The Effect of Implicit Bias and Role Misidentification in the Learning Environment.

Background: Little is known about the impact of implicit bias our trainees experience in the form of role misidentification in the clinical learning environment.

Activity: We surveyed 540 residents and clinical medical students to determine the frequency and impact of role misidentification.

Results And Discussion: Most respondents (85%,  = 162) experienced role misidentification, resulting in heightened emotions that led to guarded behavior.

Geriatric All-Terrain Vehicle Trauma: An Unhelmeted and Severely Injured Population.

Background: All-terrain vehicle (ATV) use is widespread, however, little is known about injury patterns and outcomes in geriatric patients. We hypothesized that geriatric patients would have distinct and more severe injuries than non-geriatric adults after ATV trauma.

Methods: A retrospective cohort study was performed using the National Trauma Databank comparing non-geriatric (18-64) and geriatric adults (≥65) presenting after ATV trauma at Level 1 and 2 trauma centers from 2011 to 2015.

Geriatric Snowmobile Trauma: Longer Courses After Similar Injuries.

Background: Snowmobiling is a popular activity that leads to geriatric trauma admissions; however, this unique trauma population is not well characterized. We aimed to compare the injury burden and outcomes for geriatric versus nongeriatric adults injured riding snowmobiles.

Materials And Methods: A retrospective cohort study was performed using the National Trauma Databank comparing nongeriatric (18-64) and geriatric adults (≥65) presenting after snowmobile-related trauma at level 1 and 2 trauma centers from 2011 to 2015.

Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study.

Background: Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma.

Materials And Methods: Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code.

Geriatric ATV and snowmobile trauma at a rural level 1 trauma center: A blow to the chest.

Introduction: As the population ages, trauma centers are seeing a significant volume of injured geriatric patients. However, there is limited data on geriatric off-roading incidents. We investigated the injury patterns, severity and outcomes of geriatric versus younger adult all-terrain vehicle (ATV) and snowmobile related trauma with the hypothesis that geriatric patients will have higher mortality and worsened outcomes.

Gender Representation by Specialty Track at Surgical Meetings: The American and Australasian Experiences.

Background: We compared the representation of women panelists at two large, general interest surgical meetings: the American College of Surgeons (ACS) Clinical Congress and Royal Australasian College of Surgeons (RACS) Scientific Congress.

Materials And Methods: We performed comprehensive analyses of panels and panelists at ACS and RACS meetings (2013-2018). Manual review was conducted to determine counts and proportions of invited panelists by gender.

Evaluating Patient-Reported Outcomes in Inguinal Hernia Clinical Trials.

Background: Patient-reported outcomes (PROs) are increasingly reported in the literature and are subsequently relied on for clinical decision-making. In 2013, CONSORT (Consolidated Standards of Reporting Trials) added 5 guidelines for reporting PROs in randomized controlled trials, the PRO extensions. Adherence to the extensions among inguinal hernia trials is unknown.

Trends in Gender Representation at the American College of Surgeons Clinical Congress and the Academic Surgical Congress: A Mixed Picture of Progress.

Background: There has been increasing attention to gender inequity in speakers at professional meetings. The aim of this study was to evaluate temporal trends in representation of women at the Academic Surgical Congress (ASC) and American College of Surgeons Clinical Congress (CC), 2 prominent general interest, national surgical meetings.

Study Design: We reviewed ASC (2014-2019) and CC (2013-2018) meeting programs to determine counts and proportions of invited panelists and moderators by gender, including the frequency of men-only panels.

Quality assessment of the literature on surgical quality improvement.

Background: A proliferation of work on surgical quality improvement has brought about an increase in quality improvement publications. We assessed the quality of surgical quality improvement publications using the Standards of Quality Improvement Reporting Excellence (SQUIRE) guidelines.

Methods: We conducted a comprehensive review of the surgical quality improvement literature from 2008 to 2018.

Evaluative coping, emotional distress, and adherence in couples with Type 2 diabetes.

