bluuebunny/crossref_metadata_2025_split huggingface dataset:
Residents' Perspectives on Professionalism
Authors: Krain Lewis P. , Lavelle Ellen 
Published: December 2009

Abstract

Background
Research defining professionalism exists, yet little is known about how residents view this important attribute for medical practice. Knowing more about residents' interpretations of professionalism and about how they value professionalism would enhance definitions and facilitate support for the development of professionalism skills and behaviors at the graduate level.

Purpose
The purpose of this phenomenological study was to investigate how residents think about professionalism, how they value it, and how it plays out in their educational lives.

Methods
This study uses qualitative methods, employing 5 focus groups representative of a range of disciplines. Methods include providing unstructured prompts, member checking and informant feedback to support credibility, and content analysis to discern significant patterns.

Results
Content analysis supported that residents highly value professionalism and see it as a complex construct, dependent on the situation, discipline, and on personal experience. Challenges to professionalism are common in graduate medical education and a great concern for residents.

Conclusions
Physician educators often discuss professionalism as an overarching concept in medicine, especially in classes during the preclinical years. Although some general principles are applicable, residents relate more deeply to aspects of professionalism that concern their own clinical practice, situation, and specialty. Implications for measurement of professional skills and for further research are included in this report.
One Possible Future for Resident Hours: Interns' Perspective on a One-Month Trial of the Institute of Medicine Recommended Duty Hour Limits
Authors: Tessing Stephanie , Amendt Andria , Jennings Jeanine , Thomson Joanna , Auger Katherine A. , Gonzalez del Rey Javier A. 
Published: December 2009

Abstract

Background
In December 2008, the Institute of Medicine (IOM) released the report of a consensus committee recommending added limits on resident duty hours.

Methods
Perceptions of interns participating in a 1-month trial implementation of the IOM-recommended duty hour limits in one large pediatric residency program during March 2009 were aggregated.

Results
Interns experienced benefits from the shift-based schedule, including reduced hours and more nights at home. These were accompanied by shortcomings of the new schedule, most prominently increased intensity during the hours worked, weaknesses in sign-outs and handing off of tasks, and inability to know and “own” all patients on the interns' team. The experiment also changed the role and the level of engagement expected from attending physicians.

Conclusions
The trial implementation of the IOM-recommended limits highlighted that to adapt to additional reduction in hours, residency education needs a significant culture change, including better sign-outs, improved organization of bedside and didactic education, and attention to the added work intensity of a team-based model with daily admissions. Ultimately this may require an adjustment in residents' workload and different expectations and models of support from attending physicians.
Failure to Thrive: Pediatric Residents Weigh In on Feasibility Trial of the Proposed 2008 Institute of Medicine Work Hour Restrictions
Authors: Auger Katherine A. , Sieplinga Kira R. , Simmons Jeffrey M. , Gonzalez del Rey Javier A. 
Published: December 2009

Abstract

Background
In December 2008 the Institute of Medicine (IOM) released a report recommending limits on resident hours that are considerably more restrictive than the current Accreditation Council for Graduate Medical Education duty hour standards.

Intervention
In March 2009, a large pediatric residency program implemented a 1-month trial of a schedule and team structure fully congruent with the IOM recommendations to study the implications of such a schedule.

Methods
Comparison of the interns' experience in the trialed intervention schedule was made to interns working a traditional schedule with every fourth night call.

Results
The residents on the intervention schedule averaged 7.8 hours of sleep per 24-hour period compared to 7.6 hours for interns in a traditional schedule. Participation in bedside rounds and formal didactic conferences was decreased in the intervention schedule. Several factors contributed to increased perceived work intensity for interns in the intervention schedule. Redistribution of work during busy shifts altered the role of senior residents and attending physicians which may have a negative effect on senior residents' ability to develop skills as supervisors and educators.

