Kristina Dzara

Sharing of clinical trial data among trialists: a cross sectional survey

Objective To investigate clinical trialists’ opinions and experiences of sharing of clinical trial data with investigators who are not directly collaborating with the research team. Design and setting Cross sectional, web based survey. Participants Clinical trialists who were corresponding authors of clinical trials published in 2010 or 2011 in one of six general medical journals with the highest impact factor in 2011. Main outcome measures Support for and prevalence of data sharing through data repositories and in response to individual requests, concerns with data sharing through repositories, and reasons for granting or denying requests. Results Of 683 potential respondents, 317 completed the survey (response rate 46%). In principle, 236 (74%) thought that sharing de-identified data through data repositories should be required, and 229 (72%) thought that investigators should be required to share de-identified data in response to individual requests. In practice, only 56 (18%) indicated that they were required by the trial funder to deposit the trial data in a repository; of these 32 (57%) had done so. In all, 149 respondents (47%) had received an individual request to share their clinical trial data; of these, 115 (77%) had granted and 56 (38%) had denied at least one request. Respondents’ most common concerns about data sharing were related to appropriate data use, investigator or funder interests, and protection of research subjects. Conclusions We found strong support for sharing clinical trial data among corresponding authors of recently published trials in high impact general medical journals who responded to our survey, including a willingness to share data, although several practical concerns were identified.

Association of Discharge Summary Quality With Readmission Risk for Patients Hospitalized With Heart Failure Exacerbation

Patients admitted with heart failure have disproportionately high readmission rates, most recently ranging from 17.5% to 30.3% nationally.1 The Affordable Care Act penalizes hospitals with higher than average readmission rates after admissions for heart failure. However, clinicians remain uncertain, which strategies are associated with reducing readmissions in this population.2 Experts have proposed that the creation and transmission of a high-quality discharge summary to outpatient clinicians may improve the transition from hospital to home. Discharge summaries may facilitate safer transitions in care by informing outpatient clinicians about the course of hospitalization, identifying pending studies requiring follow-up, suggesting further follow-up testing, and clarifying changes in medications and treatments after discharge. Nonetheless, despite widespread enthusiasm for improving the quality of discharge summaries, there have been few studies of the effectiveness of discharge summaries in helping to avoid readmissions, and those few have found no association of timeliness,3,4 transmission,5,6 or content5 with readmission. To determine the association of discharge quality and readmission in a large national sample, we examined discharge summaries of patients enrolled in the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) randomized controlled trial. ### Study Cohort and Setting The Tele-HF study included patients living at home and hospitalized for heart failure in the previous 30 days.7 Patients in Tele-HF were recruited from 33 cardiology practices in 21 states and the District of Columbia. We obtained discharge summaries for the index hospitalization. Wherever possible, we obtained …

Hospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation

Background— Single-site studies have demonstrated inadequate quality of discharge summaries in timeliness, transmission, and content, potentially contributing to adverse outcomes. However, degree of hospital-level variation in discharge summary quality for patients hospitalized with heart failure (HF) is uncertain. Methods and Results— We analyzed discharge summaries of patients enrolled in the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) study. We assessed hospital-level performance on timeliness (fraction of summaries completed on the day of discharge), documented transmission to the follow-up physician, and content (presence of components suggested by the Transitions of Care Consensus Conference). We obtained 1501 discharge summaries from 1640 (91.5%) patients discharged alive from 46 hospitals. Among hospitals contributing ≥10 summaries, the median hospital dictated 69.2% of discharge summaries on the day of discharge (range, 0.0%–98.0%; P<0.001); documented transmission of 33.3% of summaries to the follow-up physician (range, 0.0%–75.7%; P<0.001); and included 3.6 of 7 Transitions of Care Consensus Conference elements (range, 2.9–4.5; P<0.001). Hospital course was typically included (97.2%), but summaries were less likely to include discharge condition (30.7%), discharge volume status (16.0%), or discharge weight (15.7%). No discharge summary included all 7 Transitions of Care Consensus Conference–endorsed content elements, was dictated on the day of discharge, and was sent to a follow-up physician. Conclusions— Even at the highest performing hospital, discharge summary quality is insufficient in terms of timeliness, transmission, and content. Improvements in all aspects of discharge summary quality are necessary to enable the discharge summary to serve as an effective transitional care tool.

