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Author: Brian S McGowan, PhD

RESOURCE: Small, rural hospitals lag on some quality measures

Although fewer people are dying shortly after treatment for heart attacks, heart failure and pneumonia at most U.S. hospitals than a decade ago, the same trend doesn’t apply to certain small, rural facilities, a new study suggests.

So-called critical access hospitals – which have no more than 25 beds and are typically miles from the nearest other hospital – are exempt from reporting those sort of quality and outcomes data to the government.

via Small, rural hospitals lag on some quality measures – chicagotribune.com.

RESOURCE: Integrating EHR with medical education for improved care

Physicians and other healthcare providers are mandated to complete anywhere from 12 to 50 hours of continuing medical education (CME) yearly. The problem is that few clinicians know whether those hours of education have a meaningful impact on real-world patient outcomes. In other words, does learning a new diagnostic strategy or treatment option, for example, lead to patients living healthier lives with fewer medical complications?
We can do a better job of understanding the correlation between CME and better patient outcomes today. Utilization of electronic health record (EHR) systems to integrate clinical data analytics and CME will facilitate more prescriptive education designed to specifically meet gaps in knowledge and care while improving patient outcomes. Moreover, we can better design extended curriculums that best serve a clinician’s interest and define clinical care gaps by particular patient populations.

via Integrating EHR with medical education for improved care | EHRintelligence.com.

ABSTRACT: Social media in dermatology: moving to Web 2.0

Abstract
Patient use of social media platforms for accessing medical information has accelerated in parallel with overall use of the Internet. Dermatologists must keep pace with our patients’ use of these media through either passive or active means are outlined in detail for 4 specific social media outlets. A 5-step plan for active engagement in social media applications is presented. Implications for medical professionalism, Health Insurance Portability and Accountability Act compliance, and crisis management are discussed.

via Social media in dermatology: moving to … [Semin Cutan Med Surg. 2012] – PubMed – NCBI.

ABSTRACT: Why Don’t We Know Whether Care Is Safe?

Abstract

Reliable data are essential to ensuring that health care is delivered safely and appropriately. Yet the availability of reliable data on safety remains surprisingly poor, as does our knowledge of what it costs (and should cost) to generate such data. The authors suggest the following as priorities: (1) develop valid and reliable measures of the common causes of preventable deaths; (2) evaluate whether a global measure of safety is valid, feasible, and useful; (3) explore the incremental value of collecting data for each patient safety measure; (4) evaluate if/how patient safety reporting systems can be used to influence outcomes at all levels; (5) explore the value—and the unintended consequences—of creating a list of reportable events; (6) evaluate the infrastructure required to monitor patient safety; and (7) explore the validity and usefulness of measurements of patient safety climate.

via Why Don’t We Know Whether Care Is Safe?.

MANUSCRIPT: Tweeting the meeting: an in-depth analysis of Twitter activity at Kidney Week 2011

Abstract
In recent years, the American Society of Nephrology (ASN) has increased its efforts to use its annual conference to inform and educate the public about kidney disease. Social media, including Twitter, has been one method used by the Society to accomplish this goal. Twitter is a popular microblogging service that serves as a potent tool for disseminating information. It allows for short messages (140 characters) to be composed by any author and distributes those messages globally and quickly. The dissemination of information is necessary if Twitter is to be considered a tool that can increase public awareness of kidney disease. We hypothesized that content, citation, and sentiment analyses of tweets generated from Kidney Week 2011 would reveal a large number of educational tweets that were disseminated to the public. An ideal tweet for accomplishing this goal would include three key features: 1) informative content, 2) internal citations, and 3) positive sentiment score. Informative content was found in 29% of messages, greater than that found in a similarly sized medical conference (2011 ADA Conference, 16%). Informative tweets were more likely to be internally, rather than externally, cited (38% versus 22%, p<0.0001), thereby amplifying the original information to an even larger audience. Informative tweets had more negative sentiment scores than uninformative tweets (means -0.162 versus 0.199 respectively, p<0.0001), therefore amplifying a tweet whose content had a negative tone. Our investigation highlights significant areas of promise and improvement in using Twitter to disseminate medical information in nephrology from a scientific conference. This goal is pertinent to many nephrology-focused conferences that wish to increase public awareness of kidney disease.

via Tweeting the meeting: an in-depth analysis of Twitt… [PLoS One. 2012] – PubMed – NCBI.

MANUSCRIPT: Verification in referral-based crowdsourcing

Abstract
Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through “referral-based crowdsourcing”: the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge.

via Verification in referral-based crowdsourcing. [PLoS One. 2012] – PubMed – NCBI.

