Lawrence G. Smith

Bio: Lawrence G. Smith is an academic researcher from Hofstra University. The author has contributed to research in topics: Health care & Mediocrity principle. The author has an hindex of 9, co-authored 17 publications receiving 185 citations. Previous affiliations of Lawrence G. Smith include Mount Sinai Hospital.

Investigation of correlation between house-staff work hours and prescribing errors

Abstract: PURPOSE: The possible correlation between the frequency and significance of prescribing errors and the number of hours worked during a 24-hour shift by hospital house staff was studied. METHODS: A prospective observational trial was conducted in two internal medicine units at an academic medical center. Orders written by medical house staff covering the study units between January 8 and March 10, 2001, were collected daily and evaluated for obvious prescribing errors, the type and significance of the errors, and the number of hours the resident had worked during a 24-hour shift at the time of the prescribing error. RESULTS: A total of 45,366 orders (including orders for medications, laboratory tests, diagnostic procedures, and nursing care) were entered on the study units during the study period. A total of 498 erroneous prescribing orders were identified. A majority of the erroneous orders (77%) could have resulted in significant morbidity or mortality had they reached the patient. The most common errors involved the wrong dose (18%), the wrong dosage frequency (15%), and duplicate orders (15%). There was no statistically significant correlation between the number of hours worked and the frequency or significance of the errors. CONCLUSION: The number of hours worked by medical house staff during a 24-hour shift did not appear to affect the frequency or significance of their prescribing errors.

Cultivating Empathy Through Virtual Reality: Advancing Conversations About Racism, Inequity, and Climate in Medicine.

Abstract: Problem Racism and bias are fundamental causes of health inequities, and they negatively affect the climate of academic medical institutions across the United States. Approach In 2019, the Zucker School of Medicine and Northwell Health piloted a virtual reality (VR) racism experience as a component of professional development for medical school and health system leaders, faculty, and staff. Participants experienced a 60-minute, interactive, large-group session on microaggressions and, as individuals, a 20-minute VR module. These were followed by group reflection and debriefing. The sessions, developed in collaboration with a VR academic team, represented a response to institutional climate assessment surveys, which indicated the need for expanded professional training on cross-cultural communication and enhancing inclusion. Outcomes In October 2019, 112 faculty and staff participated in the workshop. On a postworkshop survey, completed by 76 participants (67.9%), most respondents (90.8%) reported feeling engaged in the VR experience. Additionally, the majority agreed that VR was an effective tool for enhancing empathy (94.7%), that the session enhanced their own empathy for racial minorities (85.5%), and that their approach to communication would change (67.1%). In open-ended responses, participants frequently conveyed enthusiasm, powerful emotional and physiologic responses, and enhanced empathy. They also suggested more time for follow-up discussions. Next steps Next steps include assessing the scalability of the VR module; determining effective complementary engagements; and measuring the module's longitudinal effects on racial empathy, discrimination, and institutional climate. As VR becomes more common in medical education, developing VR modules to address other forms of discrimination (e.g., sexism, homophobia) could also benefit the institutional climates of medical schools and health systems as academic medicine continues to build toward health equity.

Impact of AOA Status and Perceived Lifestyle on Career Choices of Medical School Graduates

Abstract: BACKGROUND Based upon student ratings of such factors as predictable work hours and personal time, medical specialties have been identified as lifestyle friendly, intermediate, or unfriendly. Lifestyle friendly programs may be more desirable, more competitive, and for students elected to the Alpha Omega Alpha (AOA) Honor Medical Society, more attainable.

Home care training in internal medicine residencies: a national survey.

Abstract: PURPOSE To determine the amount and type of training U.S. internal medicine residents receive in providing home care to patients. METHOD A four-item questionnaire was developed and sent to the program directors of all accredited internal medicine residencies in the United States (n = 397) to assess the amounts and types of training (didactic sessions or lectures, house calls, or both) internal medicine residents receive in providing home care. Demographic information about the residency programs was also collected and analyzed. RESULTS A total of 312 (78.6%) of the program directors responded. Sixty-eight percent of their programs included instruction in home care consisting of house calls, lectures, or both. Fewer than half of the responding programs offered any lecture in home care in their curricula, and only 25% of them included a mandatory house-call experience for trainees. Residency programs that had primary care tracks were more likely than were other programs to include either of these experiences in their curricula. CONCLUSIONS Most internal medicine residents receive limited training in home care. As a consequence, future internists may be inadequately prepared to meet the needs of their patients, particularly as the population ages.

Experience and Education.

Abstract: Preparing the books to read every day is enjoyable for many people. However, there are still many people who also don't like reading. This is a problem. But, when you can support others to start reading, it will be better. One of the books that can be recommended for new readers is experience and education. This book is not kind of difficult book to read. It can be read and understand by the new readers.

