The triple helix of clinical, research, and education missions in academic health centers: A qualitative study of diverse stakeholder perspectives.

Introduction: Academic health centers are poised to improve health through their clinical, education, and research missions. However, these missions often operate in silos. The authors explored stakeholder perspectives at diverse institutions to understand challenges and identify alignment strategies. Methods: Authors used an exploratory qualitative design and thematic analysis approach with data obtained from electronic surveys sent to participants at five U.S. academic health centers (2017-18), with four different types of medical school/health system partnerships. Participants included educators, researchers, system leaders, administrators, clinical providers, resident/fellow physicians, and students. Investigators coded data using constant comparative analysis, met regularly to reconcile uncertainties, and collapsed/combined categories. Results: Of 175 participants invited, 113 completed the survey (65%). Three results categories were identified. First, five higher-order themes emerged related to aligning missions, including (a) shared vision and strategies, (b) alignment of strategy with community needs, (c) tension of economic drivers, (d) coproduction of knowledge, and (e) unifying set of concepts spanning all missions. Second, strategies for each mission were identified, including education (new competencies, instructional methods, recruitment), research (shifting agenda, developing partnerships, operations), and clinical operations (delivery models, focus on patient factors/needs, value-based care, well-being). Lastly, strategies for integrating each dyadic mission pair, including research-education, clinical operations education, and research-clinical operations, were identified. Conclusions: Academic health centers are at a crossroads in regard to identity and alignment across the tripartite missions. The study\u27s results provide pragmatic strategies to advance the tripartite missions and lead necessary change for improved patient health

A Randomized Trial Examining the Effectiveness of Switching From Olanzapine, Quetiapine, or Risperidone to Aripiprazole to Reduce Metabolic Risk: Comparison of Antipsychotics for Metabolic Problems (CAMP)

We conducted a multi-site, randomized controlled trial examining the strategy of switching from olanzapine, quetiapine, or risperidone to aripiprazole to ameliorate metabolic risk factors for cardiovascular disease

Towards an ICF core set for ADHD:a worldwide expert survey on ability and disability

This is the second in a series of four empirical studies designed to develop International Classification of Functioning, Disability and Health (ICF and Children and Youth version, ICF-CY) core sets for attention deficit hyperactivity disorder (ADHD). The objective of this stage was to gather the opinions from international experts on which ability and disability concepts were considered relevant to functioning in ADHD. An email-based survey was carried out amongst international experts in ADHD. Relevant functional ability and disability concepts were extracted from their responses and linked to the ICF/-CY categories by two independent researchers using a standardised linking procedure. 174 experts from 11 different disciplines and 45 different countries completed the survey. Meaningful concepts identified in their responses were linked to 185 ICF/-CY categories. Of these, 83 categories were identified by at least 5 % of the experts and considered the most relevant to ADHD: 30 of these were related to Body functions (most identified: attention functions, 85 %), 30 to Activities and Participation (most identified: school education, 52 %), 20 to Environmental factors (most identified: support from immediate family, 61 %), and 3 to Body structures (most identified: structure of brain, 83 %). Experts also provided their views on particular abilities related to ADHD, naming characteristics such as high-energy levels, flexibility and resiliency. Gender differences in the expression of ADHD identified by experts pertained mainly to females showing more internalising (e.g. anxiety, low self-esteem) and less externalising behaviours (e.g. hyperactivity), leading to a risk of late- and under-diagnosis in females. Results indicate that the impact of ADHD extends beyond the core symptom domains, into all areas of life and across the lifespan. The current study in combination with three additional preparatory studies (comprehensive scoping review, focus groups, clinical study) will provide the scientific basis to define the ADHD ICF/-CY core sets for multi-purpose use in basic and applied research and every day clinical practice

Activating the knowledge-to-action cycle for geriatric care in India

Despite a rapidly aging population, geriatrics - the branch of medicine that focuses on healthcare of the elderly - is relatively new in India, with many practicing physicians having little knowledge of the clinical and functional implications of aging. Negative attitudes and limited awareness, knowledge or acceptance of geriatrics as a legitimate discipline contribute to inaccessible and poor quality care for India's old. The aim of this paper is to argue that knowledge translation is a potentially effective tool for engaging Indian healthcare providers in the delivery of high quality geriatric care. The paper describes India's context, including demographics, challenges and current policies, summarizes evidence on provider behaviour change, and integrates the two in order to propose an action plan for promoting improvements in geriatric care

MATISSE, perspective of imaging in the mid-infrared at the VLTI

International audienceMATISSE is foreseen as a mid-infrared spectro-interferometer combining the beams of up to four UTs/ATs of the Very Large Telescope Interferometer (VLTI) of the European Southern Observatory. The related science case study demonstrates the enormous capability of a new generation mid-infrared beam combiner. MATISSE will constitute an evolution of the two-beam interferometric instrument MIDI. MIDI is a very successful instrument which offers a perfect combination of spectral and angular resolution. New characteristics present in MATISSE will give access to the mapping and the distribution of the material (typically dust) in the circumstellar environments by using a wide mid-infrared band coverage extended to L, M and N spectral bands. The four beam combination of MATISSE provides an efficient UV-coverage : 6 visibility points are measured in one set and 4 closure phase relations which can provide aperture synthesis images in the mid-infrared spectral regime

L'esame diagnostico con il DSM-5

Pensato sia per clinici in formazione sia per clinici più esperti, L’esame diagnostico con il DSM-5® è il companion book del DSM-5 che aiuta a svolgere i colloqui diagnostici. A partire da una descrizione del colloquio, della sua struttura e dei suoi obiettivi, alleanza terapeutica compresa, questa guida insegna a condurre un colloquio in maniera ottimale, propone le giuste domande di screening e follow-up, e affronta il modo in cui il DSM-5, con il suo nuovo approccio alla diagnosi e alla classificazione, ne può influenzare lo svolgimento. Il capitolo sul colloquio diagnostico con il DSM-5, il cuore di questo libro, accompagna il clinico in una valutazione completa per ciascuna categoria diagnostica presente nel Manuale. Pur seguendo la struttura del Manuale, l’obiettivo del volume non è certo quello di rappresentare una mini versione del DSM-5: piuttosto, di fornire un modo efficace di utilizzarlo all’interno di un’intervista diagnostica sintetica ma completa

Paliperidone for Treatment of Schizophrenia

In short-term studies, oral paliperidone is an antipsychotic that is more efficacious than placebo. We found its adverse effects to be similar to those of its parent compound, risperidone, with movement disorders, weight gain, and tachycardia all more common with paliperidone than placebo. In addition, paliperidone is associated with substantial increases in serum prolactin that may be associated with sexual dysfunction, although sexual functioning outcomes were not reported. At doses greater than 3 mg per day, oral paliperidone appears comparable in efficacy to oral olanzapine 10 mg per day. Regarding the critical comparison of oral paliperidone to risperidone, we have no information and are thus unable to determine if paliperidone has any advantages or disadvantages compared to its well-known parent compound