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  1. Article ; Online: Video-Based (Livestream) and In-Person Continuing Professional Development: Participant and Course Features Associated With Choice.

    Cook, David A / Pendl, Aaron K / Pankratz, V Shane

    Academic medicine : journal of the Association of American Medical Colleges

    2023  Volume 98, Issue 8, Page(s) 949–957

    Abstract: Purpose: Information on factors influencing learner choice between in-person and video-based continuing professional development (CPD) would help course leaders with planning and implementation. This study aimed to investigate how registration patterns ... ...

    Abstract Purpose: Information on factors influencing learner choice between in-person and video-based continuing professional development (CPD) would help course leaders with planning and implementation. This study aimed to investigate how registration patterns differ between in-person and video-based offerings for the same CPD course.
    Method: The authors obtained data from 55 CPD courses offered in-person (at various U.S. locations) and via livestreamed video, January 2020 to April 2022. Participants included physicians, advanced practice providers, allied health professionals, nurses, and pharmacists. Registration rates were compared by participant and course features including professional role, age, country of residence, distance to and perceived desirability of the in-person destination, and timing of registration.
    Results: Analyses included 11,072 registrations, of which 4,336 (39.2%) were for video-based learning. There was significant heterogeneity in video-based registrations across courses, ranging 14.3% to 71.4%. Multivariable analysis showed higher video-based registrations for advanced practice providers (vs physicians; adjusted odds ratio [AOR] 1.80 [99% confidence interval, 1.55-2.10]), non-U.S. residents (AOR 3.26 [1.18-9.01]), longer distance (AOR 1.19 [1.16-1.23] for each doubling of distance), and courses in July-September 2021 (vs January-April 2022; AOR 1.59 [1.24-2.02]); video-based registrations were lower for current or former employees or trainees of our institution (AOR 0.53 [0.45-0.61]), destinations of moderate or high desirability (vs low; AOR 0.42 [0.34-0.51] and 0.44 [0.33-0.58], respectively), and early registration (AOR 0.67 [0.64-0.69] for each doubling of days between registration and course start). There was no significant difference by age (AOR 0.92 [0.82-1.05] for participants > 46 years old vs younger participants). The multivariable model correctly predicted actual registration 78.5% of the time.
    Conclusions: Video-based livestreamed CPD is popular (chosen by nearly 40% of participants), although choices varied widely by course. Professional role, institutional affiliation, distance traveled, location desirability, and registration timing have small but statistically significant associations with choice of video-based vs in-person CPD.
    MeSH term(s) Humans ; Middle Aged ; Allied Health Personnel/education ; Physicians ; Data Collection ; Pharmacists
    Language English
    Publishing date 2023-02-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 96192-9
    ISSN 1938-808X ; 1040-2446
    ISSN (online) 1938-808X
    ISSN 1040-2446
    DOI 10.1097/ACM.0000000000005174
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Autonomy and focus of attention in medical motor skills learning: a randomized experiment.

    Pollok, Franziska / Cook, David A / Shaikh, Nizamuddin / Pankratz, V Shane / Morrey, Mark E / Laack, Torrey A

    BMC medical education

    2022  Volume 22, Issue 1, Page(s) 46

    Abstract: Background: The 'OPTIMAL' (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning suggests that autonomy, external focus of attention, and perceived competence can improve learning of simple motor tasks. ...

