bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of general practitioners by video observation of communicative and medical performance in daily practice: issues of validity, reliability and feasibility
Authors: Ram  , Grol  , Rethans  , Schouten  , Vleuten  , Kester  
Published: March 2003

ObjectivesTo develop a video assessment method for General Practitioners (GPs) by analysing issues of validity, reliability and feasibility of observation of videotaped regular consultations.DesignIn a cross‐sectional study consultations of 93 GPs were video recorded in the practice during 1 week. The GPs registered consultation and patient data in a logbook; 16 consultations per GP were selected using preset criteria. The quality of communicative and medical performance of these consultations was assessed by GP observers with a validated instrument. The validity of the procedure was evaluated by checking the content of each GP’s sample using specific sample criteria. Selection bias was estimated by multiple regression analysis, with sample characteristics as independent variables and scores on communication and medical performance as dependent variables. The influence of observation on GPs and patients was assessed by a questionnaire. Generalizability theory was used to estimate reliability. Feasibility was assessed by conducting a questionnaire, by keeping accounts, and by checking the technical quality of the videotaped consultations.SettingUniversities of Nijmegen and Maastricht, The Netherlands.SubjectsGeneral Practitioners (GPs).ResultsThe domain of general practice was well covered in the samples; content validity was satisfactory. With regard to the sample characteristics, only the total duration of consultations appeared to correlate significantly with both the score on communication and the score on medical performance. A majority (71%) of GPs reported not being influenced by the observation, except in the first cases, and recognizing their usual daily performance in the videotaped consultations. An acceptable level of reliability was reached after 2·5 hours of observation, i.e. 12 cases by a single observer. The method was well accepted by both GPs and patients. The costs were £250 per GP.ConclusionsVideo assessment of GPs in daily practice according to the procedures described is a valid and reliable method, one which is useful for education and quality improvement. There is a trade‐off between feasibility on one hand and validity, reliability and credibility on the other hand. Compared to investments in observation methods in standardized settings, the costs of video observation of GPs’ actual performance are acceptable.
Gender, sequence of cases and day effects on clinical skills assessment with standardized patients
Authors: Gispert R , Rué M , Roma J , Martinez‐Carretero J M 
Published: March 2003

ObjectiveClinical skills assessment using standardized patients (SPs) is an accepted method of professional testing, but some factors can threaten the validity of the scores obtained.ObjectiveThe main objective of this work was to test whether the gender of the patients, the sequence of cases and the day of the examination have any impact on the scores of the examinees.MaterialsData from examinations conducted at three Medical Schools are used. Each student encountered 10 different SPs (5 men and 5 women).MethodsAnalysis of variance was used to test the existence of association between the variables.ResultsThe results showed no significant differences or association between the scores and the three variables analysed.ConclusionsThe results are coherent with the studies that show that performance based examination using SPs can be used without introducing biases into students score.
Teaching clinical reasoning – a preliminary controlled study
Authors: Round A P 
Published: March 2003

BackgroundThe formal and explicit teaching of clinical reasoning is rarely undertaken in medical schools despite widespread recognition that knowledge acquisition alone may be insufficient to develop good clinical judgement. Previous work studying the effects of such teaching is inconclusive.Design and methodsA controlled observational study of 4th year medical students considered the effect of a brief teaching intervention on clinical reasoning skills. A validated measure of clinical reasoning – the diagnostic thinking inventory – was used as the outcome measure.ResultsStudents participating in the teaching intervention performed significantly better on the diagnostic thinking inventory than control students.ConclusionFurther research is necessary to evaluate the long‐term impact of such teaching.
The clinical skills resource: a review of current practice
Authors: Boulay Clair du , Medway Christine 
Published: March 2003

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK.Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency.The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors.The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research.The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.
Education and training in the senior house officer grade: results from a cohort study of United Kingdom medical graduates
Authors: Cooke  , Hurlock  
Published: March 2003

