bluuebunny/crossref_metadata_2025_split huggingface dataset:
Keeping health care professionals healthy: Systematic strategies for mitigation, wellness, and burnout prevention.
Authors: Kotwal Juee , Schnaitmann Natalie , Mooney Stefanie , Lemus Mejia Lucia , Luna Joanna , Mejia Daniela , Clark Karen L. , Loscalzo Matthew J. , Dale William 
Published: June 2024

9013 Background: Health care professionals are deeply committed to the compassionate care of their patients. However, the same level of caring and compassion is not typically extended to colleagues, much less toward themselves. Escalating issues include: burnout, demoralization, personal conflicts, early retirement, and high turnover. Literature and training offer few suggestions to proactively address these complexities. There is a lack of attention to creating truly healthy work environments, with strategic infrastructure to enhance leadership, communication, and relationship among team members that directly impact wellness, engagement, and productivity. We will present the Staff Leadership Model (SLM) that integrates courageous and compassionate communication to foster healthier work environments, including how to implement and sustain the necessary infrastructure. Methods: In 4 large academic cancer settings, evolving iterations of the SLM were developed since 1995, focusing on maximizing inherent human capacities. In 2007, the Department of Supportive Care Medicine (DSCM), an interdisciplinary department at City of Hope (COH), systematically integrated the SLM. Specific processes, such as onboarding and skills training, regularly scheduled, open and honest communication, ways of working agreements, and performance evaluations that actively support value-driven behaviors, were implemented. Tailored interpersonal strategies were implemented, such as small group democratic meeting structure that equalizes all members, and problem-solving skills to deal with conflict. Clinicians received annual Press Ganey-administered surveys that measured clinician engagementas well as clinician resilience, measuring the ability to disconnect from work and ability to find meaning in their work, providing early warning indicators of burnout. Results: Sustained success has been demonstrated: 1) 5 years top tier clinician/staff engagement scores, with increase from 4.24 in 2022 to 4.32 in 2023 (+0.14 vs. overall COH) ; 2) 3.96 resilience index score vs. 3.80 overall COH in 2023 (3.23 decompression score vs. COH 2.94 and 4.69 activation score vs. COH 4.65); 3) Growth of the department from 25 professionals in 2007 to 170+ in 2024; 4) A clearly-defined clinical triage created through the expertise of the professionals; and 5) Staff creativity and leadership resulting in the creation and consistent growth of innovative, market-differentiating programs. Conclusions: Results support the relationship between the SLM and healthier work environments that increase engagement and decrease burnout, as reflected by the consistently high scores. The resilience index is a new survey measure with one year data. Cause-effect relation will continue to be evaluated. Overall, SLM creates a culture of health, wellness, support, and optimized individuals and teams.
Demographic trends and outcome measures found in randomized controlled trials of wellness interventions among medical trainees: A systematic review.
Authors: Hearn Andrew Irving , Chrabuszcz Daniella , Bao James , Hearn Kristen Elizabeth , Yaeger Lauren H , Stoll Carolyn RT , Colditz Graham A. 
Published: June 2024

