Time is of the essence: an observational time-motion study of internal medicine residents while they are on duty

Background: The effects of changes to resident physician duty hours need to be measureable. This time-motion study was done to record internal medicine residents’ workflow while on duty and to determine the feasibility of capturing detailed data using a mobile electronic tool.Methods: Junior and senior residents were shadowed by a single observer during six-hour blocks of time, covering all seven days. Activities were recorded in real-time. Eighty-nine activities grouped into nine categories were determined a priori.Results: A total of 17,714 events were recorded, encompassing 516 hours of observation. Time was apportioned in the following categories: Direct Patient Care (22%), Communication (19%), Personal tasks (15%), Documentation (14%), Education (13%), Indirect care (11%), Transit (6%), Administration (0.6%), and Non-physician tasks (0.4%). Nineteen percent of the education time was spent in self-directed learning activities. Only 9% of the total on duty time was spent in the presence of patients. Sixty-five percent of communication time was devoted to information transfer. A total of 968 interruptions were recorded which took on average 93.5 seconds each to service.Conclusion: Detailed recording of residents’ workflow is feasible and can now lead to the measurement of the effects of future changes to residency training. Education activities accounted for 13% of on-duty time.

Effects of intensive glycaemic control on ischaemic heart disease: analysis of data from the randomised, controlled ACCORD trial

The possibility that hyperglycemia accounts for the 2–3 fold higher risk of ischemic heart disease (IHD) in type 2 diabetes was explored by assessing the effect of intensive glucose lowering on IHD in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial

A web-based simulation of a longitudinal clinic used in a 4-week ambulatory rotation: a cohort study

<p>Abstract</p> <p>Background</p> <p>Residency training takes place primarily on inpatient wards. In the absence of a resident continuity clinic, internal medicine residents rely on block rotations to learn about continuity of care. Alternate methods to introduce continuity of care are needed.</p> <p>Methods</p> <p>A web-based tool, Continuity of Care Online Simulations (COCOS), was designed for use in a one-month, postgraduate clinical rotation in endocrinology. It is an interactive tool that simulates the continuing care of any patient with a chronic endocrine disease. Twenty-three residents in internal medicine participated in a study to investigate the effects of using COCOS during a clinical rotation in endocrinology on pre-post knowledge test scores and self-assessment of confidence.</p> <p>Results</p> <p>Compared to residents who did the rotation alone, residents who used COCOS during the rotation had significantly higher improvements in test scores (% increase in pre-post test scores +21.6 [standard deviation, SD, 8.0] vs. +5.9 [SD 6.8]; p < .001). Test score improvements were most pronounced for less commonly seen conditions. There were no significant differences in changes in confidence. Residents rated COCOS very highly, recommending its use as a standard part of the rotation and throughout residency.</p> <p>Conclusion</p> <p>A stand-alone web-based tool can be incorporated into an existing clinical rotation to help residents learn about continuity of care. It has the most potential to teach residents about topics that are less commonly seen during a clinical rotation. The adaptable, web-based format allows the creation of cases for most chronic medical conditions.</p

Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study.

OBJECTIVE: To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD. RESEARCH DESIGN AND METHODS: Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA RESULTS: Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%, CONCLUSIONS: CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD

Serum fetuin-A levels following recombinant human thyroid-stimulating hormone stimulation

Purpose: Fetuin-A is a hepatokine that is linked to lipid metabolism, obesity, insulin resistance, type 2 diabetes and cardiovascular disease. Elevated thyroid-stimulating hormone (TSH) levels are associated with metabolic and cardiovascular disturbances. Our aim was to determine if TSH can regulate fetuin-A levels. Methods: Fetuin-A serum levels were examined in 26 subjects (19 women; previous thyroidectomy and radioactive iodine ablation) undergoing recombinant human TSH (rhTSH) stimulation to screen for thyroid cancer recurrence. Their age was 49±10 years, and body mass index (BMI) was 28±6 (both expressed as mean±SD). The patients received two doses of rhTSH (0.9 mg), administered 24 hours apart on days 1 and 2, without discontinuation of ongoing L-thyroxine therapy. Morning blood samples were obtained on days 1 (prior to the first dose of rhTSH), 3 and 5. Results: The baseline value of fetuin-A (mean±SD) for all participants was 527±186 mg/L. Values of fetuin-A did not change in response to rhTSH administration. The lack of response was not dependent on gender, age, baseline free thyroxine level or BMI. Conclusion: Fetuin-A has been implicated in metabolic and inflammatory conditions, but there have been no reports on whether fetuin-A is influenced by TSH. Within the context of rhTSH administration for surveillance of thyroid cancer recurrence, there was no effect on serum levels of fetuin-A

Les attributs valorisés chez les cliniciens enseignants et les défis à l’égard de l’obtention de la reconnaissance ou de récompenses pour leur performance et leurs réalisations : une revue narrative

