Improving empathy of physicians through guided reflective writing

Objectives: This study was designed to explore how guided reflective writing could evoke empathy and reflection in a group of practicing physicians. Methods: Total participants recruited included 40 staff physicians at Cleveland Clinic, a tertiary care academic medical center. Twenty physicians (intervention group) were assigned to participate in a 6-session faculty development program introducing narrative medicine and engaging in guided reflective writing. Ten physicians (comparison group 1) received the assigned course reading materials but did not participate in the course sessions. Ten physicians (comparison group 2) neither received the reading materials nor participated in the sessions. Qualitative analysis of the physicians\u27 reflective writings was performed to identify major themes. The Jefferson Scale of Empathy was administered three times during the course. Results: Qualitative analysis of physicians\u27 writings showed themes of both compassionate solidarity and detached concern. Exploration of negative emotions occurred more frequently than positive ones. The most common writing style was case presentation. A total of 36 staff physicians completed the Jefferson Scale of Empathy. Results of statistical analysis suggested an improvement in empathy in the intervention group at the end of the course (p \u3c 0 .05). Conclusions: These results suggest a faculty development program using guided narrative writing can promote reflection and may enhance empathy among practicing physicians. These findings should encourage medical educators to design additional strategies for enhancing reflection and empathic behavior in trainees and specifically practicing physicians who can role model these behaviors to achieve the ultimate goal of improving the quality of patient care

Impact of a brief faculty training to improve patient-centered communication while using electronic health records

Objective Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue. Methods Faculty received four hours of training at Cleveland Clinic and a condensed 90-minute version at the University of Chicago. Both included a lecture and a Group-Objective Structured Clinical Exam (GOSCE) experience. Direct observations of 10 faculty in their clinical practices were performed pre- and post-workshop. Results Thirty participants (94%) completed a post-workshop evaluation assessing knowledge, attitude, and skills. Faculty reported that training was important, relevant, and should be required for all providers; no differences were found between longer versus shorter training. Participants in the longer training reported higher GOSCE efficacy, however shorter workshop participants agreed more with the statement that they had gained new knowledge. Faculty improved their patient-centered EHR use skills in clinical practice on post- versus pre-workshop ratings using a validated direct-observation rating tool. Conclusion A brief lecture and GOSCE can be effective in training busy faculty on patient-centered EHR use skills. Practice Implications Faculty training on patient-centered EHR skills can enhance patient-doctor communication and promotes positive role modeling of these skills to learners

Stochastic backgrounds of relic gravitons: a theoretical appraisal

Stochastic backgrounds or relic gravitons, if ever detected, will constitute a prima facie evidence of physical processes taking place during the earliest stages of the evolution of the plasma. The essentials of the stochastic backgrounds of relic gravitons are hereby introduced and reviewed. The pivotal observables customarily employed to infer the properties of the relic gravitons are discussed both in the framework of the $\Lambda$CDM paradigm as well as in neighboring contexts. The complementarity between experiments measuring the polarization of the Cosmic Microwave Background (such as, for instance, WMAP, Capmap, Quad, Cbi, just to mention a few) and wide band interferometers (e.g. Virgo, Ligo, Geo, Tama) is emphasized. While the analysis of the microwave sky strongly constrains the low-frequency tail of the relic graviton spectrum, wide-band detectors are sensitive to much higher frequencies where the spectral energy density depends chiefly upon the (poorly known) rate of post-inflationary expansion.Comment: 94 pages, 32 figure

Protein regulation of Carotenoid binding : Gatekeeper and locking amino acid residues in reaction centres of rhodobacter sphaeroides

X-ray diffraction was used to determine high-resolution structures of the reaction center (RC) complex from the carotenoidless mutant, Rb. sphaeroides R-26.1, without or reconstituted with carotenoids. The results are compared with the structure of the RC from a semiaerobically grown Rb. sphaeroides strain 2.4.1. The investigation reveals the structure of the carotenoid in the different protein preparations, the nature of its binding site, and a plausible mechanism by which the carotenoid is incorporated unidirectionally in its characteristic geometric configuration. The structural data suggest that the accessibility of the carotenoid to the binding site is controlled by a specific “gatekeeper” residue which allows the carotenoid to approach the binding site from only one direction. Carotenoid binding to the protein is secured by hydrogen bonding to a separate “locking” amino acid. The study reveals the specific molecular interactions that control how the carotenoid protects the photosynthetic apparatus against photo-induced oxidative destruction

A mechanobiological model of orthodontic tooth movement.

Orthodontic tooth movement is achieved by the process of repeated alveolar bone resorption on the pressure side and new bone formation on the tension side. In order to optimize orthodontic treatment, it is important to identify and study the biological processes involved. This article presents a mechanobiological model using partial differential equations to describe cell densities, growth factor concentrations, and matrix densities occurring during orthodontic tooth movement. We hypothesize that such a model can predict tooth movement based on the mechanobiological activity of cells in the PDL. The developed model consists of nine coupled non-linear partial differential equations, and two distinct signaling pathways were modeled: the RANKL-RANK-OPG pathway regulating the communication between osteoblasts and osteoclasts and the TGF-beta pathway mediating the differentiation of mesenchymal stem cells into osteoblasts. The predicted concentrations and densities were qualitatively validated by comparing the results to experiments reported in the literature. In the current form, the model supports our hypothesis, as it is capable of conceptually simulating important features of the biological interactions in the alveolar bone-PDL complex during orthodontic tooth movement