bluuebunny/crossref_metadata_2025_split huggingface dataset:
The current state of prostate-specific antigen testing
Authors: Lewis Ryan , Hornberger Brad 
Published: August 2016

ABSTRACT
Since prostate-specific antigen (PSA) testing was approved in 1994, the incidence of metastasis and mortality from prostate cancer have significantly decreased. However, PSA screening for prostate cancer has limitations and few large randomized controlled trials have been conducted to determine the mortality benefit of PSA screening. Two studies that have been conducted are the Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC). These were the two main studies the US Preventive Services Task Force (USPSTF) used in its recommendation against prostate cancer screening in 2012. However, new evidence has demonstrated that the PLCO trial had significant limitations and the results of the ERSPC trial were more significant than previously thought. This article describes the strengths and weaknesses of the USPSTF's recommendation, along with current guidelines for prostate cancer screening.
Struggling With Adversities of Life
Authors: Offenbaecher Martin , Dezutter Jessie , Kohls Niko , Sigl Claudia , Vallejo Miguel A. , Rivera Javier , Bauerdorf Felix , Schelling Jörg , Vincent Ann , Hirsch Jameson K. , Sirois Fuschia M. , Webb Jon R. , Toussaint Loren L. 
Published: August 2016

Objectives:
We compared the magnitude and direction of associations between forgiveness and pain, mental and physical health, quality of life, and anger in a sample of fibromyalgia syndrome (FM) participants and healthy controls. In addition, we compared FM and controls on mean levels of these variables.

Materials and Methods:
A total of 173 individuals with FM and 81 controls completed this study. FM participants and controls were residents of Germany recruited with the support of the German Fibromyalgia Patient Association and several self-help groups. FM participants and controls were about 53 years of age, mostly married (70%), Christians (81%), with levels of education ranging from 9 to 13+ years. All participants completed assessments of forgiveness, pain, health, quality of life, and anger.

Results:
Analyses revealed that FM participants reported higher pain and anger and poorer health and quality of life. FM participants also reported lower levels of both forgiveness of self and others. Size and direction of associations of forgiveness with pain, health, quality of life, and anger in were not significantly different between healthy individuals and individuals with FM.

Discussion:
Forgiveness of self and others is beneficially associated with pain, health, quality of life, and anger in FM participants at levels that are of similar size and direction as in healthy controls. However, FM participants manifest lower levels of forgiveness of self and others. Therapeutic promotion of forgiveness as a psychosocial coping strategy may help patients with FM to better manage psychological and physical symptoms, thereby enhancing well-being.
Getting Back to Living
Authors: Bruce Barbara K. , Ale Chelsea M. , Harrison Tracy E. , Bee Susan , Luedtke Connie , Geske Jennifer , Weiss Karen E. 
Published: August 2016

Objective:
This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up.

Methods:
Participants included 171 adolescents (12 to 18 y of age) with chronic pain who completed a hospital-based outpatient pediatric pain rehabilitation program. Participants completed measures of functional disability, depressive symptoms, pain catastrophizing, opioid use, school attendance, and pain severity at admission, discharge, and at 3-month follow-up.

Results:
Similar to other interdisciplinary pediatric pain rehabilitation program outcome studies, significant improvements were observed at the end of the program. These improvements appeared to be maintained or further improved at 3-month follow-up. Nearly 14% of the patients were taking daily opioid medication at admission to the program. All adolescents were completely tapered off of these medications at the end of the 3-week program and remained abstinent at 3-month follow-up.

Discussion:
This study adds to the available data supporting interdisciplinary pediatric pain rehabilitation as effective in improving functioning and psychological distress even when discontinuing opioids. Implications for future research and limitations of the study are discussed.
Esophageal Perforation in a Cervical Fracture Patient With Progressed Ankylosing Spondylitis
Authors: Wang Jianxi , Shi Liangyu , Chen Huajiang , Yuan Wen 
Published: August 2016

Study Design.
Case report and review of relevant literature.

Objective.
To report a rare complication of esophageal perforation in cervical fracture patient with progressive ankylosing spondylitis (AS) and review of relevant literature.

Summary of Background Data.
Esophageal perforation in cervical fracture is extremely rare. This complication has never been reported in AS patients. Key points in the early diagnosis and management of this severe complication along with the cervical fracture were presented in detail in this case report.

Methods.
A 61-year-old male with AS, who sustained C6 fracture and dislocation after a vehicle accident. Initial treatment strategy was combined anterior-posterior fixation and fusion. Although esophageal perforation in the dorsal wall of esophagus was detected in anterior surgery. After thorough debridement, the esophageal lesion was closed by resorbable interrupted sutures. Surgical incision was washed by saline and hydrogen peroxide without primary closure. Cervical fracture was treated by long level posterior fixation alone. After surgery, the anterior surgical incision was irrigated with normal saline twice a day and closed 3 weeks later.

