Madeline R. Sterling

The Use of Social Media in Graduate Medical Education: A Systematic Review

Purpose Despite the growing presence of social media in graduate medical education (GME), few studies have attempted to characterize their effect on residents and their training. The authors conducted a systematic review of the peer-reviewed literature to understand the effect of social media on resident (1) education, (2) recruitment, and (3) professionalism. Method The authors identified English-language peer-reviewed articles published through November 2015 using Medline, Embase, Cochrane, PubMed, Scopus, and ERIC. They extracted and synthesized data from articles that met inclusion criteria. They assessed study quality for quantitative and qualitative studies through, respectively, the Medical Education Research Study Quality Instrument and the Consolidated Criteria for Reporting Qualitative Studies. Results Twenty-nine studies met inclusion criteria. Thirteen (44.8%) pertained to residency education. Twitter, podcasts, and blogs were frequently used to engage learners and enhance education. YouTube and wikis were more commonly used to teach technical skills and promote self-efficacy. Six studies (20.7%) pertained to the recruitment process; these suggest that GME programs are transitioning information to social media to attract applicants. Ten studies (34.5%) pertained to resident professionalism. Most were exploratory, highlighting patient and resident privacy, particularly with respect to Facebook. Four of these studies surveyed residents about their social network behavior with respect to their patients, while the rest explored how program directors use it to monitor residents’ unprofessional online behavior. Conclusions The effect of social media platforms on residency education, recruitment, and professionalism is mixed, and the quality of existing studies is modest at best.

Twitter in academic medicine

Department of Health. 2013. Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values. A mandate from the Government to Health Education England: April (2013) to March (2015). Jones R, Stephenson A. 2008. Quality assurance of community-based undergraduate medical curricula by academic departments: Cross sectional survey. Educ Prim Care 19(6):135–142. Svirko E, Goldacre MJ, Lambert T. 2013. Career choices of the United Kingdom medical graduates of (2005), (2008) and (2009): Questionnaire surveys. Med Teach 35(5):365–375.

Patterns of scheduled follow-up appointments following hospitalization for heart failure: insights from an urban medical center in the United States.

Objectives Although postdischarge outpatient follow-up appointments after a hospitalization for heart failure represent a potentially effective strategy to prevent heart failure readmissions, patterns of scheduled follow-up appointments upon discharge are poorly described. We aimed to characterize real-world patterns of scheduled follow-up appointments among adult patients with heart failure upon hospital discharge. Patients and methods This was a retrospective cohort study performed at a large urban academic center in the United States among adults hospitalized with a principal diagnosis of congestive heart failure between January 1, 2013, and December 31, 2014. Patient demographics, administrative data, clinical parameters, echocardiographic indices, and scheduled postdischarge outpatient follow-up appointments were collected. Results Of the 796 patients hospitalized for heart failure, just over half of the cohort had a scheduled follow-up appointment upon discharge. Follow-up appointments were less likely among patients who were white and had heart failure with preserved ejection fraction and more likely among patients with Medicaid and chronic obstructive pulmonary disease. In an adjusted multivariable regression model, age ≥65 years was inversely associated with a scheduled follow-up appointment upon hospital discharge, despite higher rates of several cardiovascular and noncardiovascular comorbidities. Conclusion Just half of the patients discharged home following a hospitalization for heart failure had a follow-up appointment scheduled, representing a missed opportunity to provide a recommended care transition intervention. Despite a greater burden of both cardiovascular and noncardiovascular comorbidities, older adults (age ≥65 years) were less likely to have a follow-up appointment scheduled upon discharge compared with younger adults, revealing a disparity that warrants further investigation.

Can your patients with heart failure see? The prevalence of visual impairment among adults with heart failure

Heart failure (HF) management requires medication and diet adherence, as well as daily weight and fluid monitoring. In addition, patients are often asked to follow specific written instructions after hospital discharge. All of these activities require adequate visual acuity (VA). Yet, to date, little is known about the visual function of adults with HF. Herein, we provide the first national estimates of the prevalence of visual impairment (VI) among adults with HF.

Numeracy, Health Literacy, Cognition, and 30-Day Readmissions among Patients with Heart Failure

BACKGROUND Numeracy, health literacy, and cognition are important for chronic disease management. Prior studies have found them to be associated with poorer self-care and worse clinical outcomes, but limited data exists in the context of heart failure (HF), a condition that requires patients to monitor their weight, fluid intake, and dietary salt, especially in the posthospitalization period. OBJECTIVE To examine the relationship between numeracy, health literacy, and cognition with 30-day readmissions among patients hospitalized for acute decompensated HF (ADHF). DESIGN/SETTING/PATIENTS The Vanderbilt Inpatient Cohort Study is a prospective longitudinal study of adults hospitalized with acute coronary syndromes and/or ADHF. We studied 883 adults hospitalized with ADHF. MEASUREMENTS During their hospitalization, a baseline interview was performed in which demographic characteristics, numeracy, health literacy, and cognition were assessed. Through chart review, clinical characteristics were determined. The outcome of interest was 30-day readmission to any acute care hospital. To examine the association between numeracy, health literacy, cognition, and 30-day readmissions, multivariable Poisson (log-linear) regression was used. RESULTS Of the 883 patients admitted for ADHF, 23.8% (n = 210) were readmitted within 30 days; 33.9% of the study population had inadequate numeracy skills, 24.6% had inadequate/marginal literacy skills, and 53% had any cognitive impairment. Numeracy and cognition were not associated with 30-day readmissions. Though (objective) health literacy was associated with 30-day readmissions in unadjusted analyses, it was not in adjusted analyses. CONCLUSIONS Numeracy, health literacy, and cognition were not associated with 30-day readmission among this sample of patients hospitalized with ADHF.

