Lindsay A. Thompson

The Intersection of Online Social Networking with Medical Professionalism

AimTo measure the frequency and content of online social networking among medical students and residents.MethodsUsing the online network Facebook, we evaluated online profiles of all medical students (n = 501) and residents (n = 312) at the University of Florida, Gainesville. Objective measures included the existence of a profile, whether it was made private, and any personally identifiable information. Subjective outcomes included photographic content, affiliated social groups, and personal information not generally disclosed in a doctor–patient encounter.ResultsSocial networking with Facebook is common among medical trainees, with 44.5% having an account. Medical students used it frequently (64.3%) and residents less frequently (12.8%, p < .0001). The majority of accounts (83.3%) listed at least 1 form of personally identifiable information, only a third (37.5%) were made private, and some accounts displayed potentially unprofessional material. There was a significant decline in utilization of Facebook as trainees approached medical or residency graduation (first year as referent, years 3 and 4, p < .05).DiscussionWhile social networking in medical trainees is common in the current culture of emerging professionals, a majority of users allow anyone to view their profile. With a significant proportion having subjectively inappropriate content, ACGME competencies in professionalism must include instruction on the intersection of personal and professional identities.

Protected Health Information on Social Networking Sites: Ethical and Legal Considerations

Background Social networking site use is increasingly common among emerging medical professionals, with medical schools even reporting disciplinary student expulsion. Medical professionals who use social networking sites have unique responsibilities since their postings could violate patient privacy. However, it is unknown whether students and residents portray protected health information and under what circumstances or contexts. Objective The objective of our study was to document and describe online portrayals of potential patient privacy violations in the Facebook profiles of medical students and residents. Methods A multidisciplinary team performed two cross-sectional analyses at the University of Florida in 2007 and 2009 of all medical students and residents to see who had Facebook profiles. For each identified profile, we manually scanned the entire profile for any textual or photographic representations of protected health information, such as portrayals of people, names, dates, or descriptions of procedures. Results Almost half of all eligible students and residents had Facebook profiles (49.8%, or n=1023 out of 2053). There were 12 instances of potential patient violations, in which students and residents posted photographs of care they provided to individuals. No resident or student posted any identifiable patient information or likeness in text form. Each instance occurred in developing countries on apparent medical mission trips. These portrayals increased over time (1 in the 2007 cohort; 11 in 2009; P = .03). Medical students were more likely to have these potential violations on their profiles than residents (11 vs 1, P = .04), and there was no difference by gender. Photographs included trainees interacting with identifiable patients, all children, or performing medical examinations or procedures such as vaccinations of children. Conclusions While students and residents in this study are posting photographs that are potentially violations of patient privacy, they only seem to make this lapse in the setting of medical mission trips. Trainees need to learn to equate standards of patient privacy in all medical contexts using both legal and ethical arguments to maintain the highest professional principles. We propose three practical guidelines. First, there should be a legal resource for physicians traveling on medical mission trips such as an online list of local laws, or a telephone legal contact. Second, institutions that organize medical mission trips should plan an ethics seminar prior the departure on any trip since the legal and ethical implications may not be intuitive. Finally, at minimum, traveling physicians should apply the strictest legal precedent to any situation.

Pediatricians' Perceptions of and Preferred Timing for Pediatric Palliative Care

OBJECTIVES. This study investigates how pediatricians define palliative care and their preferences regarding the timing of referrals for children with life-limiting diseases. METHODS. A random sample of 800 pediatricians in Florida and California received mail and online surveys. Analyses included descriptive and multivariate regression analyses. RESULTS. Of all respondents (N = 303), 49.1% were female, 34.0% had been practicing for ≥20 years, 44.2% were members of a racial/ethnic minority, and 76.2% were in private practice. Pediatricians were divided in their definitions of palliative care; 41.9% defined it as hospice care, 31.9% offered alternative definitions, and 26.2% did not know. Although pediatricians overwhelmingly cited the need for many types of palliative care services, only 49.3% had ever referred patients to palliative care and 29.4% did not know whether local services existed. For 13 diseases that vary in life limitation, there was no consensus regarding the timing of referrals. Diversity across diseases predicted the most variation in referrals, whereas pediatrician characteristics did not. CONCLUSIONS. Despite recommendations to refer children to palliative care early in the course of illness, most pediatricians define palliative care as similar to hospice care and refer patients once curative therapy is no longer an option. Creating a more-practical definition of care, one that emphasizes an array of services throughout the course of an illness, as opposed to hospice care, may increase earlier palliative care referrals for children with life-limiting illnesses.

Partners in care: together for kids: Florida's model of pediatric palliative care.

