Should we discontinue Pap smear screening in women aged >65 years?

Women with a history of regular, normal Pap smear screening should discontinue screening by age 65 years (strength of recommendation [SOR]: B). Women without a history of serial normal Pap smears should continue screening (SOR: B)

What is the best approach to the evaluation of hirsutism?

The evaluation of hirsutism should begin with a history and physical examination to identify signs and symptoms suggestive of diseases such as polycystic ovarian syndrome (PCOS), hypothyroidism, hyperprolactinemia, hyperandrogenic insulin-resistant acanthosis nigricans (HAIR-AN) syndrome, androgenic tumors, Cushing's syndrome, or congenital adrenal hyperplasia (CAH). Findings suggestive of these diseases include rapid or early-onset hirsutism, menstrual irregularities, hypertension, severe hirsutism, virilization, or pelvic masses (strength of recommendation [SOR]: B, based on a cohort study in a referral population). Hirsutism with unremarkable history and physical exam findings should be evaluated with a serum total testosterone and dehydroepiandrosterone sulfate (DHEAS) level (SOR: B, based on a cohort study in a referral population)

A Comparative Review of Canadian Health Professional Education Accreditation Systems

Canadian governments and various stakeholder groups are advocating greater interprofessional collaboration amongst health care providers as a fundamental strategy for enhancing coordination and quality of care in the health care system. Interprofessional education for collaborative patient-centred practice (IECPCP) is an educational process by which students/learners (or workers) from different health professions learn together to improve collaboration. The educational system is believed to be a main determinant of interprofessional collaborative practice, yet academic institutions are largely influenced by accreditation, certification and licensure bodies. Accreditation processes have been linked to the continuous improvement of curricula in the health professions, and have also been identified as potential avenues for encouraging educational change and innovation. The purpose of this paper is to summarize the characteristics of the national accreditation systems of select Canadian health professional education programs at both the pre- and post-licensure educational levels and to show how these systems support and/or foster IECPCP. A review of the educational accreditation systems of medicine, nursing, pharmacy, social work, occupational therapy and physiotherapy was undertaken through key informant interviews and an analysis of accreditation process documentation. The results of this comparative review suggest that accreditation systems are more prevalent across the health professions at a pre-licensure level. Accreditation at the post- licensure level, particularly at the continuing professional education level, appears to be less well established across the majority of health professions. Overall, the findings of the review also suggest that current accreditation systems do not appear to promote nor foster interprofessional education for collaborative patient-centred practice in a systematic manner through either accreditation processes or standards. Through a critical adult learning perspective we argue that in order for traditional uni-professional structures within the health professional education system to be challenged, the accreditation system needs to place greater value on interprofessional education for collaborative patient-centred practice.Les gouvernements du Canada ainsi que divers groupes d’intervenants appellent à une plus grande collaboration interprofessionnelle entre les fournisseurs de services de santé comme stratégie fondamentale pour rehausser la coordination et la qualité des soins dans le système des soins de santé. L’éducation interprofessionnelle pour la pratique collaborative centrée sur le patient (IECPCP) constitue un processus éducatif qui permet aux étudiants/apprenants (ou travailleurs) de diverses professions de la santé d’apprendre ensemble à mieux collaborer. Le système éducatif est perçu comme le principal déterminant de la pratique collaborative interprofessionnelle; cependant, les institutions éducatives sont fortement infl uencées par les organismes qui octroient les accréditations, certifi cations et autorisations d’exercer. Les processus d’accréditation ont été reliés à l’amélioration continue des programmes d’études dans les professions de santé et ils ont été également identifi és comme avenues potentielles pour encourager le changement et l’innovation en milieu éducatif. L’objectif de cet article est de résumer les caractéristiques des systèmes nationaux d’accréditation de certains programmes de formation des professionnels de la santé au Canada à tous les niveaux (pré- et post-autorisation d’exercer) et de montrer comment ces systèmes soutiennent ou encouragent l’IECPCP. Nous avons passé en revue les systèmes d’accréditation en médecine, soins infirmiers, pharmacie, travail social, ergothérapie et physiothérapie par le biais d’entrevues avec des personnes-clés et par l’analyse de la documentation sur les processus d’accréditation. Les résultats de cette étude comparative suggèrent que les systèmes d’accréditation dans les services de santé sont plus courants avant l’octroi de l’autorisation d’exercer. L’accréditation post-autorisation d’exercer, en particulier dans le domaine de la formation professionnelle continue, semble être moins bien établie dans la majorité des professions de la santé. Globalement, les résultats de l’étude suggèrent aussi que les systèmes actuels d’accréditation ne semblent pas promouvoir ou encourager la formation interprofessionnelle pour la pratique collaborative centrée sur le patient de façon systématique par les processus ou normes d’accréditation. Dans la perspective critique de l’apprentissage des adultes, nous avançons que, pour remettre en question les structures uniprofessionnelles traditionnelles du système éducatif des professions de la santé, le système d’accréditation doit accorder une plus grande place à l’éducation interprofessionnelle sur la pratique collaborative centrée sur le patient.&nbsp

