Ranking in Canadian gastroenterology residency match: What do residents and program directors want?

BACKGROUND:

Matching to a gastroenterology (GI) fellowship position in Canada is increasingly competitive.

OBJECTIVE:

To identify factors that determine how residents rank programs across the country, and how program directors rank their applicants.

METHODS:

Using input from several current GI trainees and former program directors, two separate surveys were developed. An online survey was sent one month after the match to every resident matched to an adult GI program in the 2007 match. A separate online survey was simultaneously sent to all program directors of 14 accredited GI programs in Canada. Two subsequent cohorts (2008 and 2009) of matched residents were surveyed during the annual GI fellow endoscopy course at McMaster University (Hamilton, Ontario).

RESULTS:

The overall response rate was 64 of 91 (70%) for residents and 11 of 15 (73%) for program directors (one program had codirectors). Using a five-point Likert scale for rating the importance of various factors influencing their decision, residents from three years ranked the following factor as most important: suitable location for spouse/partner/family (median score = 5). The overall least important factor was an opportunity for pediatric elective (median score = 2). Using the same scale, program directors ranked the following factors as most important (median score = 5) in ranking residents to their program: the ability to get along with others, outstanding reference letters, exceptional curriculum vitae and applying to only one specialty.

CONCLUSIONS:

Several factors important for GI applicants and program directors were identified, as well as a few less-important factors. Based on these results, GI training programs can more effectively market their programs to applicants in the future, and residents applying to GI programs can strengthen their applications in the ever competitive match process.     

What defines quality of care for older people in aged care? A comprehensive literature review

The quality of the care provided to frail older people in aged care is a concern for all Australians and for the citizens of many other countries internationally. This paper summarizes the methods and findings from an Australian study commissioned by the Royal Commission into Aged Care Quality and Safety to identify and synthesize international literature relating to the quality of care in aged care. A comprehensive literature review was undertaken to search and identify the literature (grey and peer reviewed) relating to quality of care and/or person-centered care in aged care. The review identified nine key themes as salient to the quality of care experience, which include treating the older person with respect and dignity; acknowledging and supporting their spiritual, cultural, religious and sexual identity; the skills and training of the aged care staff providing care; relationships between the older person and the aged care staff; social relationships and the community; supporting the older person to make informed choices; supporting the older person's health and well-being; ensuring the delivery of safe care in a comfortable service environment; and the ability to make complaints and provide feedback to the aged care organization. In practice, particularly in the context of residential care, quality of care has traditionally been measured using clinical indicators of care quality. These findings highlight the central importance of person-centered care and care experience as fundamental tenets of the quality of aged care service delivery in Australia and internationally. Geriatr Gerontol Int 2021; 21: 765–778 .     

Obstructive sleep apnea in outpatient care – What to do with?

Obstructive sleep apnea is a relatively common sleep disorder, which is on the increase in the last decades. It significantly contributes to morbidity and mortality in all countries worldwide. Obstructive sleep apnea is one of the most common causes of daytime sleepiness. Typical risk factors for obstructive sleep apnea in the normal adult population are male gender, obesity (preferentially central obesity), and increased neck circumference, presence of manifest cardiovascular disease, diabetes mellitus, and anomalies in the upper respiratory tract. Early diagnosis and treatment improves not only the quality of life, but also significantly decreases patient morbidity and mortality. Nowadays screening can be performed in outpatient settings using simple and readily available devices. Such screening can contribute to early diagnosis and treatment of obstructive sleep apnea.     

What do academic primary care physicians want in an electronic journal?

To determine the interest of academic general internists and family physicians in specific features of electronic journal publications, we surveyed 350 physicians, 175 randomly selected from each of 2 medical societies: the Society of General Internal Medicine, and the Society of Teachers of Family Medicine. The response rate was 70%. Most general internists and family physicians used online journals sometimes or often. Most general internists and family physicians reported moderate to high interest in having links from original articles, reviews, or editorials to listed references (77% to 89% of internists and 65% to 81% of family physicians) and electronic medical reference texts (73% to 78% of internists and 65% to 83% of family physicians). Less than 25% of both groups reported moderate to high interest in having links to initiate dialog with other readers or to communicate comments to the author or editor. General internists were more likely than were family physicians to have moderate to high interest in having links to appendices and supportive material (e.g., 66% of general internists versus 46% of family physicians for original articles; P < .05) and less likely to have moderate to high interest in links to health-related web sites (44% of general internists versus 69% of family physicians for original articles; P < .05). We conclude that academic general internists and family physicians have strong but not identical interests in specific features of electronic publication that primary care-oriented journals should consider.     

Health care utilization by old-old long-term care facility residents: how do Medicare fee-for-service and capitation rates compare?

