Problematic mobile phone use (PMPU) has become a prevalent behavioral concern among university students, particularly in China. Although academic burnout is considered a key stressor, the temporal directionality between burnout and PMPU remains inconclusive. This study aimed to clarify their longitudinal relationship using a Random Intercept Cross-Lagged Panel Model (RI-CLPM). A three-wave longitudinal design was employed among Chinese university freshmen (N = 4,903; mean age = 19.28 years; 59.7% female), with data collected at six-month intervals over one year. Academic burnout and PMPU were assessed using validated self-report scales. RI-CLPM was applied to disentangle between-person and within-person effects. Measurement invariance and gender invariance were also tested. At the between-person level, academic burnout was positively associated with PMPU (β = 0.34, p < 0.001), indicating stable trait-level co-occurrence. At the within-person level, increases in academic burnout significantly predicted subsequent increases in PMPU (β = 0.07, p = 0.01). However, the reverse effect from PMPU to academic burnout was not significant (β = 0.03, p = 0.08). These findings support a unidirectional relationship. Multi-group analyses further demonstrated that the model was invariant across gender (Δχ² = 2.11, p = 0.72). The findings provide longitudinal evidence that higher levels of academic burnout prospectively predict subsequent increases in PMPU. PMPU may reflect a maladaptive coping response to academic resource depletion. These findings suggest that interventions targeting academic burnout may help reduce subsequent risk for PMPU.
As part of a quality improvement initiative focused on medical educator faculty development, we sought to explore the perspectives of clinician-educators based at a large urban Veterans Affairs Medical Center (VAMC) who navigate the workplace communities of both their VAMC and academic medical center (AMC). Informed by the conceptual framework of Communities of Practice proposed by Lave and Wenger, we conducted semistructured interviews from 2023-2024 with 20 VAMC-based clinician-educators holding faculty appointments at the affiliated AMC. We used purposive sampling to recruit a wide range of participants capturing differences in factors such as academic rank, subspecialist versus internal medicine specialist, and formal educational positions at the AMC. We identified three themes from the interviews: professional fulfilment from mission-driven care and mentoring of trainees; facilitation of the clinician-educator role by the VAMC environment; and the impact of geographic distance on faculty integration. In the last theme, several participants highlighted how working closely within the VAMC promoted strong collegial relationships within the facility, and physical separation from the AMC led to perceptions of professional distance from medical school faculty colleagues. Educating the next generation of healthcare professionals remains one of the core missions of the VA and supporting VA-based clinician-educators is critical to fulfilling this mission. Our study reveals the importance of the geographic distance between AMC and VAMC and its translation to perceptions of collegiate distance among individual VA faculty. We discuss strategies to foster connectivity between AMCs and VA facilities alongside strengthening VA-specific faculty development as potential solutions.
Kidney transplant is the preferred treatment for end-stage renal disease in children due to superior effects on survival, growth, and quality of life versus dialysis. However, childhood kidney transplant presents unique challenges for long-term social, academic, and professional integration as recipients transition into adulthood. We assessed the educational attainment, employment status, and marital outcomes of an adult cohort of childhood kidney transplant recipients. We retrospectively reviewed all pediatric kidney transplants at Başkent University Hospital from January 2015 through December 2024. Eligibility was defined as a renal graft before the age of 18 years with subsequent follow-up into adulthood. Data were collected via a structured, voluntary questionnaire administered during telephone interviews, which captured academic qualifications, employment status, marital status, posttransplant caregiver arrangements, and demographic information of patients' parents, including education and employment. We included 98 patients (mean age, 25.98 ±5.58 years; mean age at transplant, 14.12 ± 3.83 years), comprising 53 male (54.1%) and 45 female participants (45.9% ). Living-related donors were predominant. Regarding the recipients' parents, maternal education was predominantly low, and 82.7% of the maternal parents were homemakers. Paternal parents demonstrated higher employment rates (n = 47; 48.0% ) and more varied educational attainment. Educational attainment revealed that 48 patients (49.0% ) completed high school, 15 (15.3% ) attended university, and 9 (9.2% ) earned a bachelor-level degree. Employment status was reported by 47 recipients (47.9% ), with 48 (46.9% ) unemployed and 3 (3.1% ) employed part time. Seventeen participants (17.3% ) were married with at least 1 child. Pediatric kidney transplant recipients encounter substantial future challenges in social and professional integration as they progress through adulthood. Our cohort demonstrated moderate educational achievement and employment rates, and most were unmarried. Our findings emphasize the importance of long-term multidisciplinary support to promote successful transitions into adulthood, addressing not only medical needs but also social and occupational needs.