BACKGROUND Many children with life-limiting illnesses in the United States could benefit from pediatric palliative care. However, national, state, and local barriers exist that hinder provision. One national barrier is the Medicare hospice reimbursement regulation that limits the provision of government subsidized hospice care to the final 6 months of life. In response to the critical need to provide palliative care earlier in childrens illnesses, Florida became the first state to develop and implement an innovative model of care that provides services from the point of diagnosis onward, thereby waiving the 6-month reimbursement rule. In July 2005, the Partners in Care: Together for Kids program began. The program relies on partnerships between state-employed care coordinators who identify the children for possible enrollment and hospice staff who provide home and community-based services. OBJECTIVE Our objective was to describe Floridas experiences in designing, implementing, and operating the program. DESIGN Surveys were conducted with parents, hospices, and state agencies. Enrollment trends were identified using administrative data. RESULTS As of January 2008, 468 children have been enrolled in the program. Approximately 85% of parents report they are satisfied with the program and 95% of parents would recommend the program. CONCLUSION Floridas program is the first in the nation to provide government-subsidized pediatric palliative care from the point of diagnosis onwards. Lessons learned from Floridas experiences will help guide other states and health plans that desire to implement a similar model of care.

Regional Variation in Rates of Low Birth Weight

Objective. Low birth weight (LBW; <2500 g) is the result of complex and poorly understood interactions between the biological determinants of the mother and the fetus, the parent’s socioeconomic status, and medical care. After controlling for these established risk factors, the extent of regional variation in LBW rates remains unknown. This study measures regional variation in LBW rates and identifies regions of neonatal health services with significantly high or low adjusted rates. Methods. Linking the United States 1998 singleton birth cohort (N = 3.8 million) with county and health care characteristics, we conducted a small area analysis of LBW across 246 regions of neonatal health services. We measured observed rates and then used a multivariable, hierarchical model to estimate adjusted LBW rates by regions. We then stratified these rates by race for the 208 regions with adequate sample size. Results. Observed LBW rates varied across regions from 3.8 to 10.6 per 100 live births (interquartile range: 5.0–6.8 [25th–75th percentile]; median: 5.9). After controlling for known maternal and area risk factors, 67 (27.0%) regions had rates significantly below and 98 (39.8%) regions had rates significantly higher than the national rate of 6.0 per 100 live births. Although black mothers were more likely to give birth to an LBW newborn, regional adjusted rates still varied >3-fold within both black and nonblack subgroups. Conclusions. After controlling for known maternal and area risk factors, LBW rates markedly varied across US regions of neonatal health services for both black and nonblack mothers. Additional analyses of these regions may provide opportunities for regional accountability in pregnancy outcomes, LBW research, and targeted improvement interventions, especially in high-risk populations.

Factors associated with perceived barriers to pediatric palliative care: a survey of pediatricians in Florida and California

Purpose: The provision and uptake of pediatric palliative care continues to be plagued by barriers. Several studies have documented these barriers, but none have done so with a diverse sample (most are at a single institution) or specifically about pediatric palliative care. Moreover, none have investigated the factors associated with perceived barriers. Our study has two aims: (1) to describe the barriers to pediatric palliative care as reported by a group of pediatricians practicing in two large States in the US; and (2) to identify factors associated with these perceived barriers. Methods: Cross-sectional survey data were collected from 303 pediatricians in Florida and California. Results: The two greatest barriers reported by the pediatricians were related to families’ reluctance to accept palliative care (95%) and families viewing palliative care as giving up (94%). Only 42% of pediatricians noted that reimbursement was a barrier. Across all the regressions, three factors were consistently associated with barriers to palliative care: race/ethnicity of pediatrician practice setting, and the percentage of low-income patients. Conclusions: Our findings can be used to develop targeted educational interventions towards providers and families. Understanding the factors that are driving the low uptake in palliative care is the first step in advancing pediatric palliative care overall.

The Linkage between Pediatric Quality of Life and Health Conditions: Establishing Clinically Meaningful Cutoff Scores for the PedsQL

OBJECTIVE To link pediatric health-related quality of life (HRQOL) and health conditions by establishing clinically meaningful cutoff scores for an HRQOL instrument, the Pediatric Quality of Life Inventory (PedsQL). METHODS We conducted telephone interviews with 1745 parents whose children were between 2 and 18 years old and enrolled in the Florida KidCare program and Childrens Medical Services Network in 2006. Two anchors, the Children with Special Health Care Needs (CSHCN) Screener and the Clinical Risk Groups (CRGs), were used to identify children with special health-care needs or chronic conditions. We established cutoff scores for the PedsQLs physical, emotional, social, school, and total functioning using the areas under the curves (AUCs) to determine the discriminative property of the PedsQL referring to the anchors. RESULTS The discriminative property of the PedsQL was superior, especially in total functioning (AUC > 0.7), between children with special health-care needs (based on the CSHCN Screener) and with moderate and major chronic conditions (based on the CRGs) as compared to healthy children. For children <8 years, the recommended cutoff scores for using total functioning to identify CSHCN were 83, 79 for moderate, and 77 for major chronic conditions. For children ≥8 years, the cutoff scores were 78, 76, and 70, respectively. CONCLUSIONS Pediatric HRQOL varied with health conditions. Establishing cutoff scores for the PedsQLs total functioning is a valid and convenient means to potentially identify children with special health-care needs or chronic conditions. The cutoff scores can help clinicians to conduct further in-depth clinical assessments.