The Association of American Medical Colleges

Abstract: BIOMEDICAL RESEARCH POLICY COMMITTEE REPORT WAS PUBLISHED AS A SUPPLEMENT TO THE AUGUSTJOURNAL OF MEDICAL EDUCATION. A REPRINT IS ENCLOSED. REQUESTS FOR ADDITIONAL COPIES SHOULD BE ADDRESSED TO THISOFFICE. -COPIES ARE BEING SENT TO MEMBERS OF CONGRESS AND THE KEY MEMBERS OF THE ADMINISTRATION. CALLING UPON-YOUR SENATORSAND CONGRESSMEN TO TELL THE STORY OF THE ROLE. OF MEDICAL SCHOOLS IN BIOMEDICAL RESEARCH AND HEALTH CARE IS IMPORTANT.I STRONGLY URGE THAT YOU MAKE AN 411 APPOINTMENT TO SEE YOUR CONGRESSIONAL REPRESENTATIVES WHILE YOU ARE IN WASHINGTON FOR THE COUNCIL MEETINGON OCTOBER 29. UPON REQUEST WE CAN SUPPLY THE NAMES OF APPOINTMENT SECRETARIES AND PHONE NUMBERS OF YOUR SENATORS AND CONGRESSMEN. APPROPRIATIONS COMMITTEE ACTED WITH EXTRAORDINARY ALACRITY THIS YEAR. THE-NIH APPROPRIATION WAS INCREASED BY 242 MILLION DOLLARSOVER 1971, REPRESENTING A 142 MILLION DOLLAR INCREASE OVER. THE ADMINISTRATION BUDGET, THE BLUE SHEET ASCRIBES APPROPRIATIONS OUTCOME TO THE EFFECTIVENESS OF THE COALITION FOR HEALTH FUNDING UNDER THE LEADERSHIP OF JOHN A. D. COOPER.

The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients

Abstract: Vulnerable older people do not receive adequate care for many conditions. Care for geriatric conditions is much less likely to be optimal than care for general medical conditions.

An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education

Abstract: Prescribing errors affect patient safety throughout hospital practice. Previous reviews of studies have often targeted specific populations or settings or did not adopt a systematic approach to reviewing the literature. Therefore, we set out to systematically review the prevalence, incidence, and nature of prescribing errors in hospital inpatients. MEDLINE, EMBASE, and International Pharmaceutical Abstracts (1985 Oct 2007) were searched for studies of prescriptions for adult or child hospital inpatients giving enough data to calculate an error rate. Electronic prescriptions and errors for single diseases, routes of administration, or types of prescribing error were excluded, as were non-English language publications. Median error rate (interquartile range, IQR) was 7% (2-14%) of medication orders, 52 (8-227) errors per 100 admissions, and 24 (6-212) errors per 1000 patient days. Most studies (84%) were conducted in single hospitals and from the USA or UK (72%). Most errors were intercepted and reported before they caused harm although two studies reported adverse drugs events. Errors were commonest with antimicrobials and commoner in adults (median 18% of orders (10 studies, IQR 7-25%)) than children (median 4% (6 studies, IQR 2-17%)). Incorrect dosage was the commonest error. Overall it is clear that prescribing errors are a common occurrence affecting 7% of orders, 2% of patient days and 50% of hospital admissions. However, the reported rates of prescribing errors varied greatly and this could be partly

Pregnancy and Motherhood During Surgical Training.

Abstract: Importance Although family priorities influence specialty selection and resident attrition, few studies describe resident perspectives on pregnancy during surgical training. Objective To directly assess the resident experience of childbearing during training. Design, Setting, and Participants A self-administered 74-question survey was electronically distributed in January 2017 to members of the Association of Women Surgeons, to members of the Association of Program Directors in Surgery listserv, and through targeted social media platforms. Surgeons who had 1 or more pregnancies during an Accreditation Council for Graduate Medical Education–accredited US general surgery residency program and completed training in 2007 or later were included. Important themes were identified using focus groups of surgeons who had undergone pregnancy during training in the past 7 years. Additional topics were identified through MEDLINE searches performed from January 2000 to July 2016 combining the keywordspregnancy,resident,attrition, andparentingin any specialty. Main Outcomes and Measures Descriptive data on perceptions of work schedule during pregnancy, maternity leave policies, lactation and childcare support, and career satisfaction after childbirth. Results This study included 347 female surgeons (mean [SD] age, 30.5 [2.7] years) with 452 pregnancies. A total of 297 women (85.6%) worked an unmodified schedule until birth, and 220 (63.6%) were concerned that their work schedule adversely affected their health or the health of their unborn child. Residency program maternity leave policies were reported by 121 participants (34.9%). A total of 251 women (78.4%) received maternity leave of 6 weeks or less, and 250 (72.0%) perceived the duration of leave to be inadequate. The American Board of Surgery leave policy was cited as a major barrier to the desired length of leave by 268 of 326 respondents (82.2%). Breastfeeding was important to 329 (95.6%), but 200 (58.1%) stopped earlier than they wished because of poor access to lactation facilities and challenges leaving the operating room to express milk. Sixty-four women (18.4%) had institutional support for childcare, and 231 (66.8%) reported a desire for greater mentorship on integrating a surgical career with motherhood and pregnancy. A total of 135 (39.0%) strongly considered leaving surgical residency, and 102 (29.5%) would discourage female medical students from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training. Conclusions and Relevance The challenges of having children during surgical residency may have significant workforce implications. A deeper understanding is critical to prevent attrition and to continue recruiting talented students. This survey characterizes these issues to help design interventions to support childbearing residents.