bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mapping Cognitive Overlaps Between Practice-Based Learning and Improvement and Evidence-Based Medicine: An Operational Definition for Assessing Resident Physician Competence
Authors: Chatterji Madhabi , Graham Mark J. , Wyer Peter C. 
Published: December 2009

AbstractPurposeThe complex competency labeled practice-based learning and improvement (PBLI) by the Accreditation Council for Graduate Medical Education (ACGME) incorporates core knowledge in evidence-based medicine (EBM). The purpose of this study was to operationally define a “PBLI-EBM” domain for assessing resident physician competence.MethodThe authors used an iterative design process to first content analyze and map correspondences between ACGME and EBM literature sources. The project team, including content and measurement experts and residents/fellows, parsed, classified, and hierarchically organized embedded learning outcomes using a literature-supported cognitive taxonomy. A pool of 141 items was produced from the domain and assessment specifications. The PBLI-EBM domain and resulting items were content validated through formal reviews by a national panel of experts.ResultsThe final domain represents overlapping PBLI and EBM cognitive dimensions measurable through written, multiple-choice assessments. It is organized as 4 subdomains of clinical action: Therapy, Prognosis, Diagnosis, and Harm. Four broad cognitive skill branches (Ask, Acquire, Appraise, and Apply) are subsumed under each subdomain. Each skill branch is defined by enabling skills that specify the cognitive processes, content, and conditions pertinent to demonstrable competence. Most items passed content validity screening criteria and were prepared for test form assembly and administration.ConclusionsThe operational definition of PBLI-EBM competence is based on a rigorously developed and validated domain and item pool, and substantially expands conventional understandings of EBM. The domain, assessment specifications, and procedures outlined may be used to design written assessments to tap important cognitive dimensions of the overall PBLI competency, as given by ACGME. For more comprehensive coverage of the PBLI competency, such instruments need to be complemented with performance assessments.
Institute of Medicine Committee Report on Resident Duty Hours: A View From a Trench
Authors: Cedfeldt Andrea S. , English Clea , El Youssef Raphael , Gilhooly Joseph , Girard Donald E. 
Published: December 2009

Abstract

Background
In late 2008, the Institute of Medicine (IOM) published a report recommending more restrictive limits on resident work hours to promote patient safety. Reaction from the graduate medical education community has focused on concerns about a lack of evidence supporting the IOM’s recommendations. We highlight 3 concerns with the report: 1) a disproportionate attention to resident fatigue when changes in other areas may have a larger impact on patient safety. Data supporting a causal link between resident fatigue and medical errors that harm patients are not robust. Two areas where data support a stronger impact on patient safety include resident supervision and transitions of care; 2) a “one size fits all” model when specialty-specific recommendations may be more appropriate. For example, 16 hours on task is not at all similar for residents in different specialties (ie, surgery and primary care); and 3) the absence of a process to evaluate the impact of current or potential duty hour requirements on outcomes. Because these potential impacts have not been sufficiently researched, it is premature to support additional changes at this time.

Recommendations
To move forward in a comprehensive manner, we recommend the following: 1) support more research to evaluate the effects of duty hours in conjunction with other interrelated factors on patient safety, 2) encourage individual Accreditation Council for Graduate Medical Education (ACGME) Review committees to develop specialty specific duty hour limitations, and 3) develop partnerships between the IOM, ACGME, and the institutions directly involved with medical education to study how to maximize patient safety while maintaining quality educational outcomes.
Components of Critical Decision Making and ABSITE Assessment: Toward a More Comprehensive Evaluation
Authors: Krishnamurthy Satish , Satish Usha , Foster Tina , Streufert Siegfried , Dewan Mantosh , Krummel Thomas 
Published: December 2009

Abstract

Rationale
Accurate assessment of resident competency is a fundamental requisite to assure the training of physicians is adequate. In surgical disciplines, structured tests as well as ongoing evaluation by faculty are used for evaluating resident competency. Although structured tests evaluate content knowledge, faculty ratings are a better measure of how that knowledge is applied to real-world problems. In this study, we sought to explore the performance of surgical residents in a simulation exercise (strategic management simulations [SMS]) as an objective surrogate of real-world performance.

