Exploring the major difficulties perceived by residents in training: a pilot study.

To assess residents' difficulties during the first year of residency. In contrast to previous studies that mainly used structured questionnaires, a qualitative procedure was applied. Twenty-four consecutive first-year residents in internal medicine were asked to "Please identify two to three major difficulties or concerns related to your practice of medicine within this hospital". The answers were submitted to content analysis performed by three independent researchers. Inter-rater agreement was high (kappa coefficient = 0.92). Disagreements were solved by consensus. Physicians' characteristics: female 37%, mean age 28 +/- 2.2 years, mean duration of postgraduate training 2.5 +/- 1.3 years. Total number of answers: 122, average answers/resident 5.1 +/- 1.3. Nine categories were extracted from content analysis: communication problems at the workplace, feelings of not being respected, constraints of collaborative work, experiencing the gap between medical school and clinical care, work overload, responsibility towards and emotional investment in patients, worries about career plans, and lack of theoretical knowledge. Residents expressed major difficulties in communicating with and being respected by seniors and peers in particular, and hospital staff in general. They also voiced problems in coping with emotions, either their own or those of their patients. The residents' responses stressed the complexity of blending the requirements of the physician's role when instrumental/cognitive knowledge is not sufficient to deal with problems requiring personal and relational dimensions. Learning to combine medical knowledge and practice necessitates helping students/residents identify and deal with the constraints of these requirements

Aharonov-Bohm ring with fluctuating flux

We consider a non-interacting system of electrons on a clean one-channel Aharonov-Bohm ring which is threaded by a fluctuating magnetic flux. The flux derives from a Caldeira-Leggett bath of harmonic oscillators. We address the influence of the bath on the following properties: one- and two-particle Green's functions, dephasing, persistent current and visibility of the Aharonov-Bohm effect in cotunneling transport through the ring. For the bath spectra considered here (including Nyquist noise of an external coil), we find no dephasing in the linear transport regime at zero temperature. PACS numbers: 73.23.-b, 73.23.Hk, 73.23.Ra, 03.65.YzComment: 17 pages, 8 figures. To be published in PRB. New version contains minor corrections and additional discussion suggested by referee. A simple introduction to the basics of dephasing can be found at http://iff.physik.unibas.ch/~florian/dephasing/dephasing.htm

EuroSpine Task Force on Research: support for spine researchers

In recognition of the value of research to the practice of spine care, Federico Balagué and Ferran Pellisé, at the time President and Secretary for EuroSpine, asked Margareta Nordin to set up a Task Force on Research (TFR) for EuroSpine during summer 2011. The concept was to stimulate and facilitate a research community within the society, through two main functions: (1) distribution of EuroSpine funds to researchers; (2) develop and deliver research training/education courses. What has the EuroSpine TFR accomplished since its inception

Health Expect

BACKGROUND: The patient has always been at the centre of the evidence-based medicine model. Case-based critical reviews, such as best-evidence topics, however, are incomplete reflections of the evidence-based medicine philosophy, because they fail to consider the patient's perspective. We propose a new framework, called the 'Shared Decision Evidence Summary' (ShaDES), where the patient's perspective on available treatment options is explicitly included. METHODS: Our framework is grounded in the critical appraisal of a clinical scenario, and the development of a clinical question, including patient characteristics, compared options and outcomes to be improved. Answers to the clinical question are informed by the literature, the evaluation of its quality and its potential usefulness to the clinical scenario. Finally, the evidence synthesis is presented to the patient to facilitate the formulation of an evidence-informed decision about the treatment options. KEY RESULTS: Using three similar but contrasted clinical scenarios of patients with low back pain, we illustrate how considering the patient's preferences on the proposed treatment options impact the bottom line, a synthetic formulation of the answer to the focused question. ShaDES includes clinical and psychosocial components, transformed in a searchable question, with a full search strategy. CONCLUSIONS: ShaDES is a practical framework that may facilitate clinical decisions adapted to psychological, social and other relevant non-clinical characteristics of patients

A PROSPECTIVE CONTROLLED STUDY OF LOW BACK SCHOOL IN THE GENERAL POPULATION

There are no data on the efficacy of a back school in primary prevention of back pain in the general population or on the characteristics of the population who volunteers. After announcement in the local press, 494 healthy adults volunteered and paid for a back school course in Switzerland. A total of 371 controls were matched for sex, age, profession, nationality and back pain. A statistically significant decrease in numbers of doctor's visits was found by the participants during the following 6 months compared with the controls. However, there were no significant between-group differences in the four remaining parameters (presence and intensity of back pain, drug intake and sick leave). Three-quarters of participants changed their attitudes after the back school. Volunteering for a back pain prevention programme was associated with the presence of back pain problems. Reasons for volunteering are further discussed. Overall, the results of this study showed that a back school for the general population may not solve the problem of low back pain, but improves self-help in a subgroup of the populatio

Dephasing in sequential tunneling through a double-dot interferometer

We analyze dephasing in a model system where electrons tunnel sequentially through a symmetric interference setup consisting of two single-level quantum dots. Depending on the phase difference between the two tunneling paths, this may result in perfect destructive interference. However, if the dots are coupled to a bath, it may act as a which-way detector, leading to partial suppression of the phase-coherence and the reappearance of a finite tunneling current. In our approach, the tunneling is treated in leading order whereas coupling to the bath is kept to all orders (using P(E) theory). We discuss the influence of different bath spectra on the visibility of the interference pattern, including the distinction between "mere renormalization effects" and "true dephasing".Comment: 18 pages, 8 figures; For a tutorial introduction to dephasing see http://iff.physik.unibas.ch/~florian/dephasing/dephasing.htm

Mesoscopic circuits with charge discreteness:quantum transmission lines

We propose a quantum Hamiltonian for a transmission line with charge discreteness. The periodic line is composed of an inductance and a capacitance per cell. In every cell the charge operator satisfies a nonlinear equation of motion because of the discreteness of the charge. In the basis of one-energy per site, the spectrum can be calculated explicitly. We consider briefly the incorporation of electrical resistance in the line.Comment: 11 pages. 0 figures. Will be published in Phys.Rev.

