bluuebunny/crossref_metadata_2025_split huggingface dataset:
Curriculum Design of a Case‐based Knowledge Translation Shift for Emergency Medicine Residents
Authors: Friedman Sara , Sayers Benjamin , Lazio Matthew , Friedman Scott , Gisondi Michael A. 
Published: October 2010

AbstractBackground:  Principles of evidence‐based medicine (EBM) may be inconsistently applied to clinical decision‐making due to lack of practice‐based training, experience, and time.Objectives:  The authors sought to design, implement, and test the feasibility of an experiential learning model for senior emergency medicine (EM) residents to apply EBM principles during real‐time clinical practice.Methods:  Targeted program evaluation of this learning model was conducted through a prospective observational cohort study involving EM residents at a large, urban, 4‐year EM residency program. The curriculum development of a case‐based knowledge translation shift followed Kern’s six‐step design process. Subjects asynchronously completed a 1‐hour EBM tutorial and were then assigned to clinical shifts in which they contributed to the care of emergency department (ED) patients by completing formal literature searches related to active management questions. Pre‐ and post‐intervention self‐assessments of practice norms and attitudes were used to evaluate the effect of this experiential learning model for individual residents. Self‐assessments of the likelihood that the experience would result in future practice change were reported on a five‐point Likert scale (1 = greatly impeded, 2 = somewhat impeded, 3 = no change, 4 = somewhat improved, 5 = greatly improved). Subjects presented available evidence to the primary ED team, formally disseminated their findings as a brief “EBM rounds” at sign‐out and completed an “EBM consult note” and case log to document shift performance. Changes in patient management and/or disposition were recorded. EBM search questions and resultant findings were entered in a local database.Results:  Of the 45 eligible senior EM resident shifts, 91% resulted in complete sets of performance data and self‐assessments. A total of 80 patient encounters were documented during 45 scheduled shifts over a 3‐month study period. Literature review took a mean (±SD) of 36.2 (±26.4) minutes per case. During the 3‐hour interval before or after shift sign‐out, residents completed a mean (±SD) of 2.11 (±1.4) literature searches and recorded a mean (±SD) of 3.0 (±1.5) articles for each case. Alterations in ED management for 13 of 80 patient encounters (16.3%) were documented to be the direct result of on‐shift literature searches.Conclusions:  Case‐based knowledge translation shifts for senior EM residents can provide opportunities to practice EBM skills in the ED. This experiential learning model may result in future practice change by resident learners, as well as affect the management of active patients in the ED.ACADEMIC EMERGENCY MEDICINE  2010; 17:S42–S48 © 2010 by the Society for Academic Emergency Medicine
Missing in Action: A Case Study of the Application of Methods for Dealing With Missing Data to Trauma System Benchmarking
Authors: O’Reilly Gerard M. , Jolley Damien J. , Cameron Peter A. , Gabbe Belinda 
Published: October 2010

