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Using Multivariate Statistics

Basics of qualitative research: Grounded theory procedures and techniques

https://link.springer.com/content/pdf/10.2307%2F3343168.pdf

Development as Freedom

https://science.sciencemag.org/content/sci/5/110/206.full.pdf

The american psychological association.

PurposeTo systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.MethodMedline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxie

http://www.medical-mastermind-community.com/uploads/63-Systematic_Review_of_Depression_Anxiety_and.9.pdf

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

The objective of this study was to evaluate the performance of the Professional Fulfillment Index (PFI), a 16-item instrument to assess physicians’ professional fulfillment and burnout, designed for sensitivity to change attributable to interventions or other factors affecting physician well-being. A sample of 250 physicians completed the PFI, a measure of self-reported medical errors, and previously validated measures including the Maslach Burnout Inventory (MBI), a one-item burnout measure, the World Health Organization’s abbreviated quality of life assessment (WHOQOL-BREF), and PROMIS short-form depression, anxiety, and sleep-related impairment scales. Between 2 and 3 weeks later, 227 (91%) repeated the PFI and the sleep-related impairment scale. Principal components analysis justified PFI subscales for professional fulfillment, work exhaustion, and interpersonal disengagement. Test-retest reliability estimates were 0.82 for professional fulfillment (α = 0.91), 0.80 for work exhaustion (α = 0.86), 0.71 for interpersonal disengagement (α = 0.92), and 0.80 for overall burnout (α = 0.92). PFI burnout measures correlated highly (r ≥ 0.50) with their closest related MBI equivalents. Cohen’s d effect size differences in self-reported medical errors for high versus low burnout classified using the PFI and the MBI were 0.55 and 0.44, respectively. PFI scales correlated in expected directions with sleep-related impairment, depression, anxiety, and WHOQOL-BREF scores. PFI scales demonstrated sufficient sensitivity to detect expected effects of a two-point (range 8–40) change in sleep-related impairment. PFI scales have good performance characteristics including sensitivity to change and offer a novel contribution by assessing professional fulfillment in addition to burnout.

/pdf/a-brief-instrument-to-assess-both-burnout-and-professional-325122heqn.pdf

A Brief Instrument to Assess Both Burnout and Professional Fulfillment in Physicians: Reliability and Validity, Including Correlation with Self-Reported Medical Errors, in a Sample of Resident and Practicing Physicians

This Viewpoint discusses the opportunities and ethical implications of using machine learning technologies, which can rapidly collect and learn from large amounts of personal data, to provide individalized patient care.

Machine Learning and the Profession of Medicine

OBJECTIVE: Informed consent is built upon the elements of information, decisional capacity, and voluntarism. Of these elements, voluntarism in clinical and research consent is the least well understood. This has interfered with the ability to resolve key ethical problems faced by the field of psychiatry. METHOD: The author suggests that voluntarism encompasses an individual’s ability to act in accordance with one’s authentic sense of what is good, right, and best in light of one’s situation, values, and prior history. Voluntarism further entails the capacity to make this choice freely and in the absence of coercion. Deliberateness, purposefulness of intent, clarity, genuineness, and coherence with prior life decisions are implicitly emphasized in this construction. RESULTS: The author offers and illustrates a framework for voluntarism in clinical and research consent decisions, focusing on four domains of potential influence: 1) developmental factors, 2) illness-related considerations, 3) psychological is...

