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Biomedical subjects

Vineet Arora

Publications and source records attributed to Vineet Arora.

10 recordsLinked to original sources
PubMed2006

The effects of on-duty napping on intern sleep time and fatigue.

BACKGROUND: Naps during extended work shifts are effective in reducing fatigue in other industries, but the use of a nap as a countermeasure to prevent fatigue in residents is uncertain. OBJECTIVE: To assess the effects of a call-night nap on resident sleep and fatigue. DESIGN: 1-year, within-participant, paired trial with crossover at midmonth. SETTING: Academic teaching hospital. PARTICIPANTS: 38 of 40 internal medicine interns. MEASUREMENTS: Sleep was measured by using wristwatch actigraphy. By using the experience sampling method on a personal digital assistant, random alerts prompted interns to rate fatigue on the 7-point Stanford Sleepiness Scale (7 is most tired). Hospital paging logs and structured interviews provided information on use of coverage. INTERVENTION: For 2 weeks of every month, interns were assigned to the nap schedule, which provided coverage to on-duty interns from midnight to 7:00 a.m. so that they could finish their work and take a nap. The other 2 weeks of the month constituted a standard schedule. RESULTS: Interns received 41 more minutes of sleep while on call with the nap schedule (185 minutes vs. 144 minutes; P < 0.001). When interns with the nap schedule used coverage, they received 68 more minutes of sleep (210 minutes vs. 142 minutes; P < 0.001). Despite these small increases in sleep, interns reported less overall fatigue while on the nap schedule than while on the standard schedule (1.74 vs. 2.26; P = 0.017). Postcall fatigue with the nap schedule was lower by nearly 1 point (2.23 vs 3.16; P = 0.036), which is almost equivalent to the difference between on-call and postcall fatigue with the standard schedule (2.06 vs. 3.16). However, use of coverage by interns on the nap schedule was impaired by their desire to care for their patients and concerns about discontinuity of care. LIMITATIONS: This was a single-institution study that did not have the power to examine outcomes related to intern or patient well-being. CONCLUSIONS: Coverage to allow a nap during an extended duty-hour shift can increase sleep and decrease fatigue for residents.

Continuity of Patient Care↗
PubMed2006

Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out.

BACKGROUND: Restrictions in the hours residents can be on duty have resulted in increased sign-outs, that is, transfer of patient care information and responsibility from one physician to a cross-coverage physician, leading to discontinuity in patient care. This sign-out process, which occurs primarily in the inpatient setting, traditionally has been informal, unstructured, and idiosyncratic. Although studies show that discontinuity may be harmful to patients, this is little data to assist residency programs in redesigning systems to improve sign-out and manage the discontinuity. PURPOSE: This article reviews the relevant medical literature, current practices in non-health professions in managing discontinuity, and summarizes the existing practice and experiences at 3 academic internal medicine hospitalist-based programs. CONCLUSIONS: We provide recommendations and strategies for best practices to design safe and effective sign-out systems for residents that may also be useful to hospitalists working in academic and community settings.

Academic Medical Centers↗
PubMed2006

Preparing for "diastole": advanced training opportunities for academic hospitalists.

Academic hospital medicine can be described as comprising periods of "systole," during which hospitalists provide clinical care, and periods of "diastole," the portion of a hospitalist's time spent in nonclinical activities. Far from being a period of relaxation, diastole is an active component of a hospitalist's work, the time devoted to the pursuit of career advancement. This period is a critical opportunity for career development in terms of medical research, education, quality improvement, or administration. An appropriate balance of systole and diastole may potentially prevent burnout and allow hospitalists opportunities to focus on academic advancement. Although an increasing number of residency graduates opt for a career in academic hospital medicine, few are prepared for the period of diastole. This article describes several career options in academic hospital medicine, specifically, opportunities in education, research, quality improvement, and administrative opportunities. By informing future hospitalists about the career opportunities within academic hospital medicine possible through managing their diastolic time, we hope that future generations of trainees will be better prepared to enter this field.

Education, Medical, Graduate↗
PubMed2006

A model for building a standardized hand-off protocol.

BACKGROUND: The Joint Commission has made a "standardized approach to hand-off communications" a National Patient Safety Goal. METHOD: An interactive 90-minute workshop (hand-off clinic) was developed in 2005 to (1) develop a standardized process for the handoff, (2) create a checklist of critical patient content, and (3) plan for dissemination and training. CONCLUSION: To date, 7 of 10 residency programs have participated. Analysis of these protocols demonstrated that the hand-off process is highly variable and discipline-specific. Although all disciplines required a verbal handoff, because of competing demands, verbal communication did not always occur. In some cases, the transfer of professional responsibility was separated in time and space from the transfer of information. For example, in two cases, patient tasks were assigned to other team members to facilitate timely departure of a postcall resident (to meet resident duty-hour restrictions), but results were not formally communicated to anyone. The hand-off clinic facilitated the incorporation of "closed-loop" communication by requiring that follow-up on these tasks be conveyed to the on-call resident. DISCUSSION: This model for design and implementation can be applied to other health care settings.

Algorithms↗
PubMed2006

Residents' perceptions over time of pharmaceutical industry interactions and gifts and the effect of an educational intervention.