AbstractBackground: Trauma registry data are usually incomplete. Various methods for dealing with missing data have been used, some of which lead to biased results. One method that reduces bias, multiple imputation (MI), has not been widely adopted. There is no standardization of the approach to missing data across trauma registries.Objectives: This study examined the effect of using selected methods for handling missing data on a recognized trauma outcome measure.Methods: Data from the Victorian State Trauma Registry (VSTR) were used for the period July 2003 to June 2008. Three methods for handling missing data were investigated: complete case analysis, single imputation, and MI. The latter was applied using five distinct models, each with a different combination of variables (Trauma and Injury Severity score [TRISS] variables; prehospital Glasgow Coma Scale [GCS], respiratory rate, and systolic blood pressure; arrival by ambulance; transfer to a second hospital; and whether the GCS was “legitimate” according to the TRISS definition). For each method, TRISS analysis (comparing actual and expected deaths) was performed; the W‐score and Z‐statistic were derived. A Z‐statistic greater than 1.96 in absolute value was considered statistically significant.Results: Of 10,180 cases, 2,398 (24%) were missing at least one of the component variables necessary for TRISS analysis. With the use of complete case analysis, the W‐score was 0.54 unexpected survivors for every 100 cases, with a Z‐statistic of −1.96. Using two approaches to single imputation, the W‐scores were −1.41, with Z‐statistics of −5.19 and −5.30. Applying four of the five combinations of variables used for MI, there was a statistically significant number of unexpected survivors (W = −0.60, Z = −2.23; W = −0.52, Z = −1.97; W = −0.53, Z = −1.97; W = −0.63, Z = −2.24). However, using MI confined to TRISS variables only, there was a statistically significant number of unexpected deaths (W = +0.52, Z = +1.98).Conclusions: Missing data methods can influence the assessment of trauma care performance and need to be reported in all analyses. It is important that validated standardized approaches to dealing with missing data are universally adopted and reported.ACADEMIC EMERGENCY MEDICINE 2010; 17:1122–1129 © 2010 by the Society for Academic Emergency Medicine
Optimizing Resident Training: Results and Recommendations of the 2009 Council of Residency Directors Consensus Conference
Authors: Stahmer Sarah , Kuhn Gloria 
Published: October 2010

AbstractThis paper reports the results of a consensus conference of the Council of Emergency Medicine Residency Directors (CORD) to discuss the experiential training component of residency education in the emergency department (ED) and to make recommendations on structuring clinical training.   Self‐selected emergency medicine (EM) educators discussed experiential training focusing on three topic areas: 1) methods to optimize training in the clinical setting, 2) identification of goals and objectives by training year, and 3) determination of measurable behaviors demonstrating achievement of goals and objectives by residents. Topic areas were organized into the following questions: 1) what is the optimal number and evolution of ED shifts for EM residents during their residency training, 2) what clinical skills are expected of a resident at each level of training, and 3) what objective measures should be used to provide evidence of resident competency?   Participants attended a lecture on the goals of the conference, the questions to be answered, and the role and implementation of deliberate practice into experiential training. Attendees were divided into three groups, each discussing one question. Each group had two discussion leaders. All discussions were digitally recorded for accuracy. After discussion all groups reconvened and reported summaries of discussions and recommendations to ensure group agreement. There were 59 participants representing 42 training programs.   Educators agree that essential features of designing the ED clinical experience include the need to: 1) structure and tailor the clinical experience to optimize learning, 2) establish expectations for clinical performance based on year of training, and 3) provide feedback that is explicit to year‐specific performance expectations.ACADEMIC EMERGENCY MEDICINE 2010; 17:S78–S86 © 2010 by the Society for Academic Emergency Medicine
Incorporating Evidence‐based Medicine into Resident Education: A CORD Survey of Faculty and Resident Expectations
Authors: Carpenter Christopher R. , Kane Bryan G. , Carter Merle , Lucas Raymond , Wilbur Lee G. , Graffeo Charles S. 
Published: October 2010

AbstractBackground:  The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence‐based medicine (EBM) principles through the practice‐based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists.Objectives:  The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non–journal club directors.Methods:  A 19‐question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum.Results:  A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy‐seven (77% of respondents) were either residency program directors or assistant/associate program directors. The majority of participants were from university‐based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners’ most important EBM skill is to identify secondary peer‐reviewed resources, non–journal club directors identified residents’ ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%).Conclusions:  Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation.ACADEMIC EMERGENCY MEDICINE 2010; 17:S54–S61 © 2010 by the Society for Academic Emergency Medicine
It’s Time: An Argument for a National Emergency Medicine Education Research Center
Authors: Beeson Michael S. , Deiorio Nicole M. 
Published: October 2010

