32,168 research outputs found

    “We lie about what we do. We lie to our students about what they're going to do”: Unstandardizing standardized ways of knowing in health professions educatio

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    In Health Professions Education, students’ and their educators’ work in the 21st century is geared towards demonstrating “competence” in order to gain certification or licensure to practice. Drawing on two complementary Institutional Ethnographic studies, we explicate the dominance of standardization through text-mediated epistemologies or ways of knowing, for student doctors and student paramedics. We examine different lines of fault where the actual work of becoming a health professional is subsumed by an accountability focused agenda, contributing to students feeling unprepared for their (non-standard) clinical work and work settings at a time where burnout is recognized as a big issue in healthcare. We also discuss how educators are located at a line of fault between what counts institutionally as good educational knowledge/practice and teaching practices geared towards the everyday actualities of complex work and work settings. We advocate for a more generous approach to certification of health professionals, based on non-standardized patients and the realities of ever-evolving work settings that healthcare work must orient to and is organized by

    Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

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    Association between the American Board of Emergency Medicine Oral Certifying Examination and Future State Medical Board Disciplinary Actions.

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    OBJECTIVES: The American Board of Emergency Medicine (ABEM) requires a written examination (the Qualifying Examination) followed by the Oral Certifying Examination (OCE) to obtain ABEM certification. Maintaining ABEM certification is associated with fewer state medical board (SMB) disciplinary actions. We sought to determine the association between poor initial performance on the OCE and subsequent severe SMB disciplinary action. METHODS: We included physicians who completed US categorical emergency medicine residencies in 2016 and earlier. We classified OCE performance as good (passed on first attempt) and poor (never passed or required \u3e 1 attempt to pass). We obtained data on physician SMB disciplinary actions from the National Practitioner Data Bank that were limited to actions that denied licensure or altered the status of a medical license (eg, suspension). We determined the association between poor OCE performance and subsequent severe SMB disciplinary action. RESULTS: Of 34,871, 93.5% passed the OCE on the first attempt, 6.1% required multiple attempts, and 0.3% never passed. Of the physicians (93.5%) with good OCE performance, 1.0% received a severe SMB action. Among physicians with poor OCE performance, 2.3% received a severe action; and of those who never passed, 1.7% received a severe action (Table 1). Poor OCE performance was associated with an increased odds of severe SMB disciplinary action (OR 2.21, 95% CI: 1.57-3.12). CONCLUSION: Physicians with poor OCE performance exhibited higher odds of experiencing a subsequent severe SMB disciplinary action. The OCE may have utility as a predictor of future professionalism or clinical performance

    Time-restricted ketogenic diet in amyotrophic lateral sclerosis: a case study

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    Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disorder. The most devastating variant is bulbar-onset ALS, which portends a median survival of 24 months from the onset of symptoms. Abundant evidence indicates that neuron metabolism and mitochondrial function are impaired in ALS. Metabolic strategies, particularly fasting and ketogenic diet protocols, alter neuron metabolism and mitochondria function in a manner that may mitigate the symptoms of this disorder. We report the case of a 64-year-old man with a 21-month history of progressive, deteriorating bulbar-onset ALS, with an associated pseudobulbar affect, who implemented a time-restricted ketogenic diet (TRKD) for 18 months. During this time, he improved in ALS-related function (7% improvement from baseline), forced expiratory volume (17% improvement), forced vital capacity (13% improvement), depression (normalized), stress levels (normalized), and quality of life (19% improvement), particularly fatigue (23% improvement). His swallowing impairment and neurocognitive status remained stable. Declines were measured in physical function, maximal inspiratory pressure, and maximal expiratory pressure. Weight loss was attenuated and no significant adverse effects occurred. This case study represents the first documented occurrence of a patient with ALS managed with either a fasting or ketogenic diet protocol, co-administered as a TRKD. We measured improved or stabilized ALS-related function, forced expiratory volume, forced vital capacity, swallowing, neurocognitive status, mood, and quality of life. Measurable declines were restricted to physical function, maximal inspiratory pressure, and maximal expiratory pressure. Now over 45 months since symptom onset, our patient remains functionally independent and dedicated to his TRKD