Introduction: Spousal support is one of the strongest and most consistent predictors of Type 2 diabetes treatment adherence. However, the effects of both spouses' evaluations of dyadic coping on emotional distress and patients' physical health remain largely unknown.

Method: Dyadic data from 117 married couples in which one member is diagnosed with Type 2 diabetes were evaluated in two separate models to explore the associations between (a) patients' and spouses' depression symptoms and patients' adherence to dietary and exercise regimens, and (b) patients' and spouses' acute stress levels and patients' adherence to dietary and exercise regimens.

Associations Between Economic Pressure and Diabetes Efficacy in Couples With Type 2 Diabetes.

Objective: The purpose of this study was to explore dyadic associations between economic pressure and diabetes self-efficacy via emotional distress in patients with type 2 diabetes and their partners.

Background: Understanding how economic pressure is associated with successful diabetes management is an important area for research, as couples with type 2 diabetes can incur heavy economic pressures that could likely influence diabetes outcomes.

Method: Data from 117 married couples were used to test actor-partner associations using moderated mediation analyses in a structural equation modeling framework.

A Picture is Worth 1,000 Words. The Use of Clinical Images in Electronic Medical Records.

Objective: To understand how clinicians utilize image uploading tools in a home grown electronic health records (EHR) system.

Methods: A content analysis of patient notes containing non-radiological images from the EHR was conducted. Images from 4,000 random notes from July 1, 2009 - June 30, 2010 were reviewed and manually coded.

Does Personality Matter in Diabetes Adherence? Exploring the Pathways between Neuroticism and Patient Adherence in Couples with Type 2 Diabetes.

Background: Personality has received some attention in the Type 2 diabetes literature; however, research has not linked personality and diabetes adherence behaviors (diet and exercise), identified pathways through which they are associated, nor taken into consideration important contextual factors that influence behavior (the patient's partner).

Methods: Dyadic data from 117 married, heterosexual couples in which one member is diagnosed with Type 2 diabetes was used to explore associations between each partner's neuroticism and patient dietary and exercise adherence through the pathways of negative affect, depression symptoms, and couple-level diabetes efficacy (both patient and spouse report of confidence in the patient's ability to adhere to diabetes management regimens).

Results: Results revealed that higher levels of neuroticism were associated with lower patient dietary and exercise adherence through (1) higher levels of depression symptoms (for patients' neuroticism) and negative affect (for spouses' neuroticism), and (2) lower levels of couple-level diabetes efficacy.

A dyadic multiple mediation model of patient and spouse stressors predicting patient dietary and exercise adherence via depression symptoms and diabetes self-efficacy.

Using dyadic data from 117 married couples in which one partner was diagnosed with Type 2 diabetes, the purpose of this study was to determine whether a number of specific patient and spouse stressors (chronic life stress, diabetes-specific stress, and physical health stress in the form of the number of comorbidities) were associated with Type 2 diabetes patients' dietary and exercise adherence through two potentially modifiable patient and spouse factors-depression symptoms and diabetes self-efficacy. We found that patient and spouse stressors, particularly patient and spouse diabetes stress and the number of patient comorbidities, were related to patient dietary and exercise adherence through patient depression symptoms and both patient and spouse diabetes self-efficacy. These conclusions were strengthened by incorporating a number of relevant control variables in our models and by testing four alternative models which supported our proposed model.

Spousal overprotection is indirectly associated with poorer dietary adherence for patients with type 2 diabetes via diabetes distress when active engagement is low.

Objectives: The current study sought to explore the indirect association of spousal overprotection on patient dietary adherence through the mechanism of diabetes distress and whether the link between overprotection and diabetes distress was moderated by spouse active engagement.

Method: Participants were 117 married couples in which one member had been diagnosed with type 2 diabetes and were recruited from a patient registry at a Midwestern (USA) medical centre. Data were gathered from spouses and patients through a self-report survey instrument.

A senior scholars forum can enhance the scholarship process.