Conclusions
The trial implementation suggests it is possible to implement the proposed duty hour limits in a pediatric residency, but it would require a significant increase in the resident workforce (at least 25% and possibly 50%) to care for the same number of patients. Furthermore, the education model would need to undergo significant changes. Further trials of the IOM recommendations are needed prior to widespread implementation in order to learn what works best and causes the least harm, disruption, and unnecessary cost to the system.
The Revolution in Medical Education—The Role of Simulation
Authors: Satava Richard M. 
Published: December 2009

Abstract
The last major change in medical education was the Flexner Report, over a century ago. Since that time, iterative improvements have occurred to the question-and-answer and “see one, do one, teach one” educational environment. However, multiple external forces—from the 80-hour work week to the emphasis on patient safety to competing demands on student and faculty time—have raised calls for a fundamental revamping of the entire medical educational process. Fortunately, new methods, curricula, and processes, such as Accreditation Council for Graduate Medical Education competencies or Objective Structured Assessment of Technical Skills, as well as innovative technologies such as web-based learning and simulation, have provided opportunities to support the revolution in medical education that will be responsive to national priorities, the public concern, and, most of all, to patient safety.
Systematic assessment of inflammation by magnetic resonance imaging in the posterior elements of the spine in ankylosing spondylitis
Authors: Maksymowych Walter P. , Crowther Sean M. , Dhillon Suhkvinder S. , Conner‐Spady Barbara , Lambert Robert G. W. 
Published: December 2009

AbstractObjectiveMagnetic resonance imaging (MRI) is sensitive for scoring inflammatory lesions in the spine, but attention has primarily focused on vertebral bodies, and no study has systematically examined the posterior elements. We aimed to systematically determine the frequency and distribution of inflammatory changes in the posterior elements of the spine using MRI, and to assess the reliability of their detection and their impact on discrimination of spinal MRI.MethodsWe scanned 32 patients recruited to placebo‐controlled trials of anti–tumor necrosis factor therapy. Inflammatory lesions were detected by systematic review of consecutive sagittal STIR slices of the entire spine. Two readers evaluated pretreatment and posttreatment scans, blinded to treatment and time point. Inflammation was scored dichotomously (present/absent) in each posterior structure. Reproducibility was assessed by calculating random model variance components and generalizability coefficients, and discrimination by using Guyatt's effect size.ResultsMost patients (87.5%) had ≥1 lesion in the posterior elements (mean ± SD number of affected spinal levels per patient 6.7 ± 5.3), and they were detected most frequently in the thoracic spine. Interobserver reproducibility for total lesion count was very good to excellent for lesions in the thoracic spine and transverse and spinous processes. The addition of a simple dichotomous method for scoring posterior element inflammation substantially enhanced the discrimination observed using established MRI methods for scoring vertebral body inflammation.ConclusionInflammatory lesions in the posterior elements were present in the majority of patients with AS, and standard MRI protocols of the spine should be modified to ensure adequate visualization of posterolateral structures.
Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint
Authors: Madsen Karen Berenth , Jurik Anne Grethe 
Published: December 2009

AbstractObjectiveTo develop a new grading method to quantify activity and chronic spondylarthritis (SpA) changes in the sacroiliac (SI) joints identified by magnetic resonance imaging (MRI), taking into account the complex joint anatomy, and to compare the findings with radiographic changes.MethodsA total of 37 patients (15 men, 22 women) fulfilling the European Spondylarthropathy Study Group criteria for SpA were examined by MRI of the SI joint using a semicoronal T1‐weighted and T1‐weighted fat‐saturated (T1FS) sequence, a semiaxial STIR sequence, and postcontrast semicoronal and semiaxial T1FS sequences. The images were assessed independently by 2 radiologists for presence of bone marrow edema and enhancement, fatty marrow deposition, and joint erosion at both the cartilaginous and the ligamentous joint portion. Conventional radiographs were scored in accordance with the modified New York criteria.ResultsInter‐ and intraobserver agreements for grading activity and chronic changes were good, with kappa values between 0.72 and 0.86 and between 0.83 and 0.90, respectively. Nearly half of the disease activity changes were due to inflammation in the ligamentous joint portion, which was significantly related to ankylosing spondylitis (AS). Patients with AS had significantly higher erosion and fatty marrow deposition scores than patients with nonprimary AS forms of SpA. The degree of erosion by MRI was significantly related to radiographic stages.ConclusionSeparate assessment of the ligamentous joint portion by MRI may be valuable for differentiating AS from nonprimary AS forms of SpA. Erosive changes on MRI were significantly related to radiographic changes, implying a possibility for substituting radiography with MRI.
Development and validation of a case ascertainment tool for ankylosing spondylitis
Authors: Weisman Michael H. , Chen Lan , Clegg Daniel O. , Davis John C. , Dubois Robert W. , Prete Pamela E. , Savage Laurie M. , Schafer Laura , Suarez‐Almazor Maria E. , Yu Hsing‐Ting , Reveille John D. 
Published: December 2009

