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Article ; Online: Overuse of Primary Thromboprophylaxis in Medical Inpatients at Low Risk of Venous Thromboembolism.

Djulbegovic, Mia / Chen, Kevin / Sureshanand, Soundari / Chaudhry, Sarwat

2021 Volume 36, Issue 9, Page(s) 2883–2885

MeSH term(s)	Anticoagulants/adverse effects ; Heparin, Low-Molecular-Weight ; Humans ; Inpatients ; Risk ; Risk Assessment ; Risk Factors ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/prevention & control
Chemical Substances	Anticoagulants ; Heparin, Low-Molecular-Weight
Language	English
Publishing date	2021-01-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-020-05993-x
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Article ; Online: An Update on the "Novel" and Direct Oral Anticoagulants, and Long-Term Anticoagulant Therapy.

Djulbegovic, Mia / Lee, Alfred Ian

Clinics in chest medicine

2018 Volume 39, Issue 3, Page(s) 583–593

Abstract: The mainstay of treatment of venous thromboembolism (VTE) is anticoagulation. Direct oral anticoagulants (DOAC) have revolutionized anticoagulation management, although their efficacy and safety in specialized populations such as antiphospholipid ... ...

Abstract	The mainstay of treatment of venous thromboembolism (VTE) is anticoagulation. Direct oral anticoagulants (DOAC) have revolutionized anticoagulation management, although their efficacy and safety in specialized populations such as antiphospholipid syndrome, advanced renal disease, cancer thrombosis, and geriatric patients remain uncertain. Concerns about bleeding risks of DOACs persist despite reassuring data in the literature and the development of specific antidotes. In this article, the authors present an overview of the basic pharmacology of DOACs and discuss their use in acute VTE, secondary VTE prevention, and specialized VTE patient populations and discuss therapeutic monitoring and reversal in the event of major bleeding.
MeSH term(s)	Administration, Oral ; Anticoagulants/pharmacology ; Anticoagulants/therapeutic use ; Humans ; Venous Thromboembolism/drug therapy
Chemical Substances	Anticoagulants
Language	English
Publishing date	2018-08-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	447455-7
ISSN	1557-8216 ; 0272-5231
ISSN (online)	1557-8216
ISSN	0272-5231
DOI	10.1016/j.ccm.2018.04.010
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Article ; Online: Outcomes of Medicare Patients Admitted for Less Than 24 Hours: an Observational Study.

Chen, Kevin / Djulbegovic, Mia / Agarwal, Ritu / Chaudhry, Sarwat I

Journal of general internal medicine

2021 Volume 37, Issue 6, Page(s) 1558–1560

MeSH term(s)	Aged ; Hospitalization ; Humans ; Length of Stay ; Medicare ; United States/epidemiology
Language	English
Publishing date	2021-05-03
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-021-06822-5
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Article ; Online: The Patient Care Ownership Scale: Development of an Instrument to Measure Patient Care Ownership Among Internal Medicine Trainees.

Djulbegovic, Mia / Beckstead, Jason W / Fraenkel, Liana

Journal of general internal medicine

2019 Volume 34, Issue 8, Page(s) 1530–1537

Abstract: Background: Patient care ownership is essential to delivering high-quality medical care but appears to be eroding among trainees. The lack of an objective measure has limited the study of ownership in physicians.: Objective: To develop an instrument ... ...

Abstract	Background: Patient care ownership is essential to delivering high-quality medical care but appears to be eroding among trainees. The lack of an objective measure has limited the study of ownership in physicians. Objective: To develop an instrument to measure psychological ownership of patient care. Design: Cross-sectional study. Participants: Internal medicine trainees in a large, academic hospital completing an inpatient rotation. Main measures: Our scale prototype adapted an existing ownership scale (developed in the non-medical setting) based on themes identified in qualitative studies of patient care ownership. We conducted cognitive interviews to determine face validity of the scale items. Our finalized scale measures ownership's key constructs: advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, and perceived ownership. We distributed an online, anonymous, 46-question survey to 219 residents; 192 residents completed the survey; and 166 responses were included in the analysis. We calculated Cronbach's α to determine the scale's internal consistency. Exploratory factor analysis was used to explore possible subscales. We examined construct validity using bivariate and correlational analysis. Key results: The 15-item ownership scale demonstrated good internal consistency (Cronbach's α = 0.89). We identified three possible subscales corresponding to assertiveness, being the "go-to" person, and diligence. Training level and prior intensive care unit experience significantly predicted ownership (p < 0.01). There was no significant relationship between ownership and age, gender, inpatient service type, call schedule, patient turnover, or supervisory experience of the attending physician. We found a significant negative correlation between ownership and perceived degree of burnout (r = - 0.33), depression (r = - 0.24), detachment (r = - 0.35), and frustration (r = - 0.31) and a significant positive association between ownership and fulfillment (r = 0.37) and happiness (r = 0.36). Conclusion: We developed an instrument to quantify patient care ownership in residents. Our scale demonstrates good internal consistency and preliminary evidence of validity. With further validation, we expect this to be a valuable tool to evaluate interventions aimed at improving ownership.
MeSH term(s)	Adult ; Attitude of Health Personnel ; Female ; Humans ; Internal Medicine/education ; Internship and Residency ; Male ; Ownership ; Patient Care/psychology ; Qualitative Research ; Reproducibility of Results ; Surveys and Questionnaires/standards ; Young Adult
Language	English
Publishing date	2019-06-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-019-05066-8
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Article ; Online: Which patients with unprovoked venous thromboembolism should receive extended anticoagulation with direct oral anticoagulants? A systematic review, network meta-analysis, and decision analysis.