Methods
Forty surgical residents participated in the SMS simulation that entailed decision making in a real-world−oriented task situation. The task requirements enable the assessment of decision making along several parameters of thinking under both crisis and noncrisis situations. Performance attributes include “simpler” measures of competency (activity level), intermediate categories (information management and emergency responses) to complex measures (breadth of approach and strategy). Scores obtained in the SMS were compared with the scores obtained on the American Board of Surgery In-Training Examination (ABSITE).

Results
The data were intercorrelated and subjected to a multiple regression analysis with ABSITE as the dependent variable and simulation scores as independent variables. Using a 1-tail test analysis, only 3 simulation variables correlated with performance on ABSITE at the .01 level (ie, basic activity, focused activity, task orientation). Other simulation variables showed no meaningful relationships to ABSITE scores at all.

Conclusions
The more complex real-world−oriented decision-making parameters on SMS did not correlate with ABSITE scores. We believe that techniques such as the SMS, which focus on critical thinking, complement assessment of medical knowledge using ABSITE. The SMS technique provides an accurate measure of real-world performance and provides objective validation of faculty ratings.
Utilizing Quality Improvement Methods to Improve Patient Care Outcomes in a Pediatric Residency Program
Authors: Akins Ralitsa B. , Handal Gilbert A. 
Published: December 2009

Abstract

Objective
Although there is an expectation for outcomes-oriented training in residency programs, the reality is that few guidelines and examples exist as to how to provide this type of education and training. We aimed to improve patient care outcomes in our pediatric residency program by using quality improvement (QI) methods, tools, and approaches.

Methods
A series of QI projects were implemented over a 3-year period in a pediatric residency program to improve patient care outcomes and teach the residents how to use QI methods, tools, and approaches. Residents experienced practice-based learning and systems-based assessment through group projects and review of their own patient outcomes. Resident QI experiences were reviewed quarterly by the program director and were a mandatory part of resident training portfolios.

Results
Using QI methodology, we were able to improve management of children with obesity, to achieve high compliance with the national patient safety goals, improve the pediatric hotline service, and implement better patient flow in resident continuity clinic.

Conclusion
Based on our experiences, we conclude that to successfully implement QI projects in residency programs, QI techniques must be formally taught, the opportunities for resident participation must be multiple and diverse, and QI outcomes should be incorporated in resident training and assessment so that they experience the benefits of the QI intervention. The lessons learned from our experiences, as well as the projects we describe, can be easily deployed and implemented in other residency programs.
Burnout, Psychological Skills, and Empathy: Balint Training in Obstetrics and Gynecology Residents
Authors: Ghetti Chiara , Chang Judy , Gosman Gabriella 
Published: December 2009

Abstract

Objectives
To assess burnout, behavioral-medicine skills, and empathy among obstetrics and gynecology residents before and after implementation of Balint training.

Methods
This was a prospective educational study. Balint training was introduced into the obstetrics and gynecology residency curriculum in July 2005. All 36 residents were approached for this study. The Psychological Medicine Inventory, the Maslach Burnout Inventory, and the Jefferson Scale of Physician Empathy were administered prior to initiating training and at 12 months. Baseline and 12-month scores were compared by Wilcoxon signed rank test.

Results
Seventeen residents completed baseline and 12-month questionnaires: 6 were postgraduate year (PGY) 1, 3 were PGY-2, 6 were PGY-3, and 2 were PGY-4. At baseline, 70% of participating residents reported high burnout scores. Burnout and empathy remained unchanged at 12 months. Psychological medicine skills improved at 12 months.

