Twelve tips for teaching brief motivational interviewing to medical students

Background: Shifting from paternalistic to patient-centred doctor-patient relationships has seen a growing number of medical programs incorporate brief motivational interviewing training in their curriculum. Some medical educators, however, are unsure of precisely what, when, and how to incorporate such training. Aims: This article provides educators with 12 tips for teaching brief motivational interviewing to medical students, premised on evidence-based pedagogy. Methods: Tips were drawn from the literature and authors’ own experiences. Results: The 12 tips are: (1) Set clear learning objectives, (2) Select experienced educators, (3) Provide theoretical perspectives, (4) Share the evidence base, (5) Outline the “spirit”, principles, and sequence, (6) Show students what it looks like, (7) Give students a scaffold to follow, (8) Provide opportunities for skill practice, (9) Involve clinical students in teaching, (10) Use varied formative and summative assessments, (11) Integrate and maintain, and (12) Reflect and evaluate. Conclusions: We describe what to include and why, and outline when and how to teach the essential components of brief motivational interviewing knowledge and skills in a medical curriculum

Fracture healing following high energy tibial trauma: Ilizarov versus Taylor Spatial Frame

Introduction: The optimal treatment of high energy tibial fractures remains controversial and a challenging orthopaedic problem. The role of external fi xators for all these tibial fractures has been shown to be crucial. Methods: A fi ve-year consecutive series was reviewed retrospectively, identifying two treatment groups: Ilizarov and Taylor Spatial Frame (TSF; Smith & Nephew, Memphis, TN, US). Fracture healing time was the primary outcome measure. Results: A total of 112 patients (85 Ilizarov, 37 TSF) were identifi ed for the review with a mean age of 45 years. This was higher in women (57 years) than in men (41 years). There was no signifi cant difference between frame types (p=0.83). The median healing time was 163 days in both groups. There was no signifi cant difference in healing time between smokers and non-smokers (180 vs 165 days respectively, p=0.07), open or closed fractures (p=0.13) or age and healing time (Spearman's r=0.12, p=0.18). There was no incidence of non-union or re-fracture following frame removal in either group. Conclusions: Despite the assumption of the rigid construct of the TSF, the median time to union was similar to that of the Ilizarov frame and the TSF therefore can play a signifi cant role in complex tibial fractures

Adaptive Evolution as a Predictor of Species-Specific Innate Immune Response

It has been proposed that positive selection may be associated with protein functional change. For example, human and macaque have different outcomes to HIV infection and it has been shown that residues under positive selection in the macaque TRIM5α receptor locate to the region known to influence species-specific response to HIV. In general, however, the relationship between sequence and function has proven difficult to fully elucidate, and it is the role of large-scale studies to help bridge this gap in our understanding by revealing major patterns in the data that correlate genotype with function or phenotype. In this study, we investigate the level of species-specific positive selection in innate immune genes from human and mouse. In total, we analyzed 456 innate immune genes using codon-based models of evolution, comparing human, mouse, and 19 other vertebrate species to identify putative species-specific positive selection. Then we used population genomic data from the recently completed Neanderthal genome project, the 1000 human genomes project, and the 17 laboratory mouse genomes project to determine whether the residues that were putatively positively selected are fixed or variable in these populations. We find evidence of species-specific positive selection on both the human and the mouse branches and we show that the classes of genes under positive selection cluster by function and by interaction. Data from this study provide us with targets to test the relationship between positive selection and protein function and ultimately to test the relationship between positive selection and discordant phenotypes

Innovation in Community Rehabilitation – Desistance through Personalization: Early Findings

This article describes the early stages of a socially innovative project to develop and implement a personalized approach to offender rehabilitation in the probation sector in England, drawing on the concept of ‘desistance’. The Policy Evaluation and Research Unit at Manchester Metropolitan University has been working in collaboration with Interserve Ltd to develop and evaluate a model of personalized offender rehabilitation in 5 of the 21 Community Rehabilitation Companies (CRCs) that deliver probation services in England and Wales. We have identified learning from personalization in the UK social care sector and used this to specify a pilot project

Automated algorithm for CBCT-based dose calculations of prostate radiotherapy with bilateral hip prostheses