OBJECTIVE: To describe the healthcare utilization of a long-term care population receiving primary and specialty care in a closed system and to compare Medicare fee-for-service (FFS) reimbursement with the amount that would have been paid under capitation for these services. SETTING: A life care community in California composed of two facilities, both having residential care and nursing facility (NF) beds. PARTICIPANTS: Residents (n = 700) living in the community between September 1995 and February 1996. METHODS: Data on Medicare Part A and Part B reimbursements were gathered from billing records for hospitalizations, based on diagnostic related group payments, primary and specialty care visits, various procedures, diagnostic tests, and therapeutic services. These data were compared with what the facility, in collaboration with the providers and an affiliated hospital, would have received under Medicare capitated rates at that time. RESULTS: Annually, residents averaged 16.3 primary care visits, 7.7 specialist visits, and 3453 hospital days per thousand. Nursing facility residents received significantly more primary care than did those in residential care. Total Medicare Part A and B payments per resident per month averaged $558. The monthly capitation rate in effect at the time for this population was substantially higher at $1085, generating an annual "risk pool" of $9.1 million. Care provided in the two facilities varied greatly. Hospitalization rates, clinic-based primary care and specialist visits, and therapy sessions were greater in facility one. Overall expenditures were lower for residents at facility two, where the majority of care was provided by trained geriatricians in collaboration with physician extenders and without sophisticated clinical pathways and utilization controls. CONCLUSIONS: Our data support other studies that suggest that teams of geriatricians and physician extenders can reduce hospitalization rates and overall expenditures. Capitated rates for the frail, geriatric population warrant careful study. These rates must balance fiscal responsibility with the need for adequate, risk-adjusted payments that create incentives for providers to produce high quality as well as cost-effective care.     

Factors influencing decision‐making processes for unwell residents in residential aged care: Hospital transfer or Residential InReach referral?

Objective

To investigate decision‐making around hospital transfer and/or referral of residents to a Residential InReach (RiR) service in north‐eastern metropolitan Melbourne, Australia, from the perspectives of residential aged care facility (RACF) staff, general practitioners (GPs) and RiR registered nurses (RNs).

Methods

Thirty‐one staff from eight RACFs, five GPs and four RiR RNs participated in individual or group interviews.

Results

Residential aged care facility staff and GPs valued and relied upon RiR to manage unwell residents. Thematic analysis identified RiR utilisation was driven by the following: (i) complexity of decision‐making processes in RACFs; (ii) variability in facility‐based medical and nursing care; and (iii) impact of RiR service outcomes on patients and referrers.

Conclusion

Availability of timely and appropriate medical and nursing care in RACFs was reported to influence transfers to the hospital and/or referrals to RiR. RiR was used to complement or substitute usual care available to residents. Further research and improvements in RACF and RiR resources are required.

     

What do Australian patients with inflammatory arthritis value in treatment? A discrete choice experiment

Clinical Rheumatology - The purpose of this study was to develop an understanding of treatment preferences in patients with inflammatory arthritis (IA) [rheumatoid arthritis (RA), ankylosing...     

Statins in children: What do we know and what do we need to do?

Children have been tested and treated for hypercholesterolemia for more than 30 years. Although most treatment regimens have been limited to dietary intervention, statin use is increasing. Statins have been used in children since 1987, but published sources have only reported on small numbers of children with severe hypercholesterolemia. The available data indicates that statins can be useful and well tolerated. New data will be available in the next few years that will lead to the wider use of these drugs. Although statin drugs have proven to be safe in the adult population, physicians will be obliged to follow pediatric patients closely when these agents are widely used in the first few years. The use of highly effective safe drugs such as statins will allow for the assessment of the best time to initiate therapy in younger populations and what benefits may be found over the long term.     

Alcohol use disorders in primary care: do gender-specific differences exist?

OBJECTIVE: To describe how alcohol use disorders (AUDs) affect women, focusing on gender-specific implications for primary care physicians (PCPs). DESIGN: An overview of literature from 1966 to 2000 identified by a MEDLINE, PsychINFO and HealthSTAR/Ovid Healthstar database search using key words “women,” “alcohol” and “alcoholism.” MEASUREMENTS AND MAIN RESULTS: Although the prevalence of AUDs is greater in men than in women, women with AUDs are more likely to seek help, but less likely to be identified by their physicians. Psychiatric comorbidities (especially depression and eating disorders) are more common in women with AUDs than in men with AUDs. A past history of sexual and/or physical abuse places a woman at increased risk for AUDs. Women have a greater sensitivity to alcohol, have an accelerated progression from alcohol toxicity, and have increased mortality at lower levels of consumption compared to men. Women and men who are light-to-moderate drinkers have lower coronary artery disease mortality than do abstainers or heavy drinkers. Risk of breast cancer is increased in women who drink ≥1 drinks daily. Common barriers to treatment include: fear of abandonment by partner; fear of loss of children; and financial dependency. Brief interventions have been shown to be effective in reduction of alcohol consumption in women with at-risk drinking. It is unclear if women-only treatment programs improve outcomes. CONCLUSION: PCPs should be alert to gender-specific differences for women with AUDs.