    Abstract Background: The 'OPTIMAL' (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning suggests that autonomy, external focus of attention, and perceived competence can improve learning of simple motor tasks. The authors hypothesized that enhanced (vs. routine) autonomy and external (vs. internal) focus of attention would improve first-try performance of two medical motor tasks.
    Methods: The authors conducted a randomized two-by-two factorial design study with high school students as participants. Task instructions promoted either enhanced or routine autonomy, and either external or internal focus of attention. These conditions were replicated in a crossover design for two common medical tasks (chest compressions on a manikin and a Fundamentals of Laparoscopic Surgery peg transfer task). Primary outcomes were objective measures of task performance (chest compression deviation from target depth; peg transfer time with penalties for errors). Secondary outcomes included subjective perceptions of confidence, autonomy, and workload.
    Results: One hundred thirty-three high school students participated in this study. The primary outcomes concerning enhanced vs. routine autonomy demonstrated no statistically significant difference in either task (chest compression depth deviation: difference -0.7 mm [score range 0 to 37.5 mm]; 95% confidence interval (CI95) -3.85, 2.41; p = .65; peg transfer penalized time: rate ratio 1.03; CI95 0.91, 1.31; p = .79). The authors likewise found no statistically significant difference for external vs. internal focus of attention (depth deviation: difference 1.1 mm; CI95 -2.04, 4.17; p = .50; penalized time: rate ratio 0.89; CI95 0.75, 1.13; p = .33). The authors found no statistically significant differences for either comparison in confidence, autonomy and workload (p > .09; differences ranged from -0.83 to 0.79 [scale range 0 to 10]).
    Conclusions: First-try performance of chest compressions and peg transfer by novice learners is not significantly affected by enhanced (vs. routine) autonomy or external (vs. internal) focus of attention.
    MeSH term(s) Attention ; Humans ; Learning ; Motivation ; Motor Skills ; Task Performance and Analysis
    Language English
    Publishing date 2022-01-19
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/s12909-021-03020-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Sessile serrated lesion detection rates continue to increase: 2008-2020.

    Edwardson, Nicholas / Adsul, Prajakta / Gonzalez, Zorisadday / Pankratz, V Shane / Parasher, Gulshan / English, Kevin / Mishra, Shiraz

    Endoscopy international open

    2023  Volume 11, Issue 1, Page(s) E107–E116

    Abstract: Background and study ... ...

    Abstract Background and study aims
    Language English
    Publishing date 2023-01-26
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2761052-4
    ISSN 2196-9736 ; 2364-3722
    ISSN (online) 2196-9736
    ISSN 2364-3722
    DOI 10.1055/a-1990-0509
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: A pilot randomized, placebo-controlled, double-blind study of omega-3 fatty acids to prevent paclitaxel-associated acute pain syndrome in breast cancer patients: Alliance A22_Pilot2.

    Tawfik, Bernard / Dayao, Zoneddy R / Brown-Glaberman, Ursa Abigail / Pankratz, V Shane / Lafky, Jacqueline M / Loprinzi, Charles L / Barton, Debra L

    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

    2023  Volume 31, Issue 12, Page(s) 637

    Abstract: Purpose: Paclitaxel is associated with an acute pain syndrome (P-APS- and chronic chemotherapy-induced peripheral neuropathy (CIPN). P-APS is associated with higher risk of CIPN. Omega-3 fatty acids have well-established anti-inflammatory and ... ...

    Abstract Purpose: Paclitaxel is associated with an acute pain syndrome (P-APS- and chronic chemotherapy-induced peripheral neuropathy (CIPN). P-APS is associated with higher risk of CIPN. Omega-3 fatty acids have well-established anti-inflammatory and neuroprotective properties. The primary purpose of this pilot study was to assess whether omega-3 fatty acids could decrease P-APS and thus CIPN.
    Methods: Patients scheduled to receive weekly paclitaxel for breast cancer were randomized to receive 4 g of omega-3 acid ethyl esters (Lovaza) or placebo, beginning 1 week prior and continued until paclitaxel was stopped. Patients completed acute pain questionnaires at baseline, daily after each treatment, and 1 month after completion of therapy.
    Results: Sixty patients (49 evaluable) were randomized to treatment versus placebo. Seventeen (68.0%) patients receiving the omega-3 fatty acids intervention experienced P-APS, compared to 15 (62.5%) of those receiving placebo during the first week of treatment (p = 0.77). Over the full 12-week study, 21 (84.0%) patients receiving the omega-3 fatty acid intervention experienced P-APS, compared to 21 (87.5%) of those receiving placebo (p = 1.0). Secondary outcomes suggested that those in the intervention arm used more over-the-counter analgesics (OR: 1.65, 95% CI: 0.72-3.78, p = 0.23), used more opiates (OR: 2.06, 95% CI: 0.55-7.75, p = 0.28), and experienced higher levels of CIPN (12.8, 95% CI: 7.6-19.4 vs. 8.4, 95% CI: 4.6-13.2, p = 0.21).
    Conclusions: The results of this pilot study do not support further study of the use of omega-3 fatty acids for the prevention of the P-APS and CIPN.
    Trial registration: Number: NCT01821833.
    MeSH term(s) Humans ; Female ; Paclitaxel ; Breast Neoplasms/drug therapy ; Pilot Projects ; Acute Pain/drug therapy ; Acute Pain/prevention & control ; Acute Pain/chemically induced ; Double-Blind Method ; Fatty Acids, Omega-3/therapeutic use ; Peripheral Nervous System Diseases/chemically induced
    Chemical Substances Paclitaxel (P88XT4IS4D) ; Fatty Acids, Omega-3
    Language English
    Publishing date 2023-10-17
    Publishing country Germany
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 1134446-5
    ISSN 1433-7339 ; 0941-4355
    ISSN (online) 1433-7339
    ISSN 0941-4355
    DOI 10.1007/s00520-023-08082-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Cervical Cancer Knowledge and Screening Patterns in Zuni Pueblo Women in the Southwest United States.