Tanzania is currently advancing universal health coverage (UHC) through the 2026 launch of its Universal Health Insurance scheme, creating a critical policy window to strengthen primary health care (PHC). This paper reflects on the first Family Medicine Symposium in Morogoro (January 2026), a milestone event designed to advocate for the integration of Family Medicine (FM) into the national health system. Utilizing a deliberative dialogue approach, the symposium convened 51 diverse stakeholders-including Tanzanian policymakers and academic partners from eight countries-to examine FM through the "5 Cs" framework: first-contact access, continuity, comprehensiveness, coordination, and person-centered care. The event featured expert presentations, case vignettes, and facilitated discussions structured around the 5 Cs. In addition to the 5 Cs we also discussed training, financing, and workforce transitions. We describe a unique, multinational, multidisciplinary and informal academic partnership that drove this initiative. Rather than following rigid, highly resourced programmatic frameworks, this collaboration was relationship-driven, built on 3 years of trust-building and the contextual expertise of international partners with prior lived experience in Tanzania. While the absence of immediate formal policy commitments remains a limitation, the engagement established a vital transnational platform for collective advocacy. This paper highlights how informal, context-sensitive partnerships can align FM educational initiatives with health system needs to advance PHC transformation.
Large language model (LLM) chat tools have the potential to transform healthcare workflows by improving efficiency and reducing administrative burdens. While prior research has predominantly focused on clinicians, non-clinician healthcare staff constitute the majority of the workforce, and their real-world chat tool use remains uncharacterized. This retrospective, cross-sectional study analyzed de-identified chat logs from a secure, HIPAA-compliant LLM chat tool deployed at an academic medical center over an 11-month period. Among 30,503 chat threads analyzed, 98% originated from non-clinician users across 239 roles. Usage was dominated by administrative tasks including email and document writing (53.9%), text manipulation (9.1%), and brainstorming (6.7%). A notable proportion of interactions included off-label queries unrelated to work or organizational goals, including 5.9% involving clinical decision-making. These findings highlight the need for targeted training, tailored governance policies, and refined evaluation frameworks to optimize appropriate LLM use while mitigating risks in healthcare settings.
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Neurocognitive impairment is a well-recognized complication of sickle cell disease (SCD) that begins early in childhood and persists across development. While cerebrovascular injury contributes substantially to risk, neurocognitive deficits are also observed in children without overt or silent cerebral infarctions, suggesting additional contributing factors. Social drivers of health (SDoH) may modify neurocognitive outcomes but remain underexplored in SCD. We conducted a retrospective cohort study of children and adolescents with SCD who completed standardized neurocognitive screening between January 2023 and May 2025. Participants were English-fluent and had no history of overt stroke or moyamoya. Neighborhood-level SDoH were measured using the Childhood Opportunity Index (COI). Neurocognitive domains assessed included visual-spatial, fluid reasoning, working memory, language, processing speed, auditory attention, and academic achievement. Ninety participants with a mean age of 7.7 years completed screening. More than half had the HbSS genotype. Most lived in areas of low or very low childhood opportunity. Areas with more childhood opportunity (higher COI) were significantly associated with better performance in fluid reasoning, working memory, language, reading, spelling, and math. COI education subdomain scores showed consistent associations across cognitive and academic measures. Neighborhood-level childhood opportunity is strongly associated with neurocognitive outcomes in children with SCD, independent of known neurological injury. These findings highlight the importance of integrating SDoH into neurocognitive risk assessment and support early, embedded screening models in SCD care to address structural contributors to cognitive disparities.