AbstractEducation research in emergency medicine has made some advances, but still suffers from poorly designed studies and isolated projects that are small and cannot be generalized to other institutions. This commentary argues for the need of an emergency medicine education research group (EMERG). EMERG would facilitate and coordinate better quality educational research projects at multiple institutions. This in turn would promote faculty development in education research and potentially result in improved educational outcomes and patient care.ACADEMIC EMERGENCY MEDICINE 2010; 17:S11–S12 © 2010 by the Society for Academic Emergency Medicine
A Core Competency–based Objective Structured Clinical Examination (OSCE) Can Predict Future Resident Performance
Authors: Wallenstein Joshua , Heron Sheryl , Santen Sally , Shayne Philip , Ander Douglas 
Published: October 2010

AbstractObjectives:  This study evaluated the ability of an objective structured clinical examination (OSCE) administered in the first month of residency to predict future resident performance in the Accreditation Council for Graduate Medical Education (ACGME) core competencies.Methods:  Eighteen Postgraduate Year 1 (PGY‐1) residents completed a five‐station OSCE in the first month of postgraduate training. Performance was graded in each of the ACGME core competencies. At the end of 18 months of training, faculty evaluations of resident performance in the emergency department (ED) were used to calculate a cumulative clinical evaluation score for each core competency. The correlations between OSCE scores and clinical evaluation scores at 18 months were assessed on an overall level and in each core competency.Results:  There was a statistically significant correlation between overall OSCE scores and overall clinical evaluation scores (R = 0.48, p < 0.05) and in the individual competencies of patient care (R = 0.49, p < 0.05), medical knowledge (R = 0.59, p < 0.05), and practice‐based learning (R = 0.49, p < 0.05). No correlation was noted in the systems‐based practice, interpersonal and communication skills, or professionalism competencies.Conclusions:  An early‐residency OSCE has the ability to predict future postgraduate performance on a global level and in specific core competencies. Used appropriately, such information can be a valuable tool for program directors in monitoring residents’ progress and providing more tailored guidance.ACADEMIC EMERGENCY MEDICINE 2010; 17:S67–S71 © 2010 by the Society for Academic Emergency Medicine
Thymic epithelial tumours in Iceland: incidence and histopathology, a population‐based study
Authors: MARIUSDOTTIR ELIN , NIKULASSON SIGFUS , BJORNSSON JOHANNES , GUDBJARTSSON TOMAS 
Published: October 2010

Mariusdottir E, Nikulasson S, Bjornsson J, Gudbjartsson T. Thymic epithelial tumours in Iceland: incidence and histopathology, a population‐based study. APMIS 2010; 118: 927–33.The objective of this study was to re‐examine histologically and restage thymic epithelial tumours during a 25‐year period and to correlate clinical and follow‐up data. We utilized centralized registries in Iceland to establish a true nationwide incidence rate, previously unreported. A retrospective whole population study was carried out by including all patients diagnosed with a thymic epithelial tumour in Iceland between 1 January 1984 and 30 April 2010. Medical records were reviewed and presenting symptoms, diagnostic procedures and surgical outcome tabulated. The histology of all cases was reclassified according to the 2004 World Health Organization classification (A–TC). The Masaoka system was used for tumour staging. Median follow‐up was 67 months. A total of 19 patients were identified, 11 men (58%) and 8 women, with mean age at presentation of 63 years (31–87 years). The age‐standardized incidence rate (ASR) was 0.3 and 0.2/100 000/year for men and women, respectively. Types B2 (n = 5) and A (n = 5) were the most common histological subtypes. Half of the patients had local symptoms, and eight were diagnosed incidentally. Of 19 patients, 11 underwent resection of the tumour through median sternotomy. Five‐year overall survival was 53%. All four patients with thymic carcinoma (TC) died of disease within 2 years of diagnosis. For the other 15 patients, no recurrences were reported. Thymic tumours are rare in Iceland with an ASR (w) of 0.28 per 100 000 a year. To our knowledge, these are the first nationwide ASR (w) figures reported. The prognosis for most thymic epithelial cell tumours is excellent. However, TCs have a dismal long‐term survival.
Comparison of three different techniques for application of water solutions to Finn Chambers®
Authors: Frick‐Engfeldt Malin , Gruvberger Birgitta , Isaksson Marléne , Hauksson Inese , Pontén Ann , Bruze Magnus 
Published: October 2010