Background: The purpose of our study was to evaluate the educational value of an annual Senior Scholars Forum (SSF) of graduating Emergency Medicine resident participants and attendees.

Description: This study was conducted at an urban academic medical center with a PGY1-4 year residency program. After completion of the 2nd annual SSF, a web-based survey instrument was sent to all resident and faculty attendees.

Spousal protective buffering and type 2 diabetes outcomes.

Objective: Guided by the developmental-contextual model of couples coping with chronic illness (Berg & Upchurch, 2007), the purpose of this study is to explore moderated associations between spousal protective buffering and illness outcomes for partners diagnosed with type 2 diabetes (dietary adherence, frequency of exercise, and HbA1c level). Patient diabetes appraisals (distress, control, self-efficacy, and consequences) were explored as potential moderators.

Methods: Participants were 117 married couples in which one member had been diagnosed with type 2 diabetes.

Longitudinal validation of a tool for asthma self-monitoring.

Objectives: To establish longitudinal validation of a new tool, the Asthma Symptom Tracker (AST). AST combines weekly use of the Asthma Control Test with a color-coded graph for visual trending.

Methods: Prospective cohort study of children age 2 to 18 years admitted for asthma.

Common dyadic coping is indirectly related to dietary and exercise adherence via patient and partner diabetes efficacy.

Using cross-sectional data from 117 married couples in which one member is diagnosed with type 2 diabetes, the current study sought to explore a possible indirect association between common dyadic coping and dietary and exercise adherence via the mechanism of patient and spouse reports of diabetes efficacy. Results from the structural equation model analysis indicated common dyadic coping was associated with higher levels of diabetes efficacy for both patients and spouses which, in turn, was then associated with better dietary and exercise adherence for the patient. This model proved a better fit to the data than three plausible alternative models.

A novel clinician interface to improve clinician access to up-to-date genetic results.

Objectives: To understand the impact of GeneInsight Clinic (GIC), a web-based tool designed to manage genetic information and facilitate communication of test results and variant updates from the laboratory to the clinics, we measured the use of GIC and the time it took for new genetic knowledge to be available to clinicians.

Methods: Usage data were collected across four study sites for the GIC launch and post-GIC implementation time periods. The primary outcome measures were the time (average number of days) between variant change approval and notification of clinic staff, and the time between notification and viewing the patient record.

Relationship beliefs and illness appraisals are differentially associated with specific ways of coping in spouses of patients with type 2 diabetes.

Using data from 117 spouses of patients diagnosed with type 2 diabetes and multiple-group path analysis, the current study explored the association of four relationship beliefs (satisfaction, sacrifice, confidence and instability) and four diabetes appraisals (consequences, distress, control and efficacy) with illness-specific coping behaviour: active engagement, protective buffering and overprotection. The potential moderating effect of gender was also tested. Results indicated gender did moderate the associations among the variables in the model, with the association of relationship satisfaction and active engagement being significantly stronger for men, while diabetes control was more strongly related to protective buffering for women.

How physicians document outpatient visit notes in an electronic health record.

Background: Clinical documentation, an essential process within electronic health records (EHRs), takes a significant amount of clinician time. How best to optimize documentation methods to deliver effective care remains unclear.

Objective: We evaluated whether EHR visit note documentation method was influenced by physician or practice characteristics, and the association of physician satisfaction with an EHR notes module.

Preventability of adverse drug events involving multiple drugs using publicly available clinical decision support tools.

Purpose: The results of a retrospective evaluation of the frequency and preventability of adverse drug events (ADEs) involving multiple drugs among hospital inpatients are reported.

Methods: Data collected in a previous cohort study of 180 actual ADEs and 552 potential ADEs (PADEs) at six community hospitals in Massachusetts were analyzed to determine the frequency and types of multiple-drug ADEs and the extent to which the ADEs might have been prevented using publicly available clinical decision-support (CDS) knowledge bases. None of the hospitals had a computerized prescriber-order-entry system at the time of data collection (January 2005-August 2006).