Predictors of clinical trial data sharing: exploratory analysis of a cross-sectional survey

BackgroundA number of research funders, biomedical journals, pharmaceutical companies, and regulatory agencies have adopted policies advocating or mandating that clinical trialists share data with external investigators. We therefore sought to determine whether certain characteristics of trialists or their trials are associated with more unfavorable perceptions of data sharing. To date, no prior research has addressed this issue.MethodsWe conducted an exploratory analysis of responses to a cross-sectional, web-based survey. The survey sample consisted of trialists who were corresponding authors of clinical trials published in 2010 or 2011 in one of six general medical journals with the highest impact factors in 2011. The following key characteristics were examined: trialists’ academic productivity and geographic location, trial funding source and size, and the journal in which it was published. Main outcome measures included: support for data sharing in principle, concerns with data sharing through repositories, and reasons for granting or denying requests. Chi-squared tests and Fisher’s exact tests were used to assess statistical significance.ResultsOf 683 potential respondents, 317 completed the survey (response rate 46%). Both support for data sharing and reporting of specific concerns with sharing data through repositories exceeded 75%, but neither differed by trialist or trial characteristics. However, there were some significant differences in explicit reasons to share or withhold data. Respondents located in Western Europe more frequently indicated they have or would share data in order to receive academic benefits or recognition when compared with respondents located in the United States or Canada (58 versus 31%). In addition, respondents who were the most academically productive less frequently indicated they have or would withhold data in order to protect research subjects when compared with less academically productive respondents (24 versus 40%), as did respondents who received industry funding when compared with those who had not (24 versus 43%).ConclusionsRespondents indicated strong support for data sharing overall. There were few notable differences in how trialists viewed the benefits and risks of data sharing when categorized by trialists’ academic productivity and geographic location, trial funding source and size, and the journal in which it was published.

Resident and medical student viewpoints on their participation in a telepsychiatry rotation.

Telepsychiatry involves the use of electronic communication and information technologies to provide psychiatric care from a distance (1, 2). Treatment may be provided through the telephone, e-mail, the Internet, and television (1, 2). Videoconferencing is a useful and effective way for psychiatrists to treat patients (2, 3). Patients and providers are satisfied with the use of telepsychiatry, which provides therapeutic outcomes similar to those of face-toface encounters (2, 3). Because telepsychiatry is an evolving form of treatment provision, we have much to learn about its effective incorporation into medical training (4–6). The use of telepsychiatry as part of resident and medical student training in psychiatry has not been adequately investigated (4–6). Previous work tends to center around patients with developmental disabilities (5, 6). Szeftel et al., in 2008, reported the findings of a pilot study, assessing the effectiveness of a developmental-disabilities telepsychiatry clinic training and supervision model. Residents and fellows improved in psychiatric knowledge and skills. They note that a telepsychiatry clinic may be an effective way of providing direct supervision (5). Our objectives were to better understand how psychiatry residents and medical students evaluate the training provided in the telepsychiatry rotation (R1), whether they perceive direct supervision as useful (R2), and whether they find it useful as part of their training for future practice (R3).

Do regulated resident working hours affect medical graduate education? Trends in the American psychiatry board pass rates pre- and post-2003 duty hours regulations

Aims and method To assess trends of the American Board of Psychiatry and Neurology examination pass rates before and after the 2003 duty hours regulations (DHR). We obtained the pass rates for part I and II for years 2000–2010. Data were divided pre-DHR (2000–2003) and post-DHR (2007–2010). Results During the pre-DHR period, first- and multiple-attempt group pass rates were 80.7% and 39.0% which changed in the post-DHR period to 89.7% and 39.1% respectively. Similarly for the part II exam, the pre-DHR first- and multiple-attempt group pass rates were 60.2% and 43.5% respectively, which increased to 78.7% and 53.8%, among the post-DHR group. Overall, there was a significant increase in the first-attempt candidates pass rates for parts I and II, whereas multiple-attempt candidates did not benefit as strongly. Clinical implications The results suggest that the 2003 DHR may have had a positive impact on examination-based medical knowledge in psychiatry.