IntroductionThis paper shows the findings from a survey of 439 senior house officers undertaken as part of the British Medical Association cohort study of 1995 medical graduates. The aim of the study was to assess the quality of senior house officer training in the United Kingdom.MethodIn July 1997 a postal questionnaire was sent to a sample of 545 doctors who graduated from medical school in 1995. Responses were received from 515 (95%). Only those doctors who had worked as a senior house officer in the previous 12 months were included in the analysis (n = 439).ResultsEncouraging results are that 69% of the senior house officers surveyed had discussed their progress directly with their consultant, and 24% rated their supervision by their consultant as ‘excellent’. Of concern are the findings that 47% of respondents did not receive protected teaching time and 16% were unable to take study leave.DiscussionThe study revealed wide variability in the quality of training received by senior house officers in the United Kingdom. Whilst some respondents – notably those in general practice, accident and emergency, paediatrics and psychiatry – had enjoyed a high standard of education and training, it was clear that a minority of posts continue to offer little if any educational value to the post holder. The results point to a need for a more systematic approach to maintaining standards in senior house officer training with greater incentives for under‐performing trusts.
Amplified fragment length polymorphism (AFLP) reveals introgression in weedyOnopordumthistles: hybridization and invasion
Authors: O’Hanlon P. C. , Peakall Rod , Briese D. T. 
Published: March 2003

AbstractOnopordumL. (Compositae) is an extremely diverse genus of thistles, which includes several species that have become serious pasture weeds in several regions of the world. We present a comparison of the genetic diversity in invasive forms ofOnopordumfrom Australia with several known native European species. A total of 108 polymorphic genetic markers was generated using amplified fragment length polymorphism (AFLP) fingerprinting. Non‐metric multidimensional scaling (NMDS) revealed that Australia containedO. acanthium,O. illyricumand a full range of genetic intermediates between these species. Intermediates largely comprised segregating fragments diagnostic for EuropeanO. acanthiumandO. illyricumwith a low frequency of fragments that were diagnostic for other species never recorded in Australia. The current genetic patterns in Australia may be best explained by a combination of processes, both in the native and in the alien range. These include multiple introductions of seed, including hybrid material, and the continuous dispersal in Australia, leading to an increase in the contact among hybridizing taxa. Such processes appear to have produced more widespread hybridization and introgression in AustralianOnopordumthan is found in Europe.
Phylogeography and postglacial dispersion of the chub (Leuciscus cephalus) in Europe
Authors: Durand J. D. , Persat H. , Bouvet Y. 
Published: March 2003

AbstractA phylogeographic analysis of mitochondrial DNA variation was performed in order to test the hypothesis of a postglacial recolonization of mid‐ and north‐European rivers from a Danubian refuge. Over 345 chub specimens from European rivers covering most of the species’ native range were investigated using 600 bp of the cytochrome b gene. Chub in European rivers belong to four highly divergent mitochondrial groups (lineages) differing by mean divergence estimates from 5.2% to 7.89%. These four lineages have a largely allopatric distribution, implying four geographical sets: two Mediterranean, and two north‐European sets. This pattern provided strong evidence for: (i) the eradication of this species from most of Europe during maximum ice extent; (ii) its survival in four refugia (Adriatic side of the Balkans, eastern Greece (Aegean Rivers), southern tributaries of the Danube, and periphery of Black and Caspian Seas); (iii) a differential postglacial recolonization of mid‐ and northern Europe from the last two refugia only; (iv) the occurrence of this recolonization in two steps for the Danubian (western) lineage that entered western Europe (Rhine–Rhone–Loire drainages) during the Riss–Würm interglacial period and survived the last glaciation there before colonizing Garonne, UK and German drainages up to the Elbe during the Holocene; and (v) the occurrence of this recolonization in a single step for the Ponto‐Caspian (eastern) lineage that entered the Baltic area as far as the Oder in the Holocene. Both lineages came into contact in the River Elbe without evident mixing.
Population genetic structure of the African elephant in Uganda based on variation at mitochondrial and nuclear loci: evidence for male‐biased gene flow
Authors: Nyakaana Silvester , Arctander Peter 
Published: March 2003