Best Practices to Increase Efficacy of Graduate School Admissions Communications at Clark University

Within the period of time that a graduate student deposits and subsequently arrives at their academic institution, receiving timely information is important for their preparation. This process has been deemed by the Deans of the Enterprise Schools at Clark University as one that needs further investigation. As such, this Capstone looks at the array of communication that goes out to each graduate student during this four-month period. The purpose of examining this communication is to analyze its effectiveness in engaging students. To analyze the effectiveness of this communication, surveys were distributed to current students in these schools to gather data surrounding their experience after applying to Clark. In addition to looking at Clark University’s current process, we conducted an analysis of trends and best practices from colleges and universities across the country. Based on findings from this research and our firsthand interviews of the aforementioned Deans and involved staff members, we have provided recommendations to improve this process. Ultimately, in order to improve student engagement our group has created recommendations that could improve some of the challenges in engaging and retaining students during this period of time

Crisis y proteccionismo de rescate: algunas tendencias

Ante la desaceleración de la actividad económica a nivel global, los gobiernos de los países industrializados y en desarrollo recurrieron a medidas anticíclicas en una suerte de “proteccionismo de rescate”. Ello ha dado origen a nuevas tendencias y patrones proteccionistas.Fil: Curran, Linda. Facultad Latinoamericana de Ciencias Sociales. Sede Académica Argentina Buenos Aires; ArgentinaFil: Tussie, Diana Alicia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Facultad Latinoamericana de Ciencias Sociales. Sede Académica Argentina Buenos Aires; Argentin

Viendo llover en Macondo: Una visión secular del proteccionismo

A medida que la crisis financiera se extiende hacia la economía real los países han recurrido a una suerte de "proteccionismo de rescate" acompañado de políticas de apuntalamiento de la demanda. La protección es puntual, contingente,legalizada. Se trata de reconocer que no existen zonas oscuras de proteccionismo y zonas transparentes de librecambio, sino una continua y constante combinación de regulación selectiva.As the ripples of the financial crisis make their way into real economy governments have resorted to a series of anti-cyclical measures. In order to tackle negative impacts on levels of production andemployment, in a sort of “salvation/rescue/last-resource protectionism” hand in hand with active demand management. While, under normal circumstances this would entail an undesirable distortion of incentives, within a crisis context, and in the absence of a “first best” –perfect policy coordi-nation among countries–, a precise, contingent and legalized degree of protectionism, transparently implemented and subject to public scrutiny, can lead to a greater general welfare. In essence, there are no “black” times of protectionism and “white” times of free trade, but rather a continuous com-bination of liberalization and selective regulation.Fil: Tussie, Diana Alicia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Facultad Latinoamericana de Ciencias Sociales. Sede Académica Argentina Buenos Aires. Area de Relaciones Internacionales. Programa de Instituciones Económicas Internacionales; ArgentinaFil: Curran, Linda. Facultad Latinoamericana de Ciencias Sociales. Sede Académica Argentina Buenos Aires. Area de Relaciones Internacionales. Programa de Instituciones Económicas Internacionales; Argentin

Improving the medical school–residency transition

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138225/1/tct12576_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138225/2/tct12576.pd

Evaluation of a simulation‐based curriculum for implementing a new clinical protocol

ObjectiveTo evaluate the implementation of a new clinical protocol utilizing on‐unit simulation for team training.MethodsA prospective observational study was performed at the obstetrics unit of Von Voightlander Women’s Hospital, Michigan, USA, between October 1, 2012 to April 30, 2013. All members of the labor and delivery team were eligible for participation. Traditional education methods and in‐situ multi‐disciplinary simulations were used to educate labor and delivery staff. Following each simulation, participants responded to a survey regarding their experience. To evaluate the effect of the interventions, paging content was analyzed for mandated elements and adherence to operating room entry‐time tracking was examined.ResultsIn total, 51 unique individuals participated in 12 simulations during a 6‐month period. Simulation was perceived as a valuable activity and paging content improved. Following the intervention, the inclusion of a goal time for reaching the operation room increased from 7% to 61% of pages and the proportion of patients entering to operating room within 10 minutes of the stated goal increased from 67% to 85%.ConclusionThe training program was well received, and the accuracy of the communication and the goal set for reaching the operating room improved.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135397/1/ijgo333.pd