9014 Background: To our knowledge, there is no systematic review that identifies and characterizes the wellness interventions with high-quality evidence in the form of randomized controlled trials (RCTs) among medical education trainees (medical students, residents, and fellows). Methods: A medical librarian (YL) searched Embase, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), APA PsycINFO, and Clinicaltrials.gov from the earliest timepoint to March 2022. We included full text/ published studies that were prospective RCTs that included quantifiable measures related to mental health, wellness, or other measures of wellbeing. Medical students, residents, and/or fellows must be included in the intervention that is intended to improve wellbeing. We excluded studies that included only qualitative outcome measures, had no control group, or took place outside the USA. Results: Our search strategy resulted in 3,806 unique articles. 161 articles passed initial screening of titles and abstracts, and 46 studies met eligibility criteria with dates ranging from 1980 to 2022. A total of 8,016 participants were studied with the majority of studies (26) focusing on medical students, a minority of studies (20) focusing on residents, and no studies that included fellows. A minority (10) of studies were multi-institutional with the vast majority (36) being single-institutional. Outcome measures shared among two or more studies include variants of the Maslach Burnout Inventory (MBI) (5), Perceived Stress Scale (PSS) (5), PHQ-9 (5), Five-Facet Mindfulness Questionnaire (FFMQ) (5), State Trait Anxiety Inventory (STAI) (3), step count (3), Epworth Sleepiness Scale (ESS) (2), General Anxiety Disorder-7 (GAD-7) (2), Global Severity Index (GSI) (2), and Brief Symptom Index (BSI) (2). Interventions included in two or more studies center around mindfulness and/or meditation practices (15), cognitive behavioral therapy (CTB) (3), hypnosis (3), activity trackers (2), flexible work hours (2), and massage and/or manipulation (2). Conclusions: We conducted a systematic review to identify evidence-based wellness interventions and in the process potentially inform future research in regards to standardized outcome measures and highlighting the need for interventions targeting fellows, particularly in fields with a majority of physicians reporting burnout such as hematology/oncology.1 1. McKenna J. Medscape Physician Burnout & Depression Report 2024: “We Have Much Work to Do". Medscape. Published 2024. https://www.medscape.com/slideshow/2024-lifestyle-burnout-6016865.
Factors influencing career choices and post-fellowship perspectives in adult hematology/oncology fellows: A nationwide cross-sectional study.
Authors: Gonzalez Mosquera Luis , Balanchivadze Nino , Ali Faria , Meranda Matthew , Hinojosa Castro Oscar , Kuriakose Philip 
Published: June 2024

9016 Background: The aim ofour study was to explore the characteristics, aspirations, and factors influencing career choices among adult Hematology/Oncology (HO) fellows, as well as their post-fellowship perspectives. Methods: An anonymous 25-question survey was distributed online to adult HO fellowship programs in the United States. The survey collected data on demographics, educational background, career plans, and specific factors influencing career choices. Results: Of the 56 fellows completing the survey, 54% identified as male, and 46% as female. The majority were White (40%), followed by Asian (34%), Middle Eastern (12%), Hispanic (7%), and Black (3%). Most fellows (79%) were aged 30-34 years, and 68% were MD graduates of US/Caribbean schools. A significant proportion expressed certainty (80%) during residency about pursuing adult HO as a career. Thirty eight percent of the respondents planned to practice both hematology and Oncology. While 39% hoped to work in an academic/university setting, 41% planned to stay within the community. Geographically, 45% preferred suburban, and 39% urban areas. Only 3% of respondents had plans to pursue a career in classical hematology. Factors influencing career choice included clinical interest in the field (98%), previous research experience in HO (54%), career mentorship (70%), lifestyle considerations (66%), and perceived job market (60%) (Table). Almost all respondents (97%) expressed a high likelihood of pursuing adult HO fellowship if they had to choose again. Fellows were confident about finding positions aligned with their interests, including clinical (72%), providing research opportunities (43%), and those offering intellectual stimulation (73%). While the majority were confident in achieving work-life balance (84%), 16% expressed some concerns. Conclusions: This study offers valuable insights into the factors influencing career choices among adult HO fellows. The findings emphasize the necessity of adjusting strategies to align with the evolving needs and aspirations of prospective fellows. Key initiatives could include fortifying career mentorship programs, providing increased support for those interested in classical hematology, fostering research experiences during residency training, and actively promoting a diverse and inclusive environment. Understanding these aspects and results is crucial for program directors, educators, and policymakers to optimize training programs and support the diverse needs of future practitioners in the field. [Table: see text]
Fortifying the workforce: A national survey of hematology/oncology fellowship program directors and training fellows for community-based careers.
Authors: Iacoviello Anthony , Agrawal Shubham , Berry Jonathan L , Widick Page , Roberts Daniel Aaron , Patell Rushad , Rangachari Deepa 
Published: June 2024

