Developing a Competency‐Based Educational Structure within Clinical and Translational Science

In the emerging field of clinical and translational science (CTS), where researchers use both basic and clinical science research methodologies to move discoveries to clinical practice, establishing standards of competence is essential for preparing physician–scientists for the profession and for defining the field. The diversity of skills needed to execute quality research within the field of CTS has heightened the importance of an educational process that requires learners to demonstrate competence. Particularly within the more applied clinical science disciplines where there is a multi‐ or interdisciplinary approach to conducting research, defining and articulating the unique role and associated competencies of a physician–scientist is necessary. This paper describes a systematic process for developing a competency‐based educational framework within a CTS graduate program at one institution.     

Competency Lies in the Eye of the Beholder? Comparing the Interpersonal Skills of Currently, Formerly and Never Depressed Females Using Self and Partner Reports

Research examining the social skills of currently and remitted depressed individuals has yielded inconsistent results. The current study aimed to clarify some of this research by comparing the responses of 58 female partners (10 currently depressed, 23 formerly depressed, and 25 never depressed) to hypothetical marital conflict vignettes. Male partners were also asked to report on how their partners would respond in each of the conflict situations. As anticipated, results indicated that currently and formerly depressed females reported behaviors suggestive of lower competency than did never depressed females. The analysis controlled for female relationship quality. However, the reports of the male partner indicated that men’s relationship quality, rather than female depression status, affected men’s reports of their partner’s competency, such that men who were happier in their relationship reported higher levels of competent behavior in their partners. Our findings provide converging evidence for interpersonal models of depression using standardized measures of social competence and also highlight the importance of taking the quality of the interpersonal relationship into account when testing interpersonal models of depression.     

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m based on 16-bits singlechip computer is presented. In the system, the capacity of driving load can be improved by employing robust current control technique and current prediction technique is adopted to shorten the dead time of current control, which     

Proximal junctional kyphosis and failure—diagnosis,prevention, and treatment

Technical advancements have enabled the spinal deformity surgeon to correct severe spinal mal-alignment. However, proximal adjacent segment pathology (ASP) remains a significant issue. Examples include proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Agreement on the definition, classification, and pathophysiology of PJK and PJF remains incomplete, and an understanding of the risk factors, means of prevention, and treatment of this problem remains to be elucidated. In general, PJK is a relatively asymptomatic radiographic diagnosis managed with patient reassurance and monitoring. On the other hand, PJF is characterized by mechanical instability, pain, and more severe kyphosis, with potential for neurologic compromise. Patients who develop PJF more often require revision surgery than those with PJK. This chapter will review the current understanding of PJK and PJF.     

Shared decision making and physical therapy: What,when, how,and why?

BackgroundShared decision making is a means of translating evidence into practice and facilitating patient-centred care by helping patients to become more active in the decision-making process. Shared decision making is a collaborative process that involves patients and clinicians making health-related decisions after discussing the available options; the benefits and harms of each option; and considering the patient's values, preferences, and personal circumstances.MethodsThis paper describes what shared decision making is, why it is important, when it is appropriate, and key elements. We report on physical therapists’ current use of and attitudes to shared decision making and explore factors that influence its uptake. Lastly, we examine what is needed to promote greater use of this approach.ResultsKey elements in the shared decision making process are: identifying the problem that requires a decision; providing an explanation of the health problem, including, where appropriate, the natural history of the condition; discussing the available options and the potential benefits and harms of each option; eliciting the patient's values, preferences, and expectations; and assisting the patient to weigh up the options to reach an informed decision. When applied in practice, shared decision making has been found to improve patient-clinician communication; improve patients’ accuracy of their expectations of intervention benefits and harms, involvement in decision-making, and feeling of being informed; and increase both patients’ and clinicians’ satisfaction with care.ConclusionDespite physical therapists’ enthusiasm for shared decision making, uptake of this approach has been slow. Multi-level strategies and behaviour change are required to encourage and support the sustainable incorporation of shared decision making in practice.     

Revisiting antithrombin in health and disease,congenital deficiencies and genetic variants,and laboratory studies on α and β forms