PURPOSE: To describe change in residents' attitudes toward gifts from and interactions with industry and to measure the effects of a formal educational workshop on changes in perceptions. METHOD: At the University of Chicago, 118 internal medicine residents completed an observational survey and took part in a controlled intervention across three years (2001-2004) of residency. Four cohorts of residents completing the program in 2004-2007 participated. The intervention was an interactive educational workshop, including reviews of literature and guidelines, and three videos demonstrating routine resident interactions with pharmaceutical representatives. Residents graduating in 2005 were the intervention group and residents graduating in 2004 the comparison group. Analysis of variance and linear regression models were used to determine the relationship between variables. RESULTS: Residents perceived "lunch sponsored at noon conference" and "pharmaceutical representative brief talk at noon conference" as increasingly appropriate over their training period (p < .02). Residents perceived "pens, notepads, pocket antibiotic guides" as increasingly appropriate and "tickets to sporting events," "round of golf," and "travel/registration for national conference" as increasingly inappropriate (p < .05). The intervention group was more likely to rate only one item, "lunch at noon conference," as less appropriate (p = .042). CONCLUSIONS: Residents' perceptions toward industry gifts and interactions changed modestly during their training to reflect institutional policy. "Appropriate" gifts of minimal value were generally perceived as increasingly appropriate, whereas "inappropriate" gifts were perceived as increasingly inappropriate over time. An educational workshop alone may not significantly alter residents' perceptions toward industry without the implementation of broad and consistent institutional policy.

Advertising↗
PubMed2006

Effect of the inpatient general medicine rotation on student pursuit of a generalist career.

BACKGROUND: Entry into general internal medicine (GIM) has declined. The effect of the inpatient general medicine rotation on medical student career choices is uncertain. OBJECTIVE: To assess the effect of student satisfaction with the inpatient general medicine rotation on pursuit of a career in GIM. DESIGN: Multicenter cohort study. PARTICIPANTS: Third-year medical students between July 2001 and June 2003. MEASUREMENTS: End-of-internal medicine clerkship survey assessed satisfaction with the rotation using a 5-point Likert scale. Pursuit of a career in GIM defined as: (1) response of "Very Likely" or "Certain" to the question "How likely are you to pursue a career in GIM?"; and (2) entry into an internal medicine residency using institutional match data. RESULTS: Four hundred and two of 751 (54%) students responded. Of the student respondents, 307 (75%) matched in the 2 years following their rotations. Twenty-eight percent (87) of those that matched chose an internal medicine residency. Of these, 8% (25/307) were pursuing a career in GIM. Adjusting for site and preclerkship interest, overall satisfaction with the rotation predicted pursuit of a career in GIM (odds ratio [OR] 3.91, P<.001). Although satisfaction with individual items did not predict pursuit of a generalist career, factor analysis revealed 3 components of satisfaction (attending, resident, and teaching). Adjusting for preclerkship interest, 2 factors (attending and teaching) were associated with student pursuit of a career in GIM (P<.01). CONCLUSIONS: Increased satisfaction with the inpatient general medicine rotation promotes pursuit of a career in GIM.

Career Choice↗
PubMed2002

Detection of Salmonella typhi by polymerase chain reaction: implications in diagnosis of typhoid fever.

The present study was conducted to detect Salmonella typhi by polymerase chain reaction (PCR) in a clinical setting. A group of 40 clinically suspected cases of typhoid fever, lasting for about 3-11 days, with or without chills and rigors and hepatosplenomegaly were selected. Of these, 20 were culture positive and the remaining 20 were found to be negative by conventional blood culture technique. Primary PCR was followed by nested PCR using two sets of primers corresponding to flagellar gene of S. typhi strain. Two bands of about 458 and 343 bp were detected in 20 blood culture positive cases and 12 of the 20 culture negative ones. In the simulated group of samples, no amplification was detected. Our results suggest that PCR-based diagnosis is particularly useful for all clinically suspected cases of typhoid fever. The sensitivity of PCR and its potential use in routine diagnosis and epidemiological studies of typhoid fever can be exploited to complement studies by including bone marrow culture, faeces and bile samples.

Humans↗
PubMed2002

Chronic/recurrent cough in rural children in Ludhiana, Punjab.

OBJECTIVE: To determine the prevalence, age distribution and common causes of chronic/recurrent cough in rural children. DESIGN: Prospective study. SETTING: Pediatric population in five villages of Dehlon Block of Ludhiana, Punjab. METHODS: 2275 children in the age group of 1 to 15 years were screened by house to house survey for chronic/recurrent cough using defined criteria. A detailed work up of selected cases was carried out. Underlying etiology was determined using clinical and laboratory parameters. Five hundred children in the study population formed the control group. Variables associated with chronic/recurrent cough were analyzed in cases and controls. RESULTS: Twenty four children were diagnosed with chronic/recurrent cough showing a prevalence rate of 1.06 percent. The most common cause was bronchial asthma (66.7 percent) followed by postnasal drip syndrome (25 percent). Family history of allergy/asthma was noted in 11 (45.8 percent) children as compared to 52 (10.4 percent) in the control group (p < 0.01). Family history of smoking was recorded in 16.7 percent of cases in contrast to 6.4 percent in controls (p = 0.05). There was no significant association with overcrowding, pets and kind of cooking fuel used. CONCLUSIONS: The most common cause of chronic/recurrent cough was bronchial asthma. There was a significant association with family history of allergy/asthma and smoking.

Adolescent↗