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Ara Tekian Olle ten Cate Eric Holmboe Trudie Roberts John Norcini 《Medical teacher》2020,42(6):698-704
AbstractWith increased interest in the use of entrustable professional activities (EPAs) in undergraduate and postgraduate medical education, comes questions about their implications for curriculum development and assessment. This paper addresses some of those questions, discussed at a symposium of the 2017 conference of AMEE, by presenting the components of an EPA, describing their importance and application, identifying their implications for assessment, and pinpointing some of challenges they pose in undergraduate and postgraduate settings. It defines entrustment, describes the three levels of trust, and presents trainee and supervisor factors that influence it as well as perceived benefits, and risks. Two aspects of EPAs have implications for assessment: units of professional practice and decisions based on entrustment, which impact an assessment’s blueprint, test methods, scores, and standards. In an undergraduate setting EPAs have great appeal, but work is needed to identify and develop a robust assessment system for core EPAs. At the postgraduate level, there is tension between the granularity of the competencies and the integrated nature of the EPAs. Even though work remains, EPAs offer an important step in the evolution of competency-based education. 相似文献
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Olle Muren Ehsan Akbarian Mats Salemyr Henrik Bodén Thomas Eisler André Stark Olof Sk?ldenberg 《Acta orthopaedica》2015,86(5):569-574
Background and purpose
We have previously shown that during the first 2 years after total hip arthroplasty (THA), periprosthetic bone resorption can be prevented by 6 months of risedronate therapy. This follow-up study investigated this effect at 4 years.Patients and methods
A single-center, double-blind, randomized placebo-controlled trial was carried out from 2006 to 2010 in 73 patients with osteoarthritis of the hip who were scheduled to undergo THA. The patients were randomly assigned to receive either 35 mg risedronate or placebo orally, once a week, for 6 months postoperatively. The primary outcome was the percentage change in bone mineral density (BMD) in Gruen zones 1 and 7 in the proximal part of the femur at follow-up. Secondary outcomes included migration of the femoral stem and clinical outcome scores.Results
61 of the 73 patients participated in this 4-year (3.9- to 4.1-year) follow-up study. BMD was similar in the risedronate group (n = 30) and the placebo group (n = 31). The mean difference was −1.8% in zone 1 and 0.5% in zone 7. Migration of the femoral stem, the clinical outcome, and the frequency of adverse events were similar in the 2 groups.Interpretation
Although risedronate prevents periprosthetic bone loss postoperatively, a decrease in periprosthetic BMD accelerates when therapy is discontinued, and no effect is seen at 4 years. We do not recommend the use of risedronate following THA for osteoarthritis of the hip.Adaptive bone remodeling around the femoral stem following total hip arthroplasty (THA) results in regional loss of bone mass, especially in proximal parts of the femur—most of which takes place within the first postoperative year (Bodén et al. 2006, Sköldenberg et al. 2006). Periprosthetic bone loss may predispose to periprosthetic fracture, aseptic loosening, and difficulties at revision surgery (Lindahl 2007, Streit et al. 2011, Sköldenberg et al. 2014).The bisphosphonate (BP) risedronate has been used successfully to prevent osteoporotic fractures, mainly in the hip and vertebrae, by inhibiting osteoclast activity (McClung et al. 2001). In recent years, the possible use of BPs to prevent or ameliorate periprosthetic adaptive bone resorption, osteolysis, and implant migration has been investigated thoroughly in animal models and humans. The short-term results of several studies showing the effects of postoperative BP treatment in reducing periprosthetic bone loss up to a year after the arthroplasty have already been published (Venesmaa et al. 2001, Wilkinson et al. 2001, Hennigs et al. 2002, Wilkinson et al. 2005, Arabmotlagh et al. 2006).We have previously found that risedronate given once a week for 6 months after THA reduces periprosthetic bone resorption around an uncemented femoral stem in the first and second postoperative year (Sköldenberg et al. 2011). We now report the 4-year outcome in the same cohort. 相似文献5.
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Simen W. Schive Hanne Scholz Afaf Sahraoui Kristine Kloster‐Jensen Geir Hafsahl Olle Korsgren Aksel Foss Trond G. Jenssen 《Transplant international》2015,28(10):1235-1239
Pancreatic islet transplantation is a treatment option for patients with type 1 diabetes (T1D), but pregnancy has generally not been advised for women after receiving an islet allograft. We hereby describe what is to our knowledge the first successful pregnancy and persistent graft function in a woman 4 years after her initial islet transplantation. A 37‐year‐old woman with brittle type 1 diabetes was transplanted with two separate islet graft infusions, eventually becoming insulin independent. Ten months after her second transplantation, her immunosuppression was switched from tacrolimus and sirolimus to tacrolimus, azathioprine, and prednisolone, due to her wish to become pregnant. She became pregnant one year later, and after 38 weeks of uncomplicated pregnancy, she gave birth to a healthy child by C‐section. The current report suggests that pregnancy and childbirth can be accomplished after islet transplantation without loss of islet graft function. 相似文献
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Abolhassani Hassan Vosughimotlagh Ahmad Asano Takaki Landegren Nils Boisson Bertrand Delavari Samaneh Bastard Paul Aranda-Guillén Maribel Wang Yating Zuo Fanglei Sardh Fabian Marcotte Harold Du Likun Zhang Shen-Ying Zhang Qian Rezaei Nima Kämpe Olle Casanova Jean-Laurent Hammarström Lennart Pan-Hammarström Qiang 《Journal of clinical immunology》2022,42(1):1-9
Journal of Clinical Immunology - Coronavirus disease 2019 (COVID-19) exhibits a wide spectrum of clinical manifestations, ranging from asymptomatic to critical conditions. Understanding the... 相似文献
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Abolhassani Hassan Landegren Nils Bastard Paul Materna Marie Modaresi Mohammadreza Du Likun Aranda-Guillén Maribel Sardh Fabian Zuo Fanglei Zhang Peng Marcotte Harold Marr Nico Khan Taushif Ata Manar Al-Ali Fatima Pescarmona Remi Belot Alexandre Béziat Vivien Zhang Qian Casanova Jean-Laurent Kämpe Olle Zhang Shen-Ying Hammarström Lennart Pan-Hammarström Qiang 《Journal of clinical immunology》2022,42(3):471-483
Journal of Clinical Immunology - Inborn errors of immunity (IEI) and autoantibodies to type I interferons (IFNs) underlie critical COVID-19 pneumonia in at least 15% of the patients, while the... 相似文献
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The pre- and postoperative cineradiographic findings in 14 dysphagic patients who underwent cricopharyngeal myotomy were compared. The reason for the operation was Zenker's diverticulum (7 patients), lack of cricopharyngeal coordination (5 patients), or a cervical esophageal web (2 patients). After the operation the function of the epiglottis, laryngeal vestibule, and pharyngeal constrictors was unaltered (11 patients) or improved (3 patients), although 4 cases showed residual impression due to the cricopharyngeal muscle. Postoperatively, 9 patients developed defective peristalsis and 10 had impaired tonicity of the cervical esophagus. It is concluded that myotomy alters the motor function of the pharyngoesophageal segment considerably. Moreover, certain functions of the pharynx proper are changed by this procedure. 相似文献