AbstractObjectiveAnkylosing spondylitis (AS) diagnosis is often delayed. The availability of effective biologic agents for treating AS has increased the importance of early diagnosis. We tested questions derived from a comprehensive literature review and an advisory board in a case–control study designed to identify patients with AS from among patients with chronic back pain (CBP).MethodsQuestion items were cognitively tested among patients with AS, and then in case–control studies for validation and creation of a scoring algorithm and question item reduction. AS cases were recruited from a known database, and CBP subjects (controls) were recruited from clinics, employers, and from the SpineUniverse Web site. We used individual question items in a multivariate framework to discriminate between people with and without AS.ResultsForty‐three questions yielded 24 items for analyses; 12 of these were entered into a multivariate regression model. Individual items yielded odds ratios ranging from 0.07 to 30.31. Question items with a significant positive relationship to AS included male sex, neck or hip pain/stiffness, longer pain duration, decreased pain/stiffness with daily physical activity, pain relief within 48 hours of nonsteroidal antiinflammatory drugs, and diagnosis of iritis. The tool demonstrated a sensitivity of 67.4 and a specificity of 94.6. The tool was developed from clinically and radiologically diagnosed AS cases and therefore is designed to distinguish AS cases among CBP subjects. In addition, ∼54% of the AS cases in the study were treated with biologic agents, which may impact questionnaire responses.ConclusionThis tool can identify undiagnosed patients with AS and, potentially, those at an earlier stage in their disease course.
A comparison of strength training, self‐management, and the combination for early osteoarthritis of the knee
Authors: McKnight Patrick E. , Kasle Shelley , Going Scott , Villanueva Isidro , Cornett Michelle , Farr Josh , Wright Jill , Streeter Clara , Zautra Alex 
Published: December 2009

AbstractObjectiveTo assess the relative effectiveness of combining self‐management and strength training for improving functional outcomes in patients with early knee osteoarthritis.MethodsWe conducted a randomized intervention trial lasting 24 months at an academic medical center. Community‐dwelling middle‐aged adults (n = 273) ages 35–64 years with knee osteoarthritis, pain, and self‐reported physical disability completed a strength training program, a self‐management program, or a combined program. Outcomes included 5 physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and 2 self‐reported measures of pain and disability.ResultsA total of 201 participants (73.6%) completed the 2‐year trial. Overall, compliance was modest for the strength training (55.8%), self‐management (69.1%), and combined (59.6%) programs. The 3 groups showed a significant and large increase from pre‐ to posttreatment in all of the physical functioning measures, including leg press (d = 0.85), range of motion (d = 1.00), work capacity (d = 0.60), balance (d = 0.59), and stair climbing (d = 0.59). Additionally, all 3 groups showed decreased self‐reported pain (d = −0.51) and disability (d = −0.55). There were no significant differences among the groups.ConclusionMiddle‐aged, sedentary persons with mild early knee osteoarthritis benefited from strength training, self‐management, and the combination program. These results suggest that both strength training and self‐management are suitable treatments for the early onset of knee osteoarthritis in middle‐aged adults. Self‐management alone may offer the least burdensome treatment for early osteoarthritis.
Long‐term outcome and prognostic factors of juvenile dermatomyositis: A multinational, multicenter study of 490 patients
Authors: Ravelli Angelo , Trail Lucia , Ferrari Cristina , Ruperto Nicolino , Pistorio Angela , Pilkington Clarissa , Maillard Susan , Oliveira Sheila K. , Sztajnbok Flavio , Cuttica Ruben , Beltramelli Matilde , Corona Fabrizia , Katsicas Maria Martha , Russo Ricardo , Ferriani Virginia , Burgos‐Vargas Ruben , Magni‐Manzoni Silvia , Solis‐Valleoj Eunice , Bandeira Marcia , Zulian Francesco , Baca Vicente , Cortis Elisabetta , Falcini Fernanda , Alessio Maria , Alpigiani Maria Giannina , Gerloni Valeria , Saad‐Magalhaes Claudia , Podda Rosanna , Silva Clovis A. , Lepore Loredana , Felici Enrico , Rossi Federica , Sala Elena , Martini Alberto 
Published: December 2009