AbstractA drastic decline has occurred in the size of the Uganda elephant population in the last 40 years, exacerbated by two main factors; an increase in the size of the human population and poaching for ivory. One of the attendant consequences of such a decline is a reduction in the amount of genetic diversity in the surviving populations due to increased effects of random genetic drift. Information about the amount of genetic variation within and between the remaining populations is vital for their future conservation and management. The genetic structure of the African elephant in Uganda was examined using nucleotide variation of mitochondrial control region sequences and four nuclear microsatellite loci in 72 individuals from three localities. Eleven mitochondrial DNA (mtDNA) haplotypes were observed, nine of which were geographically localized. We found significant genetic differentiation between the three populations at the mitochondrial locus while three out of the four microsatellite loci differentiated KV and QE, one locus differentiated KV and MF and no loci differentiated MF and QE. Expected heterozygosity at the four loci varied between 0.51 and 0.84 while nucleotide diversity at the mitochondrial locus was 1.4%. Incongruent patterns of genetic variation within and between populations were revealed by the two genetic systems, and we have explained these in terms of the differences in the effective population sizes of the two genomes and male‐biased gene flow between populations.
Spatial and temporal population genetic structure of the butterfly Aglais urticae L. (Lepidoptera, Nymphalidae)
Authors: Vandewoestijne Sofie , Nève Gabriel , Baguette Michel 
Published: March 2003

AbstractThe genetic diversity and the temporal and spatial genetic population structure of the butterfly Aglais urticae, a highly mobile species, were studied by allozyme electrophoresis. High levels of allozyme diversity were found. Most of the total genetic diversity occurred at the within‐population scale rather than at the between‐population scale. This variation could not be accounted for by Wright’s model of ‘isolation by distance’. No significant temporal variation was observed for those populations that were sampled in different years. A process combining high movement rate between neighbouring patches, long‐distance migration and rare extinction/recolonization is suggested to explain the observed genetic structure. This hypothesis is favoured over an island model of population structure because migration in A. urticae is uniform neither with distance nor with time.
A comparison of two indirect methods for estimating average levels of gene flow using microsatellite data
Authors: Gaggiotti O. E. , Lange O. , Rassmann K. , Gliddon C. 
Published: March 2003

AbstractWe compare the performance of Nm estimates based on FST and RST obtained from microsatellite data using simulations of the stepwise mutation model with range constraints in allele size classes. The results of the simulations suggest that the use of microsatellite loci can lead to serious overestimations of Nm, particularly when population sizes are large (N > 5000) and range constraints are high (K < 20). The simulations also indicate that, when population sizes are small (N ≤ 500) and migration rates are moderate (Nm ≈ 2), violations to the assumption used to derive the Nm estimators lead to biased results. Under ideal conditions, i.e. large sample sizes (ns ≥ 50) and many loci (nl ≥ 20), RST performs better than FST for most of the parameter space. However, FST‐based estimates are always better than RST when sample sizes are moderate or small (ns ≤ 10) and the number of loci scored is low (nl < 20). These are the conditions under which many real investigations are carried out and therefore we conclude that in many cases the most conservative approach is to use FST.
Population structure delineated with microsatellite markers in fragmented populations of a tropical tree, Carapa guianensis (Meliaceae)
Authors: Dayanandan S. , Dole J. , Bawa K. , Kesseli R. 
Published: March 2003

AbstractDeforestation and selective logging in the tropics may have serious consequences on genetic processes in tropical tree populations, affecting long‐term survival of a given species as well as tropical forest communities. Because understanding the effects of human‐induced changes on genetic processes is of utmost importance in formulating sound conservation and management plans for tropical forest communities, we developed microsatellite or simple sequence repeat (SSR) markers for the tropical tree Carapa guianensis (Meliaceae) and assessed the polymorphism of SSRs in adult and sapling populations in a large contiguous forest and in selectively logged and fragmented forests. The number of alleles in polymorphic loci ranged between 4 and 28. No inbreeding was detected in saplings or adult cohorts, but the allelic richness was lower in the sapling cohort of the isolated fragment. Genetic distances, Nei’s D and (δµ)2, and RST values among saplings were greater than among adult cohorts, suggesting restriction of gene flow due to deforestation and habitat fragmentation. These SSR loci may be used to address many related questions regarding the population and conservation genetics of tropical trees.
Comparison of the population genetics and densities of five Pinanga palm species at Kuala Belalong, Brunei
Authors: Shapcott A. 
Published: March 2003

