Nine Forward–Backward Translations of the Hopkins Symptom Checklist-25 With Cultural Checks

Introduction: The Hopkins Symptom Checklist-25 (HSCL-25) is an effective, reliable, and ergonomic tool that can be used for depression diagnosis and monitoring in daily practice. To allow its broad use by family practice physicians (FPs), it was translated from English into nine European languages (Greek, Polish, Bulgarian, Croatian, Catalan, Galician, Spanish, Italian, and French) and the translation homogeneity was confirmed. This study describes this process.Methods: First, two translators (an academic translator and an FP researcher) were recruited for the forward translation (FT). A panel of English-speaking FPs that included at least 15 experts (researchers, teachers, and practitioners) was organized in each country to finalize the FT using a Delphi procedure.Results: One or two Delphi procedure rounds were sufficient for each translation. Then, a different translator, who did not know the original version of the HSCL-25, performed a backward translation in English. An expert panel of linguists compared the two English versions. Differences were listed and a multicultural consensus group determined whether they were due to linguistic problems or to cultural differences. All versions underwent cultural check.Conclusion: All nine translations were finalized without altering the original meaning.

Advanced practice providers should interpret 12-lead ECGs

Funding Acknowledgements Type of funding sources: None. Background Due to the rapid development of cardiac diagnostic modalities such as imaging techniques, device therapies, invasive procedures and cardiogenomics, many cardiology trainees lack personal interest in clinical electrocardiography (ECG) training. In addition, fewer and fewer practioners are mentoring trainees in this skill. Thus, most ECGs are read by non-cardiologists, including emergency, urgent care and family practice-physicians who do not necessarily have clinical ECG training. Purpose: The purpose of this proposal is to promote the training and certification of Advanced Practice Providers (APPs) to interpret 12-lead ECGs. Rationale. By tradition, as health care tasks increase in complexity, many physician-based tasks are delegated to APPS, especially in the demanding hospital setting. For example, nurses continuously monitor and interpret all bedside ECG arrhythmias and myocardial ischemia. The transition of cardiologist read 12-lead ECGs to APP read 12-lead ECG makes sense in light of the ubiquitous computerization of the ECG which provides high quality waveforms with sophisticated algorithms to help guide in decision making. Despite significant improvements in cardiac technology, the 12-lead ECG remains the classic, non-invasive gold standard for the diagnosis of a myocardial infarction (MI) and it is expected to be interpreted within 10 minutes of chest pain onset. Conclusion: Cardiologists have moved on to utilize new technology for secondary and tertiary evaluations, 12-lead ECGs are the first line diagnostic tool in diagnosis of MI. By training and certifying APPs in ECG interpretation, higher quality, rapid initial diagnosis will be made without delays.

Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development

Background: Longitudinal faculty development (LFD) may allow for increased uptake of teaching skills, especially in a forum where teachers can reflect individually and collectively on the new skills. However, the exact processes by which such interventions are effective need further exploration. Methods: This qualitative study examined an LFD initiative teaching a novel feedback approach attended by five family practice physicians. The initiative began with two 1.5-hour workshops: Goal-Oriented Feedback (as the teaching skill to be developed) and Narrative Reflection (as the tool to support personal reflection on the skill being learned). Over the subsequent six-months, the five participants iteratively applied the feedback approach in their teaching and engaged in narrative reflection at four 1-hour group sessions. Transcripts from the group discussions and exit interviews were analyzed using thematic analysis. Results: Iteratively trialing, individually reflecting on, and collectively exploring efforts to implement the new feedback approach resulted in the development of a learning community among the group. This sense of community created a safe space for reflection, while motivating ongoing efforts to learn the skill. Individual pre-reflection prepared individuals for group co-reflection; however, written narratives were not essential. Conclusion: LFD initiatives should include an emphasis on ensuring opportunities for iterative attempts of teaching skills, guided self-reflection, and collaborative group reflection and learning to ensure sustainable change to teaching practices.

Why do challenges still exist in primary care for patients with spinal cord injury?