Results.
Esophageal perforation was healed completely and neurologic results were improved significantly after surgery. Union of the fracture and segmental stability of cervical spine was confirmed radiologically at 1-year follow up.

Conclusion.
Esophageal perforation in cervical fracture patient with progressed AS is an extremely rare and potentially life-threatening complication. Surgical debridement and drainage with intensive care are essential for good outcome.

Level of Evidence: 5
Co-Creating Quality in Health Care Through Learning and Dissemination
Authors: Holmboe Eric S. , Foster Tina C. , Ogrinc Greg 
Published: August 2016

Abstract:
For most of the 20th century the predominant focus of medical education across the professional continuum was the dissemination and acquisition of medical knowledge and procedural skills. Today it is now clear that new areas of focus, such as interprofessional teamwork, care coordination, quality improvement, system science, health information technology, patient safety, assessment of clinical practice, and effective use of clinical decision supports are essential to 21st century medical practice. These areas of need helped to spawn an intense interest in competency-based models of professional education at the turn of this century. However, many of today's practicing health professionals were never educated in these newer competencies during their own training. Co-production and co-creation of learning among interprofessional health care professionals across the continuum can help close the gap in acquiring needed competencies for health care today and tomorrow. Co-learning may be a particularly effective strategy to help organizations achieve the triple aim of better population health, better health care, and lower costs. Structured frameworks, such as the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines, provide guidance in the design, planning, and dissemination of interventions designed to improve care through co-production and co-learning strategies.
Medical Teachers' Humanistic Perspective on Pedagogy: A New Starting Point for Faculty Development
Authors: Barrett Jenny , Yates Lyn , McColl Geoffrey 
Published: August 2016

Introduction:
This study investigated the perspectives on pedagogy held by medical teachers in hospitals.

Methods:
The teachers were interviewed after they had been observed in both clinical and classroom settings.

Results:
The study showed the teachers' reliance on the relational aspects of pedagogy more than on technical pedagogical knowledge. Teachers referred to their aims and approaches as “interactive,” but this does not refer to any deliberate pedagogical design or acts. Asking questions was the technique used most commonly but not always skillfully, and they cited influences from the past rather than the present or the future.

Discussion:
This research suggests the pedagogic approach of these medical teachers is “humanistic.” It emphasizes personal and interpersonal factors, meaningful learning, and the affective, as well as cognitive aspects of clinical knowledge. It also captures a commitment to nonthreatening, nonhumiliating environments. Acknowledgment of this particular pedagogical perspective, it is argued, could better connect the health professional teachers with the education and development missions of universities, professional bodies, and governments. The teachers' expressed values and goals offer a new starting point for faculty development. Their reliance on the relational over the technical and on their own biographical experience, could be more respectfully valued and addressed to advance a more productive balance with the technical pedagogical elements that often concern educationalists, researchers, and administrators.
The Gene Messenger Impact Project: An Innovative Genetics Continuing Education Strategy for Primary Care Providers
Authors: Carroll June C. , Grad Roland , Allanson Judith E. , Pluye Pierre , Permaul Joanne A. , Pimlott Nicholas , Wilson Brenda J. 
Published: August 2016

Introduction:
Primary care providers (PCP) will need to be integrally involved in the delivery of genomic medicine. The GenetiKit trial demonstrated effectiveness of a knowledge translation intervention on family physicians' (FP) genetics referral decision-making. Most wanted to continue receiving Gene Messengers (GM), evidence-based summaries of new genetic tests with primary care recommendations. Our objective was to determine the value of GMs as a continuing education (CE) strategy in genomic medicine for FPs.

Methods:
Using a “push” model, we invited 19,060 members of the College of Family Physicians of Canada to participate. Participants read GMs online, receiving 12 emailed topics over 6 months. Participants completed an online Information Assessment Method questionnaire evaluating GMs on four constructs: cognitive impact, relevance, intended use of information for a patient, and expected health benefits.

Results:
One thousand four hundred two FPs participated, 55% rated at least one GM. Most (73%) indicated their practice would be improved after reading GMs, with referral to genetics ranked highly. Of those who rated a GM relevant, 94% would apply it to at least one patient and 79% would expect health benefits. This method of CE was found useful for genetics by 88% and 94% wanted to continue receiving GMs.