Djulbegovic, Mia / Lee, Alfred Ian / Chen, Kevin

Journal of evaluation in clinical practice

2019 Volume 26, Issue 1, Page(s) 7–17

Abstract: Introduction: Direct oral anticoagulants (DOACs) effectively prevent recurrent venous thromboembolism (VTE). However, it is unknown which agents should be used to prevent recurrent VTE and which patients with unprovoked VTE should receive extended ... ...

Abstract	Introduction: Direct oral anticoagulants (DOACs) effectively prevent recurrent venous thromboembolism (VTE). However, it is unknown which agents should be used to prevent recurrent VTE and which patients with unprovoked VTE should receive extended anticoagulation. We therefore sought to compare the efficacy and safety among DOACs for secondary prevention of VTE. We also determined a risk-adapted threshold for initiating extended anticoagulation based on the likelihood of VTE recurrence (without treatment) and bleeding (with treatment) in patients with unprovoked VTE. Methods: Our systematic review of randomized controlled trials compares extended anticoagulation with DOACs to another DOAC, aspirin, or placebo for the prevention of recurrent VTE. We searched PubMed, EMBASE, and Cochrane Registry of Controlled Trials (CENTRAL) in October 2018. Our outcomes of interest were VTE recurrence, major bleeding, and all clinically relevant bleeding. We used network meta-analysis to make indirect comparisons among DOACs. We populated the threshold decision-analytic model with data from our meta-analysis to determine the risk of VTE recurrence above which the benefits of extended anticoagulation outweigh the harms compared with no treatment. Results: We included four, high-quality, randomized trials comprising 8386 participants. Low-dose apixaban, full-dose apixaban, low-dose rivaroxaban, full-dose rivaroxaban, and dabigatran reduce VTE recurrence compared with placebo (RR = 0.19, 95% CI, 0.12-0.31; RR = 0.20, 95% CI, 0.12-0.32; RR = 0.08, 95% CI, 0.03-0.27; RR = 0.14, 95% CI, 0.06-0.35; RR = 0.19, 95% CI, 0.09-0.40, respectively). No DOACs increased major bleeding risk compared with placebo. A VTE recurrence risk above 0.3% to 0.4% at approximately 1 year is the threshold to treat a patient with unprovoked VTE with extended anticoagulation (with any DOAC). Conclusions: All DOACs exhibit comparable efficacy for the prevention of recurrent VTE. Given that the risk of VTE recurrence is much higher than the calculated threshold for treatment, extended thromboprophylaxis should be considered in all patients with unprovoked VTE who do not have increased bleeding risk.
MeSH term(s)	Administration, Oral ; Anticoagulants/adverse effects ; Decision Support Techniques ; Humans ; Network Meta-Analysis ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/prevention & control
Chemical Substances	Anticoagulants
Language	English
Publishing date	2019-06-12
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1327355-3
ISSN	1365-2753 ; 1356-1294
ISSN (online)	1365-2753
ISSN	1356-1294
DOI	10.1111/jep.13194
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Article ; Online: Translating and validating a Japanese version of the Patient Care Ownership Scale: a multicenter cross-sectional study.

Fujikawa, Hirohisa / Son, Daisuke / Kondo, Kayo / Djulbegovic, Mia / Takemura, Yousuke / Eto, Masato

BMC medical education

2021 Volume 21, Issue 1, Page(s) 415

Abstract: Background: Patient care ownership (PCO) is an essential component in medical professionalism and is crucial for delivering high-quality care. The 15-item PCO Scale (PCOS) is a validated questionnaire for quantifying PCO in residents; however, no ... ...