Pediatric feeding disorder is a prevalent, impactful diagnosis for children and their families. This diagnosis is heterogenous in presentation and requires the care of a multidisciplinary team of providers. Existing research suggests providers are underprepared to assess and treat pediatric feeding disorder, therefore more information on training and clinical practice is needed. This study conducted focus groups to describe the training journey of providers across all four pediatric feeding disorder domains (medical, nutrition, feeding skill, psychosocial). Seven focus groups (total of 25 providers) were conducted and analyzed using thematic analysis. Four themes were identified: differences in academic preparation, workplace infrastructure and access, desire for comprehensiveness and feasibility, and value of the family perspective. Overall, results point to opportunities to improve provider training and therefore patient care including academic exposure to pediatric feeding disorder and multi-disciplinary collaboration practices, increased access to mentorship, training, and evidenced-based resources, and enrichment of the research to practice pipeline with a focus on family-centered care.
Combat casualty care requires standardized proficiency criteria to ensure readiness in austere environments, yet gaps persist in defining performance thresholds for critical trauma skills. The Combat Medical Skills Sustainment Consortium (CMSSC), a novel military-civilian collaboration, aimed to validate competency thresholds for 21 Department of Defense-identified trauma skills. A prospective cohort study (2022-2025) enrolled 1,495 military and civilian personnel across five academic centers, stratified by experience (novice, intermediate, expert). Skills, including cricothyroidotomy, whole blood transfusion, and ultrasound-guided vascular access, were assessed using validated checklists in Role 2-congruent simulations. Statistical analysis compared checklist performance against participant experience with a priori checklist scores estimated at 40% (novices) and 90% (experts). Competency thresholds were established, ranging from 77% (mechanical ventilation) to 100% (handoff). Experts achieved 85%-98% proficiency across most skills, with novices at 34%-97%. A ceiling effect was observed for less complex skills consistent with the power law of practice. The Combat Medical Skills Sustainment Consortium validated standardized assessment tools, with potential to address readiness gaps through military-civilian synergy. Findings support consortium-guided curriculum development and highlight the need for longitudinal skill decay studies. This study sets a benchmark for trauma care skills assessment, facilitating rapid adoption across military and civilian settings.
In order to optimize learner development, align rigorous assessment with individualized instruction, and ensure graduates can consistently provide trustworthy, excellent patient care, Emergency Medicine has joined a global medical education movement toward competency-based medical education (CBME). This shift focuses less on teaching specific content in a fixed period of time, and more on ensuring graduating physicians can be trusted to perform the essential activities required of their specialty. Emergency medicine collaborators have piloted implementing the five components of CBME: (1) An outcomes competency framework; (2) Developmental sequencing of competencies; (3) Individualized clinical experiences tailored to the competencies; (4) Competency-centered coaching; (5) Programmatic assessment with emphasis on workplace-based assessment. This work has included developing specialty-specific entrustable professional activities (EPAs), mapping EPAs to the ACGME Milestones, defining an ideal individualized learning plan, coaching pilots across multiple institutions, and implementing workplace-based assessment. Through these efforts across diverse residency programs, educators have experienced both the promise of CBME and the challenges to implementation and sustainability. In order to move the field forward, the 2025 Academic Emergency Medicine Consensus Conference aimed to develop a prioritized 10-year research agenda for CBME in Emergency Medicine graduate medical education to guide discovery over the next decade. This paper reports the process and results of the consensus proceedings, and outlines key research priorities for the following aspects of CBME specific to Emergency Medicine graduate medical education: (1) Coaching and individualized learning; (2) Faculty and Learner Development; (3) Assessment; and (4) Implementation and Change Management.