AbstractObjectiveTo investigate the long‐term outcome and prognostic factors of juvenile dermatomyositis (DM) through a multinational, multicenter study.MethodsPatients consisted of inception cohorts seen between 1980 and 2004 in 27 centers in Europe and Latin America. Predictor variables were sex, continent, ethnicity, onset year, onset age, onset type, onset manifestations, course type, disease duration, and active disease duration. Outcomes were muscle strength/endurance, continued disease activity, cumulative damage, muscle damage, cutaneous damage, calcinosis, lipodystrophy, physical function, and health‐related quality of life (HRQOL).ResultsA total of 490 patients with a mean disease duration of 7.7 years were included. At the cross‐sectional visit, 41.2–52.8% of patients, depending on the instrument used, had reduced muscle strength/endurance, but less than 10% had severe impairment. Persistently active disease was recorded in 41.2–60.5% of the patients, depending on the activity measure used. Sixty‐nine percent of the patients had cumulative damage. The frequency of calcinosis and lipodystrophy was 23.6% and 9.7%, respectively. A total of 40.7% of the patients had decreased functional ability, but only 6.5% had major impairment. Only a small fraction had decreased HRQOL. A chronic course, either polycyclic or continuous, consistently predicted a poorer outcome. Mortality rate was 3.1%.ConclusionThis study confirms the marked improvement in functional outcome of juvenile DM when compared with earlier literature. However, many patients had continued disease activity and cumulative damage at followup. A chronic course was the strongest predictor of poor prognosis. These findings highlight the need for treatment strategies that enable a better control of disease activity over time and the reduction of nonreversible damage.
Genotoxicity of anti–tumor necrosis factor therapy in patients with juvenile idiopathic arthritis
Authors: Demirkaya Erkan , Cok Ismet , Durmaz Emre , Ulutas Onur K. , Ayaz Nuray Aktay , Besbas Nesrin , Özen Seza 
Published: December 2009

AbstractObjectiveTo assess the possible effects of both inflammation and the anti–tumor necrosis factor agents (anti‐TNF) on DNA damage with a specific assay, and their effects on the repair capacity of DNA.MethodsFrom a group of 20 children with juvenile idiopathic arthritis (JIA), 16 patients who completed the study and 16 control subjects were evaluated. DNA damage and repair capacity were analyzed by the comet assay at the level of peripheral lymphocytes before anti‐TNF (etanercept) injections and on the 15th, 90th, and 180th days after the first injection.ResultsThe amount of damage as detected by the aforementioned assay was higher in patients with JIA compared with controls. On the 15th day after the initial anti‐TNF injection, there was a decrease in the mean DNA tail length of JIA patients, however on the 90th day an increase was observed; thereafter, an upward trend was observed until the end of the study. JIA patients had a DNA repair capacity that was significantly less than that of controls.ConclusionThe results of the comet technique suggests that JIA patients already have increased basal DNA damage before anti‐TNF therapy; they are more sensitive to the DNA damage produced by H2O2, and have a less efficient DNA repair system in comparison with control cells. After an initial improvement at 2 weeks, parameters of genotoxicity worsened, and DNA repair was further impaired 6 months after the addition of an anti‐TNF agent to treatment.
A modified sharp score demonstrates disease progression in established psoriatic arthritis
Authors: Ravindran J. , Cavill C. , Balakrishnan C. , Jones S. M. , Korendowych E. , McHugh N. J. 
Published: December 2009