Despite having high healthcare needs, individuals with spinal cord injury (SCI) receive suboptimal primary care; they are less likely than able-bodied persons to receive preventive care and more likely to have unmet health care needs. The aim of this mixed quantitative (surveys) and qualitative (interviews) study was to gather primary care health provider and rehabilitation specialists’ perspectives on why these challenges persist despite the increasing body of evidence identifying delivery service gaps. Surveys were completed by 12 family physicians who referred individuals with SCI to an interprofessional primary care mobility clinic. Interviews were completed with eight SCI rehabilitation providers. Questions in both the survey and interviews were asked related to the barriers to the provision of optimal care for SCI, potential solutions, and preferred methods for knowledge dissemination. Skill and attitudinal reasons were offered for the lack of evidence to practice transfer including: the absence of patient self-management, poor access to specialists, lack of education for family practice physicians, fragmentation of community resources and co-ordination upon hospital discharge. Solutions offered included greater patient self-management, better access to specialists, specialized primary care services and provision of SCI guidelines and protocols. Participant explanations and solutions were then analyzed through a social disability lens to see if new understandings could be identified to explain the lack of uptake from research findings to clinical practice for this underserviced vulnerable population.

The need for speed: observational study of physician driving behaviors

ObjectiveTo determine whether fast driving, luxury car ownership, and leniency by police officers differ across medical specialties.DesignObservational study.SettingFlorida, USA.Participants5372 physicians and a sample of 19 639 non-physicians issued a ticket for speeding during 2004-17.Main outcome measuresObserved rates of extreme speeding (defined as driving >20 mph above the speed limit), luxury car ownership, and leniency of the speeding ticket by police officers, by physician specialty, after adjustment for age and sex.ResultsThe sample included 5372 physicians who received 14 560 speeding tickets. The proportion of drivers who were reported driving at speeds greater than 20 mph was similar between physicians and a sample of 19 639 non-physicians who received a ticket for speeding (26.4% v 26.8% of tickets, respectively). Among physicians who received a ticket, psychiatrists were most likely to be fined for extreme speeding (adjusted odds ratio of psychiatry compared with baseline specialty of anesthesia 1.51, 95% confidence interval 1.07 to 2.14). Among drivers who received a ticket, luxury car ownership was most common among cardiologists (adjusted proportion of ticketed cardiologists who owned a luxury car 40.9%, 95% confidence interval 35.9% to 45.9%) and least common among physicians in emergency medicine, family practice, pediatrics, general surgery, and psychiatry (eg, adjusted proportion of luxury car ownership among family practice physicians 20.6%, 95% confidence interval 18.2% to 23.0%). Speed discounting, a marker of leniency by police officers in which ticketed speed is recorded at just below the threshold at which a larger fine would otherwise be imposed, was common, but rates did not differ by specialty and did not differ between physicians and a sample of non-physicians.ConclusionsRates of extreme speeding were highest among psychiatrists who received a ticket, whereas cardiologists were the most likely to be driving a luxury car when ticketed. Leniency by police officers was similar across specialties and between physicians and non-physicians.

Providers’ Reports of Environmental Conditions and Resources at Births in the United States

Environmental conditions and resources that may influence provider’s behaviors have been investigated in birth environments focusing on location rather than conditions and available resources. Using a descriptive, cross sectional design, we surveyed a random sample of certified nurse-midwives (CNMs), obstetricians, family practice physicians, and certified professional midwives (CPMs) to describe conditions, resources, and workforce present during U.S. births. In all, 1,243 midwives and physicians reported most environmental resources were present at almost 100% of births they attended. Conditions varied: room noise acceptability restriction of phone calls/texts from any source and lighting kept to a minimum. Trainees were present at most births regardless of setting and provider type. The impact of room noise, phone calls/texting, and lighting on outcomes should be determined. The roles and impact of personnel, including trainees, should be described. The extent to which clusters of resources are associated with outcomes might provide new directions for interventions that improve care.

