ATS scholar最新文献

{"title":"An International Survey of Extracorporeal Membrane Oxygenation Education and Credentialing Practices","authors":"Bhoumesh Patel, Ahmed S. Said, Angelo Justus, Darryl Abrams, Tái Pham, Marta Velia Antonini, Elizabeth Moore, Kiran Shekar, Bishoy Zakhary","doi":"10.34197/ats-scholar.2022-0132oc","DOIUrl":"https://doi.org/10.34197/ats-scholar.2022-0132oc","url":null,"abstract":"Background: The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly over the past decades because of evolving indications, advances in circuit technology, and encouraging results from modern trials. Because ECMO is a complex and highly invasive therapy that requires a multidisciplinary team, optimal education, training, and credentialing remain a challenge. Objective: The primary objectives of this study were to investigate the prevalence and application of ECMO education and ECMO practitioner credentialing at ECMO centers globally. In addition, we explored differences among education and credentialing practices in relation to various ECMO center characteristics. Methods: We conducted an observational study of ECMO centers worldwide using a survey querying participants in two major domains: ECMO education and ECMO practitioner credentialing. Of note, the questionnaire included ECMO program characteristics, such as type and size of hospital and ECMO experience and volume, to explore the association with the two domains. Results: A total of 241 (32%) of the 732 identified ECMO centers responded to the survey, representing 41 countries across the globe. ECMO education was offered at 221 (92%) of the 241 centers. ECMO education was offered at 105 (98.0%) high–ECMO volume centers compared with 136 (87.5%) low–ECMO volume centers (P = 0.005). Credentialing was established at 101 (42%) of the 241 centers. Credentialing processes existed at 52 (49.5%) high–ECMO volume centers compared with 51 (37.5%) low–ECMO volume centers (P = 0.08) and 101 (49.3%) Extracorporeal Life Support Organization centers compared with 1 (2.7%) non–Extracorporeal Life Support Organization center (P < 0.001). Conclusion: We found significant variability in whether ECMO educational curricula are offered at ECMO centers. We also found fewer than half of the ECMO centers surveyed had established credentialing programs for ECMO practitioners. Future studies that assess variability in outcomes among centers with and without standardized educational and credentialing practices are needed.","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"168 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135932746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke and Obstructive Sleep Apnea: What Patients Need to Know","authors":"Raman G. Kutty, Dan-Victor Giurgiutiu, Younghoon Kwon, William J. Healy","doi":"10.34197/ats-scholar.2023-0034pe","DOIUrl":"https://doi.org/10.34197/ats-scholar.2023-0034pe","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"20 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135933835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Landscape and Future Directions of Patient Education in Adults with Interstitial Lung Disease","authors":"Tina M. Savvaides, Michelle R. Demetres, Kerri I. Aronson","doi":"10.34197/ats-scholar.2023-0069re","DOIUrl":"https://doi.org/10.34197/ats-scholar.2023-0069re","url":null,"abstract":"Background: Understandable, comprehensive, and accessible educational materials for patients with interstitial lung disease (ILD) are lacking. Patients consistently ask for improved access to evidence-based information about ILD. Nonetheless, few research studies focus directly on developing and evaluating interventions to improve patient knowledge. Objective: We describe the current landscape of patient education in ILD, identify gaps in current approaches to information delivery, and provide frameworks to address these challenges through novel educational tools. Methods: A literature review was conducted in collaboration with a medical librarian (M.R.D.) in April 2022 using Ovid MEDLINE (1946–), Embase (1947–), Cochrane Central (1993–), and CINAHL (1961–). Search terms included “interstitial lung disease,” “pulmonary fibrosis,” “patient education,” and “information seeking behavior” (see the data supplement for full search terms). Reference lists from selected articles were used to identify additional studies. Results: Currently, patient education is commonly combined with exercise regimens in pulmonary rehabilitation programs in which benefits of the educational component alone are unclear. Few studies investigate improving knowledge access and acquisition for patients with ILD and their caregivers regarding self-management, oxygen use, and palliative care plans. Online distribution of health information through social media runs the risk of being unregulated and outdated, although it is an avenue of increasing accessibility. Conclusion: By expanding access to novel ILD-specific education programs and accounting for social determinants of health that impact healthcare access, patient education has the potential to become more attainable, improving patient-centered outcomes. Further research into optimal development, delivery, and efficacy testing of patient education modalities in ILD is warranted.","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135883949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education for Tobacco Use Disorder Treatment: Current State, Evidence, and Unmet Needs","authors":"Anne C. Melzer, Zachary A. Reese, Lorraine Mascarhenas, Caitlin B. Clancy, Janaki Deepak, Hyma Gogineni, Yaron Gesthalter, Joanna L. Hart","doi":"10.34197/ats-scholar.2022-0131re","DOIUrl":"https://doi.org/10.34197/ats-scholar.2022-0131re","url":null,"abstract":"Background: Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients. Objective: We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams. Methods: We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT. Results: Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams. Conclusion: TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135883234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Entrustment Decision Making in the Intensive Care Unit: It’s About More Than the Learner","authors":"Megan Conroy, Jennifer McCallister, Jillian Gustin","doi":"10.34197/ats-scholar.2023-0060oc","DOIUrl":"https://doi.org/10.34197/ats-scholar.2023-0060oc","url":null,"abstract":"Background: