A systematic review of the effects of residency training on patient outcomes

<p>Abstract</p> <p>Background</p> <p>Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.</p> <p>Methods</p> <p>The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.</p> <p>Results</p> <p>Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design.Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.</p> <p>Conclusions</p> <p>The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.</p

Identification of individuals' emotional response to the indoor soundscape in public study areas via semantic differentiation

Aims of this research is to identify individuals' emotional response to the sound environment of public study areas. The research has taken place in the public study areas of Bilkent University Campus. These study areas are located at the Dormitories, the Fine Arts Buildings, the library, and the Faculty of Science. In order to explore individuals' response to the auditory environment, a questionnaire survey and in-situ measurement of sound levels (LAeq) have been conducted. Questionnaire survey consisted of two main parts. In first part students have identified the sound source, how often they hear each one, and their satisfaction with the sound environment. Second part consisted of twelve seven point semantic differential scales (SD). Semantic scales were chosen in order to identify individuals' emotional response to the soundscape. Questionnaire survey are held with 30 student from each public study area, 120 students in total. The data gathered from the questionnaire survey are analysed using IBM SPSS 21 Statistics Software. Factor analysis was used to identify the perceptual dimensions of soundscape. Three factors were identify as a result of the analysis, which are, well-being, activity/communication and functionality. Even though the ANOVA F-Test found no statistically significant difference between the study areas in terms of satisfaction with the soundscapes, each areas has sound environment characteristics. © 2017 Institute of Noise Control Engineering. All rights reserved

PErceived auditory environment in historic spaces of anatolian culture: A case study on HacI Bayram mosque

This article reports the initial finds of a research that is concerned with the perceived auditory environment within an historical mosque and its surroundings. Haci Bayram Mosque and its surrounding area of Hamamönü has been selected as the research site due to being the historical center of Ankara. Although there are studies concerned with the acoustical characteristics of mosques, there isn't enough research focusing on users' expectation and interpretation of the perceived auditory environment within a mosque. This study adopts the user focused of Grounded Theory to capture individuals' auditory sensation and interpretation of the perceived auditory environment within a historical mosque and its surroundings. In depth interviews are held with the congregation of the mosque and with the individuals sitting around the surrounding area. Based on their subjective responses, a theoretical framework is generated to gain an insight on the factors that affect individuals understanding and expectation from mosques. Acoustical characteristics of the mosque are analyzed by computer simulation and in-situ measurements of sound pressure levels. Objective room-acoustic indicators consist of reverberation time (RT) and speech transmission index (STI). The conceptual framework generated through Grounded Theory shows how perceived auditory environment may influence individuals' response to the physical environment of the mosque by showing the associations between the soundscape elements, spatial function and sense of place

Construction of a collagen-based, split-thickness cornea substitute

Tissue-engineered corneas may become a promising alternative to allografts in the treatment of serious cornea defects because of the tunable characteristics of the biomaterials, biomimetic designs, and incorporation of patient's own cells. In this study, collagen foam was coated with a fibrous mat to mimic the stromal layer and the Bowman's layer. The stromal layer substitute was made of N-ethyl-N-(3-dimethyl aminopropyl)carbodiimide/N-hydroxysuccinimide-cross-linked collagen-chondroitin sulfate foam and seeded with primary human corneal keratocytes (HK). Retinal pigment epithelium (RPE) cells served as the epithelial layer after seeding on a dehydrothermally cross-linked collagen type I fibrous mat deposited directly on top of the foams by electrospinning. The physical characterization and the in vitro studies showed that the designed cornea replacement was suitable for cell attachment and growth, and co-culture of the two cell types induced more extracellular matrix (ECM) deposition than the single cell-seeded constructs. The fiber layer was shown to be successful in separating the HK and RPE cells, and still allowed them to maintain cell-cell communication as the increase in ECM deposition and the maintenance of the high transparency (similar to 80%) suggested. This split-thickness corneal substitute was also shown to be readily suturable without any major tears at the end of a short co-culture of 30days

Chemical composition of Turkish olive oil, Ayvalik

Although large amounts of olive oil are produced in Turkey, not much information on its chemical composition is available in the literature to date. The aim of this study was to evaluate the chemical composition of commercial olive oils produced from the Ayvalik olive cultivar in Canakkale, Turkey. Five different samples corresponding to the olive oil categories of extra virgin (conventional, extra virgin olive oil (EVOO), and organic extra virgin olive oil (OGOO) production), virgin olive oil (OO-1), ordinary virgin olive oil (OO-2) and refined olive oil (RFOO) were evaluated. Olive oils were collected from two consecutive production years. According to the free fatty acids, the absorbance values (K-232 and K-270), and peroxide values of all the samples conformed to the European standards for olive oil. The level of oleic acid was in the range of 68-73%; while the linoleic acid content was significantly lower in the refined olive oils. The tocopherol and polyphenol content was in the lower range of some European olive oils. However, pinoresinol was a major phenolic compound (5-77 mg/kg depending on the oil category). Its content was markedly higher than in many other oils, which would be a useful finding for olive oil authentication purposes