Synchronicity: Coincidence Detection and Meaningful Life Events

Early therapeutic use of coincidences is described by Carl Jung, who coined the term ‘synchronicity,’ referring to the low-probability co-occurrence of two different events in a narrow window of time, perceived as striking for the individual experiencing it.1 It is now accepted that, for coincidences to qualify as a synchronicity, they have to be meaningful, and help one’s individuation.2 A self-reported coincidence scale (Weird Coincidence Scale, WCS-2; see Table 1, page 574) was recently designed and revised1 to offer a tool to study coincidences in a general population and to characterize those who may detect coincidences more often.3 One population in this WCS-2 study included people affi liated with a university; the second population comprised undergraduate students in a psychology class at the same university. People who are high-frequency coincidence detectors are likely to score high on referential thinking, faith in intuition, vitality, negative affect, and search for meaning scales.3 Researchers were urged to improve the measurement of self-reported coincidences, since model fi t statistics were close to acceptable levels.3 The relationship has not been explored between the perceived coincidence experiences and age or stressful life events. Our objectives were to retest the WCS-2 constructs in an academic medical setting and assess how they relate to respondents’ age, direct patient care, and positive or negative emotional events. Assessing these relationships may provide a deeper insight into the experience of coincidences by those working in an academic medical center. STUDY CRITERIA We emailed an invitation to complete a Web-based survey to everyone at Southern Illinois University School of Medicine (SIU-SM) (2,862 people). Respondents were introduced to the idea of synchronicity and were notifi ed that the purpose of the study was to elicit their opinion on their experiences with coincidences. Respondents were informed that the questionnaire would be available for 6 days and would take 5 to 10 minutes to complete. Voluntary, anonymous participation was emphasized. The survey included a prototype coincidence story as published by Coleman2 and the WCS-2.3 The survey consisted of demographic information (age, gender, ethnicity, and religious affi liation) and a question regarding whether they worked in direct patient care. Respondents were also asked about their experiences with perceived coincidences around positive (eg, marriage, birth of a child, promotion, achievement, vacation) and negative life events (eg, injury, illness, death, divorce, fi nancial stress, stress at work, school).4 Participants were asked to rate WCS-2 questions such as “I think of calling someone, only to have that perGeorge Costin, MD, is Assistant Professor, Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV. Kristina Dzara, PhD, is Research Instructor, Department of Psychiatry, Southern Illinois University School of Medicine, Springfi eld, IL. David Resch, MD is Professor of Medicine/ Psychiatry, Department of Medicine/Psychiatry, Southern Illinois University School of Medicine, Springfi eld, IL. Portions of this paper were presented in poster form at the 2011 American Psychiatric Association Annual Meeting. Address correspondence to: George Costin, MD, 936 Sharpe Hospital Rd., Weston, WV, 26452-8550; email: george.costin@wv.gov. Drs. Costin, Dzara, and Resch have disclosed no relevant fi nancial relationships. doi: 10.3928/00485713-20111104-04 George Costin, MD; Kristina Dzara, PhD; and David Resch, MD

Residency-Coordinator Perceptions of Psychiatry Residency Candidates: A Pilot Study

ObjectiveThe authors sought to assess whether Residency Training Coordinators (RTCs) can predict psychiatry residency applicants’ success in obtaining a residency position.MethodRTCs completed a rating form to measure their perceptions of the residency candidates’ attentiveness, communication, attitude, and professionalism and answered the question “Would you feel comfortable seeing this person as your doctor?” These data were paired with ranking data from the National Residency Matching Program.ResultsResidency candidates rated highly by the coordinators were more likely to be ranked by Southern Illinois University (SIU) match at SIU. A “No” answer to the question “Would you feel comfortable seeing this person as your doctor?” was especially predictive of failure to match.ConclusionsRTCs can provide an important perspective on residency candidates’ attentiveness, communication, attitude, and professionalism. Asking RTCs the question “Would you feel comfortable seeing this person as your doctor?” provides a simple and powerful screening tool.