ABSTRACT: Physician preferences for accredited online continuing medical education

Abstract
INTRODUCTION:
The need for up-to-date and high-quality continuing medical education (CME) is growing while the financial investment in CME is shrinking. Despite online technology’s potential to efficiently deliver electronic CME (eCME) to large numbers of users, it has not yet displaced traditional CME. The purpose of this study was to explore what health care providers want in eCME and how they want to use it.
METHODS:
This was a qualitative study. Two 3-hour focus groups were held with physicians in both academic and community practices as well as trainees knowledgeable in the hypertension clinical practice guidelines with a willingness to discuss eCME. Content/thematic analysis was used to examine the data.
RESULTS:
Three main themes emerged: credibility, content/context, and control. Credibility was the most consistent and dominant theme. Affiliations with medical organizations and accreditation were suggested as methods by which eCME can gain credibility. The content and need for discussion of the content emerged as a key pivot point between eCME and traditional CME: a greater need for discussion was linked to a preference for traditional face-to-face CME. Control over the content and how it was accessed was an emergent theme, giving learners the ability to control the depth of learning and the time spent. They valued the ability to quickly find information that was in a format (podcast, video, mobile device) that best suited their learning needs or preferences at the time.
DISCUSSION:
This study provides insight into physician preferences for eCME and hypotheses that can be used to guide further research.

via Physician preferences for accredit… [J Contin Educ Health Prof. 2011] – PubMed – NCBI.

MANUSCRIPT: Good experiences with an audience response system used in medical education

Abstract
INTRODUCTION:
Audience response systems (ARS) are increasingly being used to heighten participants’ involvement. Knowledge of technical and pedagogical challenges is, however, limited. The purpose of this paper is to evaluate ARS as a tool for 1) evaluation, 2) knowledge testing, 3) attention raising and 4) discussion stimulation.
MATERIAL AND METHODS:
ARS was used 33 times at four different courses. Data include voting results, observations, questionnaires and interviews.
RESULTS:
A total of 215 participants and 12 teachers were included. The majority of the participants found ARS suitable for course evaluation. The teachers found it useful for obtaining the results immediately and thereby for receiving feedback on their own teaching. The participants and the teachers found ARS suitable for knowledge testing. ARS was used as an instrument to increase activity and attention. The system was found to increase the level of concentration and the interactivity. ARS was used to initiate discussions. The participants found that the questions could be a good starting point for discussion. The teachers found it challenging to comment on answers. Our experiences are that thorough planning and preparation is needed for the successful implementation of ARS.
CONCLUSION:
Our experiences indicate that ARS is suitable for course evaluation. Overall, we find ARS a valuable technology that may stimulate discussion and support learning, but teachers need to be technically and pedagogically well prepared to use the tool. The use of ARS does not in itself entail that the quality of the teaching increases.

via Good experiences with an audience response syst… [Dan Med Bull. 2011] – PubMed – NCBI.

ABSTRACT: Physicians’ self-assessment of cancer pain treatment skills–more training required.

Abstract
PURPOSE:
Adequate pain control is essential in cancer treatment. We surveyed Finnish physicians’ perception on their skills and training needs on palliative pain management.
METHODS:
A structured questionnaire with multiple choices and open ended questions was used for collecting data in 2006-2008. Of 720 physicians participating, 59 were working in oncology and 661 physicians in internal medicine, geriatrics, and primary health care.
RESULTS:
The principles of the WHO guidelines of cancer pain management were not well known. Forty-six percent of oncologists and 32% of other physicians (P < 0.0001) knew the analgesic ladder consisting of three steps. Forty-seven percent of oncologists and 61% of other physicians considered pain treatment of cancer patients being well managed in Finland. Only 24% of oncologists and 5% of other physicians considered the education in palliative care being currently at a satisfactory level. Oncologists reported a need of training in interaction and communication skills, ethical questions, and palliative home care. The other physicians expressed the strongest need for training in pain management and palliative care.
CONCLUSIONS:
To have more confidence in treating cancer, pain physicians would benefit in training and education in palliative care. It should be systematically included both in general and specialist training and continuous medical education.

via Physicians’ self-assessment of cancer pa… [Support Care Cancer. 2012] – PubMed – NCBI.

ABSTRACT: Creating a virtual pharmacology curriculum in a problem-based learning environment: one medical school’s experience.

Abstract
Integrating pharmacology education into a problem-based learning (PBL) curriculum has proven challenging for many medical schools, including the Pennsylvania State University College of Medicine (Penn State COM). In response to pharmacology content gaps in its PBL-intensive curriculum, Penn State COM in 2003 hired a director of medical pharmacology instruction to oversee efforts to improve the structure of pharmacology education in the absence of a stand-alone course. In this article, the authors describe the ongoing development of the virtual pharmacology curriculum, which weaves pharmacology instruction through the entire medical school curriculum with particular emphasis on the organ-based second year. Pharmacology is taught in a spiraling manner designed to add to and build upon students’ knowledge and competency. Key aspects of the virtual curriculum (as of 2011) include clearly stated and behaviorally oriented pharmacology learning objectives, pharmacology study guides that correspond to each PBL case, pharmacology review sessions that feature discussions of United States Medical Licensing Examination (USMLE)-type questions, and pharmacology questions for each PBL case on course examinations to increase student accountability. The authors report a trend toward improved USMLE Step 1 scores since these initiatives were introduced. Furthermore, graduates’ ratings of their pharmacology education have improved on the Medical School Graduation Questionnaire. The authors suggest that the initiatives they describe for enhancing pharmacology medical education are relevant to other medical schools that are also seeking ways to better integrate pharmacology into PBL-based curricula.

via Creating a virtual pharmacology curriculum in a pro… [Acad Med. 2013] – PubMed – NCBI.