Background: With regard to contact allergy, the dose of a sensitizer per unit skin area is an important factor for both sensitization and elicitation, and therefore a known amount/volume of test preparation should be applied at patch testing. Objectives: To compare three different techniques for the application of aqueous solutions to Finn Chambers, in order to determine the precision and accuracy of each technique when the recommended 15 µl volume is applied. Methods: Four technicians applied formaldehyde 1.0% aq. (wt/vol) and methylchloroisothiazolinone/methylisothiazolinone 200 ppm (wt/vol) in sets of 10 onto Finn Chambers, with three different techniques: (i) micro‐pipetting; (ii) dripping the solutions; and (iii) dripping the solutions followed by removal of excess solution with a soft tissue. Assessment of the variations was performed with the use of descriptive data. The ability to apply the exact amount was assessed by Fisher's exact test by categorizing each application as in or out of the range 12–18 µl. Results/Conclusions: The micro‐pipette technique had the best accuracy and precision, as well as the lowest inter‐individual variation. The technique in which excess solution was removed had good precision, but failed in the application of the defined amount, i.e. 15 µl.
Safety and efficacy of two manual toothbrushes
Authors: Rosema NAM , Timmerman MF , Versteeg PA , Van Palenstein Helderman WH , Van Der Velden U , Van Der Weijden GA 
Published: October 2010

To cite this article:

Int J Dent Hygiene 8, 2010; 280–285 DOI: 10.1111/j.1601‐5037.2010.00475.x Rosema NAM, Timmerman MF, Versteeg PA, van Palenstein Helderman WH, van der Velden U, van der Weijden GA. Safety and efficacy of two manual toothbrushes.Abstract:  Objective:  The purpose of this study was to test the efficacy and safety of a newly designed multi‐level manual toothbrush (Profit‐Haije‐Brush) compared with a control flat‐trimmed manual reference toothbrush from the American Dental Association (ADA).Material and methods:  For this study, 36 healthy subjects without previous experience in the use of the Profit‐Haije‐Brush (PHB) were selected. Subjects were given a period of 2 weeks to become familiar with both types of brushes and were instructed to use them on alternate days for 2 min twice daily. Prior to their visit, subjects refrained from all oral hygiene procedures for 48 h. Prebrushing plaque and gingival abrasion scores were assessed. Subsequently, two randomly chosen contra‐lateral quadrants were brushed with one of both brushes and the other two quadrants with the alternate brush. Subjects were supervised during their 2‐min brushing exercise. After brushing, plaque and gingival abrasion were re‐assessed. A questionnaire was filled out to investigate the subjects’ attitudes towards both brushes.Results:  The overall mean prebrushing PI was 2.47 for the PHB and 2.44 for the ADA. The reduction in PI was 1.32 and 1.23 respectively (P < 0.05). With regard to gingival abrasion the overall mean prebrushing scores were 4.57 (PHB) and 5.34 (ADA). Post‐brushing scores were 13.49 and 13.77 for the PHB and ADA respectively.Conclusion:  Statistically, the multi‐level PHB was significantly more efficacious than the flat‐trimmed ADA. However, the difference is clinically considered small and the amount of remaining plaque was not significantly different between brushes. No greater potential to cause gingival abrasion to the oral tissues was observed.
The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3‐day non‐brushing model
Authors: Slot DE , Rosema NAM , Hennequin‐Hoenderdos NL , Versteeg PA , Van Der Velden U , Van Der Weijden GA 
Published: October 2010

To cite this article:

Int J Dent Hygiene 8, 2010; 294–300 DOI: 10.1111/j.1601‐5037.2010.00487.x Slot DE, Rosema NAM, Hennequin‐Hoenderdos NL, Versteeg PA, van der Velden U, van der Weijden GA. The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3‐day non‐brushing model.Abstract:  Aim:  The purpose of the study was to compare the effects of four treatments on ‘de novo’ plaque accumulation. Treatments included tray application of 1% chlorhexidine gel (CHX‐Gel), 0.12% chlorhexidine dentifrice‐gel (CHX‐DFG), a regular dentifrice (RDF) tray application, or 0.2% chlorhexidine mouthwash (CHX‐MW) in a 3‐day non‐brushing model.Material and methods:  The study was designed as a single blind, randomized parallel clinical trial. After professional prophylaxis, subjects abstained from all other forms of oral hygiene during a 3‐day non‐brushing period. Subjects were randomly assigned to one of the four test groups (CHX‐Gel, CHX‐DFG, RDF applied in a fluoride gel tray or rinsing with a CHX‐MW). After 3 days, the Quigley & Hein plaque index (PI) and Bleeding on Marginal Probing (BOMP) index was assessed. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale.Results:  After 3 days, the full‐mouth PI means were 0.88 for the CHX‐gel regimen, 0.79 for CHX‐MW, 1.16 for CHX‐DFG and 1.31 for the RDF regimen. The two dentifrices (CHX‐DFG and RDF) were significantly less effective than the CHX‐Gel or the CHX‐MW.Conclusion:  Within the limitations of the present 3‐day non‐brushing study design, it can be concluded that the effect of a 1% CHX‐Gel application tray is significantly greater than that of 0.12% CHX‐DFG or RDF in inhibiting plaque accumulation. The 1% CHX‐Gel applied via a tray and 0.2% CHX‐MW rinse were comparably effective.
Exposure to Mother’s Pregnancy and Lactation in Infancy is Associated with Sexual Attraction to Pregnancy and Lactation in Adulthood
Authors: Enquist Magnus , Aronsson Hanna , Ghirlanda Stefano , Jansson Liselotte , Jannini Emmanuele A. 
Published: October 2010

ABSTRACT

Introduction
Several theories, including psychodynamic theories, sexual imprinting and early conditioning have been formulated to explain sexual development. Empirical data, however, remain insufficient for a thorough evaluation of these theories.

Aim
In this study, we test the hypothesis that a critical period exists for the acquisition of sexual preferences, as suggested by empirical findings in birds and mammals (sexual imprinting).

Methods
An Internet questionnaire was used.

Main Outcome Measures
We gather data from individuals with a sexual preference for pregnant and/or lactating women, under the hypothesis that pregnancy or lactation may become sexually attractive in adulthood following an exposure to pregnant or lactating women in infancy.

Results
We find that these preferences are more common in older siblings, i.e., in individuals who have been exposed to more maternal pregnancy and lactation. This result is independent of respondent and sibling sex. In addition, only maternal pregnancies and lactations experienced between 1.5 and 5 years of age are associated with the preferences.

Conclusions
We discuss our findings in relation to theories of sexual development and to earlier reports of birth order effects on sexual behavior. We suggest that this age range may constitute a sensitive period for the acquisition of sexual preferences.
Segregation effects according to the evolutionary stage of galaxy groups
Authors: Ribeiro A. L. B. , Lopes P. A. A. , Trevisan M. 
Published: October 2010

Abstract
We study segregation phenomena in 57 groups selected from the 2dF Percolation-Inferred Galaxy Groups (2PIGG) catalogue of galaxy groups. The sample corresponds to those systems located in areas of at least 80 per cent redshift coverage out to 10 times the radius of the groups. The dynamical state of the galaxy systems was determined after studying their velocity distributions. We have used the Anderson–Darling test to distinguish relaxed and non-relaxed systems. This analysis indicates that 84 per cent of groups have galaxy velocities consistent with the normal distribution, while 16 per cent of them have more complex underlying distributions. Properties of the member galaxies are investigated taking into account this classification. Our results indicate that galaxies in Gaussian groups are significantly more evolved than galaxies in non-relaxed systems out to distances of ∼4R200, presenting significantly redder (B−R) colours. We also find evidence that galaxies with MR≤−21.5 in Gaussian groups are closer to the condition of energy equipartition.