Existing formal feedback systems in graduate medical education often rely heavily on intangible Likert Scales linked to ACGME milestones as an end-of-rotation summative assessment. However, more frequent, actionable, formative feedback based on observations is essential to personal growth. To evaluate the impact of changing from a milestone-based evaluation form to a brief narrative-based feedback form in a Pulmonary Disease and Critical Care Medicine (PCCM) fellowship as an exploratory pilot project. Our aim was to describe change in perception of feedback quality and the impact on Clinical Competency Committee (CCC) decisions. We compared the quality of written rotation feedback before and after implementing a shorter feedback form on January 1, 2024 for 15 PCCM fellows at a single large academic institution using the Quality of Assessment for Learning (QuAL) score, (July 2023-December 2023 compared to January 2024-July 2024), fellow pre- and post-surveys (December 2023 and June 2024) and a CCC focus group (June 2024). Overall QuAL score improved significantly after narrative-based feedback form implementation (2.71 pre [n = 75] vs 3.70 post [n = 85], p < 0.001). Surveys had 13/14 (92.8%) fellows respond pre-intervention and 8/14 (57.1%) post-intervention. There was significant improvement in the number of fellows indicating they could identify new learning goals based on written feedback after implementation of the new form (23.1% pre vs 75.0% post, p = 0.03). The CCC focus group with 5 of 8 eligible faculty participating described milestone decisions were better supported by more detailed narratives. Implementing a brief narrative-based form improved feedback quality and the number of trainees able to create learning goals. The CCC identified that the new form provided better details to support milestone recommendations.
Children with systemic rheumatologic diseases (SRD) and autoinflammatory diseases can experience life-threatening deterioration requiring intensive care. We conducted a retrospective cohort study with 2 complementary components: (1) a descriptive analysis of clinical presentations and outcomes; and (2) an exploratory derivation of a bedside risk-stratification tool, intended as a candidate severity overlay on established pediatric intensive care unit (PICU) scoring systems rather than as a fully validated general-purpose prognostic model. Retrospective observational cohort study with exploratory prognostic model development. Propensity-score matching was used as a secondary, descriptive analysis to contextualize outcomes against comparable populations and is not intended to support causal inference. Single academic pediatric intensive care unit (January 2005 to December 2015). Forty children with confirmed SRD requiring PICU admission (first admission per patient) and propensity-matched controls (2:1 ratio). Nearly two-thirds (62.2%) of patients experienced their first disease manifestation as a life-threatening crisis. Hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS) was associated with the majority of deaths, accounting for 83.3% of fatalities despite representing only 20% of admissions (disease-specific mortality 62.5% vs. 6.3% for other diagnoses combined, p<0.001). Backward stepwise logistic regression identified 3 predictors that were combined, with equal weighting, into the exploratory PHV Score (PRISM-HLH-Vasoactive): Pediatric Risk of Mortality III (PRISM-III) at 24 hours >20, HLH/MAS diagnosis, and requirement for ≥2 vasoactive agents. In this derivation sample the score showed encouraging discrimination [apparent area under the curve (AUC) 0.91, 95% CI 0.83-0.99; optimism-corrected AUC 0.88]; however, given the very limited event count (n=6 deaths), wide CIs, and the fact that the PHV Score partially incorporates PRISM-III, head-to-head AUC comparisons with PRISM-III (AUC 0.72), PELOD-2 (Pediatric Logistic Organ Dysfunction-2; AUC 0.68), and pediatric SOFA (Sequential Organ Failure Assessment; AUC 0.64) should be interpreted with caution and regarded as hypothesis-generating. At the optimal cutoff of ≥2 (Youden index), sensitivity was 83.3% and specificity 91.2%; predictive values are prevalence-dependent and may not generalize to centers with different case mixes. In this retrospective single-center cohort, HLH/MAS was associated with most PICU deaths among children with systemic rheumatologic and autoinflammatory diseases. The PHV Score is an exploratory, candidate bedside tool that appears to refine risk stratification in our cohort but requires prospective multicenter external validation.