    Accelarated immune ageing is associated with COVID-19 disease severity

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    Background The striking increase in COVID-19 severity in older adults provides a clear example of immunesenescence, the age-related remodelling of the immune system. To better characterise the association between convalescent immunesenescence and acute disease severity, we determined the immune phenotype of COVID-19 survivors and non-infected controls. Results We performed detailed immune phenotyping of peripheral blood mononuclear cells isolated from 103 COVID-19 survivors 3–5 months post recovery who were classified as having had severe (n = 56; age 53.12 ± 11.30 years), moderate (n = 32; age 52.28 ± 11.43 years) or mild (n = 15; age 49.67 ± 7.30 years) disease and compared with age and sex-matched healthy adults (n = 59; age 50.49 ± 10.68 years). We assessed a broad range of immune cell phenotypes to generate a composite score, IMM-AGE, to determine the degree of immune senescence. We found increased immunesenescence features in severe COVID-19 survivors compared to controls including: a reduced frequency and number of naïve CD4 and CD8 T cells (p < 0.0001); increased frequency of EMRA CD4 (p < 0.003) and CD8 T cells (p < 0.001); a higher frequency (p < 0.0001) and absolute numbers (p < 0.001) of CD28−ve CD57+ve senescent CD4 and CD8 T cells; higher frequency (p < 0.003) and absolute numbers (p < 0.02) of PD-1 expressing exhausted CD8 T cells; a two-fold increase in Th17 polarisation (p < 0.0001); higher frequency of memory B cells (p < 0.001) and increased frequency (p < 0.0001) and numbers (p < 0.001) of CD57+ve senescent NK cells. As a result, the IMM-AGE score was significantly higher in severe COVID-19 survivors than in controls (p < 0.001). Few differences were seen for those with moderate disease and none for mild disease. Regression analysis revealed the only pre-existing variable influencing the IMM-AGE score was South Asian ethnicity ( = 0.174, p = 0.043), with a major influence being disease severity ( = 0.188, p = 0.01). Conclusions Our analyses reveal a state of enhanced immune ageing in survivors of severe COVID-19 and suggest this could be related to SARS-Cov-2 infection. Our data support the rationale for trials of anti-immune ageing interventions for improving clinical outcomes in these patients with severe disease

    sj-docx-1-jic-10.1177_08850666231224396 - Supplemental material for Simultaneous Venous-Arterial Doppler Ultrasound During Early Fluid Resuscitation to Characterize a Novel Doppler Starling Curve: A Prospective Observational Pilot Study

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    Supplemental material, sj-docx-1-jic-10.1177_08850666231224396 for Simultaneous Venous-Arterial Doppler Ultrasound During Early Fluid Resuscitation to Characterize a Novel Doppler Starling Curve: A Prospective Observational Pilot Study by Jon-Émile S. Kenny, Ross Prager, Philippe Rola, Korbin Haycock, Stanley O. Gibbs, Delaney H. Johnston, Christine Horner and Joseph K. Eibl, Vivian C. Lau, Benjamin O. Kemp in Journal of Intensive Care Medicine</p

    353 Genetic and non-genetic effects gestation length on northern Australian tropically adapted beef breeds

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    Decreasing gestation length (GL) has been shown to reduce calving difficulties and help maintain an annual calving pattern (Jeyaruban et al. 2016). Although a simple trait by definition currently it is only recorded for animals mated by Artificial Insemination (AI), and this limits the available number of records. There have been no recent genetic parameters estimates for tropical breeds in Australia, and very few available estimates elsewhere. The aim of this study was to estimate the genetic and non-genetic effects for GL in northern Australia beef breeds

    Search for Eccentric Black Hole Coalescences during the Third Observing Run of LIGO and Virgo