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Donald Austin

Publications and source records attributed to Donald Austin.

4 recordsLinked to original sources

A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical center.

BACKGROUND: The Accreditation Council for Graduate Medical Education's (ACGME) new requirements raise multiple challenges for academic medical centers. We sought to evaluate career satisfaction, emotional states, positive and negative experiences, work hours and sleep among residents and faculty simultaneously in one academic medical center after implementation of the ACGME duty hour requirements. METHODS: Residents and faculty (1330) in the academic health center were asked to participate in a confidential survey; 72% of the residents and 66% of the faculty completed the survey. RESULTS: Compared to residents, faculty had higher levels of satisfaction with career choice, competence, importance and usefulness; lower levels of anxiousness and depression. The most positive experiences for both groups corresponded to strong interpersonal relationships and educational value; most negative experiences to poor interpersonal relationships and issues perceived outside of the physician's control. Approximately 13% of the residents and 14% of the faculty were out of compliance with duty hour requirements. Nearly 5% of faculty reported working more than 100 hours per week. For faculty who worked 24 hour shifts, nearly 60% were out of compliance with the duty-hour requirements. CONCLUSION: Reasons for increased satisfaction with career choice, positive emotional states and experiences for faculty compared to residents are unexplained. Earlier studies from this institution identified similar positive findings among advanced residents compared to more junior residents. Faculty are more frequently at risk for duty-hour violations. If patient safety is of prime importance, faculty, in particular, should be compliant with the duty hour requirements. Perhaps the ACGME should contain faculty work hours as part of its regulatory function.

Academic Medical Centers↗

Recursive partitioning for risk stratification in men undergoing repeat prostate biopsies.

BACKGROUND: The current study was performed to identify risk factors and risk groups for carcinoma detection in men undergoing repeat prostate biopsies. METHODS: The medical records of all men who had a negative initial prostate biopsy and underwent at least one repeat biopsy between 1992 and 2003 were reviewed to extract age, race, family history of prostate carcinoma, body mass index, referral indication, all prostate-specific antigen (PSA) values, digital rectal examination, PSA density (PSAD), the presence of a hypoechoic lesion, and the presence of high-grade prostatic intraepithelial neoplasia (HGPIN) on initial biopsy. Risk factors for a subsequent diagnosis of prostate carcinoma were identified using the log-rank test and a stepwise, stratified Cox regression model. Based on the risk factors identified by Cox regression analysis, recursive partitioning was further used for risk stratification. RESULTS: A total of 373 patients underwent 975 biopsy procedures. During a median follow-up of 37.0 months, prostate carcinoma was detected in 107 of 373 patients (28.9%). Independent predictors of a positive biopsy (P < 0.05) were PSA doubling time (PSADT), PSAD, referral indication, the presence of HGPIN, patient age, and family history of prostate carcinoma. Recursive partitioning identified 4 distinct risk groups that were characterized by their PSADT and PSAD and the presence of HGPIN and had estimated 2-year and 5-year carcinoma detection rates of 3 +/- 1% and 21 +/- 4%, 28 +/- 5% and 40 +/- 7%, 22 +/- 6% and 58 +/- 8%, and 66 +/- 9% and 100%, respectively. CONCLUSIONS: The authors identified a series of independent risk factors for prostate carcinoma detection after an initial negative prostate biopsy and characterized clinically meaningful and distinct patient risk groups. Despite a negative initial biopsy, patients with high-risk features remain at risk for the detection of prostate carcinoma.

Adult↗

Stages of smoking acquisition versus susceptibility as predictors of smoking initiation in adolescents in primary care.

We evaluated whether susceptibility, the stages of smoking acquisition, and socio-environmental factors can identify adolescents who will become smokers. Our data came from a randomized controlled trial of an intervention to prevent adolescent smoking. Subjects were adolescents (n=1955) ages 14-17 being seen for routine medical care. The dependent variable was 30-day smoking status at 2-year follow-up (89.6% response rate). Independent variables included susceptibility, the stages of acquisition, and socio-environmental factors. Susceptible adolescents were two to three times more likely to be smokers than non-susceptible adolescents. Compared to acquisition precontemplators, acquisition contemplators were three to five times more likely, and acquisition preparers were five to eight times more likely, to be smokers. When combined into a single measure, susceptible precontemplators were two times, contemplators were six times, and preparers were nine times more likely to be smokers than non-susceptible precontemplators. Our findings suggest that acquisition stage and susceptibility can independently predict smoking onset. They may be used together to target teens for smoking prevention efforts in the clinical setting.

Adolescent↗

Review of case-control studies related to breastfeeding and reduced risk of childhood leukemia.

OBJECTIVE: To conduct a systematic review to evaluate the evidence for the effect of breastfeeding on the risk of developing childhood leukemia. REVIEW METHODS: We sought studies providing data regarding the association of breastfeeding and occurrence of childhood leukemia. Studies were identified by using Medline, HHS Blueprint for Action on Breastfeeding, US Department of Health and Human Services Office on Women's Health, Cochrane Database of Systematic Reviews, National Centre for Reviews and Dissemination, reference lists, and national experts. Methodologic quality was evaluated for each study by using criteria from the US Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination. RESULTS: We reviewed 111 citations to identify 32 potentially eligible full-text articles. Of the 10 studies reviewed, only 4 were sufficient to provide at least fair-quality evidence regarding the association between maternal breastfeeding and childhood leukemia. Studies conflicted regarding the protective effect of breastfeeding on childhood leukemia. In the 2 largest and highest quality studies, breastfeeding was associated with a significant risk reduction in one study with longer breastfeeding duration, reflecting greater protection, and a nonsignificant but suggestive difference in the other. Taken together, half of the studies associated breastfeeding with a lower risk of acute lymphocytic leukemia. CONCLUSIONS: There are few high-quality studies that examine the potential for a protective effect of breastfeeding for childhood leukemia. Furthermore, the few studies that exist disagree regarding the association. It is estimated that the United States spends 1.4 billion dollars annually on the treatment of childhood leukemia. Patients, clinicians, and policy makers do not have the data that they need to make decisions regarding this important potential preventive measure.

Breast Feeding↗