Musculoskeletal health,frailty and functional decline

Frailty in older people is associated with a vulnerability to adverse events. While ageing is associated with a loss of physiological reserves, identifying those with the syndrome of frailty has the potential to assist clinicians to tailor treatments to those at the risk of future decline into disability with an increased risk of complications, morbidity and mortality. Sarcopenia is a key component of the frailty syndrome and on its own puts older people at risk of fragility fractures; however, the clinical syndrome of frailty affects the musculoskeletal and non-musculoskeletal systems. Hip fractures are becoming a prototype condition in the study of frailty. Following a hip fracture, many of the interventions are focused on limiting mobility disability and restoring independence with activities of daily living, but there are multiple factors to be addressed including osteoporosis, sarcopenia, delirium and weight loss. Established techniques of geriatric evaluation and management allow systematic assessment and intervention on multiple components by multidisciplinary teams and deliver the best outcomes. Using the concept of frailty to identify older people with musculoskeletal problems as being at the risk of a poor outcome assists in treatment planning and is likely to become more important as effective pharmacological treatments for sarcopenia emerge.This review will focus on the concept of frailty and its relationship with functional decline, as well as describing its causes, prevalence, risk factors, potential clinical applications and treatment strategies.     

Training the Next Generation’s Nephrology Workforce

The subspecialty of nephrology faces several critical challenges, including declining interest among medical students and internal medicine residents and worrisome declines in the number of applicants for nephrology fellowships. There is an urgent need to more clearly define the subspecialty and its scope of practice, reinvigorate meaningful research training and activities among trainees, and ensure that fellows who complete training and enter the practice of nephrology are experts in the broad scope of nephrology. This need requires a critical look at fellowship training programs and training requirements. A new workforce analysis is also needed that is not focused on primarily meeting estimated future clinical needs but rather, ensuring that there is alignment of supply and demand for nephrology trainees, which will ensure that those entering nephrology fellowships are highly qualified and capable of becoming outstanding nephrologists and that there are desirable employment opportunities for them when they complete their training.     

The impact of residents’ training in Electronic Medical Record (EMR) use on their competence: Report of a pragmatic trial

ObjectivesEven though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor–patient–computer communication (DPCC).Methods36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training.ResultsPerformance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction.ConclusionWe assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills.Practice implicationSimulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.     

Mandatory communication training of all employees with patient contact

In 2010 a communication program that included mandatory communication skills training for all employees with patient contact was developed and launched at a large regional hospital in Denmark.     

Training and Education in Clinical Psychology in the Context of the Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act of 2010 (ACA) is revamping the access, quality, and financing of the health and mental health systems. However, its impact on training and education in clinical psychology is unclear. This article aims to identify specific components of the ACA, in particular the Mental and Behavioral Health Education and Training Grants, that are expected to affect training and education in the field. The article further connects the ACA with four paradigm shifts in clinical psychology that have broad implications for training and education—evidence‐based practices, research methodology, interprofessionalism, and the quality indicator movement. The overarching goal of this article is to begin timely discussions on the future directions of the field under the current healthcare reform.     

运动性心脏肥大：AT1受体、细胞自噬和miRNAs的调节

As a mechanical and exogenous stimulus, exercise training induces cardiac physiological hypertrophy, and the cardiac structure is changed slowly, steadily and coordinately. Simultaneously, energy metabolism and function of the cardiac muscle are also improved. These are positive adaptations in the heart when experiencing endurance exercise training. Recently, angiotensin Ⅱ type 1 (AT1) receptor, autophagy and miRNAs are all considered as important regulators to cardiac hypertrophy induced by exercise training at different molecular levels. Fully understanding the relations and the important role of AT1 receptor, autophagy and miRNAs in cardiac physiological hypertrophy will further enrich the signaling pathway of cardiac hypertrophy induced by exercise training.