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Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review

Glick, Alexander F; Farkas, Jonathan S; Magro, Juliana; Shah, Aashish V; Taye, Mahdi; Zavodovsky, Volmir; Rodriguez, Rachel Hughes; Modi, Avani C; Dreyer, Benard P; Famiglietti, Hannah; Yin, H Shonna
CONTEXT/BACKGROUND:Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking. OBJECTIVE:To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC. DATA SOURCES/METHODS:PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched. STUDY SELECTION/METHODS:Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated. DATA EXTRACTION/METHODS:Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS:Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies. LIMITATIONS/CONCLUSIONS:No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review. CONCLUSIONS:Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.
PMID: 37846504
ISSN: 1098-4275
CID: 5605632

Mapping the pathways to health sciences librarianship: reflections and future implications from an immersion session

Laynor, Gregory; Tagge, Natalie; Magro, Juliana; Armond, Megan De; Rau, Renée A; Vardell, Emily
OBJECTIVE/UNASSIGNED:Many health sciences librarians enter the profession without specific health sciences training. Some LIS programs have health sciences courses or tracks, but health sciences training within an LIS program is only one path to entering health sciences librarianship. To develop a map of pathways into health sciences librarianship, an immersion session at the Medical Library Association conference in 2022 asked health sciences librarians to share how they entered the profession. METHODS/UNASSIGNED:The immersion session was structured in three parts: facilitator introductions, small group discussions, and a whole group summary discussion. Guided by questions from the facilitators, small groups discussed what pathways currently exist, how to promote existing pathways, what new pathways should be created, and how to develop and promote pathways that make the profession more equitable, diverse, and inclusive. RESULTS/UNASSIGNED:Through in-the-moment thematic analysis of the small group discussions, the following emerged as key pathways: library school education; internships and practica; the Library and Information Science (LIS) pipeline; on-thejob training; mentoring; self-teaching/hands-on learning; and continuing education. Themes of equity, diversity, and inclusion arose throughout the session, especially in the concluding whole group discussion. CONCLUSION/UNASSIGNED:Small group discussions in a conference immersion session showed the value of community building in a profession that has multiple pathways for entrance, highlighting the importance of unearthing hidden knowledge about avenues for exploring and enhancing career pathways. The article seeks to address barriers to entry into the profession and adds to the literature on strengthening the field of health sciences librarianship.
PMID: 37928122
ISSN: 1558-9439
CID: 5609772

The Role of Gender in Careers in Medicine: a Systematic Review and Thematic Synthesis of Qualitative Literature

Winkel, Abigail Ford; Telzak, Beatrice; Shaw, Jacquelyn; Hollond, Calder; Magro, Juliana; Nicholson, Joseph; Quinn, Gwendolyn
BACKGROUND:Gender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention. METHODS:A systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999). FINDINGS/RESULTS:Among 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women's careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women's integration of personal and professional values. CONCLUSION/CONCLUSIONS:Medical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.
PMID: 33948802
ISSN: 1525-1497
CID: 4866392

H5P [Resource Review]

Magro, Juliana
ISSN: 1558-9439
CID: 4942502

Results from a Psychology OER pilot program: faculty and student perceptions, cost savings, and academic outcomes

Magro, Juliana; Tabaei, Sara V
ISSN: 2304-070x
CID: 4483582