Evidence-based choices of physicians: a comparative analysis of physicians participating in Internet CME and non-participants

<p>Abstract</p> <p>Background</p> <p>The amount of medical education offered through the Internet continues to increase, providing unprecedented access for physicians nationwide. However, the process of evaluating these activities is ongoing. This study is a continuation of an earlier report that found online continuing medical education (CME) to be highly effective in making evidence-based decisions.</p> <p>Methods</p> <p>To determine the effectiveness of 114 Internet CME activities, case vignette-based surveys were administered to U.S.-practicing physicians immediately following participation, and to a representative control group of non-participants. Survey responses were analyzed based on evidence presented in the content of CME activities. An effect size for each activity was calculated using Cohen's <it>d </it>to determine the amount of difference between the two groups in the likelihood of making evidence-based clinical decisions.</p> <p>Results</p> <p>In a sample of 17,142 U.S. physicians, of the more than 350,000 physicians who participated in 114 activities, the average effect size was 0.82. This indicates an increased likelihood of 48% that physicians participating in online activities were making clinical choices based on evidence.</p> <p>Conclusion</p> <p>Physicians who participated in online CME activities continue to be more likely to make evidence-based clinical choices than non-participants in response to clinical case vignettes.</p

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

Psychological interventions used by athletic trainers in the rehabilitation of the injured athlete.

Recent research suggests that psychological techniques may facilitate injured athletes' rehabilitation, yet little is known about the psychological techniques trainers currently employ and how they view these interventions. In this study, 206 athletic trainers assigned Likert scale ratings to 11 psychological techniques indicating how much they valued a specific technique, how skillfully they employed it, and how often they utilized it. Trainers also responded to an open ended question asking how they would deal with the psychological aspects of an injury described in a short scenario. Results revealed a tentative model for the way trainers view psychological techniques. Categories of techniques included techniques involving the modification of physical and psychological states (goal setting, pain management, relaxation, imagery, and breathing techniques), techniques involving verbal cognitive techniques (communicating openly, changing negative self talk, emotional counseling, and crisis counseling), and non-recommended techniques (encouraging heroism and screening negative information). The study explored trainers' perceptions of each of the 11 psychological techniques in depth and discussed these findings. The study found that although trainers highly value psychological interventions in their work with injured athletes, they assigned low ratings to the techniques they knew little about. However, as exposure to sport psychology information increased, ratings assigned to the techniques that modify physical and psychological states also increased. Similarly, the longer trainers had worked in their field, the more highly they valued the verbal cognitive interventions. In contrast, neither exposure to sport psychology information or athletic training experience proved predictive of ratings assigned to the non-recommended psychological techniques. These findings suggest the importance of introducing skills training for psychological techniques early in the athletic trainers' educational curriculum so that trainers can gain awareness of the efficacy of certain psychological techniques and skill at using these techniques. Moreover, trainers could benefit from course work explaining potential negative consequences of employing harmful or ineffectual psychological interventions

Psychological interventions used in the rehabilitation of the injured athlete

Nine psychological techniques used in the rehabilitation of injured athletes were assessed. Fifteen athletic trainers and 68 athletes were asked to rate how valuable each technique was, how skillful the trainer was in using each technique, and how often each technique was used in treatment. A 3 x 11 x 2 (question type x technique x subject type) MANOVA revealed significant main effects for question type F(2,134) = 26.71, p .001 and technique F(10,670) = 15.56, p .001, but not for subject type F(1,67) = 1.81, p =.183. Techniques were more highly valued and trainers were more skilled in employing them than they were used (p .05 for both). Techniques most valued were communicating openly, goal setting, monitoring self talk, emotional counseling, crisis counseling, pain management and relaxation techniques; least valued were breathing techniques and imagery. These findings support the position that psychological interventions are an important part of the rehabilitation of injured athletes

Kcne2 deletion uncovers its crucial role in thyroid hormone biosynthesis.

Thyroid dysfunction is a global health concern, causing defects including neurodevelopmental disorders, dwarfism and cardiac arrhythmia. Here, we show that the potassium channel subunits KCNQ1 and KCNE2 form a thyroid-stimulating hormone-stimulated, constitutively active, thyrocyte K+ channel required for normal thyroid hormone biosynthesis. Targeted disruption of Kcne2 in mice impaired thyroid iodide accumulation up to eightfold, impaired maternal milk ejection, halved milk tetraiodothyronine (T4) content and halved litter size. Kcne2-deficient mice had hypothyroidism, dwarfism, alopecia, goiter and cardiac abnormalities including hypertrophy, fibrosis, and reduced fractional shortening. The alopecia, dwarfism and cardiac abnormalities were alleviated by triiodothyronine (T3) and T4 administration to pups, by supplementing dams with T(4) before and after they gave birth or by feeding the pups exclusively from Kcne2+/+ dams; conversely, these symptoms were elicited in Kcne2+/+ pups by feeding exclusively from Kcne2-/- dams. These data provide a new potential therapeutic target for thyroid disorders and raise the possibility of an endocrine component to previously identified KCNE2- and KCNQ1-linked human cardiac arrhythmias