Background: Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards. Methods: We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature. Results: We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. ‘Provides feedback’, ‘excellent communication skills’, ‘good supervision’, and ‘organizational skills’ were common cognitive attributes considered for recognition and rewards. ‘Stimulates’, ‘passionate and enthusiastic’, and ‘creates supportive environment’, were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers. Conclusions: The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.Contexte : Depuis 31 ans, nous sommes témoins d’efforts institutionnels visant à offrir aux cliniciens enseignants une plus grande reconnaissance et à récompenser leur travail. Cependant, d’après leur perception, la valorisation de leurs réalisations en matière d’enseignement clinique demeure insuffisante. Cette revue narrative a un double objectif : d’une part, repérer les qualités qui sont prises en considération en vue de l’octroi d’une reconnaissance officielle ou de l’attribution de récompenses (prix) aux cliniciens enseignants et d’autre part recenser les éléments qui empêchent certains candidats de se voir accorder une telle reconnaissance ou récompense. Méthodes : Nous avons effectué des recherches dans OVID Medline, Embase, Education Source et Web of Science pour repérer les articles pertinents publiés entre 1990 et 2020. Le contenu des résultats des 43 articles sélectionnés a ensuite été analysé pour dégager les principales tendances et questions abordées. Résultats : La plupart des articles pertinents se rapportaient au contexte des États-Unis. En revanche, peu d’articles pertinents concernaient celui du Canada. Sur le plan international, la question des qualités des cliniciens enseignants et des éléments qui peuvent les empêcher d’obtenir la reconnaissance ou une récompense suscite moins d’intérêt depuis 2010. Le fait « d’offrir de  la rétroaction », d’avoir « d’excellentes habiletés de communication », d’assurer une « bonne supervision », et un bon « sens de l’organisation » sont des compétences cognitives souvent considérées pour l’octroi de la reconnaissance et l’attribution de récompenses. Parmi les compétences non cognitives, on note le fait d’être « stimulant », d’être « passionné et enthousiaste » et de « créer un environnement offrant du soutien ». La dévalorisation de l’enseignement, le manque de critères clairs et l’utilisation de mesures d’évaluation peu fiables sont les principaux obstacles à l’octroi de la reconnaissance ou à l’attribution d’une récompense aux cliniciens enseignants. Conclusions : Les résultats de notre revue narrative mettent en évidence la nécessité de mener des recherches empiriques localement en matière de reconnaissance et de récompense afin d’éclairer les réformes locales des politiques et des pratiques dans le milieu spécifique où elles sont appliquées

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers’ performances and achievements: A narrative review

Background: Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards.Methods: We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature.Results: We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. ‘Provides feedback’, ‘excellent communication skills’, ‘good supervision’, and ‘organizational skills’ were common cognitive attributes considered for recognition and rewards. ‘Stimulates’, ‘passionate and enthusiastic’, and ‘creates supportive environment’, were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers.Conclusions: The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.Contexte : Depuis 31 ans, nous sommes témoins d’efforts institutionnels visant à offrir aux cliniciens enseignants une plus grande reconnaissance et à récompenser leur travail. Cependant, d’après leur perception, la valorisation de leurs réalisations en matière d’enseignement clinique demeure insuffisante. Cette revue narrative a un double objectif : d’une part, repérer les qualités qui sont prises en considération en vue de l’octroi d’une reconnaissance officielle ou de l’attribution de récompenses (prix) aux cliniciens enseignants et d’autre part recenser les éléments qui empêchent certains candidats de se voir accorder une telle reconnaissance ou récompense.Méthodes : Nous avons effectué des recherches dans OVID Medline, Embase, Education Source et Web of Science pour repérer les articles pertinents publiés entre 1990 et 2020. Le contenu des résultats des 43 articles sélectionnés a ensuite été analysé pour dégager les principales tendances et questions abordées.Résultats : La plupart des articles pertinents se rapportaient au contexte des États-Unis. En revanche, peu d’articles pertinents concernaient celui du Canada. Sur le plan international, la question des qualités des cliniciens enseignants et des éléments qui peuvent les empêcher d’obtenir la reconnaissance ou une récompense suscite moins d’intérêt depuis 2010. Le fait « d’offrir de  la rétroaction », d’avoir « d’excellentes habiletés de communication », d’assurer une « bonne supervision », et un bon « sens de l’organisation » sont des compétences cognitives souvent considérées pour l’octroi de la reconnaissance et l’attribution de récompenses. Parmi les compétences non cognitives, on note le fait d’être « stimulant », d’être « passionné et enthousiaste » et de « créer un environnement offrant du soutien ». La dévalorisation de l’enseignement, le manque de critères clairs et l’utilisation de mesures d’évaluation peu fiables sont les principaux obstacles à l’octroi de la reconnaissance ou à l’attribution d’une récompense aux cliniciens enseignants.Conclusions : Les résultats de notre revue narrative mettent en évidence la nécessité de mener des recherches empiriques localement en matière de reconnaissance et de récompense afin d’éclairer les réformes locales des politiques et des pratiques dans le milieu spécifique où elles sont appliquées

Lack of Evidence to Guide Deprescribing of Antihyperglycemics: A Systematic Review

<p><strong>Article full text</strong></p> <p><br> The full text of this article can be found <a href="https://link.springer.com/article/10.1007/s13300-016-0220-9"><b>here</b>.</a><br> <br> <strong>Provide enhanced digital features for this article</strong><br> If you are an author of this publication and would like to provide additional enhanced digital features for your article then please contact <u>[email protected]</u>.<br> <br> The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.<br> <br> Other enhanced features include, but are not limited to:<br> • Slide decks<br> • Videos and animations<br> • Audio abstracts<br> • Audio slides<u></u></p> <p> </p> <p> </p> <p> </p