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Surgery For Obesity and Related... Feb 2024The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database collects data from all accredited centers in the US. A prior study...
BACKGROUND
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database collects data from all accredited centers in the US. A prior study showed data quality issues limiting use of up to 20% of the 2015 database.
OBJECTIVES
To evaluate the completeness and data quality (internal validity, accuracy, and consistency) of the MBSAQIP database between 2015 and 2019.
SETTING
United States.
METHODS
All subsets of data from the MBSAQIP Participant User Data File (PUDF) were compiled into one main file. Completeness, internal validity, accuracy, and consistency were evaluated. Completeness was determined via missing values. Internal validity was assessed using the percentage of patients with a body mass index (BMI) < 30 kg/m who underwent primary bariatric surgery. Accuracy was evaluated using reported versus calculated BMI. Consistency was assessed using the percentage of patients with a gain of >5 or a loss of >20 units of BMI change in 30 days. Effects across years were assessed using a chi-squared test.
RESULTS
Missing data for age, BMI, and ASA was consistently low (<2.5%) with no significant difference across years. Only .02% of patients who underwent a primary bariatric procedure had a reported BMI <30 kg/m. The mean difference between reported versus calculated BMI was -.02 units. A maximum of .33% of patients gained >5 units of BMI, and a maximum of .85% of patients lost > 20 units of BMI in early follow-up.
CONCLUSIONS
While the MBSAQIP is a database with acceptable data quality and minimal changes from 2015-2019, ongoing efforts are needed to improve data.
Topics: Humans; United States; Child, Preschool; Obesity, Morbid; Quality Improvement; Treatment Outcome; Bariatric Surgery; Accreditation; Retrospective Studies; Gastrectomy; Gastric Bypass
PubMed: 37778942
DOI: 10.1016/j.soard.2023.08.018 -
Journal of Education & Teaching in... Jan 2024Emergency medicine residents and medical students on emergency medicine rotation.
AUDIENCE
Emergency medicine residents and medical students on emergency medicine rotation.
BACKGROUND
Calcium channel blocker (CCB) overdoses can be severe with potentially serious adverse outcomes. CCBs work by blocking the calcium channels on smooth and cardiac muscle tissue. At low dose ranges, dihydropyridine CCBs (such as nifedipine, amlodipine, and nicardipine) block the L-type calcium receptors in the peripheral vasculature, whereas non-dihydropyridine CCBs (such as: verapamil and diltiazem) affect the L-type calcium receptors in the myocardium.1 Because of this distinction, dihydropyridine CCB toxicity manifests as arterial vasodilation and non-dihydropyridine CCB toxicity is associated with cardiac manifestations such as bradycardia and negative inotropy.2 It is important to note that in high concentrations (such as in overdoses), CCBs lose specificity for their specific receptors and can show all the manifestations of toxicity such as bradycardia, peripheral vasodilation, and hypotension. Patients can develop both vasoplegic shock from peripheral vasodilation and cardiogenic shock. This is a high acuity low occurrence case with infrequently used but specific treatments, and thus this case provides educational value.
EDUCATIONAL OBJECTIVES
At the end of this oral board session, examinees will: (1) demonstrate ability to evaluate a patient with undifferentiated shock with bradycardia and discuss the differential diagnosis, (2) recognize the signs and symptoms of calcium channel blocker overdose, (3) demonstrate ability to manage treatment of a patient with calcium channel overdose.
EDUCATIONAL METHODS
This oral board case followed the standard American Board of Emergency Medicine-style case in a tertiary care hospital with access to all specialists and resources needed. This case was tested using 12 resident volunteers ranging from PGY 1-2 in an ACGME (Accreditation Council for Graduate Medical Education) accredited emergency medicine residency program.
RESEARCH METHODS
Immediate feedback was solicited both from the learners and from the evaluators following the debriefing session. Residents were asked to evaluate the educational value of the case using a 1-5 Likert scale (5 being excellent). Evaluators were asked to score the residents using the ACGME core competencies with a scale of 1-8, 1-4 being unacceptable and 5-8 being acceptable.
RESULTS
Seven PGY1 residents and five PGY2 residents, thus twelve residents in total, completed the case. The average score was 5.10/8. Three residents missed zero critical actions. The most common critical action missed was consulting cardiology or cardiothoracic surgery for circulatory support options. Many residents failed to recognize that the patient did not have a perfusing blood pressure at the beginning of the case and did not start CPR. Although most residents recognized the patient's hemodynamic collapse was from a calcium channel blocker overdose, most did not know the treatment for this beyond atropine and intravenous fluids.The learners rated the educational value of the case as 4.9/5. Seven residents reported that the case definitely increased their medical knowledge; five residents reported that it somewhat increased their medical knowledge. All residents rated the case as helpful in preparing to manage this medical condition.
DISCUSSION
The educational content from this case was effective. This is a high acuity low occurrence case that has unique treatments that are not commonly used. This makes this case excellent for practice and discussion. We learned during implementation that this case has a high degree of difficulty compared to other cases, and junior learners will need more prompting. It is also important for the proctor to keep the case moving because there is a lot to cover in the allotted amount of time.