AbstractThis study investigated the effect of population density on the population genetic structure of five co‐occurring congeneric understorey palm species: Pinanga aristata, P. sp. aff. brevipes, P. dumetosa, P. tenella var. tenella and P. veitchii, all endemic to northern Borneo. The average population densities of the study species varied across a wide spectrum, ranging from 343 (plants per ha) in P. tenella to 10 (plants per ha) in P. veitchii. All species of Pinanga palms studied had quite high levels of genetic diversity (HE: 0.379, 0.256, 0.294, 0.133, 0.352). Genetic diversity (HE) was correlated with population density (D;rs = − 0.433, P < 0.01) and the average distance to the nearest conspecific neighbour (NN;rs = 0.576, P < 0.001) such that the most‐dense species had less genetic diversity and the less‐dense species had greater genetic diversity. Gene flow (Nm) among populations approximately followed a gradient of increasing species density and abundance, such that the most common species P. dumestosa had the greatest gene flow (Nm = 2.268) between its populations and the rarest, most sparsely distributed species P. sp. aff. brevipes had the lowest (Nm = 0.698). All species of Pinanga were effectively inbred (F: 0.760, 0.856, 0.640, 0.753, 0.674). The amount of homozygosity and inbreeding (HO, F) were not correlated (P > 0.05) with population density (D) or the distance between nearest neighbouring plants of the same species (NN).
Impact of gene flow from cultivated beet on genetic diversity of wild sea beet populations
Authors: Bartsch Detlef , Lehnen Marc , Clegg Janet , Pohl‐Orf Matthias , Schuphan Ingolf , Ellstrand Norman C. 
Published: March 2003

AbstractGene flow and introgression from cultivated plants may have important consequences for the conservation of wild plant populations. Cultivated beets (sugar beet, red beet and Swiss chard: Beta vulgaris ssp. vulgaris) are of particular concern because they are cross‐compatible with the wild taxon, sea beet (B.vs. ssp. maritima). Cultivated beet seed production areas are sometimes adjacent to sea beet populations; the numbers of flowering individuals in the former typically outnumber those in the populations of the latter. In such situations, gene flow from cultivated beets has the potential to alter the genetic composition of the nearby wild populations. In this study we measured isozyme allele frequencies of 11 polymorphic loci in 26 accessions of cultivated beet, in 20 sea beet accessions growing near a cultivated beet seed production region in northeastern Italy, and 19 wild beet accessions growing far from seed production areas. We found one allele that is specific to sugar beet, relative to other cultivated types, and a second that has a much higher frequency in Swiss chard and red beet than in sugar beet. Both alleles are typically rare in sea beet populations that are distant from seed production areas, but both are common in those that are near the Italian cultivated beet seed production region, supporting the contention that gene flow from the crop to the wild species can be substantial when both grow in proximity. Interestingly, the introgressed populations have higher genetic diversity than those that are isolated from the crop. The crop‐to‐wild gene flow rates are unknown, as are the fitness consequences of such alleles in the wild. Thus, we are unable to assess the long‐term impact of such introgression. However, it is clear that gene flow from a crop to a wild taxon does not necessarily result in a decrease in the genetic diversity of the native plant.
Marine population structure in an anadromous fish: life‐history influences patterns of mitochondrial DNA variation in the eulachon, Thaleichthys pacificus
Authors: McLean Jennifer E. , Hay D. E. , Taylor Eric B. 
Published: March 2003

AbstractDue to the apparent decline in size of a number of populations, eulachon, Thaleichthys pacificus, have recently become the focus of a conservation movement in the northeast Pacific. Little is known of the marine life‐history phase of this anadromous fish, and although it has been suggested that eulachon spawning in different rivers may form distinct populations, nothing is known of their population structure. Molecular genetic data were used to investigate population structure and possible management schemes. Mitochondrial DNA genotypes, determined through restriction fragment length polymorphisms (RFLP) analysis, were resolved in fish from several rivers throughout the geographical range of eulachon. Our data support the idea that extant eulachon populations result from postglacial dispersal from a single Wisconsinan glacial refuge. Further, while three of the 37 haplotypes recovered account for approximately 79% of the samples, many private haplotypes were observed, suggesting possible regional population structure. While a great deal of genetic variation was observed (37 haplotypes in 315 samples), an amova showed that > 97% of the total variation was detected within populations. As yet, it is unclear whether genetically distinct populations of eulachon exist, or if these fish may be treated as one or a few large populations. Results were tested against predictions made from hypotheses concerning the origin and persistence of subdivided populations in marine species, and seem to be more consistent with the Member–Vagrant hypothesis than isolation by distance. Eulachon present an interesting situation that illustrates the difficulties involved in defining management units in organisms with high levels of gene flow.