    Cartwright, Kate / Kosich, Mikaela / Gonya, Madison / Kanda, Deborah / Leekity, Samantha / Sheche, Judith / Edwardson, Nicholas / Pankratz, V Shane / Mishra, Shiraz I

    Journal of cancer education : the official journal of the American Association for Cancer Education

    2023  Volume 38, Issue 5, Page(s) 1531–1538

    Abstract: American Indian women experience cervical cancer disparities, including later-stage diagnosis and a higher cervical cancer mortality rate. These disparities are interconnected and linked to cervical cancer screening disparities. Cervical cancer when ... ...

    Abstract American Indian women experience cervical cancer disparities, including later-stage diagnosis and a higher cervical cancer mortality rate. These disparities are interconnected and linked to cervical cancer screening disparities. Cervical cancer when identified early is highly treatable. Individual- and health system-level factors often contribute to gaps in cervical cancer screening. To better understand the source of these inequities experienced by American Indian women, specifically Zuni women, this paper examines how knowledge about cervical cancer and related risk factors is linked to cervical cancer screening for Zuni women using primary data gathered by the Zuni Health Initiative in 2020 and 2021. We find that of the women who completed the survey (n = 171), women with greater cervical cancer knowledge are statistically significantly more likely to have received cervical cancer screening. Closer examination of knowledge on the specific risk factors for cervical cancer provides evidence upon which to develop a cervical cancer education intervention.
    MeSH term(s) Female ; Humans ; Early Detection of Cancer ; Indians, North American ; Papanicolaou Test ; Risk Factors ; United States/epidemiology ; Uterine Cervical Neoplasms/diagnosis ; Uterine Cervical Neoplasms/prevention & control ; Health Knowledge, Attitudes, Practice
    Language English
    Publishing date 2023-04-13
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 632898-2
    ISSN 1543-0154 ; 0885-8195 ; 1543-1154
    ISSN (online) 1543-0154
    ISSN 0885-8195 ; 1543-1154
    DOI 10.1007/s13187-023-02295-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Breast cancer screening attitudes, beliefs, and behaviors of Zuni Pueblo women: identifying cornerstones for building effective mammogram screening intervention programs.

    Cartwright, Kate / Kanda, Deborah / Kosich, Mikaela / Sheche, Judith / Leekity, Samantha / Edwardson, Nicholas / Pankratz, V Shane / Mishra, Shiraz I

    Cancer causes & control : CCC

    2023  Volume 35, Issue 4, Page(s) 583–595

    Abstract: Purpose: Breast cancer is the leading form of cancer and has the second highest mortality rate of cancers for American Indian/Alaska Native (AI/AN) women. Early screening is critical. This study examines the breast cancer-related knowledge, beliefs, and ...

