Publications by authors named "V Shane Pankratz"

394 Publications

Autonomy and focus of attention in medical motor skills learning: a randomized experiment.

BMC Med Educ 2022 Jan 19;22(1):46. Epub 2022 Jan 19.

Multidisciplinary Simulation Center, Mayo Clinic, Rochester, MN, USA.

Background: The 'OPTIMAL' (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning suggests that autonomy, external focus of attention, and perceived competence can improve learning of simple motor tasks. The authors hypothesized that enhanced (vs. routine) autonomy and external (vs. internal) focus of attention would improve first-try performance of two medical motor tasks.

Methods: The authors conducted a randomized two-by-two factorial design study with high school students as participants. Task instructions promoted either enhanced or routine autonomy, and either external or internal focus of attention. These conditions were replicated in a crossover design for two common medical tasks (chest compressions on a manikin and a Fundamentals of Laparoscopic Surgery peg transfer task). Primary outcomes were objective measures of task performance (chest compression deviation from target depth; peg transfer time with penalties for errors). Secondary outcomes included subjective perceptions of confidence, autonomy, and workload.

Results: One hundred thirty-three high school students participated in this study. The primary outcomes concerning enhanced vs. routine autonomy demonstrated no statistically significant difference in either task (chest compression depth deviation: difference -0.7 mm [score range 0 to 37.5 mm]; 95% confidence interval (CI95) -3.85, 2.41; p = .65; peg transfer penalized time: rate ratio 1.03; CI95 0.91, 1.31; p = .79). The authors likewise found no statistically significant difference for external vs. internal focus of attention (depth deviation: difference 1.1 mm; CI95 -2.04, 4.17; p = .50; penalized time: rate ratio 0.89; CI95 0.75, 1.13; p = .33). The authors found no statistically significant differences for either comparison in confidence, autonomy and workload (p > .09; differences ranged from -0.83 to 0.79 [scale range 0 to 10]).

Conclusions: First-try performance of chest compressions and peg transfer by novice learners is not significantly affected by enhanced (vs. routine) autonomy or external (vs. internal) focus of attention.
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http://dx.doi.org/10.1186/s12909-021-03020-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8772150PMC
January 2022

Association of Physician Continuous Professional Development and Referrals: A Systematic Review and Meta-Analysis.

Acad Med 2022 Jan 4. Epub 2022 Jan 4.

D.A. Cook is professor of medicine and medical education; director, Section of Research and Data Analytics, School of Continuous Professional Development; and director of education science, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science; and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633. C.R. Stephenson is assistant professor of medicine, Mayo Clinic College of Medicine and Science; associate program director, Mayo-Rochester Internal Medicine Residency Program, and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-8537-392X. V.S. Pankratz is professor of internal medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; ORCID: https://orcid.org/0000-0002-3742-040X. J.M. Wilkinson is associate professor of family medicine, Mayo Clinic College of Medicine and Science, and consultant, Department of Family Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1156-8577. S. Maloney is professor of health professions education and deputy head of school, Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia; ORCID: https://orcid.org/0000-0003-2612-5162. L.J. Prokop is a reference librarian, Plummer Library, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7197-7260. J. Foo is a lecturer, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4533-8307.

Purpose: Both overuse and underuse of clinician referrals can compromise high-value health care. The authors sought to systematically identify and synthesize published research examining associations between physician continuous professional development (CPD) and referral patterns.

Method: The authors searched MEDLINE, Embase, PsycInfo, and the Cochrane Database on April 23, 2020, for comparative studies evaluating CPD for practicing physicians and reporting physician referral outcomes. Two reviewers, working independently, screened all articles for inclusion. Two reviewers reviewed all included articles to extract information, including data on participants, educational interventions, study design, and outcomes (referral rate, intended direction of change, appropriateness of referral). Quantitative results were pooled using meta-analysis.

Results: Of 3,338 articles screened, 31 were included. These studies enrolled at least 14,458 physicians and reported 381,165 referral events. Among studies comparing CPD with no intervention, 17 studies with intent to increase referrals had a pooled risk ratio of 1.91 (95% CI, 1.50, 2.44; P < .001), and 7 studies with intent to decrease referrals had a pooled risk ratio of 0.68 (95% CI 0.55, 0.83; P < .001). Five studies did not indicate the intended direction of change. Subgroup analyses revealed similarly favorable effects for specific instructional approaches (including lectures, small groups, Internet-based instruction, and audit/feedback) and for activities of varying duration. Four studies reported head-to-head comparisons of alternate CPD approaches, revealing no clear superiority for any approach. Seven studies adjudicated the appropriateness of referral, and 9 studies counted referrals that were actually completed (versus merely requested).

Conclusions: Although between-study differences are large, CPD is associated with statistically significant changes in patient referral rates in the intended direction of impact. There are few head-to-head comparisons of alternate CPD interventions using referrals as outcomes.
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http://dx.doi.org/10.1097/ACM.0000000000004575DOI Listing
January 2022

Southwest Harvest for Health: An Adapted Mentored Vegetable Gardening Intervention for Cancer Survivors.

Nutrients 2021 Jul 6;13(7). Epub 2021 Jul 6.

Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA.