Conclusions
This study showed that obstetrics and gynecology residents are at high risk for burnout. Interest and confidence in handling psychological aspects of patient care improved at 12 months after the introduction of Balint training.
Toward a New Paradigm in Graduate Medical Education in the United States: Elimination of the 24-Hour Call
Authors: Mautone Susan G. 
Published: December 2009

Abstract

Background
Sleep deprivation negatively affects resident performance, education, and safety. Concerns over these effects have prompted efforts to reduce resident hours. This article describes the design and implementation of a scheduling system with no continuous 24-hour calls. Aims included meeting Accreditation Council for Graduate Medical Education work hour requirements without increasing resident complement, maximizing continuity of learning and patient care, maintaining patient care quality, and acceptance by residents, faculty, and administration.

Methods
Various coverage options were formulated and discussed. The final schedule was the product of consensus. After re-engineering the master rotation schedule, service-specific conversion of on-call schedules was initiated in July 2003 and completed in July 2004. Annual in-training and certifying examination performance, length of stay, patient mortalities, resident motor vehicle accidents/near misses, and resident satisfaction with the new scheduling system were tracked.

Results
Continuous 24-hour call has been eliminated from the program since July 2004, with the longest assigned shift being 14 hours. Residents have at least 1 free weekend per month, a 10-hour break between consecutive assigned duty hours, and a mandatory 4-hour “nap” break if assigned a night shift immediately following a day shift. Program-wide, duty hours average 66 hours per week for first-year residents, 63 hours per week for second-year residents, and 60 hours per week for third-year residents. Self-reported motor vehicle accidents and/or near misses of accidents significantly decreased (P &lt; .001) and resident satisfaction increased (P  =  .42). The change was accomplished at no additional cost to the institution and with no adverse patient care or educational outcomes.

Conclusions
Pediatric residency training with restriction to 14 consecutive duty hours is effective and well accepted by stakeholders. Five years later, the re-engineered schedule has become the new “normal” for our program.
Reliability, validity, and responsiveness of five at‐work productivity measures in patients with rheumatoid arthritis or osteoarthritis
Authors: Beaton Dorcas E. , Tang Kenneth , Gignac Monique A. M. , Lacaille Diane , Badley Elizabeth M. , Anis Aslam H. , Bombardier Claire 
Published: December 2009

AbstractObjectiveArthritis often impacts a worker's ability to be productive while at work. However, the ideal approach to measuring arthritis‐attributable at‐work productivity loss remains unclear. Our objective was to evaluate the relative strengths and weaknesses of 5 measures aimed at quantifying health‐related at‐work productivity loss and to determine the best available instrument for this population.MethodsIn a 12‐month longitudinal design, the psychometric properties (reliability, validity, and responsiveness) of 5 self‐reported measures of at‐work productivity were compared in workers with either rheumatoid arthritis (RA) or osteoarthritis (OA). We tested the Workplace Activity Limitations Scale (WALS), 6‐item Stanford Presenteeism Scale (SPS‐6), Endicott Work Productivity Scale (EWPS), RA Work Instability Scale (WIS), and Work Limitations Questionnaire (WLQ).ResultsAcross all measures, participants (n = 250, 120 with RA and 130 with OA) consistently reported mild losses of at‐work productivity. The Cronbach's alpha of the scales ranged from 0.71 (for SPS‐6) to 0.94 (for EWPS), indicating some concerns over the internal consistency of the SPS‐6. The RA WIS demonstrated the strongest construct validity (|r| = 0.54–0.74), whereas the WALS was most responsive to perceived changes in work ability. Despite its increasing popularity and potential application for costing analysis, the WLQ did not compare favorably with the other scales, possibly due to psychometric concerns with its physical demands subscale.ConclusionMeasures revealed unique conceptualization of at‐work disability, but no single scale emerged as clearly superior. However, current results slightly favor the WALS and RA WIS as superior instruments for measuring at‐work productivity loss in workers with arthritis.
Knee joint stiffness during walking in knee osteoarthritis
Authors: Dixon Sharon J. , Hinman Rana S. , Creaby Mark W. , Kemp Georgie , Crossley Kay M. 
Published: December 2009