9028 Background: Most hematology/oncology (HO) care occurs in community settings. In a recent national survey of currently practicing community oncologists, we highlighted areas of unmet need regarding preparation for community-based (CB) careers during fellowship [Agrawal et al, JCO OP 2024]. Our study aims to explore attitudes of HO fellowship program directors (PDs) relating to CB HO training. Methods: We conducted a cross-sectional email survey of 185 HO fellowship PDs in the United States. The primary outcome was assessing PDs’ attitudes regarding inclusion of CB HO training during fellowship. Secondary outcomes included assessing whether programs currently have clinical and/or non-clinical training experiences specifically addressing skills relevant to community practice. Participants were also surveyed to assess PDs’ attitudes regarding what motivates fellows to choose careers in community practice. Demographics pertaining to program leadership and fellows were also obtained. Results: We received a total of 53 responses (29% response rate). The majority of respondents’ programs were in academic tertiary care hospitals (76%) with a plurality in the Northeast (32%), had a median of 5 trainees per class, and had roughly equal Male and Female (including transgender men and women) trainees (70%). The majority of PDs had been in clinical practice for ≥10 years (68%) and in their program leadership position for ≤10 years (83%). Almost all PDs (96%) reported having graduates who pursue careers in CB settings, with financial compensation cited most frequently in making this decision (98%). The majority of PDs (83%) agreed that training experiences in CB HO should be available for their trainees during fellowship. A multivariate regression analysis demonstrated that there were no significant factors associated with this outcome (p>.05). Training experiences relevant to community practice were not uniformly available amongst programs, with 74% of programs offering clinical experiences, but only 32% offering non-clinical experiences. The most cited clinical experience was the option to rotate in a CB setting (80%), and the most common non-clinical experience was exposure to training in quality improvement/patient safety (88%). Conclusions: While most HO training programs in the U.S. are embedded within academic centers, nearly all PDs indicated their programs train fellows who pursue careers in the community. PDs believe that experiences tailored to CB HO practice should be available to their fellows. Although many respondents’ programs offer CB clinical rotations, relevant extra-clinical skill development opportunities are lacking. Goal-concordant pathways for career development during HO fellowship can be optimized, particularly as they relate to training individuals for practice in CB settings, a growing need within the HO workforce.
Surveying oncologists' awareness and challenges in addressing social determinants of health: A national study.
Authors: Drew Heather , Beyer Michael , Kriz Chris , Colas Tomas , Vargas Stephany , Singer Ted 
Published: June 2024

9030 Background: Ensuring that healthcare professionals are equipped to address disparities in healthcare access and outcomes is crucial for improving overall healthcare quality. Multiple studies have shown a clear causal link between social determinants of health (SDOH) and cancer. PeerView developed a research project to understand how well oncologists understand the impact of SDOH on the care and outcomes of patients with cancer and what they need to close gaps in knowledge and skills in order to deliver equitable care. Methods: PeerView developed and sent a series of seven surveys, each with 3-5 questions, to US medical oncologists and hematologist-oncologists from June 2023 to January 2024. Each set of surveys was sent to a different group of clinicians to ensure that responses were representative of the target group. Key Areas of Analysis: Overall awareness and understanding of SDOH; Perceived challenges in achieving health equity; Barriers to improving diversity in clinical trials; Clinician needs in addressing disparities; and Educational tactics and tool preferences for SDOH training. Results: 1,536 responses from US medical oncologists and hematologist-oncologists (37% working in an academic setting; 63% community-based) Representative findings: Approximately two-thirds (67%) needed to improve their understanding of SDOH and their effects on healthcare disparities; 60% were confident in their understanding of the effects of SDOH in cancer care in 4 key areas: care delivery and quality, screening, immunotherapy efficacy, and technology literacy; Most respondents felt confident or very confident caring for patients with cancer across ethnicities (81%), cultures (83%), socioeconomic statuses (78%), genders/gender identities (82%), and age (89%); 70% expressed confidence in their ability to identify patients at higher risk because of health disparities and SDOH; While the majority (61%) felt competent in connecting patients with resources and care to overcome SDOH-related barriers, community and academic providers differed significantly in their confidence; 70% selected the lack of resources in the healthcare system as the most or second greatest significant factor contributing to healthcare disparities; and 58%believed that partnering with pharmacists, community health workers, and community groups would help increase minority participation in oncology clinical trials. Conclusions: These results outlined deficiencies in knowledge and confidence of SDOH. By integrating these insights into development of continuing education (CE) activities and sharing them with the CE community, we can help clinicians overcome care-delivery barriers related to SDOH and develop inclusive care practices that empower patients to take charge of their health. Furthermore, insights from this research can shape policy decisions, curriculum development, and resource allocation on a larger scale.
Optimizing hematology/oncology (H/O) curricula for internal medicine (IM) residents: A two-institution Delphi survey.
Authors: Silverstein Jordyn , Huppert Laura Ann , Schwede Matthew , Goglin Sarah , Johnson Tyler Paul , Babik Jennifer , Brondfield Sam 
Published: June 2024