Pharyngitis is a frequent cause of urgent care (UC) visits. The SPOTFIRE Sore Throat (SPOTFIRE ST) panel is a Clinical Laboratory Improvement Amendments-waived point-of-care test capable of detecting 14 common bacterial and viral pathogens from an oropharyngeal swab. We evaluated detection characteristics, antimicrobial prescribing, and clinician and patient perceptions associated with SPOTFIRE ST testing. We conducted a prospective, single-center study at an academic UC clinic. Eligible participants included 1-2-year-olds with fever, 3-17-year-olds with acute pharyngitis, and adult patients with acute pharyngitis and either immunocompromising or comorbid conditions. Clinical variables were collected, and specimens were tested according to SPOTFIRE ST instructions. Clinicians completed a pre-implementation survey, and clinicians and patients completed a postimplementation survey to assess perceptions and satisfaction with the test. At least 1 detected pathogen occurred in 149/200 (74.5%) patients. Compared with adults, pediatric patients had higher detections (85% vs 60%; P < .001), statistically significantly higher detections of specifically Group A Streptococcus, influenza B, and M. pneumoniae, and higher detections of a pathogen with specific antimicrobial treatment (68% vs 28%; P < .001). Antibiotics were prescribed in only 7% of cases when a virus was detected. Stakeholders reported high satisfaction with SPOTFIRE ST testing and thought it useful in guiding clinical decisions. SPOTFIRE ST testing demonstrated a high proportion of detections with distinct differences between pediatric and adult patients with acute pharyngitis. The detection characteristics and high satisfaction indicate that this test is likely to be valued by clinicians and patients and may improve clinical assessment and antimicrobial prescribing. ClinicalTrials.gov identifier. NCT06713642.
Children who are deaf and hard of hearing (DHH) require complex multidisciplinary care to achieve optimal developmental outcomes. The present study aims to conduct a scoping review of research on Patient Navigation (PN) interventions designed to support DHH children and their families after identification of a hearing loss to determine the scope, models, and effectiveness of PN to improve access to care. We searched PubMed, Web of Science, Embase, CINAHL, and PsycInfo databases. After duplicate records were reviewed, two researchers read titles and abstracts and screened the full texts. Consensus was reached among all authors for final study inclusion. Researchers independently extracted the data and performed data synthesis in tabular and narrative formats. Studies describing and evaluating PN interventions for DHH children with a confirmed hearing loss diagnosis were included, while studies describing an intervention without evaluation, targeted at adults, or conducted prior to confirmed diagnosis were excluded. Four studies met inclusion criteria. Three studies were conducted at large urban tertiary academic medical centers in the United States, two of the three included predominantly lower socioeconomic status participants, and all reported improved outcomes after PN intervention. A fourth study was conducted in Bangladesh and targeted adolescents eligible for hearing aids. There have been few studies evaluating PN interventions for DHH children after a confirmed hearing loss diagnosis. Additional work is needed to systematically evaluate the feasibility, effectiveness, and scalability of PN interventions on improving access to care and reducing inequities for DHH children.
Extremely premature infants (<28 weeks gestational age) have a greater risk of mortality and, when they survive, higher rates of significant neurological disability and need for medical care. As a result, extremely premature infants and their families often benefit from early involvement of palliative care. To identify possible associations between palliative care consultation and length of life, code status, and manner of death of extremely premature versus nonextremely premature neonates. A retrospective, cohort study of premature infants with a terminal admission at two academic medical centers in the southeastern United States. The primary hypothesis was that extreme prematurity was associated with receipt of a palliative care consultation. Secondary hypotheses examined the association between extreme prematurity with (1) time from admission to death and (2) code status and manner of death. Extreme prematurity was associated with a lower likelihood of a palliative care consultation (p < 0.001) than for older neonates. When consultations occurred, they were often within the final days or hours of life. Females had a 43% higher likelihood of a palliative care consultation than males when controlling for other factors (p < 0.001). Extremely premature infants had lower odds of having an allow natural death versus full code status than older infants (p = 0.008). Infants born extremely premature were less likely to receive palliative care consultation during a terminal admission than older preterm infants. Considering the higher burden of comorbidities and later nature of consultation, extremely premature infants may benefit from earlier and more frequent integration of palliative care.
