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Independent medical exam

S Beth Bierer, Elaine F Dannefer
PURPOSE: The move toward competency-based education will require medical schools and postgraduate training programs to restructure learning environments to motivate trainees to take personal ownership for learning. This qualitative study explores how medical students select and implement study strategies while enrolled in a unique, nontraditional program that emphasizes reflection on performance and competence rather than relying on high-stakes examinations or grades to motivate students to learn and excel...
November 2016: Academic Medicine: Journal of the Association of American Medical Colleges
James A Town, Paul A Bergl, Akhil Narang, John F McConville
BACKGROUND : The long-term retention of knowledge and skills in bedside ultrasound by internal medicine residents after ultrasound training is not well understood. OBJECTIVE : We sought to determine whether knowledge and skills acquired from focused training in bedside ultrasound are retained over time, and whether retention is related to independent practice. METHODS : We conducted a prospective observational trial of 101 internal medicine residents at an academic medical center who participated in a bedside ultrasound workshop followed by 12 months of independent practice...
October 2016: Journal of Graduate Medical Education
Ayse Sakalli Kani, Ann K Shinn, Kathryn E Lewandowski, Dost Öngür
OBJECTIVES: A variety of treatment options exist for schizophrenia, but the effects of these treatments on brain function are not clearly understood. To facilitate the development of more effective treatment strategies, it is important to identify how brain function in schizophrenia patients is affected by the diverse therapeutic approaches that are currently available. The aim of the present article is to systematically review the evidence for functional brain changes associated with different treatment modalities for schizophrenia...
October 19, 2016: Journal of Psychiatric Research
W-J Guan, G-J Yang
OBJECTIVE: We investigated the significance of a change in retinol binding protein (RBP4) levels in the plasma of patients with coronary heart disease complicated with hyperlipidemia. PATIENTS AND METHODS: 66 cases of coronary heart disease (CHD) patients in Cardiovascular Department of our Hospital from December 2014 to December 2015 were selected. Based on the diagnostic criteria of hyperinsulinemia, patients were divided into a CHD Group with 35 cases and a CHD-Hyperinsulinemia Group (CHD-H group) with 31 cases...
October 2016: European Review for Medical and Pharmacological Sciences
Phillip Ertel, Burkay Adalig, Ipek Demircan, Belinda Lartey, Michael J Manyak
AIM: To assess attitudes and beliefs towards benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) and its treatment among patients and physicians in Latin America, Asia Pacific and the Commonwealth of Independent States (CIS). METHODS: Cross-sectional, quantitative study conducted between December 2014 and September 2015. Separate questionnaires were administered to BPH/LUTS patients receiving drug treatment for their condition and to practising physicians who treat patients with BPH/LUTS...
October 2016: International Journal of Clinical Practice
Mario Maggi, Frederick C W Wu, Thomas H Jones, Graham Jackson, Hermann M Behre, Geoffrey Hackett, Antonio Martin-Morales, Giancarlo Balercia, Adrian S Dobs, Stefan T E Arver, Marcello Maggio, Glenn R Cunningham, Andrea M Isidori, Richard Quinton, Olivia A Wheaton, Flora S Siami, Raymond C Rosen
AIMS: The aim of this study was to assess cardiovascular (CV) safety of testosterone replacement therapy (TRT) in a large, diverse cohort of European men with hypogonadism (HG). METHODS: The Registry of Hypogonadism in Men (RHYME) was designed as a multi-national, longitudinal disease registry of men diagnosed with hypogonadism (HG) at 25 clinical sites in six European countries. Data collection included a complete medical history, physical examination, blood sampling and patient questionnaires at multiple study visits over 2-3 years...
October 2016: International Journal of Clinical Practice
Jonas F Ludvigsson, Benjamin Lebwohl, Anders Ekbom, Ravi Kiran, Peter Hr Green, Jonas Höijer, Olof Stephansson
BACKGROUND & AIMS: Endoscopy is an integral part of the investigation and management of gastrointestinal disease. We aimed to examine outcomes of pregnancies for women who underwent endoscopy during their pregnancy. METHODS: We performed a nationwide population-based cohort study, linking data from the Swedish Medical Birth Registry (for births from 1992 through 2011) with those from the Swedish Patient Registry. We identified 3052 pregnancies exposed to endoscopy (2025 upper endoscopies, 1109 lower endoscopies, 58 endoscopic retrograde cholangiopancreatographies)...