9033 Background: Although H/O topics are essential for primary care physicians, internists and subspecialists, the H/O curriculum is not standardized across IM residency programs. We aimed to identify the most important H/O topics for IM residents to learn, according to IM generalists and H/O specialists. Methods: We used a modified Delphi approach to conduct a 2-round cross-sectional survey of IM generalists and H/O specialists at the University of California, San Francisco and Stanford University. Participants rated the importance of H/O curricular topics gathered from national H/O and IM organizations on a 1-5 scale (very unimportant to very important). Participants then viewed their own ratings compared to the group mean and standard deviation (SD) for each topic from round 1 and could change their ratings in round 2 if they wished. We used a content validity index (CVI, the percentage of respondents who rated the topic ≥4) of >75% to identify the most important topics. We compared the effect sizes of the differences between mean generalist and specialist ratings for each topic using Cohen’s d. Results: The survey included 239 topics (75 classical hematology, 52 malignant hematology, 112 solid oncology). The round 1 survey was sent to 132 clinicians (68 generalists, 64 H/O specialists), with 92 round 1 responses (response rate [RR] 69.7%) and 77 round 2 responses (RR 83.7%). The average variance decreased from round 1 to round 2 (1.00 to 0.86), indicating increasing agreement. Ninety-two topics met the CVI threshold: 41 from classical hematology, 15 from malignant hematology, and 36 from solid oncology. The Table shows the highest rated topics as examples. Most effect sizes were small (58.6%), indicating agreement between generalists and specialists across most topics. Conclusions: With input from both generalists and H/O specialists, we identified the most important H/O topics for IM residents, which can guide curriculum development for IM residency programs. [Table: see text]
Filling the gap in competency-based training for medical oncology with supervised online patient counseling: A qualitative study.
Authors: Iugai Sergei , Panchenko Daria , King Mary Caitlin , Kovalik Vladislav , Nikiforchin Andrei , Barakat Philipp , Ledakis Panayotis , Gushchin Vadim 
Published: June 2024

9036 Background: The Higher School of Oncology (HSO) is a collaborative US-Russian postgraduate program that improves learning outcomes for young oncologists. Many HSO medical oncology (MO) residents/graduates are also engaged in online supervised patient counseling, known as ‘Just Ask.’ We aimed to explore the educational role of ‘Just Ask’ in shaping the competency-based learning outcomes of MO graduates, who have recently begun independent clinical practice. Methods: This qualitative study included 10 HSO alumni (2019-2023) who practice MO in Russia. All participants were current or prior ‘Just Ask’ consultants. Anonymous, online semi-structured in-depth interviews were conducted to explore interviewees reflection on competencies obtained at HSO and ‘Just Ask.’ The interview guide included 42 open-ended questions based on the American Accreditation Council for Graduate Medical Education (ACGME) list of competencies for MO physicians. All interviews were recorded and transcribed. Inductive-deductive coding with code categorization was followed by thematic analysis. Themes were mapped against the ACGME competencies. Results: Interviews, with a median duration of 69 (IQR: 54-80) minutes,involved participants with 0.5-3 years of practice. Six (60%) interviewees worked in hospitals, while 2 (20%) were in outpatient and another 2 (20%) were in mixed settings. We identified 85 codes and categorized them into 10 educational experience themes. Interviewees attributed learning an evidence-based approach, basic oncology knowledge, and patient communication skills through the HSO curriculum. Themes associated with learning from online counseling included integration into real-world practice, specific types of expertise (rare tumors), and advanced communication (explaining differences in management, written communication), which are less covered by HSO. This activity enhanced skills in patient navigation, advocacy, and the ability to detect care not supported by evidence. Safe-space learning provided by ‘Just Ask’ was a unique theme reflecting the ability of trainees to hone skills in a secure and resource-enriched environment with easy access to mentoring. The association of the selected 'Just Ask'-related themes with ACGME competencies is presented in the table. Conclusions: Supervised online counseling has emerged as a valuable educational tool aimed at supplementing competencies insufficiently covered by medical oncology postgraduate curriculum. [Table: see text]
Simian Episteme, circa 1200
Authors: Hong Jeehee 
Published: June 2024