    Abstract Purpose: Breast cancer is the leading form of cancer and has the second highest mortality rate of cancers for American Indian/Alaska Native (AI/AN) women. Early screening is critical. This study examines the breast cancer-related knowledge, beliefs, and behaviors of Zuni women in the Southwest United States (U.S.).
    Methods: In 2020 and 2021, a survey was administered to better understand cancer screening patterns in Zuni Pueblo; 110 women from 50 to 75 years of age were recruited to respond to the breast cancer screening portion. Inclusion criteria included self-identifying as AI, a member of the Zuni tribe, or married to a Zuni tribal member, and meeting the age and gender requirements. Descriptive statistics and bivariate analyses were conducted examining the associations between measures of breast cancer knowledge, beliefs, and behaviors and breast cancer screening status (never, ever/non-compliant, and ever/compliant).
    Results: Of survey participants, 47.3% have had a breast cancer screening and are up-to-date, 39.1% have had a screening in the past but are not up-to-date, and 13.6% have never been screened. Age was the only statistically significant socioeconomic predictor of breast cancer screening; the median (interquartile range) ages of each group are 62 (54, 68) ever/compliant, 56 (54, 68) ever/non-compliant, and 53 (51, 55) never (p-value < 0.001). Significant differences by health status and access to medical care include having a regular health care provider and going to see a provider for routine check-ups. The survey also shows differences in knowledge about breast cancer risk factors, beliefs, and behaviors. Women across all three screening statuses reported that they would get screened if encouraged by a health care provider.
    Conclusion: While survey respondents report a relatively high rate of ever having had a breast cancer screening, less than half are compliant with screening guidelines, which shows there is an opportunity to improve breast cancer screening rates. With culturally tailored interventions, providers have the potential to improve breast cancer screening for Zuni women.
    MeSH term(s) Humans ; Female ; Breast Neoplasms/diagnosis ; Breast Neoplasms/prevention & control ; Early Detection of Cancer ; Indians, North American ; Mammography ; Patient Acceptance of Health Care ; Health Knowledge, Attitudes, Practice ; Mass Screening
    Language English
    Publishing date 2023-11-09
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1064022-8
    ISSN 1573-7225 ; 0957-5243
    ISSN (online) 1573-7225
    ISSN 0957-5243
    DOI 10.1007/s10552-023-01814-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Colorectal Cancer Screening Among Adults in Zuni Pueblo: Factors Associated with FOBT and Colonoscopy Utilization.

    Edwardson, Nicholas / Cartwright, Kate / Sheche, Judith / Pankratz, V Shane / Kosich, Mikaela / Kanda, Deborah / Leekity, Samantha / Mishra, Shiraz I

    Journal of community health

    2023  Volume 48, Issue 4, Page(s) 565–575

    Abstract: Although strategies to mitigate barriers to colorectal cancer (CRC) screening have proven successful in some parts of the US, few of these strategies have been studied in rural, American Indian communities that may exhibit unique culturally driven ... ...

    Abstract Although strategies to mitigate barriers to colorectal cancer (CRC) screening have proven successful in some parts of the US, few of these strategies have been studied in rural, American Indian communities that may exhibit unique culturally driven attitudes toward and knowledge of colorectal cancer and experience increased barriers to healthcare access. In this study, we describe the results of a survey among CRC screen-eligible members of Zuni Pueblo (N = 218) on an array of questions regarding CRC screening behaviors, knowledge, satisfaction with and access to healthcare services, social support for CRC screening, perceptions toward FOBT, and preference for evidence-based interventions or strategies for improving CRC screening rates. Results from the multivariable model suggest age, having a regular healthcare provider, and harboring fewer negative perceptions toward FOBT are key drivers of ever completing CRC screening. Respondents reported strong support for Community Guide-recommended interventions and strategies for increasing CRC screening for nearly all proposed interventions. Results confirm the need for multilevel, multicomponent interventions, with a particular focus on improving Zuni Pueblo community members' access to a regular source of care, improving knowledge of CRC risk factor, and addressing negative perceptions toward CRC screening. These results provide critical, community-specific insight into better understanding the drivers of low guideline-adherent screening rates and inform local healthcare providers and community leaders of context-specific strategies to improve CRC screening in Zuni Pueblo.
    MeSH term(s) Humans ; Adult ; Early Detection of Cancer ; Colonoscopy ; Health Services Accessibility ; Surveys and Questionnaires ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/prevention & control ; Occult Blood ; Mass Screening
    Language English
    Publishing date 2023-02-08
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 426631-6
    ISSN 1573-3610 ; 0094-5145
    ISSN (online) 1573-3610
    ISSN 0094-5145
    DOI 10.1007/s10900-023-01196-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Developing questions to assess and measure patients' perceived survival benefit from adjuvant endocrine therapy in breast cancer: a mixed methods pilot study.

