Importance-There are concerns about the current quality of undergraduate medical education (UME) and its effect on students' well-being.Objective-This systematic review was designed to identify best practices for UME learning environment interventions that are associated with improved emotional well-being of students.Data Sources-Learning environment interventions were identified by searching the biomedical electronic databases Ovid MEDLINE, EMBASE, the Cochrane Library, and the ERIC database from the database inception dates to October 2016. Studies examined any intervention designed to promote medical students' emotional well-being in the setting of a US academic medical school, with an outcome defined as students' reports of well-being as assessed by surveys, semistructured interviews, or other quantitative methods.Data Extraction and Synthesis-Two investigators independently reviewed abstracts and full-text articles. Data were extracted into tables to summarize results. Study quality was assessed by the Medical Education Research Study Quality Instrument (MERQSI), which has a possible range of 5-18; higher scores indicate higher design and methods quality, and a score of ≥ 14 indicates a high-quality study.Findings-Twenty-eight articles including at least 8224 participants met eligibility criteria. Study designs included single-group cross-sectional or post-test only (n=10), single-group pre-/ post-test (n=2), nonrandomized two-group (n=13), and randomized clinical trial (n=3); 93% were
PTSD due to acute cardiovascular events may be uniquely defined by enduring perceptions of somatic threat. We tested whether PTSD at 1 month post-acute coronary syndrome (ACS) indeed required both high peritraumatic threat during the ACS and ongoing cardiac threat perceptions. We assessed peritraumatic threat during emergency department (ED) enrollment of 284 patients with a provisional ACS diagnosis, and cardiac threat perceptions and PTSD symptoms 1 month post-discharge. In a multiple regression model with adjustment for important covariates, ED threat perceptions were associated with higher 1-month PTSD symptoms only among those with high levels of ongoing cardiac threat.
Compared to the traditional one-size-fits-all, nomothetic model that generalizes population-evidence for individuals, the proposed N-of-1 model can better capture the individual difference in their stressbehavior pathways. In this paper, we demonstrate it is feasible to perform personalized exercise behavior prediction, mainly made possible by mobile health technology and machine learning analytics.
Objective:
Relationship quality is one of the most consistent psychosocial predictors of physical and mental health. Yet, little research examines relationship types or support within the immediate context of acute health events. We tested the unexplored role that close others play in patients’ experience of threat during evaluation for acute coronary syndrome (ACS) in the Emergency Department (ED), as well as the indirect effect of close others on ACS-induced posttraumatic stress disorder (PTSD).
Method:
Participants were 871 patients evaluated for ACS at an urban academic ED (60.86 years old; 54.08% male; 56.37% Hispanic, 19.86% Black, 16.65% White). Threat perceptions were assessed in-ED and median 3 days later. ACS-induced PTSD was assessed median 41 days later using the PTSD checklist cued to a specific stressor. Non-overlapping categories representing close others in the ED (i.e., spouse/significant other, child), non-close others (e.g., neighbor), or no one.
Results:
Patients who brought close others recalled experiencing greater threat in the ED: vs. no one, b = 0.11, p = .072; vs. non-close others, b = 0.16, p = .030. There was no direct effect of close others on ACS-induced PTSD; however, recalled threat mediated the effect of close others on development of ACS-induced PTSD, ps < .05.
Conclusions:
Close others were associated with recalling greater threat during ED evaluation, which predicted ACS-induced PTSD. ACS-induced PTSD is associated with medication nonadherence, event recurrence, and mortality, highlighting the need to develop a greater understanding of the impact stressful medical environments have on patients and close others.
Evaluation for acute coronary syndrome (ACS) can trigger posttraumatic stress symptoms (PSS). Research suggests that younger, versus older, individuals may be at elevated risk for PSS after ACS evaluation. It has been proposed that younger individuals may be at greater risk because they perceive the suspected ACS event as more threatening than their older counterparts; however, this has yet to be tested. We examined whether perceived threat during ACS evaluation mediated the association between age and PSS after ACS evaluation in an observational cohort study of patients presenting to the emergency department (ED) with suspected ACS. Demographics and perceived threat were assessed in the ED. PSS were measured upon inpatient transfer or by phone 3 days later. The analytic sample comprised 871 adult participants. Multiple linear regression was used to examine (1) associations of age and perceived threat with PSS and (2) whether perceived threat mediated the association. Bootstrapping with percentile-based confidence intervals (CIs) was used to test the indirect effect. Each year of age was associated with lower PSS (b = - 0.12, p < .001), independent of covariates. Older age was associated with lower perceived threat during ACS evaluation (b = - 0.05, p < .001). Greater threat perceptions predicted greater PSS (b = 0.94, p < .0001). The indirect effect (- 0.04) was statistically significant (95% CI - 0.07, - 0.02). Younger, versus older, individuals are at risk for greater PSS after ACS evaluation, and elevated perceived threat partially mediated this association. Understanding age differences in PSS development risk and the potential impact of age on threat perceptions may help inform ED treatment.
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