Mitral valve prolapse (MVP) is a common cardiac condition that is generally benign, yet a subset of affected patients develop malignant ventricular arrhythmias and sudden cardiac death. Female sex and myocardial fibrosis detected by late gadolinium enhancement on cardiovascular magnetic resonance imaging have been proposed as risk factors though their independent contributions to arrhythmic risk remain uncertain. We conducted a prospective cohort study of 550 consecutive patients with MVP referred for cardiovascular magnetic resonance at a tertiary academic center between May 2008 and December 2021. Patients with potential confounders, including coronary artery disease, cardiomyopathy, infiltrative disease, or prior cardiac surgery, were excluded. The primary end point was a composite arrhythmic outcome comprising sudden cardiac death, aborted sudden cardiac arrest, and symptomatic sustained or inducible ventricular tachycardia or ventricular fibrillation leading to implantable cardioverter defibrillator placement or ventricular ablation at an MVP-related scar site. Among the 550 patients (median age, 62 [interquartile range, 52-71] years; 50% women), LGE was present in 210 (38%). Over a median follow-up of 4.4 years (interquartile range, 2.8-7.1; 2700 patient-years), 48 patients (8.7%) reached the primary end point. On univariable analysis, both female sex (hazard ratio, 3.33 [95% CI, 1.72-6.44]; P<0.001) and LGE presence (hazard ratio, 3.17 [95% CI, 1.74-5.77]; P<0.001) were significantly associated with arrhythmic events, and both remained independently associated on multivariable analysis. Women with LGE represented the highest-risk subgroup, with a 5-year event-free survival of 76.5%, compared with 98.5% in men without LGE (P<0.001). In a large prospective cardiovascular magnetic resonance cohort of patients with MVP, female sex and myocardial fibrosis were each independently associated with life-threatening arrhythmic events. Their combination identified a subgroup at particularly elevated risk, highlighting the importance of integrating sex-specific factors and myocardial tissue characterization into MVP risk stratification strategies.
Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disease. With improved life expectancy of patients with DMD, the need for advance care planning (ACP) has been identified by patients and providers. A quality improvement effort to address this gap was initiated at an academic children's hospital where patients are seen within a multidisciplinary neuromuscular clinic, which integrates palliative care into visits starting at age 18. The team followed outcome measures of (1) health care power of attorney (HCPOA) paperwork completion and (2) code status order documentation from baseline rates of 29% and 6%, respectively, between August 2024 and August 2025 for patients with DMD aged 18 or older. Identified key drivers included provider awareness of prior ACP conversations, documentation workflow, and patient readiness for conversations. Interventions included: creation of a DMD ACP Checklist, provider education, weekly e-mails, and access to state-specific ACP documents. 123 visits were reviewed over 13 months. Improvement interventions led to a centerline shift for both outcome measures, with an increase from 29% to 68% for HCPOA paperwork completion and from 6% to 72% for code status order documentation. This project demonstrated that many young adults with DMD were open to ACP conversations, as reflected in improved rates of HCPOA paperwork completion and code status order documentation. However, some families continued to express discomfort with topics surrounding end-of-life. Further exploration is needed to understand how to best address these challenges in order to provide goal-concordant care with disease progression.
IntroductionOn-demand telehealth services are available to improve access and convenience of care, with some expectation that these visits may replace scheduled video visits and in-person visits. As on-demand telehealth becomes integrated into healthcare delivery models, there is a need to evaluate its impact on access, utilization, and charges.ObjectiveThis study evaluates an integrated, on-demand telehealth service (Express-Care) at an academic health center and how its availability and adoption influenced healthcare utilization and charges for patients seeking care for upper respiratory tract infections (URIs).MethodsA retrospective cohort study was conducted using electronic health record data from UC Davis Health between July 2018 and October 2024. A cohort of patients using Express-Care for URI was compared to patients receiving URI care via other modalities using a 1:2 propensity score match on sex, age, race/ethnicity, insurance, California Healthy Place Index, comorbidities, and household income. Patients who did not have URI visits both before and after the launch of Express-Care were excluded.ResultsAmong the 26,605 patients treated for URI, Express-Care users were more likely to be female (66.9% vs. 61.9%, p < 0.001) and commercially insured (84.6% vs. 78.5%, p < 0.001) than nonusers. In the matched patient cohort, Express-Care use replaced scheduled video visits and in-person visits 70% of the time, while 30.0% represented new utilization. Follow-up rates were higher after Express-Care visits than after compared to non-Express-Care visits (5.1% vs. 1.6%, p < 0.0001). Adjusted difference in mean charges was USD190 lower for Express-Care episodes than for non-Express-Care episodes (p < 0.0001).DiscussionAccess to Express-Care resulted in 42% more visits for URIs among users than among matched nonusers. Despite the increased visit frequency and follow-up rates for URIs, Express-Care was associated with lower mean healthcare charges.