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Biomedical subjects

Bruce Leff

Publications and source records attributed to Bruce Leff.

9 recordsLinked to original sources
PubMed2006

The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties.

PURPOSE: To describe the reading habits of medicine clerks, which previously have not been well described. Understanding issues related to student reading habits may provide insights and opportunities for medical educators to develop methods to improve clerks' clinical clerkship experiences and their information literacy skills. METHOD: The authors administered an 18-item survey tool to 120 students on their first inpatient internal medicine clerkships at the Johns Hopkins University School of Medicine in 2002-03. The questionnaire focused on issues related to what and how often they read during their basic medicine clerkship. Data were explored mainly with descriptive statistics. RESULTS: One hundred twelve of 120 (93%) medicine clerks completed the survey. Clerks reported reading for an average of 10.8 (SD 5.6) hours per week (median ten hours per week, range one to 30 hours per week). The most commonly used and useful reading sources were UpToDate and test preparation textbooks. Approximately 30% of students reported substantial problems in reading about their patients. Limited data suggest that reading habits and learning methods vary by year of medical school. Clerks are given disparate advice on appropriate reading sources to consult by attending physicians, resident physicians, and fellow students. CONCLUSIONS: Students spend significant amounts of time reading online sources during their medicine clerkship, especially UpToDate. Medical educators should become familiar with these sources and contribute to maximizing their effectiveness for students. Additional research focused on understanding how students build skills in information literacy and how educational programs can facilitate the development of those skills is needed.

Baltimore↗
PubMed2006

Satisfaction with hospital at home care.

OBJECTIVES: To examine differences in satisfaction with acute care between patients who received treatment in a physician-led substitutive Hospital at Home program and those who received usual acute hospital care. DESIGN: Survey questionnaire of participants in prospective, nonrandomized clinical trial. SETTING: Three Medicare-managed care health systems and a Department of Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis, 84 of whom were treated in Hospital at Home and 130 in the acute care hospital. INTERVENTION: Treatment in a Hospital at Home model of care that substitutes for treatment in an acute care hospital. MEASUREMENTS: A 40-question survey measuring nine domains of care for patients and a 37-question survey measuring eight domains of care for family members. RESULTS: A higher proportion of patients were satisfied with treatment in Hospital at Home than with the acute care hospital in eight of nine domains, and this difference was statistically different in four domains. Hospital at Home patients were more likely than acute hospital patients to be satisfied with their physician (adjusted odds ratio (AOR) = 3.84, 95% confidence interval (CI) = 1.32-11.19), comfort and convenience of care (AOR = 6.52, 95% CI = 1.97-21.56), admission processes (AOR = 5.90, 95% CI = 2.21-5.76), and the overall care experience (AOR = 2.98, 95% CI = 1.08-8.21). Family members of patients treated in Hospital at Home were also more likely to be satisfied with multiple domains of care. CONCLUSION: Hospital at Home care was associated with greater satisfaction than acute hospital inpatient care for patients and their family members. These findings support further dissemination of the Hospital at Home care model.

Aged↗
PubMed2005

Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients.

BACKGROUND: Acutely ill older persons often experience adverse events when cared for in the acute care hospital. OBJECTIVE: To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital at home. DESIGN: Prospective quasi-experiment. SETTING: 3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center. PARTICIPANTS: 455 community-dwelling elderly patients who required admission to an acute care hospital for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis. INTERVENTION: Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital. MEASUREMENTS: Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status, and costs of care. RESULTS: Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality standards at rates similar to those of acute hospital care. On an intention-to-treat basis, patients treated in hospital-at-home had a shorter length of stay (3.2 vs. 4.9 days) (P = 0.004), and there was some evidence that they also had fewer complications. The mean cost was lower for hospital-at-home care than for acute hospital care (5081 dollars vs. 7480 dollars) (P < 0.001). LIMITATIONS: Possible selection bias because of the quasi-experimental design and missing data, modest sample size, and study site differences. CONCLUSIONS: The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.

Acute Disease↗
PubMed2005

The effect of computerized provider order entry on medical student clerkship experiences.

OBJECTIVE: To describe medical students' attitudes toward placing orders during training, and the effect of computerized provider order entry (CPOE) on their learning experiences. DESIGN: Prospective, controlled study of all 143 Johns Hopkins University School of Medicine students who began the Basic Medicine clerkship between March 2003 and April 2004 at one of three teaching hospitals: one using CPOE, one paper orders, and one that began using CPOE midway through this study. MEASUREMENTS: Survey of students at the start and after the first month of the clerkship. RESULTS: Ninety-six percent of students responded. Students expressed a desire to place 100% of orders for their patients. Ninety-five percent of students believed that placing orders helps students learn what tests and treatments patients need. Eighty-four percent reported that being unavailable due to conferences and teaching sessions was a significant barrier to participating in the ordering process. Students at hospitals using CPOE reported placing significantly fewer of their patients' follow-up orders compared to students at hospitals using paper orders (25% vs. 50%, p < 0.01) and were more likely to report that their resident or intern did not want them to enter orders (40% vs. 16%, p < 0.01). Comparisons of students at hospitals using CPOE to each other showed that these differences were attributable to one of the hospitals. Thirty-two percent of students at both hospitals using CPOE reported that the extra length of time required for housestaff to review their orders in the computer was a significant barrier. CONCLUSION: Hospitals need to ensure that the educational potential of medical students' clinical experiences is maximized when implementing CPOE.

Attitude to Computers↗