Abstract	Background: Patient care ownership (PCO) is an essential component in medical professionalism and is crucial for delivering high-quality care. The 15-item PCO Scale (PCOS) is a validated questionnaire for quantifying PCO in residents; however, no corresponding tool for assessing PCO in Japan exists. This study aimed to develop a Japanese version of the PCOS (J-PCOS) and validate it among Japanese medical trainees. Methods: We performed a multicenter cross-sectional survey to test the validity and reliability of the J-PCOS. The study sample was trainees of postgraduate years 1-5 in Japan. The participants completed the J-PCOS questionnaire. Construct validity was assessed through exploratory and confirmatory factor analyses. Internal consistency reliability was examined by calculating Cronbach's alpha coefficients and inter-item correlations. Results: During the survey period, 437 trainees at 48 hospitals completed the questionnaire. Exploratory factor analysis of the J-PCOS extracted four factors: assertiveness, sense of ownership, diligence, and being the "go-to" person. The second factor had not been identified in the original PCOS, which may be related to a unique cultural feature of Japan, namely, a historical code of personal conduct. Confirmatory factor analysis supported this four-factor model, revealing good model fit indices. The analysis results of Cronbach's alpha coefficients and inter-item correlations indicated adequate internal consistency reliability. Conclusions: We developed the J-PCOS and examined its validity and reliability. This tool can be used in studies on postgraduate medical education. Further studies should confirm its robustness and usefulness for improving PCO.
MeSH term(s)	Cross-Sectional Studies ; Humans ; Japan ; Ownership ; Patient Care ; Psychometrics ; Reproducibility of Results ; Surveys and Questionnaires ; Translating
Language	English
Publishing date	2021-08-03
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-021-02853-y
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Article ; Online: Adding caplacizumab to standard of care in thrombotic thrombocytopenic purpura: a systematic review and meta-analysis.

Djulbegovic, Mia / Tong, Jiayi / Xu, Alice / Yang, Joanna / Chen, Yong / Cuker, Adam / Pishko, Allyson M

Blood advances

2022 Volume 7, Issue 10, Page(s) 2132–2142

Abstract: Immune thrombotic thrombocytopenic purpura (iTTP) is an acquired, fatal microangiopathy if untreated. Randomized controlled trials (RCTs) demonstrated faster time to response with addition of caplacizumab to standard of care (SOC). However, concerns ... ...

Abstract	Immune thrombotic thrombocytopenic purpura (iTTP) is an acquired, fatal microangiopathy if untreated. Randomized controlled trials (RCTs) demonstrated faster time to response with addition of caplacizumab to standard of care (SOC). However, concerns about RCT selection bias and the high cost of caplacizumab warrant examination of all evidence, including real-world observational studies. In this systematic review and meta-analysis, we searched for comparative studies evaluating SOC with or without caplacizumab for the treatment of iTTP. We assessed risk of bias using the Cochrane risk-of-bias-2 tool (RCTs) and the Newcastle-Ottawa Scale (observational studies). The primary efficacy and safety outcomes were all-cause mortality and treatment-emergent bleeding, respectively. Secondary outcomes included exacerbation and relapse, refractory iTTP, and time to response. We included 2 high-quality RCTs and 3 observational studies at high risk of bias comprising 632 total participants. Compared with SOC, caplacizumab was associated with a nonsignificant reduction in the relative risk [RR] of death in RCTs (RR, 0.21; 95% confidence interval [CI], 0.05-1.74) and observational studies (RR, 0.62; 95% CI, 0.07-4.41). Compared with SOC, caplacizumab was associated with an increased bleeding risk in RCTs (RR, 1.37; 95% CI, 1.06-1.77). In observational studies, bleeding risk was not significantly increased (RR, 7.10; 95% CI, 0.90-56.14). Addition of caplacizumab was associated with a significant reduction in refractory iTTP and exacerbation risks and shortened response time but increased relapse risk. Frontline addition of caplacizumab does not significantly reduce all-cause mortality compared with SOC alone, although it reduces refractory disease risk, shortens time to response, and improves exacerbation rates at the expense of increased relapse and bleeding risk.
MeSH term(s)	Humans ; Purpura, Thrombotic Thrombocytopenic/drug therapy ; Standard of Care ; Neoplasm Recurrence, Local ; Hemorrhage ; Purpura, Thrombocytopenic, Idiopathic
Chemical Substances	caplacizumab (2R27AB6766)
Language	English
Publishing date	2022-09-01
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2915908-8
ISSN	2473-9537 ; 2473-9529
ISSN (online)	2473-9537
ISSN	2473-9529
DOI	10.1182/bloodadvances.2022008443
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Article ; Online: Associations between hospitalist physician workload, length of stay, and return to the hospital.

Djulbegovic, Mia / Chen, Kevin / Cohen, Andrew B / Heacock, Daniel / Canavan, Maureen / Cushing, William / Agarwal, Ritu / Simonov, Michael / Chaudhry, Sarwat I

Journal of hospital medicine

2022 Volume 17, Issue 6, Page(s) 445–455

Abstract: Background: Hospitalist physicians' workload-the total number of patients they care for daily-is rising in the U.S. Hospitalists report that increased workload negatively affects patients care.: Objective: Measure the associations between hospitalist ...