TOPICS
Calcium channel blocker overdose, toxicology.
PubMed: 38344049
DOI: 10.21980/J8CQ07 -
The Journal of Physician Assistant... Dec 2023While the processes of ongoing self-assessment and accreditation provide significant benefits to physician assistant (PA) programs, faculty members are often challenged...
PURPOSE
While the processes of ongoing self-assessment and accreditation provide significant benefits to physician assistant (PA) programs, faculty members are often challenged by the required procedures and standards set by accreditation agencies. This study explored faculty perspectives regarding the processes of ongoing self-assessment and accreditation in PA programs.
METHODS
A qualitative research design centered around semistructured interviews was used. A total of 26 participants were recruited, including PA program directors, associate program directors, directors of assessment and accreditation, past Accreditation Review Commission on Education for the Physician Assistant commissioners, accreditation consultants, deans, and PA Education Association leaders.
DATA COLLECTION
Semistructured one-on-one interviews were conducted by 8 members of the research team through Zoom video conferencing. Data were collected until saturation was reached.
DATA ANALYSIS
The interview recordings were transcribed and analyzed independently by 3 researchers. The transcripts were imported into NVivo, a qualitative data analysis software, for coding and inductive thematic analysis.
RESULTS
Six emergent themes were identified under 2 major categories: facilitators and challenges. Facilitators for conducting continuous programmatic review and analysis include it takes a village, internal and external support, and sustained faculty development, whereas challenges are lack of knowledge and time, unclear expectations, and inflexibility.
CONCLUSION
The study highlights factors associated with facilitating the ongoing self-assessment process. However, a number of challenges were also identified. The study suggests opportunities for intervention at the program, institution, and profession level.
Topics: Humans; Physician Assistants; Self-Assessment; Faculty; Accreditation; Educational Status
PubMed: 37698942
DOI: 10.1097/JPA.0000000000000554 -
Journal of Perinatology : Official... Dec 2023To optimize post-graduate competency-based assessment for medical trainees, the Accreditation Council for Graduate Medical Education initiated a sub-specialty-specific... (Review)
Review
To optimize post-graduate competency-based assessment for medical trainees, the Accreditation Council for Graduate Medical Education initiated a sub-specialty-specific revision of the existing Milestones 1.0 assessment framework in 2016. This effort was intended to increase both the effectiveness and accessibility of the assessment tools by incorporating specialty-specific performance expectations for medical knowledge and patient care competencies; decreasing item length and complexity; minimizing inconsistencies across specialties through the development of common "harmonized" milestones; and providing supplemental materials, including examples of expected behaviors at each developmental level, suggested assessment strategies, and relevant resources. This manuscript describes the efforts of the Neonatal-Perinatal Medicine Milestones 2.0 Working Group, outlines the overall intent of Milestones 2.0, compares the novel Milestones to the original version, and details the materials contained in the novel supplemental guide. This new tool should enhance NPM fellow assessment and professional development while maintaining consistent performance expectations across specialties.
Topics: Infant, Newborn; Humans; Competency-Based Education; Clinical Competence; Education, Medical, Graduate; Medicine; Accreditation; Internship and Residency
PubMed: 37095228
DOI: 10.1038/s41372-023-01683-8 -
BMJ Quality & Safety Oct 2023
Topics: Humans; Accreditation; Delivery of Health Care
PubMed: 37353314
DOI: 10.1136/bmjqs-2023-016129 -
Family Medicine Nov 2023Scholarly activity is a core requirement set by the Accreditation Council for Graduate Medical Education (ACGME). A previous study documented a significant 302% increase...
BACKGROUND AND OBJECTIVES
Scholarly activity is a core requirement set by the Accreditation Council for Graduate Medical Education (ACGME). A previous study documented a significant 302% increase in scholarly activity at Eglin Family Medicine Residency after implementation of a standard set of interventions from 2016 to 2019. Few researchers have explained why such interventions to increase scholarly activity are effective. Prior work has suggested that many different interventions are helpful, but why? Our qualitative study took a multilevel approach to explain accompanying cultural factors and to determine how specific interventions led to the observed increases in quality and quantity of resident scholarship.
METHODS
Taking a grounded theory qualitative approach, we interviewed a cross-section of high- and low-producing residents (12) and faculty (5) using a semistructured interview guide. Data analysis occurred concurrently with interviews. The team iterated the interview guide three times until core code saturation was achieved. Then axial coding occurred, and our team developed a grounded theory of scholarship cultural change.
RESULTS
During the transformation period of 2016 to 2019, participants identified mentorship availability, interest/opportunity alignment, research mechanics demystification, leadership support affecting productivity, and scholarship begets scholarship as key factors that promulgated the culture change leading to increased scholarship productivity. No single factor led to increased scholarship. Collectively, they mutually reinforced one another.
