011-2012 (adjusted odds ratio [aOR], 3.9; 95% CI, 3.7-4.2; p<.01) and 2018-2019 (aOR, 3.5; 95% CI, 3.4-3.7; p<.01). Length of stay was prolonged for patients with PRs in 2011-2012 (adjusted mean difference [aMD], 4.3 days; 95% CI, 4.1-4.5; p<.01) and even longer in 2018-2019 (aMD, 5.8 days; 95% CI, 5.6-6.0; p<.01). Total hospital charges were higher for patients with PRs in 2011-2012 (aMD, +$55,003; 95% CI, $49,309-$60,679; p<.01). Following adjustment for inflation, total charges remained higher for patients with PRs compared with those without PRs in 2018-2019 (aMD, +$70,018; 95% CI, $65,355-$74,680; p<.01). Conclusion: Overall, PR rates did not decrease across the study period, suggesting that messaging and promulgating best practice guidelines have yet to translate into a substantive change in practice patterns.

An 8-Year Review of Match Outcomes From a Primary Care Pipeline Program.

BACKGROUND AND OBJECTIVES: Primary care supports the global health care system. With an increased need for primary care physicians, medical schools must provide resources, role models, and opportunities to increase the number of medical students matching into primary care residencies. Some medical schools have developed primary care pipeline programs for students. The outcomes of one such program-the Primary Care Program (PCP)-at the Keck School of Medicine (KSOM) of the University of Southern California (USC), an urban and private academic medical training center, are evaluated here. METHODS: We reviewed PCP student outcome data for students who graduated between 2015 and 2022. Data were gathered through surveys, residency match lists, and graduation records. RESULTS: Among PCP matriculates (n=134), 70% were female and 39% were underrepresented in medicine. Thirteen percent (n=16) of PCP graduates (n=122) completed a master of public health (MPH) degree. Among PCP graduates, 70% matched into primary care residencies compared to 36% of non-PCP graduates (P<.001). The most common residencies that PCP graduates matched into were family medicine (n=45, 37%), internal medicine (n=20, 16%), pediatrics (n=12, 10%), surgery (n=10, 8%), and psychiatry (n=9, 7%). A higher percentage of KSOM students matched into primary care residencies in the 8 graduation years after PCP was instituted (39%) than in the 8 graduation years before PCP was instituted (33%, P=.003). CONCLUSIONS: The PCP data demonstrate the program's success at increasing the number of KSOM graduates matching into primary care residencies. The program provides a replicable training model.

Implementation of an online and in-person addiction medicine course and its impact on medical students' knowledge on substance use disorders.

BACKGROUND: Substance use is a public health crisis that requires improved education on substance use disorders (SUDs) in medical school curriculum to ensure that the future generation of physicians is prepared to care for this growing patient population. OBJECTIVES: This study evaluates how the implementation of an online and in-person addiction medicine course impacted medical students' knowledge on SUD and caring for patients with SUD. METHODS: 86 third-year and fourth-year medical students participated in either an online or in-person elective course on addiction medicine. Students learned about SUDs through various modalities, such as online SUD modules, clinical encounters, movies, books, participation in support group meetings and learning evidence-based tools to screen or treat patients. To assess the impact of the course curriculum on students' knowledge in treating SUDs, a pre and post survey was administered and analyzed. RESULTS: After completing the SUD course, students showed significant improvement (P < 0.01) in caring for SUD patients. Specifically, they improved in the areas of: assessing a patient with SUD, comfort and knowledge in using motivational interviewing to affect behavior change in a patient with a SUD, and knowledge of community resources related to SUD. Students also showed a significant improvement (P < 0.01) in the number of unique SUDs (such as opioids or alcohol) they felt knowledgeable about and in the number of treatment modalities for unique SUDs. CONCLUSIONS: Implementation of an addiction medicine course that utilizes various teaching modalities can significantly improve medical students' fundamental knowledge on SUD.

Describing the Breadth and Scope of Keck Medical Student Primary Care Research Projects.

Introduction: Primary care research is an important field of study within medicine, but little research has characterized medical students' projects on this topic. Second-year medical students at the Keck School of Medicine (KSOM) of University of Southern California are required to complete a research project on a topic of their choice. This study seeks to describe the scope of primary care medical student research conducted by KSOM medical students and specifically Primary Care Program (PCP) pipeline students. The PCP consists of students with a vested interest in primary care, and who we hypothesize are more likely to complete a primary care project. Methods: To assess students' primary care (PC) research output, we reviewed and sorted 1,408 KSOM abstracts between 2014 and 2020 into PC or non-PC. PC projects were then recategorized into more specific PC topics. χ2 analysis determined significance at P<.05. Results: We reviewed abstracts from 1,408 KSOM medical students (n=122 PCP; 1,286 non-PCP). Results revealed that the number of PC research projects conducted by 122 PCP students (67.2%, n=82) was statistically significantly higher than by 1,286 non-PCP students (14.7%, n=189, P<.00001). The most common PC research topics (n= 271) were education (patient/medical, n=71, 26%), health diversity/disparities (n=60, 22%), mental health/psychiatry/behavioral science (n=58, 21%), and community medicine (n=48, 18%). Conclusions: Our study describes the breadth and scope of Keck medical student PC research. Supporting PC research efforts by medical students may increase the proportion of students conducting PC research, students choosing PC careers, and faculty producing PC scholarship.

Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.

BACKGROUND: Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates. METHODS: In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie. RESULTS: The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels). CONCLUSIONS: Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions. (ClinicalTrials.gov number, NCT00160108.)

Effect of changes in the intake of weight of specific food groups on successful body weight loss during a multi-dietary strategy intervention trial.

BACKGROUND: Distinct weight loss dietary strategies are associated with changes in specific food groups. OBJECTIVE: To address the effect of changes in specific weight of food groups on weight loss in a 2-year low-fat, Mediterranean, low-carbohydrate intervention trial (DIRECT). METHODS: We assessed changes in the intake of 12 food groups among 322 participants (body mass index [BMI] = 31 kg/m(2); age = 52 years; 86% men), using a validated electronic food frequency questionnaire. RESULTS: The weight of the 3592.9 ± 1558 (g/d ± SD) of baseline food consumed consisted mainly of liquids, excluding water (32.6% of total weight of food); vegetables (18.8%), fruits (17.7%), dairy (9.0%), meat (7.7%), and bread/cereal/pasta/potatoes (7.1%). Participants significantly reduced food intake by 283.73 ± 1342 (g/d ± SD) at 6 months and by 963.36 ± 1869 (g/d ± SD) at 24 months (p < 0.05 as compared with baseline). Food weight changes were similar across diet groups (p = 0.366), whereas 6-month body weight loss was -4.6 ± 4.4 kg, -4.7 ± 4.9 kg, and -6.4 ± 6.6 kg for low-fat, Mediterranean, and low-carbohydrate groups, respectively; p < 0.026). In multivariate regression models, adjusted for age, sex, baseline body weight, and changes in weight intake of 12 food groups (g/d), independent dietary predictors (standardized-ß) at 6 months (rapid weight loss phase) were as follows: decreased consumption of sweets and cakes (ß = 0.493; p = 0.008) in the low-fat group, tendency toward increased crude legumes (ß = -0.196; p = 0.061) in the Mediterranean group, and increased vegetable intake (ß = -0.249; p = 0.018) in the low-carbohydrate diet group. In the entire group, in models further adjusted for diet type, leading predictors for rapid weight loss phase were as follows: increased vegetables by ~140 g/d (ß = -0.116; p = 0.045) and decreased intake of sweets and cakes by ~30 g/d (ß = 0.162; p = 0.010). Universal predictors for 2-year successful weight loss in the entire group were as follows: increased intake of vegetables (ß = -0.192; p = 0.007) and meat (ß = -0.146; p = 0.026) and decreased intake of eggs (ß = 0.187; p = 0.003), processed legumes (ß = 0.195; p = 0.002), and beverages (ß = 0.135; p = 0.032). CONCLUSIONS: Two-year weight loss is associated with a decrease of ~1 kg of total food consumed and may be achieved by a variety of changes in specific food groups within different diet strategies. Universal predictors of successful weight loss in the rapid weight loss phase across all diet strategies are increasing the weight of intake of vegetables and decreasing the weight of intake of sweets and cakes.

Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial (DIRECT).

BACKGROUND: Data are limited as to whether participants in diet trials truly adhere to their assigned diet and the factors that affect their adherence. METHODS: We evaluated success and adherence in a two-year dietary intervention randomized controlled trial (DIRECT) in which 322 moderately obese participants (mean age 52 yrs, mean body-mass-index (BMI) 31 kg/m(2), 86% men) were randomized to one of three groups: low-fat, Mediterranean, or low-carbohydrate diets. RESULTS: Overall compliance at month-24 was 85%, with 90% in low-fat, 85% in Mediterranean, and 78% in low-carbohydrate diet (p = .042 between groups). Attrition was higher in women (29% vs. 14% men, p = .001) and current smokers (25% vs. 14% among maintainers, p = 0.04). In a multivariate model, independent predictors of dropping-out were: higher baseline BMI (OR = 1.11; CI: 1.03-1.21) and less weight loss at month-6 (OR = 1.20; CI: 1.1-1.3). In a multivariate model, greater weight loss achieved at month-6 was the main predictor associated with success in weight loss (> 5%) over 2 years (OR = 1.5; CI: 1.35-1.67). Self-reported complete adherence score to diet was greater on low-carbohydrate diet (p < .05 compared to low-fat) until month-6, but dropped overall from 81% at month-1 to 57% at month-24. Holidays were a trigger to a significant decrease in adherence followed by a partial rebound. Changes in diet composition from month-1 to month-12 were more pronounced in the multi-stage low-carbohydrate diet-group (p < .05). Generally, the most irresistible restricted food items were cookies (45% of dieters) and fruits (30%). Among the physically active (n = 107), 44% reported a tendency to eat less after exercising compared to 10% who tended to eat more. CONCLUSION: Initial 6-month reduction in weight is the main predictor of both long-term retention and success in weight loss. Special attention is needed for women, current smokers, and during holidays. Physical activity is associated with subsequent reduction in energy intake.