Focusing on the Future of Cardiovascular Outcomes Research: Highlights From the American Heart Association/American Stroke Association Quality of Care and Outcomes Research 2018 Scientific Sessions

The American Heart Association/American Stroke Association Quality of Care and Outcomes Research (QCOR) 2018 Scientific Sessions was recently held in Arlington, VA, from April 6 to 7. The 2-day conference featured >50 oral presentations and 170 poster presentations across an array of topics, including the use of big data science in clinical practice, the shifting policy landscape in cardiovascular care, and the expanding role of social media in science.nnOne key theme throughout the conference was the future of cardiovascular outcomes research, which was highlighted by the 2018 QCOR Outstanding Achievement Award recipient and keynote speaker Eric D. Peterson, MD, MPH. Dr Peterson reflected on the progress of cardiovascular outcomes research as a field and the QCOR community in general. What was once a small group of geeks running simple regression models on manually chart-reviewed data has grown into a much larger group of wonks applying machine learning techniques to hundreds of thousands of electronic medical records, he reflected. He also forecasted the future of cardiovascular outcomes research, which included the potential of big data science to improve outcomes, the importance of fostering partnerships with patients who actively participate in research, and the development and use of living clinical registries. Above all, he stressed the importance of mentorship and investing in the future generation of cardiovascular outcomes researchers.nnWithin the context of this theme, we offer several directions of cardiovascular outcomes research that were presented at QCOR 2018 Scientific Sessions. In addition, we present updates on the current and future state of Get With The Guidelines (GWTG) registries and highlight the career development opportunities that QCOR 2018 provided to young investigators.nn### Translating Big Data to Clinical PracticennThe opening plenary session of QCOR 2018 highlighted opportunities that big data science offers, including machine learning, artificial intelligence, and natural language processing. In addition, the challenges to implementing …

Let’s talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure

Objective To examine the perspectives of adults with heart failure (HF) about numerical concepts integral to HF self-care. Setting This qualitative study took place at an urban academic primary care practice. Participants Thirty men and women aged 47–89u2009years with a history of HF were recruited to participate. Eligibility criteria included: a history of HF (≥1u2009year), seen at the clinic within the last year, and a HF hospitalisation within the last 6u2009months. Non-English speakers and those with severe cognitive impairment were excluded. Methods In-depth semistructured interviews were conducted. Participants were interviewed about numeracy across three domains of HF self-care: (1) monitoring weight,(2) maintaining a diet low in salt and (3) monitoring blood pressure. Interviews were audio-taped, transcribed verbatim and analysed using grounded theory and word cloud techniques. Results Five key themes reflecting participants’ attitudes towards numerical concepts pertaining to weight, diet and blood pressure were identified: (1) Communication between healthcare providers and patients is a complex, multistage process; (2) Patients possess a wide range of knowledge and understanding; (3) Social and caregiver support is critical for the application of numerical concepts; (4) Prior health experiences shape outlook towards numerical concepts and instructions and (5) Fear serves as a barrier and a facilitator to carrying out HF self-care tasks that involve numbers. The findings informed a theoretical framework of health numeracy in HF. Conclusion Effective communication of numerical concepts which pertain to HF self-care is highly variable. Many patients with HF lack basic understanding and numeracy skills required for adequate self-care. As such, patients rely on caregivers who may lack HF training. HF-specific training of caregivers and research that seeks to elucidate the intricacies of the patient–caregiver relationship in the context of health numeracy and HF self-care are warranted.

N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study

BackgroundN-terminal pro B-type peptide (NT-proBNP) has been associated with risk of myocardial infarction (MI), but less is known about the relationship between NT-proBNP and very small non ST-elevation MI, also known as microsize MI. These events are now routinely detectable with modern troponin assays and are emerging as a large proportion of all MI. Here, we sought to compare the association of NT-proBNP with risk of incident typical MI and microsize MI in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.MethodsThe REGARDS Study is a national cohort of 30,239 US community-dwelling black and white adults aged ≥u200945xa0years recruited from 2003 to 2007. Expert-adjudicated outcomes included incident typical MI (definite/probable MI with peak troponin ≥u20090.5xa0μg/L), incident microsize MI (definite/probable MI with peak troponin <u20090.5xa0μg/L), and incident fatal CHD. Using a case-cohort design, we estimated the hazard ratio of the outcomes as a function of baseline NT-proBNP. Competing risk analyses tested whether the associations of NT-proBNP differed between the risk of incident microsize MI and incident typical MI as well as if the association of NT-proBNP differed between incident non-fatal microsize MI and incident non-fatal typical MI, while accounting for incident fatal coronary heart disease (CHD) as well as heart failure (HF).ResultsOver a median of 5xa0years of follow-up, there were 315 typical MI, 139 microsize MI, and 195 incident fatal CHD. NT-proBNP was independently and strongly associated with all CHD endpoints, with significantly greater risk observed for incident microsize MI, even after removing individuals with suspected HF prior to or coincident with their incident CHD event.ConclusionNT-proBNP is associated with all MIs, but is a more powerful risk factor for microsize than typical MI.