AbstractObjectiveTo use a modified Sharp score (MSS) to measure radiologic progression and to assess its relationship to other radiologic features, peripheral joint disease, and physical function in psoriatic arthritis (PsA).MethodsTwo sets of hand radiographs (median interval 5.75 years) in 139 patients with established PsA were scored using an MSS. Seventy‐four patients had standardized clinical joint and Health Assessment Questionnaire (HAQ) scores and other radiologic features of PsA documented at baseline and followup (median interval 5 years).ResultsRadiologic damage was present in 58% of patients at baseline and 74% at followup. The median MSS and its components, erosion score and joint space abnormality score, were significantly greater at followup (P < 0.001). The median MSS progression was +1.08 units/year. There was strong correlation between MSS and clinical joint scores at baseline and followup (r = 0.72 and r = 0.81, respectively). There was weak correlation between MSS and HAQ at baseline (r = 0.29), but stronger correlation at followup (r = 0.48). There was a strong association between MSS and other characteristic radiologic features of PsA (bony proliferation, periostitis, bony ankylosis) at baseline and followup (P < 0.001). However, the presence of soft‐tissue swelling on radiographs at baseline was the only radiologic parameter associated with an increased rate of change of MSS (corrected P < 0.006).ConclusionThe MSS shows good construct validity with measures of peripheral joint involvement such as clinical joint scores and other radiologic features of PsA, and is able to demonstrate that radiologic damage is progressive beyond early disease.
Physician preference motivates the use of anti–tumor necrosis factor therapy independent of clinical disease activity
Authors: Curtis Jeffrey R. , Chen Lang , Harrold Leslie R. , Narongroeknawin Pongthorn , Reed George , Solomon Daniel H. 
Published: December 2009

AbstractObjectivePhysician preference has previously been shown to be an important determinant of prescription patterns, independent of patient‐specific factors. We evaluated whether physician preference was important in the decision to select anti–tumor necrosis factor (anti‐TNF) therapy rather than nonbiologic disease‐modifying antirheumatic drugs (DMARDs) among rheumatoid arthritis (RA) patients initiating a new RA medication.MethodsUsing data from the Consortium of Rheumatology Researchers of North America, we identified RA patients who had never taken biologics initiating either anti‐TNF therapy or a DMARD in 2001–2008. Physician preference for the use of anti‐TNF agents was calculated using data from the preceding calendar year for each physician's other RA patients. Multivariable logistic regression with generalized estimating equations accounted for clustering of patients within the physician practice and evaluated the relationship between physician preference and receipt of anti‐TNF therapy, controlling for patient‐related factors and disease activity using the Clinical Disease Activity Index.ResultsWe identified 1,532 RA patients initiating anti‐TNF therapy or a DMARD. In models adjusting for tender and swollen joint counts and global disease activity, physician preference for the use of anti‐TNF therapy was an independent predictor of receipt of these agents. Patients of physicians in the highest and middle tertiles of physician preference had a 2.50 (95% confidence interval [95% CI] 1.76–3.56) and 1.70 (95% CI 1.22–2.39) greater likelihood of receiving anti‐TNF medications, respectively.ConclusionPhysician preference is an important determinant of patients' receipt of anti‐TNF therapy and may be useful to examine in future studies of RA treatment patterns, costs, and medication safety.