Abstract	Background: Hospitalist physicians' workload-the total number of patients they care for daily-is rising in the U.S. Hospitalists report that increased workload negatively affects patients care. Objective: Measure the associations between hospitalist physicians' workload and clinical outcomes. Design, settings, and participants: Observational study, using electronic health record (EHR) data, of adults hospitalized on the hospitalist service at Yale-New Haven Hospital from 2015-2018. Main outcome and measures: We defined hospitalists' workload as the number of patients they cared for on the first full hospital day of a given patient's encounter. We used multilevel Poisson and logistic regression to examine associations between workload and length of stay (LOS), return to the Emergency Department (ED), and readmission. We adjusted for sociodemographic factors, patient complexity and severity of illness, and weekend admission (for LOS) or discharge (for ED visits or readmission). Results: We analyzed 38,141 hospitalizations. Median patient age was 64 years (IQR 51-78 years), 53% were female, and 34% were nonwhite. Mean workload was 15 patients (SD 3 patients; range 10-34 patients). LOS was prolonged by 0.05 days (95% CI 0.02, 0.08; p(0.001) when comparing the 75th workload percentile (16 patients) to the 25th workload percentile (13 patients). There were no associations between workload and ED visits or readmission within 7 and 30 days. Conclusions: There was a statistically significant but modest relationship between workload and LOS; workload was not associated with ED visits or readmissions.Given clinical reports of the deleterious effects of increased hospitalist workload, there is a need for prospective research assessing a range of outcomes, beyond those measurable in contemporary EHR data.
MeSH term(s)	Adult ; Aged ; Female ; Hospitalists ; Hospitals ; Humans ; Length of Stay ; Male ; Middle Aged ; Patient Readmission ; Retrospective Studies ; Workload
Language	English
Publishing date	2022-06-06
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2233783-0
ISSN	1553-5606 ; 1553-5592
ISSN (online)	1553-5606
ISSN	1553-5592
DOI	10.1002/jhm.12847
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Article ; Online: Translating and validating a Japanese version of the Patient Care Ownership Scale

Hirohisa Fujikawa / Daisuke Son / Kayo Kondo / Mia Djulbegovic / Yousuke Takemura / Masato Eto

BMC Medical Education, Vol 21, Iss 1, Pp 1-

a multicenter cross-sectional study

2021 Volume 7

Abstract: Abstract Background Patient care ownership (PCO) is an essential component in medical professionalism and is crucial for delivering high-quality care. The 15-item PCO Scale (PCOS) is a validated questionnaire for quantifying PCO in residents; however, no ...

Abstract	Abstract Background Patient care ownership (PCO) is an essential component in medical professionalism and is crucial for delivering high-quality care. The 15-item PCO Scale (PCOS) is a validated questionnaire for quantifying PCO in residents; however, no corresponding tool for assessing PCO in Japan exists. This study aimed to develop a Japanese version of the PCOS (J-PCOS) and validate it among Japanese medical trainees. Methods We performed a multicenter cross-sectional survey to test the validity and reliability of the J-PCOS. The study sample was trainees of postgraduate years 1–5 in Japan. The participants completed the J-PCOS questionnaire. Construct validity was assessed through exploratory and confirmatory factor analyses. Internal consistency reliability was examined by calculating Cronbach’s alpha coefficients and inter-item correlations. Results During the survey period, 437 trainees at 48 hospitals completed the questionnaire. Exploratory factor analysis of the J-PCOS extracted four factors: assertiveness, sense of ownership, diligence, and being the “go-to” person. The second factor had not been identified in the original PCOS, which may be related to a unique cultural feature of Japan, namely, a historical code of personal conduct. Confirmatory factor analysis supported this four-factor model, revealing good model fit indices. The analysis results of Cronbach’s alpha coefficients and inter-item correlations indicated adequate internal consistency reliability. Conclusions We developed the J-PCOS and examined its validity and reliability. This tool can be used in studies on postgraduate medical education. Further studies should confirm its robustness and usefulness for improving PCO.
Keywords	Patient care ownership ; Patient ownership ; Professionalism ; Resident ; Trainee ; Duty hour restriction ; Special aspects of education ; LC8-6691 ; Medicine ; R
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Implications of the principle of question propagation for comparative-effectiveness and "data mining" research.

Djulbegovic, Mia / Djulbegovic, Benjamin

JAMA

2011 Volume 305, Issue 3, Page(s) 298–299

MeSH term(s)	Clinical Medicine/trends ; Comparative Effectiveness Research ; Data Mining ; Health Services Research/trends ; Medical Laboratory Science/trends ; Registries ; Research Design
Language	English
Publishing date	2011-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2010.2013
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