    Tawfik, Bernard / Jacobson, Kendal / Brown-Glaberman, Ursa / Kosich, Mikaela / Van Horn, M Lee / Nemunaitis, Jacklyn / Dayao, Zoneddy / Pankratz, V Shane / Sussman, Andrew L / Guest, Dolores D

    Clinical and experimental medicine

    2024  Volume 24, Issue 1, Page(s) 36

    Abstract: This mixed method study developed multiple question types to understand and measure women's perceived benefit from adjuvant endocrine therapy. We hypothesis that patients do not understand this benefit and sought to develop the questions needed to test ... ...

    Abstract This mixed method study developed multiple question types to understand and measure women's perceived benefit from adjuvant endocrine therapy. We hypothesis that patients do not understand this benefit and sought to develop the questions needed to test this hypothesis and obtain initial patient estimates. From 8/2022 to 3/2023, qualitative interviews focused on assessing and modifying 9 initial varied question types asking about the overall survival (OS) benefit from adjuvant endocrine therapy. Subsequent focus groups modified and selected the optimal questions. Patients' self-assessment of their OS benefit was compared to their individualized PREDICT model results. Fifty-three patients completed the survey; 42% Hispanic, 30% rural, and 47% with income < $39,999 per year. Patients reported adequate health care literacy (61.5%) and average confidence about treatment and medication decisions 49.4 (95% CI 24.4-59.5). From the original 9 questions, 3 modified questions were ultimately found to capture patients' perception of this OS benefit, focusing on graphical and prose styles. Patients estimated an OS benefit of 42% compared to 4.4% calculated from the PREDICT model (p < 0.001). In this group with considerable representation from ethnic minority, rural and low-income patients, qualitative data showed that more than one modality of question type was needed to clearly capture patients' understanding of treatment benefit. Women with breast cancer significantly overestimated their 10-year OS benefit from adjuvant endocrine therapy compared to the PREDICT model.
    MeSH term(s) Humans ; Female ; Pilot Projects ; Breast Neoplasms/drug therapy ; Ethnicity ; Minority Groups ; Combined Modality Therapy
    Language English
    Publishing date 2024-02-14
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2053018-3
    ISSN 1591-9528 ; 1591-8890
    ISSN (online) 1591-9528
    ISSN 1591-8890
    DOI 10.1007/s10238-023-01261-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: American Indian/Alaska Native and black colon cancer patients have poorer cause-specific survival based on disease stage and anatomic site of diagnosis.

    Pankratz, V Shane / Kosich, Mikaela / Edwardson, Nicholas / English, Kevin / Adsul, Prajakta / Li, Yiting / Parasher, Gulshan / Mishra, Shiraz I

    Cancer epidemiology

    2022  Volume 80, Page(s) 102229

    Abstract: Objectives: Studies of race-specific colon cancer (CC) survival differences between right- vs. left-sided CC typically focus on Black and White persons and often consider all CC stages as one group. To more completely examine potential racial and ethnic ...