Assessing the Practices and Perceptions of Dually-Trained Physicians: A Pilot Study

Combined Internal Medicine/Psychiatry (IMP) and Family Medicine/Psychiatry (FMP) residency programs are specific to the United States, and have existed for almost 20 years (1, 2). They produce physicians who are well prepared to provide optimal, integrated care (1, 2). Although some physicians become dually trained via sequential programs, IMP and FMP training programs are relatively uncommon, and few medical students elect to pursue combined training (1, 3, 4). Currently, an estimated 92 and 55 residents are pursuing IMP and FMP, respectively (4). One possible explanation for the low numbers is lack of awareness regarding what dually-trained physicians do. Surveys assessing IMP and FMP physicians are limited, and most are dated (1, 2, 5). Previous respondents were satisfied with training but reported practicing mostly psychiatry and underutilizing their integrative skills (1, 2, 5). In this pilot survey, we bring attention to the diverse roles and responsibilities that dually-trained physicians might undertake, with the goal of stimulating interest in combined training. A survey was distributed at the 2010 Annual Association of Medicine & Psychiatry Conference in Chicago, to all dually-trained physicians who have completed training in IMP or FMP (sequentially or combined). The project was approved by the Springfield Committee for Research Involving Human Subjects (Institutional Review Board; Springfield, IL). PASW-18 was utilized for analysis (SPSS, Inc.; Chicago, IL). Of 34 dually-trained physician-attendees, 28 (82.4%) returned surveys. The average age was 38 years (range: 28–56), and the majority were women (53.6%; N 15) and U.S. citizens who attended a U.S. medical school (67.9%; N 19). Most (92.9%; N 26) completed combined (rather than sequential) training, and most (78.6%; N 22) completed IMP training. Respondents completed training between 1984 and 2010 (median: 2005). Most (78.6%; N 22) report board certification in both specialties. Twelve respondents report fellowship training in Psychosomatic Medicine, Hospice and Palliative Medicine, Sleep Medicine, Geriatric Psychiatry, Addiction Medicine, and Endocrinology. Most respondents (75%; N 21) work in a primarily academic setting, with a diverse array of work responsibilities, including education (N 22), clinic-based (N 18), hospital-based (N 17), consultative (N 17), administrative (N 17) and research (N 11). Only three respondents practice in only one specialty (two in Psychiatry, one in Primary Care). The majority (67.9%; N 19) report providing integrated patient care. In addition to the survey results shown in Table 1, respondents reported satisfaction with their ability to keep current with new knowledge in Psychiatry (4.07; SD: 0.81; range: 2–5; mode: 4) and Primary Care (3.75; SD: 0.97; range: 2–5; mode: 4). Only 28.6% (N 8) report better compensation than colleagues in Psychiatry, whereas 42.9% (12) report better compensation than Primary-Care colleagues. Respondents feel strongly that they contribute positively to various aspects of patient care, such as handling complex patients and improving outcomes. However, respondents are not confident that the U.S. healthcare system encourages the practice of integrated medicine (2.61; SD 1.17; range: 1–4; mode: 2). Finally, most respondents report that, if they had to choose again, they would still choose a combined training program (92.9%; N 26). This survey is the first in over a decade to assess attitudes of dually-trained physicians in IMP and FMP. Overall, most report satisfaction with their career choice, their training, their current work, and their field (Table 1). Dually-trained physicians fill many roles. As compared with previous surveys (1, 2, 5), we found a higher proportion of physicians working in both Psychiatry and Primary Care and providing inpatient care. This trend is encouraging for combined training program directors and important to highlight for medical students who are interested in combined training and academic careers but who are concerned that their practice may be limited to one discipline. Furthermore, program directors have noted that singlecategory residents may benefit academically and clinically Received February 19, 2011; revised July 31, September 13, 2011; accepted October 11, 2011. From the Dept. of Internal Medicine & Psychiatry, Southern Illinois University School of Medicine, Springfield, IL (GJ, DSR); Dept; of Psychiatry, Southern Illinois Univ. School of Medicine (KD); Dept. of Psychiatry & Behavioral Sciences and Dept. of Medicine, Duke Univ. Health Systems, Durham, NC (JPG); Dept. of Psychiatry amd Behavioral Sciences and Medicine, Univ. of California Davis School of Medicine, Sacramento, CA (GX); Dept. of Psychiatry and Dept. of Medicine, Tufts University School of Medicine, Boston, MA (PS). Correspondence: gjain@siumed.edu; drgauravjain@gmail.com (e-mail). Copyright