Physicians-in-training are challenged every day with grueling academic requirements, job strain, and patient safety concerns. Residency shapes the skills and values that will percolate to patient ...care and professional character. Unfortunately, impediments to the educational process due to medical resident mistreatment by bullying remain highly prevalent in training today.
A PubMed literature review was undertaken using key terms to help define resident mistreatment by bullying, determine its prevalence, identify its potential causes and sequelae, and find suggestions for changing this detrimental culture of medical training.
We identified 62 relevant articles. The most frequently noted form of mistreatment was verbal abuse, with the most common perpetrators being fellow physicians of higher hierarchical power. Mistreatment exists due to its cyclical nature and the existing culture of medical training. These disruptive behaviors affect the wellbeing of both medical residents and patients.
This article highlights the importance of creating systems that educate physicians-in-training about professional mistreatment by bullying and the imperative in recognizing and correcting these abuses. Resident bullying leads to increased resident stress, decreased resident wellbeing as well as risks to patient safety and increased healthcare costs. Solutions include education of healthcare team members, committee creation, regulation of feedback, and creation of a zero-tolerance policy focused on the health of both patients and residents. Altering workplace attitudes will diminish the detrimental effects that bullying has on resident training.
The emergent identity of the specialty area of public health and general preventive medicine (PH-GPM),1 referred to as preventive medicine (PM) in this paper, spawns from several historical and ...contemporary trends. The tripartite birth of the specialty, resulting in its three specialty areas with distinct names (i.e., PH and aerospace medicine in 1949, occupational medicine in 1953, GPM in 1957, and its merger with PH in 1983 for examination purposes),2 makes any unified branding attempt challenging. Because PM draws from both PH and medicine as distinct fields of knowledge, many longstanding dichotomies exist among its practitioners, including whether to pursue clinical or non-clinical work, emphasize PH or GPM,1,3,4 and prioritize community and population medicine or lifestyle and clinical PM.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purpose: Eye injuries occur frequently in the United States resulting in vision loss. Protective eyewear (PE) is a simple, effective way to prevent these injuries. The study aims to evaluate ...characteristics associated with no PE usage in hopes to better understand factors that may be targeted to alleviate future injuries.
Methods: Individuals from the 2016 National Health Interview Survey (NHIS) who performed recreational activities that could cause eye injury were divided into two groups - those with and without PE usage during these activities - and compared on several variables consisting of age group, gender, race, family income, ability to afford eyeglasses, employment, wearing of corrective lenses, and visitation with general and eye care providers. Statistical analyses were performed with SAS controlling for the complex same design via chi-square tests and logistic regression.
Results: From a total of 8,199 subjects, those who are female, Asian, black, Hispanic, ages 18-24 years old, have a family income <$35,000, unemployed, not wearers of corrective lenses, and have not seen a general or eye care provider showed increased no PE usage according to chi-square analysis. With multivariate analysis, only race, gender, age, and wearing of corrective lenses correlated to PE usage.
Conclusions: Comparing 2002 and 2016 NHIS, PE usage had increased from 34.7% to 65.1%. Individuals who were younger, female, of a minority race, or who did not wear corrective lenses had increased odds of not using PE during recreational activities. Prevention should target these associated groups in efforts to reduce recreational eye injuries.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To evaluate the dynamic remodeling of drusen in subjects with unilateral neovascular age-related macular degeneration (AMD) receiving a three-year course of oral docosahexaenoic acid (DHA) or ...placebo.
Institutional setting.
Three hundred subjects with age-related maculopathy and neovascular AMD in the fellow eye were randomly assigned to receive either 840 mg/day DHA or placebo for 3 years. Main outcome measures of this post-hoc sub-group analysis were progression of drusen number, total diameter, and total area on fundus photography, and their association with DHA supplementation, socio-demographic and genetic characteristics.
Drusen progression was analyzed in 167 subjects that did not develop CNV (87 that received DHA and 80 that received placebo). None of the drusen remodeling outcomes were significantly associated with DHA supplementation. Total drusen diameter reduction in the inner subfield was significantly associated with age (older patients: r = -0.17; p = 0.003). Women showed a tendency to decreased total drusen diameter in the inner subfield with CFH polymorphism (p = 0.03), where women with TT genotype tended to have a greater reduction in drusen diameter than other genotypes (CC and CT). Drusen area in the inner subfield was more reduced in older patients (r = -0.17) and in women (p = 0.01). Drusen number showed no significant trends.
Dynamic drusen remodeling with net reduction in drusen load over three years was found in patients with exudative AMD in one eye and drusen in the other eye (study-eye). This reduction was correlated with increased age and female gender, and showed a tendency to be influenced by CFH genotype, but did not appear to be affected by DHA supplementation.
Controlled-Trials.com ISRCTN98246501.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To systematically evaluate the incremental predictive value of cardiac computed tomographic (CT) angiography beyond the assessment of coronary artery calcium (CAC) in patients who present with acute ...chest pain but without evidence of acute coronary syndrome (ACS).
The human research committee approved this study and waived the need for individual written informed consent. The study was HIPAA compliant. A total of 458 patients (36% male; mean age, 55 years ± 11) with acute chest pain at low to intermediate risk for coronary artery disease underwent coronary calcification assessment with cardiac CT angiography. All patients who did not experience ACS at index hospitalization were followed for instances of a major adverse cardiac event (MACE), such as a myocardial infarct, revascularization, cardiac death, or angina requiring hospitalization. CAC score and cardiac CT angiography were used to derive the presence and extent of atherosclerotic plaque (calcified, noncalcified, or mixed), and obstructive lesions (>50% luminal narrowing) were related to outcomes by using univariate and adjusted Cox proportional hazards models.
Of the 458 patients, 70 (15%) experienced MACE (median follow-up, 13 months). Patients with no plaque at cardiac CT angiography remained free of events during the follow-up period, while 11 (5%) of 215 patients with no CAC had MACE. The extent of plaque was the strongest predictor of MACE independent of traditional risk factors (hazard ratio HR, 151.77 for four or more segments containing plaque as compared with those containing no plaque; P < .001). Patients with mixed plaque were more likely to experience MACE (HR, 86.96; P = .002) than those with exclusively noncalcified plaque (HR, 58.06; P = .005) or exclusively calcified plaque (HR, 32.94; P = .02).
The strong prognostic value of cardiac CT angiography is incremental to its known diagnostic value in patients with acute chest pain without ACS and is independent of traditional risk factors and CAC.
Following a reviews of adult models of leadership and of leadership programs for young people that are derived from adult theories of leadership, we report results from a decade-long study in ...under-served and at-risk communities of young people identified and promoted as leaders within out-of-school youth organizations. This work reveals how emerging youth leadership differs from established measures and leadership theories drawn from adults. Views and enactments of leadership among the young focus on how leadership happens, not all who leaders are as power figures, skillful managers, or individuals bearing specific traits. These perspectives from youth carry strong links to recent work in cognitive psychology and organizational sociology that maintains the key importance of adaptation, engagement with situation, and distribution of knowledge and roles.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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