Abstract
This article examines intersensory practices between seeing and hearing surrounding the medium of painting in middle-period China. Deviating from the better-known pictorial practice in which a mimetic image of a sound maker provides an entryway into a fictive soundscape, the central work discussed in this article depicts only a listener, and an unusual one at that: a seated monkey at the intersection of poetic, religious, and ecological boundaries. Attentive to the puzzling nonhuman form of the represented subject as an unlikely listener, it probes how the interplay between seeing and hearing gave rise to a complex sonic environment in pictorial medium. The unveiling of the mixed modality steers us toward an underrecognized role of painting in Chinese history as a material stimulus for multisensorial experiences, beyond the rhetoric of “soundless poetry” that has often stifled such dynamic potential of the medium.
What Noise Does a Psychotic Door Listen To? Information, Intermediality, and Guo Baochang's Peking Opera Film Dream of the Bridal Chamber
Authors: Lam Ling Hon 
Published: June 2024

Abstract
The Chinese opera film criticism of the late 1950s coincided with the introduction of cybernetics to China. Echoing cybernetics’ emphasis on the homeostasis of an artificial or living machine archived by filtering noise from information in the environment, film critics aimed no less at maintaining the steady states of Chinese culture (epitomized by traditional opera) when taking on the treacherous milieu called modernization (in the form of cinema). The whole problematic of opera films—in which one is forced to choose filtering out formulaic operatic gestures or realistic cinematic mise-en-scène as noise to maintain a self-cohesive cultural system—follows from the mistake of essentializing media specificities as prior to the contingent encounter among different mediums. However, an alternative approach lies in treating noise not as interference that must be eliminated but as surplus information that introduces system errors, triggers phase shifts, and brings about random changes for genuine self-organization, allowing us to confront control with the noise in its own channels. A revamping of cybernetics in this regard opens up new possibilities of understanding opera films through the peculiar prism of Guo Baochang's 2005 opera film Chungui meng 春閨夢 (Dream of the Bridal Chamber). And that prism particularly takes the form of a series of moon gates (yueliang men 月亮門), an architectural trope invoked throughout the film signifying the cybernetic circuit of gateways that at once exerts control over and yet is disturbed and reshaped by the noisy signals arising from the mutual interferences among opera, film, and, ultimately, television.
Founder mutations and rare disease in the Arab world
Authors: Marafi Dana 
Published: June 2024

ABSTRACT
Founder mutations are disease-causing variants that occur frequently in geographically or culturally isolated groups whose shared ancestor(s) carried the pathogenic variant. While some disease alleles may vanish from the genetic pool due to natural selection, variants with weaker effects may survive for a long time, thereby enhancing the prevalence of some rare diseases. These are predominantly autosomal recessive diseases but can also be autosomal dominant traits with late-onset or mild phenotypes. Cultural practices, such as endogamy and consanguinity, in these isolated groups lead to higher prevalence of such rare diseases compared to the rest of the population and worldwide. In this Perspective, we define population isolates and the underlying genetic mechanisms for accumulating founder mutations. We also discuss the current and potential scientific, clinical and public-health implications of studying founder mutations in population isolates around the world, with a particular focus on the Arab population.