Discussion:
FPs found this novel CE strategy, brief individual reflective e-learning, to be valuable for learning about genetics. This method of information delivery may be an especially effective method for CE in genomic medicine where discoveries occur at a rapid pace and lack of knowledge is a barrier to integration of genetic services.
Factors Influencing Participation in Continuing Professional Development: A Focus on Motivation Among Pharmacists
Authors: Tjin A Tsoi Sharon L. N. M. , de Boer Anthonius , Croiset Gerda , Koster Andries S. , Kusurkar Rashmi A. 
Published: August 2016

Introduction:
The interest in continuing education (CE) for pharmacists has increased because of patient safety issues, advancing science and the quick changes in the profession. Therefore, contemporary pharmaceutical care requires an effective and sustainable system for pharmacists to maintain and improve competencies. Although motivation plays an important role both as a facilitator (desire to learn) and a barrier (lack of motivation), there is little investigated about this specific factor. The aim of the study was to explore what factors influence pharmacists' participation in CE with a focus on motivation.

Methods:
The theoretical framework was self-determination theory (SDT), which describes autonomous motivation (AM) representing motivation from an internal locus of causality, controlled motivation (CM) originating from an external locus of causality, and relative autonomous motivation (RAM) that measures the AM in an individual after correcting for the CM. The relationship between pharmacists' characteristics, especially their motivation (AM, CM and RAM) in CE, and their participation in CE activities was explored using the AMS-questionnaire and the Dutch online portfolio system.

Results:
RAM was positively correlated with CE participation of pharmacists and explained 7.8% of the variance. The correlations between the independent variables AM and CM and CE hours were negative (−0.301 and −0.476, respectively). Other factors influencing CE participation were pharmacy school (6.8%), traineeship (10.9%), and work experience (7.8%). Pharmacists participated for 27.0 hours on average in CE during 11 months and preferred face-to-face-learning (85.5%) above e-learning (13.8%).

Discussion:
Our findings show a positive relationship between RAM and CE participation. The current CE system is probably not conducive to stimulation of AM. Further research is needed to understand the factors that stimulate pharmacists' motivation and participation in CE.
Exploring the Top-Cited and Most Influential Articles in Medical Education
Authors: Azer Samy A. 
Published: August 2016

Introduction:
The citations received by a scientific publication have been used as a proxy measurement of scientific quality and in ranking researchers. Although these practices have been observed in several institutes, careful assessment of top-cited articles may provide more insight into exploring their characteristics. The aim of this study was to analyze the top-cited articles in medical education identified by Azer 2015 and explore the characteristics of these articles that can provide insight into their assessment.

Methods:
The most frequently cited articles identified by searching the Web of Science under the category “Education, Scientific Discipline” were included in the analysis. The following issues were further analyzed: 1) comparing the mean yearly citations received by articles published before the year 2000 and those published after, 2) assessing whether there was a correlation between the number of grants, number of authors, number of institutes, or number of countries involved and the number of citations received, 3) assessing the number of female representation in authorship, 4) assessing the representation of none-medical staff in the authorship, and 5) exploring any association between top authors identified and those who were awarded the Karolinska Institutet Prize for research in medical education.

Results:
Although there was no correlation between the number of citations and the number of years since publications, the mean number of citations received by articles published before the year 2000 varied from zero to 18.2 ± 16.6, whereas for those published after the year 2000 the mean varied from 2.0 ± 2.1 to 35.3 ± 26.8. No correlation was found between the number of citations obtained and number of grants, number of authors, number of institutes, or number of countries involved. Females comprised 50% of the total number of authors. However, no correlation was found between the number of females in authorship and the number of citations obtained. Similarly, the number of authors with non-medical degrees did not correlate with the number of citations obtained. An association was found between authoring more than one article in the list and receiving the Karolinska Institutet Prize for research in medical education.

Discussion:
The analysis shows that the higher number of citations received are not necessarily related to funding, working collaboratively with a big team from several institutes or from several countries. The finding that authors of more than one top-cited article received the Karolinska Institutet Prize for research in medical education indicates that this could be a parameter in selecting the candidates for the award.
Learn to Change: Teaching Toward a Shifting Health Care Horizon
Authors: Hart Laura C. 
Published: August 2016

Abstract:
Changes in health care—including a growing emphasis on quality, outcomes, and lower costs—are transforming the delivery of care and creating a knowledge gap that continuing education must bridge. As clinicians and health leaders spend less time in hospital settings, educational activities are likely to extend their reach, for instance through online education distributed on laptops, tablets, or smartphones. Ezekiel J. Emanuel, MD, PhD, explored this shift in his 2016 keynote to the World Congress for Continuing Professional Development: “Learn to Change: Teaching Toward a Shifting Health Care Horizon.” This article describes some of the main trends in health care that Dr. Emanuel foresees, focusing on the implications of the changing role of hospitals for innovation in continuing education.
More Than Reducing Complexity: Canadian Specialists' Views of the Royal College's Maintenance of Certification Framework and Program
Authors: Horsley Tanya , Moreau Katherine , Lockyer Jocelyn , Zeiter Jeanie , Varpio Lara , Campbell Craig 
Published: August 2016

Introduction:
Maintenance of Certification (MOC) programs are facing competing pressures from physicians and regulators to design and deliver systems that ensure physicians sustain or maintain competence postcertification. Adding to these pressures is an emerging discourse of dissatisfaction by physicians participating in MOC programs suggesting physicians themselves are seeking programs that are relevant to their scope of practice. The object was to determine Canadian specialists' views of a redesigned Royal College of Physician and Surgeons of Canada's MOC program in five priority areas: complexity, motivation, impact, credit sufficiency, and enhancement.

