Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 4 de 4
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Acad Med ; 99(1): 58-62, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37656803

RESUMO

PROBLEM: Traditional metrics used in residency application review processes are systematically biased against applicants from minoritized communities that are underrepresented in medicine (URiM). These biases harm not just URiM applicants but also residency programs and patients. Although several residency programs have implemented holistic reviews to mitigate these biases, few tested tools exist that can be adapted and implemented in a wide variety of settings within academic medicine. APPROACH: This article describes advances made in the third year of a longitudinal, ongoing quality improvement project that used the A3 framework to improve recruitment of URiM residents to a family medicine residency program. The authors devised a systematic holistic application review process (SHARP) to determine which applicants to invite to interview with the program. SHARP's development began in August 2019, and after significant discussion with program leadership and iterations of rubric refinement, the program adopted SHARP in September 2020 to review applications for the 2021 application cycle. OUTCOMES: Compared with the 2016 to 2020 period before SHARP implementation, data from the 2021 and 2022 residency application cycles after SHARP implementation showed a significant increase in the proportion of interviewed candidates who identify as URiM (from 23% to 38%, P < .001) and matched candidates who identify as URiM (from 27% to 62%, P = .004). There was also a notable increase in the number and diversity of reviewers who evaluated applicants to the program. NEXT STEPS: SHARP is a promising tool to mitigate the effects of racism and other biases against URiM applicants to residency programs. Residency programs across specialties may benefit from adopting SHARP and adapting it based on their own goals and priorities.


Assuntos
Internato e Residência , Medicina , Humanos
2.
Br J Pain ; 17(6): 546-559, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37974635

RESUMO

Objectives: A scoping review was selected to explore what non-pharmacological and non-invasive pain management interventions are available for individuals from Turkish-speaking ethnic groups with chronic pain and what represents the most appropriate intervention. Inclusion Criteria: Adults with non-malignant chronic pain from Turkish-speaking ethnic groups residing in or outside of Turkey. All non-pharmacological and non-invasive pain management interventions were considered. No limits were placed on geographic location, gender, sex or healthcare setting. Methods: The MEDLINE database was searched for published literature in April 2022. An English language filter was applied. No limits were placed on study design or date of publication. Data was charted from eligible studies into a data extraction table. Key concepts were identified during data extraction by DN. Results: Eleven studies were included in the final review. All were conducted within a quantitative research paradigm. The studies were completed in Turkey (7), Belgium (1), Sweden (1) and Switzerland (1). One was a multi-country review. No studies were conducted in the UK. The primary interventions were heterogenous and included: pain science education (2), cognitive behavioural therapy (2), transcranial magnetic stimulation (1), balneotherapy (1), extracorporeal shockwave therapy (1), transcutaneous electrical nerve stimulation (1), wool therapy (1), exercise and patient dialogues (1) and aromatherapy massage and reflexology (1). Location of pain, outcome measures and timings of follow-ups were heterogeneous. Conclusions: Intervention heterogeneity, exclusively quantitative methodology and absence of studies completed in the UK meant no conclusions could be made on what represents the most appropriate non-pharmacological and non-invasive interventions intervention for individuals from Turkish speaking ethnic groups with non-malignant chronic pain.

4.
Med Care ; 43(8): 792-800, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16034293

RESUMO

BACKGROUND: Many patients use emergency departments (EDs) for primary care. Previous studies have found that patient characteristics affect ED utilization. However, such studies have led to few policy changes. OBJECTIVES: We sought to determine whether Medicaid patients' ED use is associated with characteristics of their primary care practices. RESEARCH DESIGN: This was a cohort study. SUBJECTS: A total of 57,850 patients, assigned to 353 primary care practices affiliated with a Medicaid HMO, were included. MEASURES: Predictor variables were characteristics of primary care practices, which were measured by visiting each practice. The outcome variable was ED use adjusted for patient characteristics. RESULTS: On average, patients made 0.80 ED visits/person/yr. Patients from practices with more than 12 evening hours/wk used the ED 20% less than patients from practices without evening hours. A higher ratio of the number of active patients per clinician-hour of practice time was associated with more ED use. When more Medicaid patients were in a practice, these patients used the ED more frequently. Other factors associated with ED use included equipment for the care of asthma and presence of nurse practitioners and physician assistants. DISCUSSION: Modifiable characteristics of primary care practices were associated with ED use. Because the observational design of this study does not allow definitive conclusions about causality, future studies should include intervention trials to determine whether changing practice characteristics can reduce ED use. CONCLUSIONS: Improving primary care access and scope of services may reduce ED use. Focusing on systems issues rather than patient characteristics may be a more productive strategy to improve appropriate use of emergency medical care.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Programas de Assistência Gerenciada , Medicaid , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...