ABSTRACTOBJECTIVE:Cone beam CT (CBCT) images contain more scatter than a conventional CT image and therefore provide inaccurate Hounsfield units (HUs). Consequently, CBCT images cannot be used directly for radiotherapy dose calculation. The aim of this study is to enable dose calculations to be performed with the use of CBCT images taken during radiotherapy and evaluate the necessity of replanning.METHODS:A patient with prostate cancer with bilateral metallic prosthetic hip replacements was imaged using both CT and CBCT. The multilevel threshold (MLT) algorithm was used to categorize pixel values in the CBCT images into segments of homogeneous HU. The variation in HU with position in the CBCT images was taken into consideration. This segmentation method relies on the operator dividing the CBCT data into a set of volumes where the variation in the relationship between pixel values and HUs is small. An automated MLT algorithm was developed to reduce the operator time associated with the process. An intensity-modulated radiation therapy plan was generated from CT images of the patient. The plan was then copied to the segmented CBCT (sCBCT) data sets with identical settings, and the doses were recalculated and compared.RESULTS:Gamma evaluation showed that the percentage of points in the rectum with γ < 1 (3%/3 mm) were 98.7% and 97.7% in the sCBCT using MLT and the automated MLT algorithms, respectively. Compared with the planning CT (pCT) plan, the MLT algorithm showed −0.46% dose difference with 8 h operator time while the automated MLT algorithm showed −1.3%, which are both considered to be clinically acceptable, when using collapsed cone algorithm.CONCLUSION:The segmentation of CBCT images using the method in this study can be used for dose calculation. For a patient with prostate cancer with bilateral hip prostheses and the associated issues with CT imaging, the MLT algorithms achieved a sufficient dose calculation accuracy that is clinically acceptable. The automated MLT algorithm reduced the operator time associated with implementing the MLT algorithm to achieve clinically acceptable accuracy. This saved time makes the automated MLT algorithm superior and easier to implement in the clinical setting.ADVANCES IN KNOWLEDGE:The MLT algorithm has been extended to the complex example of a patient with bilateral hip prostheses, which with the introduction of automation is feasible for use in adaptive radiotherapy, as an alternative to obtaining a new pCT and reoutlining the structures

Written education materials for stroke patients and their carers: perspectives and practices of health professionals

Inadequacies in the provision of written education materials to stroke patients and their carers have been reported. In this study, 20 stroke team health professionals were surveyed regarding their use of and perspectives on written education materials. Seventy percent of participants provided materials to 25% or fewer stroke patients and 90% believed that patients and carers are only occasionally or rarely provided with sufficient written information. Health professionals were uncertain which team members provided written information and identified the need to improve the quality of materials used. Stroke teams should implement a system that facilitates the routine provision of quality written materials to patients and carers, communication among team members, and documentation and verbal reinforcement of the information provided

Compiling SHIM

Embedded systems demand concurrency for supporting simultaneous actions in their environment and parallel hardware. Although most concurrent programming formalisms are prone to races and non-determinism, some, such as our SHIM (software/hardware integration medium) language, avoid them by design. In particular, the behavior of SHIM programs is scheduling-independent, meaning the I/O behavior of a program is independent of scheduling policies, including the relative execution rates of concurrent processes. The SHIM project demonstrates how a scheduling-independent language simplifies the design, optimization, and verification of concurrent systems. Through examples and discussion, we describe the SHIM language and code generation techniques for both shared-memory and message-passing architectures, along with some verification algorithms

But Not Both:The Exclusive Disjunction in Qualitative Comparative Analysis (QCA)

The application of Boolean logic using Qualitative Comparative Analysis (QCA) is becoming more frequent in political science but is still in its relative infancy. Boolean ‘AND’ and ‘OR’ are used to express and simplify combinations of necessary and sufficient conditions. This paper draws out a distinction overlooked by the QCA literature: the difference between inclusive- and exclusive-or (OR and XOR). It demonstrates that many scholars who have used the Boolean OR in fact mean XOR, discusses the implications of this confusion and explains the applications of XOR to QCA. Although XOR can be expressed in terms of OR and AND, explicit use of XOR has several advantages: it mirrors natural language closely, extends our understanding of equifinality and deals with mutually exclusive clusters of sufficiency conditions. XOR deserves explicit treatment within QCA because it emphasizes precisely the values that make QCA attractive to political scientists: contextualization, confounding variables, and multiple and conjunctural causation

Health status, use of healthcare, and socio-economic implications of cancer survivorship in Portugal : results from the fourth national health survey

Health status, use of healthcare, and socio-economic implications of cancer survivorship in Portugal: results from the Fourth National Health SurveyUnderstanding the morbidity and socio-economic implications of cancer survivorship is essential for a comprehensive management of oncological diseases. We compared cancer survivors (CS) with the general population regarding health status, use of healthcare resources and socio-economic condition. We analyzed data from a representative sample of the Portuguese population aged a parts per thousand yen15 years (n = 35,229). We defined three groups of CS, according to the time since diagnosis and the latest cancer treatment: CS 1 diagnosis within 12 months of interview; CS 2 diagnosis more than 12 months before and treatment in the previous 12 months; CS 3 diagnosis and treatment more than 12 months before. These were compared with the general population, adjusting for differences in sex, age, and place of residence. The prevalence of CS was 2.2 % (CS 1: 0.2 %; CS 2: 0.9 %, CS 3: 1.1 %). Self-perceived health status was worse among CS and short-time incapacity more frequent among CS 1 and CS 2. Health expenses were higher in the early stages of survivorship. Lower household income and financial difficulties were more frequent in CS 1 and CS 3 men, respectively. This study confirmed the higher consumption of healthcare resources and worse financial situation among CS. Our study provides valuable information for understanding the global impact of cancer survivorship.The authors thank the National Health Systems Observatory (Observatorio Nacional de Saude), National Institute of Health Dr. Ricardo Jorge (INSA), Ministry of Health and the National Institute of Statistics (INE) for providing the data (Ministerio da Saude, Instituto Nacional de Saude Dr. Ricardo Jorge; IP, Departamento de Epidemiologia/Instituto Nacional de Estatistica: Inquerito Nacional de Saude 2005/2006). Luis Pacheco-Figueiredo received a grant from the Fundacao para a Ciencia e a Tecnologia (SFRH/SINTD/60124/2009)