October 20, 2016: Gastroenterology
Parker Magin, Rebecca Stewart, Allison Turnock, Amanda Tapley, Elizabeth Holliday, Nick Cooling
Underperforming trainees requiring remediation may threaten patient safety and are challenging for vocational training programs. Decisions to institute remediation are high-stakes-remediation being resource-intensive and emotionally demanding on trainees. Detection of underperformance requiring remediation is particularly problematic in general (family) practice. We sought to establish early-training assessment instruments predictive of general practice (GP) trainees' subsequently requiring formal remediation...
October 21, 2016: Advances in Health Sciences Education: Theory and Practice
Wei-Cheng Chen, Kuo-Yang Huang, Chih-Wei Yao, Cing-Feng Wu, Shinn-Jye Liang, Chia-Hsiang Li, Chih-Yeh Tu, Hung-Jen Chen
BACKGROUND: Although many risk models have been tested in patients who undergo extracorporeal membrane oxygenation, few have been assessed for patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in the emergency department (ED). This study aimed to successfully predict outcomes of patients with cardiac or noncardiac failure who received VA-ECMO in the ED within 24 hours of arrival at the ED. METHOD: This retrospective, observational cohort study included 154 patients, who were classified as cardiac (n = 127) and noncardiac (n = 27) patients and received VA-ECMO within 24 hours after arrival at the China Medical University Hospital ED in Taiwan between January 2009 and September 2014...
October 22, 2016: Critical Care: the Official Journal of the Critical Care Forum
Mariya Markova, Olga Pivovarova, Silke Hornemann, Stephanie Sucher, Turid Frahnow, Katrin Wegner, Jürgen Machann, Klaus Jürgen Petzke, Johannes Hierholzer, Ralf Lichtinghagen, Christian Herder, Maren Carstensen-Kirberg, Michael Roden, Natalia Rudovich, Susanne Klaus, Ralph Thomann, Rosemarie Schneeweiss, Sascha Rohn, Andreas F H Pfeiffer
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is associated with increased risk of hepatic, cardiovascular, and metabolic diseases. High-protein diets, rich in methionine and branched chain amino acids (BCAAs), apparently reduce liver fat but may induce insulin resistance. We investigated the effects of diets high in animal protein vs plant protein, which differ in levels of methionine and BCAA, in subjects with type 2 diabetes and NAFLD. We examined levels of liver fat, lipogenic indices, markers of inflammation, serum levels of fibroblast growth factor 21 (FGF21), and activation of signaling pathways in adipose tissue...
October 17, 2016: Gastroenterology
Lauren E Arthur, Russell S Kizor, Adrian G Selim, Mieke L van Driel, Leonardo Seoane
BACKGROUND: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality, complicating the medical course of approximately 10% of mechanically-ventilated patients, with an estimated attributable mortality of 13%. To treat VAP empirically, the American Thoracic Society currently recommends antibiotic therapy based on the patients' risk of colonisation by an organism with multidrug resistance. The selection of initial antibiotic therapy in VAP is important, as inappropriate initial antimicrobial treatment is associated with higher mortality and longer hospital stay in intensive care unit (ICU) patients...
October 20, 2016: Cochrane Database of Systematic Reviews
Josefin Sundh, Scott Montgomery, Mikael Hasselgren, Mary Kämpe, Christer Janson, Björn Ställberg, Karin Lisspers
Health status is a prognostic factor included in the assessment of chronic obstructive pulmonary disease (COPD). The aim of our study was to examine the associations of clinical factors with change in health status over a 7-year follow-up period. In 2005, 970 randomly selected primary and secondary care patients with a COPD diagnosis completed questionnaires including the Clinical COPD Questionnaire (CCQ); and in 2012, 413 completed the CCQ questionnaire again. Linear regression used difference in mean total CCQ score between 2005 and 2012 as the dependent variable...
October 20, 2016: NPJ Primary Care Respiratory Medicine
Daniel Ben-Eliezer, Eldad Yechiam
Considered an antidepressant and anti-anxiety agent, Hypericum perforatum affects multiple neurotransmitters in a non-competitive synergistic manner, and may have nootropic potential. We quantitatively reviewed the pre-clinical literature to examine if there is a cognitive-enhancing effect of H. perforatum in healthy rodents. Additionally, within these studies, we compared the effects observed in intact rodents versus those whose performance has been impaired, mostly through stress manipulations. The meta-analysis incorporated studies that examined the effect of H...