    Abstract Objectives: Studies of race-specific colon cancer (CC) survival differences between right- vs. left-sided CC typically focus on Black and White persons and often consider all CC stages as one group. To more completely examine potential racial and ethnic disparities in side- and stage-specific survival, we evaluated 5-year CC cause-specific survival probabilities for five racial/ethnic groups by anatomic site (right or left colon) and stage (local, regional, distant).
    Methods: We obtained cause-specific survival probability estimates from National Cancer Institute's population-based Surveillance, Epidemiology, and End Results (SEER) for CC patients grouped by five racial/ethnic groups (Non-Hispanic American Indian/Alaska Native [AIAN], Non-Hispanic Asian/Pacific Islander [API], Hispanic, Non-Hispanic Black [NHB], and Non-Hispanic White [NHW]), anatomic site, stage, and other patient and SEER registry characteristics. We used meta-regression approaches to identify factors that explained differences in cause-specific survival.
    Results: Diagnoses of distant-stage CC were more common among NHB and AIAN persons (>22 %) than among NHW and API persons (< 20 %). Large disparities in anatomic site-specific survival were not apparent. Those with right-sided distant-stage CC had a one-year cause-specific survival probability that was 16.4 % points lower (99 % CI: 12.2-20.6) than those with left-sided distant-stage CC; this difference decreased over follow-up. Cause-specific survival probabilities were highest for API, and lowest for NHB, persons, though these differences varied substantially by stage at diagnosis. AIAN persons with localized-stage CC, and NHB persons with regional- and distant-stage CC, had significantly lower survival probabilities across follow-up.
    Conclusions: There are differences in CC presentation according to anatomic site and disease stage among patients of distinct racial and ethnic backgrounds. This, coupled with the reality that there are persistent survival disparities, with NHB and AIAN persons experiencing worse prognosis, suggests that there are social or structural determinants of these disparities. Further research is needed to confirm whether these CC cause-specific survival disparities are due to differences in risk factors, screening patterns, cancer treatment, or surveillance, in order to overcome the existing differences in outcome.
    MeSH term(s) Alaska Natives ; Colonic Neoplasms/diagnosis ; Ethnicity ; Humans ; Racial Groups ; United States/epidemiology ; American Indian or Alaska Native
    Language English
    Publishing date 2022-07-21
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2508729-0
    ISSN 1877-783X ; 1877-7821
    ISSN (online) 1877-783X
    ISSN 1877-7821
    DOI 10.1016/j.canep.2022.102229
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Associations Between Physician Continuous Professional Development and Referral Patterns: A Systematic Review and Meta-Analysis.

    Cook, David A / Stephenson, Christopher R / Pankratz, V Shane / Wilkinson, John M / Maloney, Stephen / Prokop, Larry J / Foo, Jonathan

    Academic medicine : journal of the Association of American Medical Colleges

    2022  Volume 97, Issue 5, Page(s) 728–737

    Abstract: Purpose: Both overuse and underuse of clinician referrals can compromise high-value health care. The authors sought to systematically identify and synthesize published research examining associations between physician continuous professional development ...

    Abstract Purpose: Both overuse and underuse of clinician referrals can compromise high-value health care. The authors sought to systematically identify and synthesize published research examining associations between physician continuous professional development (CPD) and referral patterns.
    Method: The authors searched MEDLINE, Embase, PsycInfo, and the Cochrane Database on April 23, 2020, for comparative studies evaluating CPD for practicing physicians and reporting physician referral outcomes. Two reviewers, working independently, screened all articles for inclusion. Two reviewers reviewed all included articles to extract information, including data on participants, educational interventions, study design, and outcomes (referral rate, intended direction of change, appropriateness of referral). Quantitative results were pooled using meta-analysis.
    Results: Of 3,338 articles screened, 31 were included. These studies enrolled at least 14,458 physicians and reported 381,165 referral events. Among studies comparing CPD with no intervention, 17 studies with intent to increase referrals had a pooled risk ratio of 1.91 (95% confidence interval: 1.50, 2.44; P < .001), and 7 studies with intent to decrease referrals had a pooled risk ratio of 0.68 (95% confidence interval: 0.55, 0.83; P < .001). Five studies did not indicate the intended direction of change. Subgroup analyses revealed similarly favorable effects for specific instructional approaches (including lectures, small groups, Internet-based instruction, and audit/feedback) and for activities of varying duration. Four studies reported head-to-head comparisons of alternate CPD approaches, revealing no clear superiority for any approach. Seven studies adjudicated the appropriateness of referral, and 9 studies counted referrals that were actually completed (versus merely requested).
    Conclusions: Although between-study differences are large, CPD is associated with statistically significant changes in patient referral rates in the intended direction of impact. There are few head-to-head comparisons of alternate CPD interventions using referrals as outcomes.
    MeSH term(s) Humans ; Physicians ; Referral and Consultation
    Language English
    Publishing date 2022-04-27
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 96192-9
    ISSN 1938-808X ; 1040-2446
    ISSN (online) 1938-808X
    ISSN 1040-2446
    DOI 10.1097/ACM.0000000000004575
    Database MEDical Literature Analysis and Retrieval System OnLINE

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