MR. FISCAL: The Effects of a Financial Education Curriculum on Family Medicine Residents\u27 and Fellows\u27 Financial Well-Being and Literacy

CONTEXT: Financial education is not routinely offered during medical training. Residents and fellows thus have low financial literacy, high debt, and deficits in their financial preparedness. Poor financial literacy contributes to the ever-growing problems of physician stress, job dissatisfaction, burnout, and depression within primary care. It is postulated that implementation of a financial education curriculum for family medicine physicians-in-training will improve their sense of financial well-being and literacy. OBJECTIVE: This study aims to determine the effects of a formal financial education curriculum on family medicine residents\u27 and fellows\u27 financial well-being and literacy. DESIGN: Solomon four group. PARTICIPANTS: Convenience sample, voluntary participation. Residents and fellows at 16 family medicine residency programs (military, academic/university, and community-based) in the U.S. INTERVENTION: A standardized video-based financial education curriculum entitled Medical Residency Financial Skills Curriculum to Advance Literacy (MR. FISCAL). Topics include: money management, credit, debt management, risk management, investment and retirement planning. Educational content designed by the research team using the Institute for Financial Literacy National Standards for Adult Financial Literacy Education content. INSTRUMENT: Anonymous, web-based, 24-question survey, administered via Qualtrics. Survey is comprised of InCharge Financial Distress/Financial Well-Being (IFDFW) Scale measuring perceived levels of financial distress/well-being, plus 16 additional questions collecting demographic and self-reported financial data. MAIN OUTCOME MEASURES: The effect of this financial education curriculum on family medicine residents’ and fellows’ financial well-being and literacy as measured by the validated and reliable IFDFW scale and comparison of pre and post-intervention self-reported financial data. RESULTS: Work-in-progress. Anticipate comparison of pretest-posttest intervention versus posttest-only control group data. Additional statistical analysis will compare level of training, type of residency program, other demographics, financial data. CONCLUSION: There is currently a paucity of information on financial well-being and literacy among family medicine residents and fellows. This financial curriculum could be shared throughout primary care if improvements are observed

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Aplicabilidade da classificação de alcoolismo tipo A/tipo B Aplicability of the type A/type B classification of alcoholics

OBJETIVOS: Avaliar a aplicabilidade da tipologia e caracterizar os subtipos identificados. MÉTODOS: Características de 300 homens alcoolistas atendidos em um programa ambulatorial foram submetidas à análise de cluster para separá-los em dois subgrupos de acordo com a tipologia de Babor et al. Efetivaram-se cruzamentos de dados (significância avaliada pelo Teste do qui-quadrado de Pearson) para se verificar a associação dos clusters com variáveis clínicas e demográficas. RESULTADOS: Comparado ao outro grupo e pacientes, um dos clusters identificados foi caracterizado por um perfil de maior gravidade clínica. Pacientes do subtipo menos grave foram mais frequentemente (65,3%) encaminhados a tratamentos simbólicos, enquanto pacientes do subtipo mais grave foram atendidos predominantemente (58,5%) por abordagem exclusivamente farmacológica e aderiram mais ao tratamento proposto. CONCLUSÕES: Como os resultados identificaram subtipos de alcoolistas com distintas características, este estudo evidenciou a aplicabilidade clínica da tipologia de Babor et al. em nosso meio sociocultural¹. Também aponta para a relevância de estudos tipológicos que possam contribuir para uma mais ampla compreensão dos aspectos etiológicos, preventivos e terapêuticos do alcoolismo.<br>OBJECTIVE: To test the applicability of this typology and to characterize the identified subtypes. METHODS: Characteristics of 300 alcoholic men attending an out-treatment program were submitted to cluster analysis for identification of two subgroups (clusters), according to the original classification. Cross-tabulations were then performed to test for possible association of identified clusters to demographic and clinical features. Statistical significance was given by Pearson chi-square tests. RESULTS: Compared to the other group, one of the identified clusters was characterized by a more severe clinical profile. Patients of the mild subtype were principally (65,3%) referred to symbolic treatments while patients of the severe subtype were mainly assisted (58,5%) exclusively through a pharmacological approach and remained in treatment for longer periods of time. CONCLUSIONS: As the results identified subtypes of alcoholics with differential features, this study brought forth the clinical applicability of Babor et al. typology in our social-cultural context¹. Results also point to the relevance of typological studies that may contribute to a more adequate understanding of etiological, preventive and therapeutic aspects of alcoholism

Comparison of infant sleep practices in African-American and U.S. Hispanic families: Implications for sleep-related infant death

BACKGROUND: African-American and Hispanic families share similar socioeconomic profiles. Hispanic rates of sleep-related infant death are four times lower than African-American rates. METHODS: Cross-sectional, multi-modal (surveys, qualitative interviews) study to compare infant care practices that impact risk for sleep-related infant death in African-American and Hispanic families. RESULTS: We surveyed 422 African-American and 90 Hispanic mothers. Eighty-three African-American and 6 Hispanic mothers participated in qualitative interviews. African-American infants were more likely to be placed prone (p<0.001), share the bed with the parent (p<0.001), and to be exposed to smoke (p<0.001). Hispanic women were more likely to breastfeed (p<.001), while African-American women were more knowledgeable about SIDS. Qualitative interviews indicate that, although African-American and Hispanic parents had similar concerns, behaviors differed. DISCUSSION: Although the rationale for infant care decisions was similar for African-American and Hispanic families, practices differed. This may help to explain the racial/ethnic disparity seen in sleep-related infant deaths