The provision of graded supervision affording progressive autonomy is fundamental to the progression of a medical learner toward competency for independent practice; the decision of how much supervision versus autonomy to provide a trainee in the execution of clinical care constitutes an entrustment decision. Despite entrustment decision making occurring both daily in practice and summatively at points of matriculation through stages of medical training, the factors influencing entrustment decisions remain poorly understood across clinical contexts. Objective: This study was designed to explore the central research question: How are entrustment decisions made in the medical intensive care unit (ICU)? Methods: This qualitative case study used semistructured interviews with attending pulmonary and critical care physicians in the medical ICU at a major midwestern medical center to explore the entrustment decision-making process as it was enacted in the clinical environment. Results: Five major themes emerged from the data: 1) task, circumstance, and trainee factors contribute to entrustment decision making; 2) ad hoc entrustment decisions are enacted by supervisors with a consideration of the care team as a unit, not only an individual; 3) autonomy does not only arise out of entrustment, but outcomes of prior autonomous actions by the trainee inform the intention to entrust; 4) entrustment decision making includes a social process of back-and-forth akin to negotiation; and 5) entrustment is a learned skill. Conclusion: The process of entrustment decision making in the ICU is more complex than prior frameworks have captured; a model with more complete incorporation of the factors that influence entrustment in the ICU is presented. It is not clear how often ad hoc entrustment decisions in clinical practice are primarily driven by factors pertaining directly to trainee competence, which carries implications in the use of entrustment for assessment.","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136211714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Group Feedback for Faculty: Turning the Wheels of Change.","authors":"Mira John, Erin Camac","doi":"10.34197/ats-scholar.2023-0059ED","DOIUrl":"10.34197/ats-scholar.2023-0059ED","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"4 3","pages":"247-249"},"PeriodicalIF":1.7,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/ea/ats-scholar.2023-0059ED.PMC10547033.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned from an Implementation Study of Intensive Care Unit Nurses' Perceptions of Patient and Family Education Material.","authors":"Jean-Marie Bruzzese","doi":"10.34197/ats-scholar.2023-0089ED","DOIUrl":"10.34197/ats-scholar.2023-0089ED","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"4 3","pages":"254-256"},"PeriodicalIF":1.7,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e5/a2/ats-scholar.2023-0089ED.PMC10547032.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Rethinking Vasopressor Education: The Need to Avoid Teaching the Bare Minimum.","authors":"Daniel K Manson,&nbsp;Amy L Dzierba,&nbsp;Kaitlin M Seitz,&nbsp;Daniel Brodie","doi":"10.34197/ats-scholar.2023-0049LE","DOIUrl":"https://doi.org/10.34197/ats-scholar.2023-0049LE","url":null,"abstract":"Division of Pulmonary, Allergy, and Critical Care Medicine and Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York; Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York; and Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"4 3","pages":"391-392"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/27/ats-scholar.2023-0049LE.PMC10547031.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41123174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Vasopressor Education: The Need to Avoid Teaching the Bare Minimum.","authors":"Michael T McCurdy,&nbsp;Laurence W Busse","doi":"10.34197/ats-scholar.2023-0030LE","DOIUrl":"https://doi.org/10.34197/ats-scholar.2023-0030LE","url":null,"abstract":"To the Editor: As medical educators, we all strive to teach in a manner that facilitates learners’ understanding, and optimizing the delivery of educational material is essential in this process. Conveying potentially complex topics to novices in an organized, methodical, and succinct approach helps to ensure that the “how” and “why” of problems are sufficiently communicated. However, the educational content (the “what”) must be sufficiently comprehensive to capture both key physiological concepts and relevant supporting data for those concepts. Although the educational format described in this brief review (1) is excellent, we believe the authors erred in their exclusion of angiotensin II and the renin-angiotensin-aldosterone system (RAAS). With regard to hemodynamic management, the authors chose “... to emphasize the evolutionary basis of human physiology rooted in ensuring survival, which may not neatly translate to sustaining life amid a prolonged shock state.” However, they preface their discussion with “...we do not discuss... angiotensin II, or other inotropes (i.e., levosimendan and milrinone), as these topics tend to distract from the core physiologic principles being conveyed... .” Excluding the RAAS from a contemporary discussion on human hemodynamic physiology and hemodynamic management is to omit one of the few evolutionary pillars of mammalian physiology that ensures adequate end-organ perfusion. It would be unthinkable to exclude the RAAS in a similar discussion about how to teach the management of hypertension. Angiotensin II, an active metabolite of the RAAS, was first described for managing vasodilatory shock in the Journal of the American Medical Association in 1961 (2), and we have previously described its more than three decades of clinical use (3).","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"4 3","pages":"389-390"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/76/1e/ats-scholar.2023-0030LE.PMC10547023.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recruitment into Pediatric Pulmonary Fellowship Programs: The Bigger the Better?","authors":"Pnina Weiss","doi":"10.34197/ats-scholar.2023-0091ED","DOIUrl":"10.34197/ats-scholar.2023-0091ED","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"4 3","pages":"250-253"},"PeriodicalIF":1.7,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/95/ats-scholar.2023-0091ED.PMC10547034.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}