AbstractObjectiveTo investigate the construct validity of walking knee stiffness as a measure to differentiate between individuals with and without knee osteoarthritis (OA) and the construct validity of walking knee stiffness as related to self‐reported knee stiffness. The contributors to walking stiffness and its relationship with loading rate and adduction moment are also investigated.MethodsThirty‐seven individuals with knee OA and 11 asymptomatic controls participated. Knee stiffness was calculated during walking as the change in knee flexion‐extension moment divided by the change in knee flexion angle. Forward‐stepwise regression models and Pearson's correlation coefficients were used to evaluate the relationships between variables.ResultsKnee stiffness in walking was significantly greater in the OA group (mean ± SD 10.1 ± 4.4 Nm/°/kg × 100) compared with the controls (mean ± SD 5.6 ± 1.5 Nm/°/kg × 100) (P < 0.001). Knee excursion range explained 39% of the variance in walking knee stiffness (B = −0.736, P < 0.001) and knee extensor moment a further 7% (B = 6.974, P = 0.045). In the OA group, walking knee stiffness was not associated with self‐reported stiffness (r = 0.029; P = 0.863). For the OA group, greater self‐reported stiffness was associated with lower peak knee adduction moment (B = −0.354, P < 0.001).ConclusionThe construct validity of walking knee stiffness is supported. The poor correlation between walking stiffness and self‐reported stiffness suggests the 2 measures evaluate different aspects of knee stiffness. Since a measure of walking stiffness is likely to provide valuable information, future research evaluating its clinical significance is merited.
Total hip or knee replacement for osteoarthritis: Mid‐ and long‐term quality of life
Authors: Rat Anne‐Christine , Guillemin Francis , Osnowycz Georges , Delagoutte Jean‐Pierre , Cuny Christian , Mainard Didier , Baumann Cédric 
Published: December 2009

AbstractObjectiveTo compare quality of life (QOL) scores 3 and 10 years after total hip arthroplasty (THA) or total knee arthroplasty (TKA) for osteoarthritis with QOL scores in a general population, and to determine factors associated with QOL after surgery.MethodsData were obtained from 2 multicenter cohorts of patients with THA or TKA: 232 patients were recruited during 2003 (3‐year cohort) and 221 patients were recruited during 1994 (10‐year cohort). Preoperative data (QOL, radiograph results) and followup data (demographics, comorbidities, pain locations, environmental factors, and QOL) were collected. QOL data for the general population were obtained from a 2003 population‐based survey.ResultsA total of 195 and 89 patients for the 3‐ and 10‐year cohorts, respectively, were followed up; the mean age at followup was 73 years. For both of the cohorts, physical functioning and role‐physical or role‐emotional QOL scores were lower than those for a general population with comparable age. Scores for pain, mental health, and social dimensions were lower than those for the reference population for only the 10‐year cohort. For both cohorts, increased number of comorbidities, painful locations other than THA or TKA location, and unfavorable environmental factors were associated with impaired QOL. Low preoperative QOL scores were predictive of impaired QOL at followup for only the 3‐year cohort.ConclusionTHA or TKA can improve QOL, but the benefits may be time limited. Addressing environmental factors and treating comorbidities and pain in locations other than the arthroplasty location could have mid‐ and long‐term effects on the QOL of patients with THA or TKA.
Validity of the bath ankylosing spondylitis disease activity index for the evaluation of disease activity in axial psoriatic arthritis
Authors: Fernández‐Sueiro José Luis , Willisch Alfredo , Pértega‐Díaz Sonia , Tasende José Antonio Pinto , Fernández‐López Jesús Carlos , Villar Natividad Oreiro , Galdo F. , Blanco Francisco Javier 
Published: December 2009