October 20, 2016: Scientific Reports
Thashi Chang, Bethan Lang, Angela Vincent
BACKGROUND: Stiff person syndrome is a highly disabling, progressive autoimmune disorder of the central nervous system characterized by muscle rigidity and spasms. Stiff person syndrome is rare, but is believed to be under diagnosed with only 14 cases been reported among a 1.7 billion population in South Asia. We report the first authenticated case from Sri Lanka. CASE PRESENTATION: A 55-year-old Sri Lankan female presented with difficulty in walking and recurrent falls due to progressive muscular rigidity in her lower limbs and trunk with superimposed muscle spasms that occurred in response to unexpected noise, startle or emotional upset...
October 18, 2016: BMC Research Notes
Paul B Perrin, Lillian F Stevens, Megan Sutter, Anthony H Lequerica, Denise Krch, Stephanie A Kolakowsky-Hayner, Juan Carlos Arango-Lasprilla
OBJECTIVE: The research attempting to disentangle the directionality of relationships between mental health and functional outcomes after traumatic brain injury (TBI) is growing but has yielded equivocal findings or focused on isolated predictors or isolated outcomes. The purpose of the current study was to use cross-lagged panel and structural equation modeling (SEM) techniques to examine causality between comprehensive indices of mental health (depression, anxiety, and life satisfaction) and functional independence in a national sample of individuals with TBI over the first 2 years after injury...
October 13, 2016: American Journal of Physical Medicine & Rehabilitation
Natalie Wagner, Christine Fahim, Krista Dunn, Diane Reid, Ranil Sonnadara
BACKGROUND: Residency training programs worldwide are experiencing a shift from the traditional time-based curriculum to competency based medical education (CBME), due to changes in the healthcare system that have impacted clinical learning opportunities. Otolaryngology-Head and Neck Surgery (OTL-HNS) programs are one of the first North American surgical specialties to adopt the new CBME curriculum. OBJECTIVE OF REVIEW: The purpose of this scoping review is to examine the literature pertaining to CBME in OTL-HNS programs worldwide, to identify the tools that have been developed, and identify potential barriers to the implementation of CBME...
October 18, 2016: Clinical Otolaryngology
Leonardo Sechi, GIanLuca Colussi, Marileda Novello, Cristiana Catena
OBJECTIVE: Primary aldosteronism is associated with increased left ventricular mass independent of blood pressure levels. Previous studies suggest that elevated aldosterone causes cardiac damage only in the presence of an inappropriate salt status. We examined the relevance of dietary salt intake on cardiac changes in patients with primary aldosteronism before and after treatment. DESIGN AND METHOD: Sixty-five patients with tumoral or idiopathic primary aldosteronism were recruited at a University medical center and followed after either surgical (n = 30) or medical (n = 35) treatment...
September 2016: Journal of Hypertension
Mao Takahashi, Tomoaki Shiba, Yuuiti Hori, Kenji Suzuki, Kohji Shirai
OBJECTIVE: Cardio ankle vascular index (CAVI) represents arterial stiffness of the aorta, femoral artery and tibial artery. We investigated whether annual change of CAVI is related to the onset of retinal abnormality on optic fundus. DESIGN AND METHOD: Subjects were 1,148 (male 47.4%) urban residents who participated in cardiovascular disease (CVD) screening in Japan during 2005- 2011. All subjects had normal finding of optic fundus at first health check and had not received medical treatment for CVD risk factor during this study...
September 2016: Journal of Hypertension
Seung Won Lee, Hyeon Chang Kim, Yong-Ho Lee, Hansol Choi, Ji Hye Park, Yumie Rhee, Chang Oh Kim
OBJECTIVE: We examined whether HbA1c is associated with carotid atherosclerosis in a community-dwelling elderly Korean population with normal fasting glucose. DESIGN AND METHOD: Using data from the Korean Urban Rural Elderly study, we conducted a cross-sectional analysis in 1,133 participants (335 men and 798 women) with mean age 71.8 years. All participants had fasting blood glucose less than 100   mg/dL (5.6mmol/L) and a level of HbA1c below 6.5% (48 mmol/mol)...
September 2016: Journal of Hypertension
Chen-Huan Chen
Blood pressure (BP) is conventionally measured with a pressure cuff over an upper arm and a cutoff of 140/90 mmHg in the office is the current criteria for diagnosing hypertension. Recently, out of office BP has been suggested as the reference standard for the management of hypertension, due to its better prognostic value over office BP.However, the above BP parameters are all measured at brachial arteries and may be different from the central blood pressure (CBP) measured in the ascending aorta or carotid arteries...
September 2016: Journal of Hypertension
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