Harvest for Health is a home-based vegetable gardening intervention that pairs cancer survivors with Master Gardeners from the Cooperative Extension System. Initially developed and tested in Alabama, the program was adapted for the different climate, growing conditions, and population in New Mexico. This paper chronicles the feasibility, acceptability, and preliminary efficacy of "Southwest Harvest for Health". During the nine-month single-arm trial, 30 cancer survivor-Master Gardener dyads worked together to establish and maintain three seasonal gardens. Primary outcomes were accrual, retention, and satisfaction. Secondary outcomes were vegetable and fruit (V and F) intake, physical activity, and quality of life. Recruitment was diverse and robust, with 30 survivors of various cancers, aged 50-83, roughly one-third minority, and two-thirds females enrolled in just 60 days. Despite challenges due to the COVID-19 pandemic, retention to the nine-month study was 100%, 93% reported "good-to-excellent" satisfaction, and 87% "would do it again." A median increase of 1.2 servings of V and F/day was documented. The adapted home-based vegetable gardening program was feasible, well-received, and resulted in increased V and F consumption among adult cancer survivors. Future studies are needed to evaluate the effectiveness of this program and to inform strategies to increase the successful implementation and further dissemination of this intervention.
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http://dx.doi.org/10.3390/nu13072319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308636PMC
July 2021

High performance implementation of the hierarchical likelihood for generalized linear mixed models: an application to estimate the potassium reference range in massive electronic health records datasets.

BMC Med Res Methodol 2021 07 24;21(1):151. Epub 2021 Jul 24.

Department of Internal Medicine, University of New Mexico School of Medicine, MSC10 5550 1 University of New Mexico Albuquerque, Albuquerque, NM, 87131, USA.

Background: Converting electronic health record (EHR) entries to useful clinical inferences requires one to address the poor scalability of existing implementations of Generalized Linear Mixed Models (GLMM) for repeated measures. The major computational bottleneck concerns the numerical evaluation of multivariable integrals, which even for the simplest EHR analyses may involve millions of dimensions (one for each patient). The hierarchical likelihood (h-lik) approach to GLMMs is a methodologically rigorous framework for the estimation of GLMMs that is based on the Laplace Approximation (LA), which replaces integration with numerical optimization, and thus scales very well with dimensionality.

Methods: We present a high-performance, direct implementation of the h-lik for GLMMs in the R package TMB. Using this approach, we examined the relation of repeated serum potassium measurements and survival in the Cerner Real World Data (CRWD) EHR database. Analyzing this data requires the evaluation of an integral in over 3 million dimensions, putting this problem beyond the reach of conventional approaches. We also assessed the scalability and accuracy of LA in smaller samples of 1 and 10% size of the full dataset that were analyzed via the a) original, interconnected Generalized Linear Models (iGLM), approach to h-lik, b) Adaptive Gaussian Hermite (AGH) and c) the gold standard for multivariate integration Markov Chain Monte Carlo (MCMC).

Results: Random effects estimates generated by the LA were within 10% of the values obtained by the iGLMs, AGH and MCMC techniques. The H-lik approach was 4-30 times faster than AGH and nearly 800 times faster than MCMC. The major clinical inferences in this problem are the establishment of the non-linear relationship between the potassium level and the risk of mortality, as well as estimates of the individual and health care facility sources of variations for mortality risk in CRWD.

Conclusions: We found that the direct implementation of the h-lik offers a computationally efficient, numerically accurate approach for the analysis of extremely large, real world repeated measures data via the h-lik approach to GLMMs. The clinical inference from our analysis may guide choices of treatment thresholds for treating potassium disorders in the clinic.
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http://dx.doi.org/10.1186/s12874-021-01318-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310602PMC
July 2021

Using big data to gauge effectiveness of breast cancer awareness month.

Prev Med 2021 09 22;150:106695. Epub 2021 Jun 22.

Division of Hematology/Oncology, University of New Mexico, Albuquerque, NM, United States of America.

Breast Cancer Awareness Month (BCAM) has been used for decades to increase awareness and screening for breast cancer, but its geographic reach and effectiveness is difficult to judge. Using Internet Search Interest (ISI) could allow for better evaluation of BCAM effects. Using Google Trends, we evaluated the ISI for "breast cancer" and "mammogram" for each state and metropolitan area from 2006 to 2019. The ISI represents population level Google internet searches relative to the highest number of searches for the United States over a given period, with a max number of 100. The ISI for each term in October (BCAM) was compared against all other months during this period, across states and across major metropolitan regions. ISI was 2.34 times higher (95% Confidence Interval [CI]: 2.10-2.61, P < .001) in BCAM than the average for all other months combined. Geographically categorized data revealed that there were significant differences in the ISI for "breast cancer" and for "mammogram" among the 50 states, and among major metropolitan areas (P < .001for each). ISI suggests that BCAM is effective at increasing breast cancer related internet searches, with significant heterogeneity across states and metro areas. Google Trends is a publicly available free tool that can be used to assess penetrance of awareness campaigns in a time sensitive and location specific manner for future targeting of populations with low breast cancer awareness. Future research is needed to assess relationships between preventive outcomes and ISI scores.
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http://dx.doi.org/10.1016/j.ypmed.2021.106695DOI Listing
September 2021
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