AbstractObjectiveTo assess the validity of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for the evaluation and definition of disease activity of axial psoriatic arthritis (PsA).MethodsFifty‐four peripheral PsA, 46 axial PsA, and 103 primary ankylosing spondylitis (AS) patients were assessed. Patients were classified as having axial PsA if they had grade 2 or higher unilateral sacroiliitis in the presence of spinal symptoms. The 3 groups of patients were evaluated using several measurements for AS. Assessments of acceptability, data quality, internal consistency, construct validity, and responsiveness of the BASDAI were undertaken. Disease activity of the disease was assessed in peripheral PsA and axial PsA patients using the BASDAI, and compared with those with AS.ResultsFor peripheral PsA patients, the Cronbach's alpha for the BASDAI was 0.783, for axial PSA patients it was 0.647, and for AS patients it was 0.786. The analysis of convergent validity showed that in peripheral PsA and axial PsA patients, the BASDAI was significantly correlated with other subjective disease activity parameters. For responsiveness, no association was found between changes in the BASDAI and changes in disease activity either in peripheral PsA or in axial PsA. BASDAI scores were similar in axial PsA and AS. Axial PsA patients with a BASDAI score >4 cm showed significant differences with peripheral PsA in terms of disease activity and were very similar to patients with AS.ConclusionThe BASDAI performed similarly in evaluating disease activity in both axial and peripheral PsA. The BASDAI does not seem to be a good index for evaluating disease activity in axial PsA.
Mutuality's prospective beneficial effects on inflammation in female patients with rheumatoid arthritis
Authors: Kasle Shelley , Wilhelm Mari S. , McKnight Patrick E. , Sheikh Saira Z. , Zautra Alex J. 
Published: December 2009

AbstractObjectiveSupportive close relationships are important for health. Mutuality, the reciprocal sharing of thoughts and feelings in close relationships, is linked with better outcomes for patients with rheumatoid arthritis (RA) in cross‐sectional data. Hypothesizing that mutuality has a beneficial impact on inflammation, we tested potentially causal relations of couple mutuality with erythrocyte sedimentation rate (ESR) in prospective data.MethodsFemale patients with RA (n = 70; mean age 57 years, mean RA disease duration 5 years) completed questionnaires at baseline, 6 months, and 12 months, including measures of mutuality, RA flares, and negative affect. ESR laboratory values available near questionnaire dates were collected from medical charts. Using regression, we examined cross‐lagged effects of mutuality and ESR over the two 6‐month time spans (baseline to 6 months, 6 months to 12 months). We anticipated that mutuality would exert lagged inverse effects on subsequent ESR levels, and that ESR would have no effect on subsequent mutuality levels.ResultsAfter controlling for lagged effects of earlier inflammation, disease‐modifying antirheumatic drugs, antiinflammatory drugs, RA flares, and negative affect, mutuality's lagged inverse effects over both time spans accounted for unique variance in subsequent levels of ESR, explaining 9% at 6 months and 12.5% at 12 months. Concomitantly, earlier ESR had no effect on subsequent mutuality.ConclusionPatients with RA reporting more mutuality had less inflammation at subsequent time points, but inflammation had no effect on subsequent reports of mutuality. This suggests that mutuality exerts a beneficial effect on inflammation. Clinical implications and potential applications are discussed.
Evidence for predictive validity of remission on long‐term outcome in rheumatoid arthritis: A systematic review
Authors: van Tuyl Lilian H. D. , Felson David T. , Wells George , Smolen Josef , Zhang Bin , Boers Maarten 
Published: December 2009

AbstractObjectiveRemission is rapidly becoming a key end point in rheumatoid arthritis (RA) clinical trials, but its definition is not satisfactory. Although it is generally believed that achieving a state of remission will lead to better structural outcome, this has not been studied systematically. As part of an undertaking to redefine remission, the current review describes the relationship between remission and long‐term structural outcome.MethodsA systematic literature search of PubMed, EMBase, and The Cochrane Library intersected 3 groups of terms: RA, remission, and long‐term outcome. The search identified 1,138 records, of which 14 were relevant to the research question.ResultsAll of the studies included in this review showed a relationship between remission and long‐term structural damage or disability. Patients that achieved a state of remission, defined in various ways, showed less deterioration of function and radiographic progression compared with patients who did not reach a state of remission.ConclusionPatients who achieved a state of remission were less likely to show deterioration of function and radiographic progression compared with patients who did not reach a state of remission.