Methods:
A national, cross-specialty, survey of Royal College of Physician and Surgeons of Canada's MOC program users who had participated for at least 1 year.

Results:
Five thousand two hundred fifty nine respondents were included in the analysis. A majority of participates either “agreed” (2258, 43%) or “strongly agreed” (631, 12%) that the new framework was simpler to understand and the redesigned submission templates were simpler to use (“agree” 2297 [43.7%], “strongly agree” 701 [13.3%]). A total of 64.5% had a good understanding of the program purposes; however, some respondents believe the program does not yet deliver intended outcomes. Maintaining Fellowship designation, regulatory requirements, and a desire to remain up-to-date were indicated as the primary motivators for engaging in MOC. The program has had a modest influence on users' approach to lifelong learning (“neither agree nor disagree”).

Discussion:
The program redesign reduced the perceived complexity of the MOC framework however it is described by some, as additional work (an add-on) by necessitating the documentation of participation in learning activities. An important “disconnect” between the program purposes and how physicians operationalize engagement was also illuminated by our study. Further attention needs to be paid to shifting the culture of continuing professional development to one that enables physicians to sufficiently demonstrate their continuing competence and enhanced performance meaningfully through participation in MOC programs.
Virtual Knowledge Brokering: Describing the Roles and Strategies Used by Knowledge Brokers in a Pediatric Physiotherapy Virtual Community of Practice
Authors: Hurtubise Karen , Rivard Lisa , Héguy Léa , Berbari Jade , Camden Chantal 
Published: August 2016

Introduction:
Knowledge transfer in pediatric rehabilitation is challenging and requires active, multifaceted strategies. The use of knowledge brokers (KBs) is one such strategy noted to promote clinician behavior change. The success of using KBs to transfer knowledge relies on their ability to adapt to ever-changing clinical contexts. In addition, with the rapid growth of online platforms as knowledge transfer forums, KBs must become effective in virtual environments. Although the role of KBs has been studied in various clinical contexts, their emerging role in specific online environments designed to support evidence-based behavior change has not yet been described. Our objective is to describe the roles of, and strategies used by, four KBs involved in a virtual community of practice to guide and inform future online KB interventions.

Methods:
A descriptive design guided this study and a thematic content analysis process was used to analyze online KB postings. The Promoting Action on Research in Health Sciences knowledge transfer framework and online andragogical learning theories assisted in the coding. A thematic map was created illustrating the links between KBs' strategies and emerging roles in the virtual environment.

Results:
We analyzed 95 posts and identified three roles: 1) context architect: promoting a respectful learning environment, 2) knowledge sharing promoter: building capacity, and 3) linkage creator: connecting research-to-practice. Strategies used by KBs reflected invitational, constructivism, and connectivism approaches, with roles and strategies changing over time.

Discussion:
This study increases our understanding of the actions of KBs in virtual contexts to foster uptake of research evidence in pediatric physiotherapy. Our results provide valuable information about the knowledge and skills required by individuals to fulfill this role in virtual environments.
Continuing Professional Development in the Twenty-First Century
Authors: Sachdeva Ajit K. 
Published: August 2016

Abstract:
The critical role of continuing professional development (CPD) in supporting delivery of patient care of the highest quality and safety is receiving significant attention in the current era of monumental change. CPD is essential in efforts to ensure effectiveness of new models of health care delivery, improve outcomes and value in health care, address external regulations, and foster patient engagement. The unique features of CPD; the use of special mastery-based teaching, learning, and assessment methods, and other special interventions to promote excellence; and direct involvement of a variety of key stakeholders differentiate CPD from undergraduate medical education and graduate medical education. The needs of procedural specialties relating to CPD are different from those of primary care disciplines and require special attention for the greatest impact. Simulation-based education and training can be very useful in CPD aimed at improving outcomes and promoting patient safety. Preceptoring, proctoring, mentoring, and coaching should be used routinely to address specific needs in CPD. Distinct CPD strategies are necessary for retraining, reentry, and remediation. Participation in CPD programs can be encouraged by leveraging the joy of learning, which should drive physicians and surgeons to strive continually to be the best in their professional work.