Citations

ObjectiveTo explore the perspectives and experiences of patients with rheumatoid arthritis (RA) whose assessments of their disease differ from those of their rheumatology care provider.MethodsA total of 20 adult RA patients with patient‐provider discordance at their most recent rheumatology appointment (within 4 weeks) were recruited. Discordance was defined by an absolute difference of 25 or more between patient and provider global assessments on a visual analog scale (VAS) of disease activity. For descriptive purposes, participants completed the Health Assessment Questionnaire II, pain VAS, and Patient Health Questionnaire 9 depression scale. Interviews were conducted in person and individually with each patient with a semistructured interview guide. Topics ranged widely, including participants’ perspectives and experiences with living with RA, clinical disease assessments, patient‐provider communication, and psychosocial or other needs. Data from the interviews were analyzed using interpretive phenomenological analysis.ResultsSix major themes emerged from the patient interviews describing patient‐provider discordance and disease assessment: being misunderstood by others, limitations of provider assessments, discrepancy with provider findings, inadequate active listening on the part of health care providers, unmet psychosocial needs, and lack of patient empowerment.ConclusionPatients described discordance in terms of symptom assessment and understanding how RA affects everyday life. Typical clinical assessments did not capture their experience. The resulting conceptual framework should inform future interventional studies seeking to enhance concordance of patient‐physician communication and to optimize satisfaction with care and health‐related quality‐of‐life outcomes for patients with RA.

Members of the Society of Hospital Medicine were surveyed about geographic cohorting (GCh); 369 responses were analyzed, two thirds of which were from GCh participants. Improved collaboration with the bedside nurse, increased nonclinical interactions, decreased paging interruptions, and improved efficiency were perceived by >50%. Narrowed clinical expertise, increased fragmentation, increased face-to-face interruptions, and an adverse impact on camaraderie within the hospitalist group were reported by 25% to 50%. Academic practices were associated with positive perceptions while higher patient loads were associated with negative perceptions. Comments on GCh benefits invoked improvements in (1) interprofessional collaboration, (2) efficiency, (3) patient-centeredness, (4) nursing satisfaction, and (5) GCh mediated facilitation of other interventions. GCh downsides included (1) professional and personal dissatisfaction, (2) concerns about providing suboptimal care, and (3) implementation barriers. GCh is receiving attention. Although it facilitates important benefits, it is perceived to mediate unintended consequences, which should be addressed in redesign efforts.

Abstract Background The American Board of Anesthesiology recently introduced the BASIC Examination, a component of its new staged examinations for primary certification, typically offered to residents at the end of their first year of clinical anesthesiology training. This analysis tested the hypothesis that the introduction of the BASIC Examination was associated with an acceleration of knowledge acquisition during the residency training period, as measured by increments in annual In-Training Examination scores. Methods In-Training Examination performance was compared longitudinally among four resident cohorts (n = 6,488) before and after the introduction of the staged system using mixed-effects models that accounted for possible covariates. Results Compared with previous cohorts in the traditional examination system, the first resident cohort in the staged system had a greater improvement in In-Training Examination scores between the first and second years of clinical anesthesiology training (by an estimated 2.0 points in scaled score on a scale of 1 to 50 [95% CI, 1.7 to 2.3]). By their second year, they had achieved a score similar to that of third-year clinical anesthesiology residents in previous cohorts. The second cohort to enter the staged system had a greater improvement of the scores between the clinical base year and the first clinical anesthesiology year, compared with the previous cohorts. Conclusions These results support the hypothesis that the introduction of the BASIC Examination is associated with accelerated knowledge acquisition in residency training and provides evidence for the value of the new staged system in promoting desired educational outcomes of anesthesiology training.

Background Dental hardware produces streak artifacts on computed tomography (CT) images reconstructed with the standard weighted filtered back projection (wFBP) method. Purpose To perform a preliminary evaluation of an iterative metal artifact reduction (IMAR) technique to assess its ability to improve anatomic visualization over wFBP in patients with dental amalgam or other hardware. Material and Methods CT images from patients with dental hardware were reconstructed using wFBP and IMAR software and soft-tissue or bone window/level settings. The anatomy most affected by metal artifacts was identified. Two neuroradiologists determined subjective and objective imaging features, including overall metal artifact score (1 = severe artifacts, 5 = no artifacts), soft-tissue visualization score of the most-compromised structure, and artifact length along the skin surface. CT numbers were used to quantify artifact severity. Results Twenty-four patients were included. IMAR improved overall metal artifact score in 18/24 cases (median =2 ± 0.9 vs. 1 ± 0.6, P < 0.001). Mean CT number in the most-affected anatomical structure significantly improved with IMAR (94.6 vs. 219 HU, P = 0.002) and length of affected skin surface decreased (40.4 mm vs. 118.7 mm, P < 0.001). However, osseous/dental artifactual defects were found in 22/24 cases with IMAR vs. 11/24 with wFBP. Conclusion IMAR software reduced metal artifact both subjectively and objectively and improved visualization of adjacent soft tissues. However, it produced a higher rate of artifactual defects in the teeth and bones than wFBP. Our findings support the use of IMAR as a valuable complement to, but not a replacement for, standard wFBP image reconstruction.