Injuries to Cyclists due to a Dog–Bicycle Interaction

Background Both dogs and bicycles are common in our society and thus a dog–bicycle interaction resulting in an injury to a cyclist is possible. It was the purpose of this study to investigate such injuries. Methods The National Electronic Injury Surveillance System (NEISS) data for the 10-year period from 2006 through 2015 associated with bicycles were accessed. Injuries involving dogs were identified and the mechanism of injury determined. Due to the stratified and weighted nature of the NEISS data, statistical analyses were performed with SUDAAN 10 software (RTI International, Research Triangle Park, North Carolina, United States). A p < 0.05 was considered statistically significant. Results There were 5,184,057 emergency department visits for bicycle-associated injuries; dogs were involved in 35,254 (0.67%) cases. The average age for those involved with a dog was 33.2 years and it was 25.5 years for those in which dogs were not involved. There were more females in the dog group (34.1 vs. 27.6%). Dog involvement increased from ages 0 to 14 years, then decreased until the age of 20 years and then progressively increased. Dog-associated injuries most frequently occurred away from home, involved the knee and distal lower extremity, 49.1% sustaining dog bites. Dog bites were more common in younger individuals. Four injury mechanisms (chased by a dog, hit/collided with a dog, swerved/tried to avoid a dog or riding with a dog) accounted for 97.5% of the injuries. Those chased by a dog were younger, more commonly released from the emergency department, had an injury involving the lower extremity and frequently sustained a bite. The most severe injuries were in those who swerved/tried to avoid a dog or hit a dog. Conclusions Approximately 1% of injuries to bicyclists are associated with dogs; one-half sustained a bite. Potential/proposed prevention strategies could be educational materials regarding bicycles and dogs to owners, dog restraint, student/parent education and educational materials in waiting rooms of veterinarians, paediatricians, family practice physicians and emergency rooms.

Primary care physician opinion survey on FDA Opioid Risk Evaluation and Mitigation Strategies

Introduction: In response to disturbing rises in prescription opioid abuse, the Food and Drug Administration (FDA) has proposed the implementation of aggressive Risk Evaluation and Mitigation Strategies (REMS) that will require prescribers to obtain mandatory education, provide mandatory patient education, register patients into registries, and so forth before prescribing certain opioids. The first opioid to be subject to the new REMS was the recently approved fentanyl buccal soluble film (Onsolis™). The FDA plans to extend mandatory REMS to other opioids, including all rapid-onset formulations and eventually all long-acting opioids, whether or not they already have FDA approval. To assess the likely impact of REMS on opioid prescribing, the authors conducted a survey of how REMS implementation might affect opioid prescribing.Methods: After obtaining Institutional Review Board’s approval, a survey regarding opioid prescribing was sent via e-mail to 2,800 physician members of the Pennsylvania Academy of Family Physicians. Practicing family practice physicians were asked to respond to questions regarding their current opioid prescribing, and how various components of REMS might alter their future opioid prescribing.Results: A total of 259 surveys were completed. Of the 259 physicians who responded, 87 percent reported themselves as being primary care practitioners; others identified themselves as specialists. Of all respondents, 96 percent currently prescribe opioids for acute pain, 77 percent for cancer pain, and 83 percent for chronic nonmalignant pain. The respondents were split from 52 percent to 48 percent in terms of being in an urban versus a rural practice setting. Forty-eight percent of all respondents reported their willingness to complete no more than 2 hours of training if it were available locally to be able to continue prescribing opioids. A similar percentage (50 percent) also said that they would encourage patient compliance with education and register their patients on a 6-month basis. However, the following percent of respondents reported that they would discontinue prescribing an opioid product if required to comply with the following REMS requirement: obtain 4-8 hours of training, followed by 2 hours of pain-related continuing medical education every 2 years (13.4 percent); complete mandatory patient education (12.2 percent); document ongoing monitoring of therapy including efficacy, safety, and monitoring for aberrant drug-related behavior (10.4 percent); or register each patient in a patient registry, and have the patient re-registered every 6 months (18.3 percent).Conclusions: The results suggest that 50 percent of the responding physicians would be willing to comply with the mandatory education component of REMS, including the requirement to provide education to patients. For some REMS components, willingness to continue to prescribe despite the restriction was higher (up to 90 percent). However, this leaves a substantial proportion of physicians who would not be willing to prescribe opioids controlled by the new REMS, which could have the unintended effect of decreasing access to these medications for legitimate medical purposes.

Congenital and Perinatal Infections

Congenital and perinatal infections are commonly encountered in clinical practice. This book provides a summation of the data regarding infections transmitted from mother to child during the antepartum, intrapartum, or postnatal period, with the goal of providing a complete and critical review of the literature regarding the prevention, diagnosis, and management of congenital and perinatal infections. Emphasis is placed on epidemiology, clinical manifestations, key diagnostic studies, and therapeutic interventions. Individual chapters elucidate the pathogenesis of these infections, as well as high-priority areas for future research. This text will prove useful to medical students and residents, fellows, and practicing physicians in obstetrics and pediatrics, as well as family-practice physicians and specialists who care for pregnant women and newborns.