Cognitive-behavioural treatment for subacute and chronic neck pain

BACKGROUND: Although research on non-surgical treatments for neck pain (NP) is progressing, there remains uncertainty about the efficacy of cognitive-behavioural therapy (CBT) for this population. Addressing cognitive and behavioural factors might reduce the clinical burden and the costs of NP in society.OBJECTIVES: To assess the effects of CBT among individuals with subacute and chronic NP. Specifically, the following comparisons were investigated: (1) cognitive-behavioural therapy versus placebo, no treatment, or waiting list controls; (2) cognitive-behavioural therapy versus other types of interventions; (3) cognitive-behavioural therapy in addition to another intervention (e.g. physiotherapy) versus the other intervention alone.SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, Web of Science, and PubMed, as well as ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to November 2014. Reference lists and citations of identified trials and relevant systematic reviews were screened.SELECTION CRITERIA: We included randomised controlled trials that assessed the use of CBT in adults with subacute and chronic NP.DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risk of bias in each study and extracted the data. If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was performed. We determined the quality of the evidence for each comparison with the GRADE approach.MAIN RESULTS: We included 10 randomised trials (836 participants) in this review. Four trials (40%) had low risk of bias, the remaining 60% of trials had a high risk of bias.The quality of the evidence for the effects of CBT on patients with chronic NP was from very low to moderate. There was low quality evidence that CBT was better than no treatment for improving pain (standard mean difference (SMD) -0.58, 95% confidence interval (CI) -1.01 to -0.16), disability (SMD -0.61, 95% CI -1.21 to -0.01), and quality of life (SMD -0.93, 95% CI -1.54 to -0.31) at short-term follow-up, while there was from very low to low quality evidence of no effect on various psychological indicators at short-term follow-up. Both at short- and intermediate-term follow-up, CBT did not affect pain (SMD -0.06, 95% CI -0.33 to 0.21, low quality, at short-term follow-up; MD -0.89, 95% CI -2.73 to 0.94, low quality, at intermediate-term follow-up) or disability (SMD -0.10, 95% CI -0.40 to 0.20, moderate quality, at short-term follow-up; SMD -0.24, 95% CI-0.54 to 0.07, moderate quality, at intermediate-term follow-up) compared to other types of interventions. There was moderate quality evidence that CBT was better than other interventions for improving kinesiophobia at intermediate-term follow-up (SMD -0.39, 95% CI -0.69 to -0.08, I(2) = 0%). Finally, there was very low quality evidence that CBT in addition to another intervention did not differ from the other intervention alone in terms of effect on pain (SMD -0.36, 95% CI -0.73 to 0.02) and disability (SMD -0.10, 95% CI -0.56 to 0.36) at short-term follow-up.For patients with subacute NP, there was low quality evidence that CBT was better than other interventions at reducing pain at short-term follow-up (SMD -0.24, 95% CI -0.48 to 0.00), while no difference was found in terms of effect on disability (SMD -0.12, 95% CI -0.36 to 0.12) and kinesiophobia.None of the included studies reported on adverse effects.AUTHORS' CONCLUSIONS: With regard to chronic neck pain, CBT was found to be statistically significantly more effective for short-term pain reduction only when compared to no treatment, but these effects could not be considered clinically meaningful. When comparing both CBT to other types of interventions and CBT in addition to another intervention to the other intervention alone, no differences were found. For patients with subacute NP, CBT was significantly better than other types of interventions at reducing pain at short-term follow-up, while no difference was found for disability and kinesiophobia. Further research is recommended to investigate the long-term benefits and risks of CBT including for the different subgroups of subjects with N

Suppression of level hybridization due to Coulomb interactions

We investigate an ensemble of systems formed by a ring enclosing a magnetic flux. The ring is coupled to a side stub via a tunneling junction and via Coulomb interaction. We generalize the notion of level hybridization due to the hopping, which is naturally defined only for one-particle problems, to the many-particle case, and we discuss the competition between the level hybridization and the Coulomb interaction. It is shown that strong enough Coulomb interactions can isolate the ring from the stub, thereby increasing the persistent current. Our model describes a strictly canonical system (the number of carriers is the same for all ensemble members). Nevertheless for small Coulomb interactions and a long side stub the model exhibits a persistent current typically associated with a grand canonical ensemble of rings and only if the Coulomb interactions are sufficiently strong does the model exhibit a persistent current which one expects from a canonical ensemble.Comment: 19 pages, 6 figures, uses iop style files, version as publishe

Effect of Charge Fluctuations on the Persistent Current through a Quantum Dot

We study coherent charge transfer between an Aharonov-Bohm ring and a side-attached quantum dot. The charge fluctuation between the two sub-structures is shown to give rise to algebraic suppression of the persistent current circulating the ring as the size of the ring becomes relatively large. The charge fluctuation at resonance provides transition between the diamagnetic and the paramagnetic states. Universal scaling, crossover behavior of the persistent current from a continuous to a discrete energy limit in the ring is also discussed.Comment: 5 pages, 4 figure