Informed Consent and the Capacity for Voluntarism

The promise of smartphone applications and connected technologies for mental health to advance diagnosis, augment treatment, and expand access has received much attention. Mental health disorders represent the leading cause of the loss of years of life because of disability and premature mortality and also contribute to employee absenteeism and lost productivity in economically established countries such as the United States. The potential of smartphone applications to offer new, at-your-fingertips tools and resources for mental health care is frequently cited. But this potential is not the only reason why it is hard to ignore smartphone applications. The reality of applications for clinical care is already here. More than 10 000 mental health–related applications are available to download, and that number increases daily. As smartphones become increasingly inexpensive and available to the entire population, including those with mental illness, the accessibility, immediacy, affordability, and bold marketing claims of applications will drive more patients to use them. This new reality is worrisome: studies suggest that most mental health apps in commercial marketplaces do not conform to clinical guidelines. Some may even offer dangerous recommendations, such as one application that advises people experiencing a bipolar manic episode to drink hard alcohol before bedtime to assist with sleeping.2 It is likely that most of these nonevidencebased applications may distract patients and potentially cause them to delay seeking care. Many applications do not respect the privacy of personal health information, and the price of a free application is often buried in a complex privacy policy requiring college reading comprehension—that price being the right to market and sell your data.3 Certainly there are exceptions, as a handful of safe, evidence-based, and useful applications exist. Still, these helpful applications may be to difficult to find among hundreds of more problematic applications. Finding these valuable applications, furthermore, is a challenge for both patients and clinicians. Mental health technologies like smartphone applications have not been thoroughly investigated through clinical science or overseen through regulatory control. Instead, there is a void in which the potential and preshpent reality of health applications are confusing, marred by a lack of transparency and trust. The situation exists partially because the US Food and Drug Administration (FDA) has taken a “hands-off” approach toward health applications, meaning that most mental health applications do not fall under federal regulations. The 21st Century Cures Act, Section 3060, “Clarifying Medical Software Regulations,” indicates that this hands-off approach will continue and become more lax. Astonishingly, the Apple iTunes and Android Google Play Store are the default arbiters and agents responsible for releasing (and on some occasions, withdrawing) applications, despite evidence that neither their wellknown star ratings nor number of downloads correlate well with health application quality.4 In early September 2016, Apple announced that it would no longer allow certain health applications in its marketplace. This announcement was seen as exerting more influence in protecting public interests related to health applications than the FDA.5 One of Apple’s guidelines states, for instance, that drug dosage calculators proffered on its health applications “must come from the drug manufacturer, a hospital, university, health insurance company, or other approved entity, or receive approval by the FDA or one of its international counterparts.”5 Such a move is a first step on a long journey, but it begs the question of how health application offerings will be evaluated transparently if manufacturers, hospitals, universities, health insurance companies, and the FDA do not gather evidence and define appropriate standards. Another recent first step is the greater engagement of professional societies. For example, the American Psychiatric Association recently released a smartphone application evaluation model that does not specifically recommend or endorse any one application, but rather guides clinicians in considering the safety, evidence, usability, and interoperability of an application to make a more informed decision about use.6 As mental health applications continue to mature, finding consensus and synergy between all stakeholder groups will be critical in creating transparency and trust. While the potential of mental health applications and connected technologies has powered the paradigm of mobile health for the field, it is time for clinical science to assume greater leadership, bringing greater trust and transparency. Application technology is not the limiting factor in adopting these digital tools—trust and transparency are. All of health care, and especially mental health care, revolves around expectations of confidentiality practices and respect for privacy when patients disclose their often most intimate experiences and vulnerabilities. To have therapeutic value, we suggest that VIEWPOINT

Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust

The global burden of neuropsychiatry diseases and related mental health conditions is enormous, underappreciated and under resourced, particularly in the developing nations. The absence of adequate and quality mental health infrastructure and workforce is increasingly recognized. The ethical implications of inequalities in mental health for people and nations are profound and must be addressed in efforts to fulfil key bioethics principles of medicine and public health: respect for individuals, justice, beneficence, and non-malfeasance. Stigma and discrimination against people living with mental disorders affects their education, employment, access to care and hampers their capacity to contribute to society. Mental health well-being is closely associated to several Millennium Development Goals and economic development sectors including education, labour force participation, and productivity. Limited access to mental health care increases patient and family suffering. Unmet mental health needs have a negati...

/pdf/mental-disorders-health-inequalities-and-ethics-a-global-4b7hvodgvi.pdf

Laura Weiss Roberts

Papers

A Brief Instrument to Assess Both Burnout and Professional Fulfillment in Physicians: Reliability and Validity, Including Correlation with Self-Reported Medical Errors, in a Sample of Resident and Practicing Physicians

Machine Learning and the Profession of Medicine

Informed Consent and the Capacity for Voluntarism

Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust

Mental disorders, health inequalities and ethics: A global perspective