Anonymous social media - Understanding the content and context of Yik Yak

Yik Yak, an anonymous social media application has garnered a pervasive following and secured millions in investment funding. The application has been a consistent topic of discussion on U.S. college campuses and in the media, often described in very negative terms. This study sought to gain an empirical understanding of the nature of communication on the application. Across three days, 4001 anonymous posts from 42 different US college campuses were collected and analyzed using emergent inductive content analysis. Overall, the content associated with each post varied widely, with a large percentage of posts (45.1%, n?=?1802) focused upon campus life and announcements or proclamations. Also frequent were posts that included profanity or vulgarities (13.5%, n?=?544), posts that asked apparently rhetorical questions (10.1%, n?=?405) and posts related to dating, sex and sexuality (9.2%, n?=?366). Many of the posts were arguably inflammatory, but few contained individualized personal information. A large proportion of posts reflected domains of perceived normative behaviors on college campuses, such as alcohol, drug use and sexuality. Importantly, posts analyzed were highly context specific, limiting the research teams ability to fully understand or appreciate the impact of a post. Finally, even in light of the highly contextual nature of the posts, based on our limited analysis, the authors of this manuscript conclude that Yik Yak, while a tool with the potential for abuse and misuse, does not represent a significant threat to young adults. Mixed methods were used to analyze 4001 Yik Yak posts from 42 college campuses.A large percentage of posts focused on context specific aspects of campus life.Profanity and vulgarity were frequent in posts, as well as sexual references.Many posts reflected domains of perceived normative behaviors on college campuses.The potential for abusive postings may be mediated by online community policies.

The relationships between asthma control, daytime sleepiness, and quality of life among children with asthma: a path analysis

OBJECTIVES We aimed to examine the relationships between asthma control, daytime sleepiness, and asthma-specific health-related quality of life (HRQOL) among children with asthma. Path analyses were conducted to test if daytime sleepiness can mediate the effect of asthma control status on asthma-specific HRQOL. METHODS 160 dyads (pairs) of asthmatic children and their parents were collected for analyses. The Asthma Control and Communication Instrument (ACCI) was used to categorize adequate and poor asthma control status. The Cleveland Adolescent Sleepiness Questionnaire (CASQ) was used to measure childrens daytime sleepiness, including sleep in school, awake in school, sleep in evening, and sleep during transport. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale was used to measure asthma-specific HRQOL. RESULTS Poorly controlled asthma was associated with daytime sleepiness and impaired asthma-specific HRQOL. Asthma control status was directly associated with asthma-specific HRQOL (P<.05), whereas sleep in school and sleep in evening domains of daytime sleepiness significantly mediated the relationship between poor asthma control and impaired HRQOL (P<.01). CONCLUSIONS Asthma control status was associated with pediatric asthma-specific HRQOL, and the association was significantly mediated by daytime sleepiness. Healthcare providers need to address pediatric sleep needs related to poor asthma control to reduce the negative impact on HRQOL.

Parental strain, parental health, and community characteristics among children with attention deficit-hyperactivity disorder

OBJECTIVE It has been documented that parenting a child with attention deficit-hyperactivity disorder (ADHD) can cause family strain, but less is known about the added stress of additional child health diagnoses on levels of strain. This study explores the relationship between family stressors (such as child comorbid conditions) and family resources (such as social support, community characteristics, and parental health) on parental strain. METHODS We used the 2007 National Survey of Childrens Health (NSCH) to identify children with ADHD and other comorbid mental and physical health conditions (n = 5473). Descriptive, bivariate, and multivariate analyses were conducted to explore the association between parental strain, social support, mothers mental health, and neighborhood amenities within groups of children with ADHD and comorbid conditions. RESULTS Parental strain was greatest when ADHD was paired with a conduct disorder, physical disorder, or other mental health disorder. Specifically, parental strain was greatest for children with ADHD plus a comorbid conduct disorder compared with ADHD alone. It was also greater for children with other mental and physical health diagnoses compared with children with ADHD alone. Better mental health of mothers in the sample is related to reduced parental strain. Greater access to social support and neighborhood amenities also are related to reduced parental strain. CONCLUSIONS Greater levels of social support and better mental health of parents is associated with decreased strain. Interventions aimed at relieving stress and building strategies to improve mental health can be beneficial for families with children with ADHD and comorbid conditions.