CONCLUSIONS
This explanatory inquiry developed into a multilevel model which suggests that the synergy of promoting elements drives increased scholarly productivity. Other residencies should consider fostering these combined elements instead of emphasizing only isolated individual elements to increase resident scholarship productivity.
Topics: Humans; Internship and Residency; Education, Medical, Graduate; Fellowships and Scholarships; Accreditation; Family Practice
PubMed: 37540530
DOI: 10.22454/FamMed.2023.239179 -
Malaysian Family Physician : the... 2023Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the...
INTRODUCTION
Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the performance of PHC centres.
METHOD
This study systematically reviewed articles published from 2000 to 2019 in the Web of Science, Scopus, ScienceDirect, Springer, PubMed and ProQuest. The following keywords were used: ((primary care OR primary health care) AND (accreditation) AND (impact OR effect OR output OR outcome OR influence OR result OR consequences)). The database search yielded a total of41256 articles, among which 30 articles were finally included in the review.
RESULTS
Accreditation showed the most positive impacts on the quality, effectiveness, human resource management and strategic management of PHC services. Accreditation also positively affected safety, responsiveness, accessibility, customer satisfaction, documentation, leadership, efficiency and continuity of care. Few negative impacts were noted, including the possibility of accreditation being used as a bureaucratic tool, high cost of acquiring accreditation, difficulties in understanding the accreditation process, high staff turnover rate in accredited PHC centres and weak sustainability of some accreditation programmes.
CONCLUSION
Given its numerous positive impacts, accreditation could be used to effectively improve the performance of PHC centres.
PubMed: 38026575
DOI: 10.51866/rv.274 -
BMJ Quality & Safety Jul 2023
Topics: Humans; Accreditation; Hospitals; Risk Assessment
PubMed: 36849249
DOI: 10.1136/bmjqs-2022-015881 -
The Veterinary Record May 2024
Topics: Accreditation; Humans; United Kingdom; Workplace; Societies, Veterinary; Veterinary Medicine
PubMed: 38700216
DOI: 10.1002/vetr.4257 -
Obesity (Silver Spring, Md.) Jan 2024The American Academy of Pediatrics (AAP) recently released clinical guidelines for the treatment of childhood obesity, including surgery being appropriate for children...
Outcomes after metabolic and bariatric surgery in preteens versus teens using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database and center-specific data.
OBJECTIVE
The American Academy of Pediatrics (AAP) recently released clinical guidelines for the treatment of childhood obesity, including surgery being appropriate for children 13 years of age and older. The use of this age cut-off was due to a lack of data for children younger than 13. To address this knowledge gap, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried to compare outcomes in preteens to teens after bariatric surgery hypothesizing that there would be no difference in outcomes between the two groups.
METHODS
Patients from the MSAQIP database (2016-2021) were identified and divided into groups <13 years and 13-18 years and were matched using propensity scores based on race, sex, and preoperative BMI. Outcomes were compared including change in BMI, complication rates, 30-day readmission or reoperation, and mortality. Additionally, the centers responsible for the bulk of the preteen patient entries queried their center-specific databases to evaluate weight loss over time.
RESULTS
A total of 4755 patients were identified, 47 of whom were <13 years of age. Preteens had similar sex distribution (66% vs. 75% female), were more likely to be Black (27.7% vs. 18.3%) or Hispanic (21.3% vs. 7.6%) race, and weighed less (274 ± 58 vs. 293 ± 85 lb, p = 0.01), but they had similar BMI (46.9 ± 7 vs. 47 ± 13 kg/m ) as their teen counterparts. Preteens were more likely to suffer from sleep apnea (34% vs. 19%, p < 0.01) and insulin-dependent type 2 diabetes (10.6% vs. 1.8%, p < 0.01). There were no complications in the preteens compared to teens (0% vs. 0.5%), and they did not undergo any unplanned readmissions (0% vs. 2.9%) or reoperations (0% vs. 0.8%) within 30 days of surgery. There were also no mortalities reported in preteens (0% vs. 0.1%). The risk-adjusted decrease in BMI between preteens and teens was also comparable at 30 days (4.2 [95% CI: 3.0-5.4] vs. 4.6 [95% CI: 4.4-4.7], p = 0.6). Decrease in BMI in preteens was 7 ± 3 kg/m at 3 months and 9 ± 4 kg/m at 12 months after surgery, which represented a percentage BMI change of 16 ± 7 and 20 ± 8, respectively.
CONCLUSIONS
This study demonstrates that bariatric surgery in preteens is safe and efficacious when performed at specialized centers, and that age criteria may not be required. The AAP and others are encouraged to include age cut-offs in their guidelines for children with obesity and bariatric surgery only when data are available to support their inclusion.
Topics: Humans; Adolescent; Female; Child; Male; Obesity, Morbid; Diabetes Mellitus, Type 2; Quality Improvement; Postoperative Complications; Pediatric Obesity; Bariatric Surgery; Accreditation; Treatment Outcome; Retrospective Studies; Gastric Bypass; Gastrectomy
PubMed: 37800184
DOI: 10.1002/oby.23908