Antithrombin [AT] is the main inhibitor for activated plasma coagulation serine esterases, inhibiting thrombin, Factors Xa and IXa, but also Factors XIIa, XIa, VIIa, kallicrein, and plasmin. Its activity is highly enhanced by heparin, through binding to the pentasaccharide sequences, for inhibition of all coagulation proteases, except thrombin, which inhibition requires its additional binding to the heparin polysaccharide chain. However, AT is the major inhibitor of thrombin in the blood circulation. Congenital or acquired deficiencies of AT expose affected patients to an increased risk of developing unprovoked and recurrent thrombo-embolic diseases. Antithrombin can be measured with various laboratory techniques, by either immunological or functional methods. Earlier, a radial immunodiffusion immunoassay allowed measurement of the protein antigenic content. Functional assays are mainly designed with Anti-Thrombin or Anti-Factor Xa chromogenic methods and are useful for detecting genetic molecular mutations with decreased inhibitory activity and contributed to study the conformational changes of antithrombin and its variants, which potentially regulate the activity of this serine protease inhibitor. These assays are not equivalent in terms of diagnosing protein abnormalities, associated with increased thrombotic incidence, and they have variable performance for reflecting impaired antithrombin binding capacity for heparin, reduced progressive inhibition of serine proteases, or accelerated switch rates to the latent and less active forms. A small proportion of AT (<10%) is present in blood in the β-form, with a lower oligosaccharide content, a lower Molecular Weight, a higher binding rate to endothelial glycosaminoglycans, and a higher anticoagulant activity, hence requiring specific laboratory methods for its measurement. The β-AT form is then of critical importance for controlling blood activation by tissue injury and preventing development of thrombo-embolic diseases. This article reviews the performance characteristics of the currently available assays, and their usefulness for monitoring the use of AT concentrates in intensive care units, disseminated intravascular coagulation or severe infections, to restore the anticoagulant protective effect of heparin by supplementing the requested AT concentration. The issues of automation, harmonization and standardization are also revisited and discussed.     

Walls,wisdom, worries,and wishes: Engaging communities in discussion about death,dying, loss,and care using Café Conversation

This paper reflects on the adaptation of the World Café concept to engage with members of the public in Compassionate Communities Café Conversation, focussing on enabling people to understand the importance of thinking and talking about the end of life. The approach enables people to come together to share their experience and ideas, wisdom, worries, and wishes. The seven design principles of the World Café are central to the process, together with the sharing of resources developed to engage people in discussion as well as practical activity. This paper outlines the preparation, presentation, and pilot evaluation of the Compassionate Communities Café Conversation experience in two towns in the Mid-West of Ireland. The experience and findings suggest that this approach offers a potentially very useful framework for use by others as part of a health promoting approach to palliative care.     

Are race, age, gender, and insurance status determinants in interhospital helicopter transport time and frequency?

OBJECTIVE: To examine the effects of age, race, gender, and insurance status on utilization and times-to-transport (TTT) for interhospital air medical transfers from rural hospitals to tertiary care centers. DESIGN: A retrospective review of interhospital transport records. The TTT was examined as a function of age, gender, race, and insurance status using the Student's t-test for unpaired samples. The Exact Binomial Test (alpha error at 0.05) was used to compare the observed versus expected transport rates for non-whites. SETTING/PARTITIPANTS: A total of 268 patient transfers from hospitals within a two-county region in central Pennsylvania to tertiary care centers was analyzed. All records with sufficient demographic, TTT, or insurance data were included. Absence of data was the only exclusion. RESULTS: The TTT (mean +/-SD) was longer (2666 +/-3940 minutes (min.) versus 619 +/-909 min., respectively) for adult than pediatric patients (p less than .01), and (2588 +/-4041 min. versus 640 +/-1301 min., respectively) for insured versus uninsured patients (p less than .01). The observed proportion of non-whites transported was less than expected (.41% versus 2.1%) based on the proportion of non-whites in the region (p less than .05). CONCLUSION: The TTT was longer for adults than for children and for the insured than the uninsured. Non-whites were transported less frequently than predicted.     

Mood and sexual side effects of hormonal contraception: Physicians�� and residents�� knowledge, attitudes, and practices

Objective

To explore physicians’ knowledge, attitudes, and practices related to sexual and mood side effects of hormonal contraceptives, and to compare residents with practising doctors.

Design

A mixed-method study with faxed or e-mailed surveys and semistructured telephone interviews.

Setting

British Columbia.

Participants

A random sample of family doctors, all gynecologists, and all residents in family medicine and gynecology in the College of Physicians and Surgeons of British Columbia registry. A subsample was interviewed.

Main outcome measures

Estimates of rates of mood and sexual side effects of contraceptives in the practice population and how the physicians informed and advised patients about these side effects.

Results

There were 79 residents and 76 practising doctors who completed the questionnaires (response rates of 42.0% and 54.7% of eligible residents and physicians, respectively). The reference sources most physicians reported using gave the rates of sexual and mood side effects of hormonal contraceptives as less than 1%, and yet only 1 (0.6%) respondent estimated similar rates for mood side effects, and 12 (7.8%) for sexual effects among their patients. The most common answers were rates of 5% to 10%, with residents reporting similar rates to practising doctors. Practising doctors were more likely to ask about sexual and mood side effects than residents were (81.1% vs 24.1% and 86.3% vs 40.5%, respectively; P < .001). Practising doctors were also more likely to recommend switching to barrier methods (37.3% vs 16.5%; P = .003) or intrauterine devices (54.7% vs 38.0%; P = .038) than residents were and more likely to give more responses to the question about how they managed sexual and mood side effects (mean of 1.7 vs 1.1 responses, P = .001). In 14 of the 15 interviews, practising doctors discussed how they had learned about side effects mainly from their patients and how this had changed their practices.

Conclusion

Physicians’ perceived rates of mood and sexual side effects from hormonal contraception in the general population were higher than the rate of less than 1% quoted in the product monographs. Practising doctors reported that they learned about the type, frequency, and severity of side effects from their patients.