Medical decision-making is a cornerstone of clinical care and a key contributor to diagnostic accuracy. Medical decision-making occurs via two primary pathways: System 1, pattern recognition, is ...fast, intuitive, and heuristically driven and occurs largely unconsciously. System 2, analytic thinking, is slow, deliberate, and under conscious control. Biases are systematic errors that can impact reasoning via either pathway but predominantly affect decisions made by pattern recognition. Debiasing strategies involve the deliberate switching from pattern recognition to analytic thinking triggered by a stimulus. This resource describes a faculty development workshop designed to train emergency medicine educators about common biases and debiasing strategies, to improve teaching of diagnostic reasoning to trainees.
This workshop was implemented at the 2017 Society for Academic Emergency Medicine Annual Meeting. The workshop consisted of a brief didactic, followed by small-group case-based learning. A retrospective survey and qualitative evaluation were administered to attendees.
The participants' self-assessment showed significant improvements (
< .001) in their abilities to recognize how pattern recognition can lead to bias, identify common types of bias in the emergency department, teach trainees about common types of bias, and apply cognitive debiasing strategies to improve diagnostic reasoning. Strengths of the workshop included the interactive case-based format, discussions of bias-mitigation strategies, and take-home resources. Suggestions for improvement included lengthening the discussion time and providing more cases.
Cognitive biases can negatively impact patient care. Faculty development is needed to improve instruction about bias and debiasing strategies for all levels of trainees.
Seismic reflection data acquired onshore to the north of Bournemouth, southern England, image clearly a series of prominent concave-up (troughs or depressions) and concave-down (mounded) structures ...within the White Chalk Subgroup. The Chalk lithostratigraphy in the area of study is established from borehole geophysical log correlations. These correlations then provide calibration of the seismic reflection data, indicating that the structures are concentrated at levels between the Lewes Nodular Chalk Formation and Tarrant Chalk Member, and towards the base of the Portsdown Chalk Formation. Onlap, downlap and truncation of reflectors are observed, with the most dramatic features forming a stacked series directly overlying faulting of Jurassic strata. Similar stratal geometries have been described from comparable levels in the Chalk of the North Sea, and in outcrop in Britain and France. To many they represent channels formed by submarine erosion and redeposition of the Chalk during relative sea-level falls, linked to tectonics. We also interpret a number of apparently incisive structures and slumped infill sequences described here as being of primary syndepositional origin. The slumping and the close association of these features with underlying faults, and proximity to nearby major crustal faults, may be indicative of submarine erosion of the Chalk caused by sea-level changes linked to syndepositional fault movements. However, evidence of toplap-downlap pairs is also suggestive of more aggradational mounding or laterally migrating surfaces or facies belts. The presence of any such structures implies rapid lateral variations in the Chalk that would have implications not only for aquifer management and future storage schemes but also during the processing of seismic reflection data and general studies and correlations of the Chalk across southern Britain.
Planning for Clients' Digital Assets Hopson, James F; Hopson, Patricia D
Journal of financial planning (Denver, Colo.),
11/2012, Letnik:
25, Številka:
11
Journal Article
Recenzirano
Most of your clients have digital assets: in fact, there are 271 million North American Internet users. However many times planning for digital assets is overlooked, even when it involves financial ...or business assets. This article examines the planning issues and concerns regarding digital assets. Questions that clients need to examine in the event of incapacity or death are explored with possible solutions to address clients' concerns. Issues addressed include: 1. What digital information to include in a digital asset inventory. 2. Security concerns involving digital assets. 3. State of the law and Web site policy concerns. 4. Why planning is important. 5. The planning process. 6. Selecting a digital asset personal representative and the information they need. 7. Disposing of digital assets. 8. Preventing identity theft. Careful planning can reduce the cost and frustration in dealing with clients digital assets, and clients need to be aware of the ramifications of failing to do so.
Suicide is a leading cause of death in the U.S. In American Indian/Alaska Native (AI/AN) urban communities and rural reservation communities, youth experience high rates of suicidal ideation, ...attempts, and deaths. An urban AI organization partnered with a university to respond to this crisis with SAMHSA funds that supported the development and implementation of youth suicide prevention and intervention programming through screening, identification, and treatment of youth. They engaged the community in developing suicide prevention and intervention programming, and designed and tested procedures for implementing community-based suicide screenings, which led to the creation of the Hope & Wellness Screening Toolkit.
Background: The increase in hospital acquisition of community oncology clinics in the US has led to a shift in the site-of-care (SOC) for infusion therapy from the physician office (PO) to the ...hospital outpatient (HO) setting.
Objective: To investigate differences by SOC in treatment patterns, quality, and cost among patients with cancer undergoing first-line infusion therapy.
Research design and methods: This retrospective analysis identified adult patients from Humana medical claims who initiated infusion therapy from 2008-2012 for five common cancer types in which infusion therapy is likely, including early stage breast cancer; metastatic breast, lung, and colorectal cancers; and non-Hodgkin's lymphoma or chronic lymphocytic leukemia. Differences by SOC in first-line treatment patterns and quality of care at end-of-life, defined as infusions or hospitalizations 30 days prior to death, were evaluated using Wilcoxon-Rank Sum and Chi-square tests where appropriate. Differences in cost by SOC were evaluated using risk-adjusted generalized linear models.
Main outcome measures: Treatment patterns, quality of care at end of life, healthcare costs.
Results: There were differences in duration of therapy and number of infusions for some therapy regimens by SOC, in which patients in the HO had shorter duration of therapy and fewer infusions. There were no differences in quality of care at end-of-life by SOC. Total healthcare costs were 15% higher among patients in HO ($55,965) compared with PO ($48,439), p < .0001.
Limitations: Analyses was restricted to a claims-based population of cancer patients within a health plan.
Conclusion: This study, in an older, predominantly Medicare Advantage oncology cohort, found differences by SOC in treatment patterns and cost, but not quality. Where differences were found, patients receiving care in the HO had shorter duration of therapy and fewer infusions for specific treatment regimens, but higher healthcare costs than those treated in a PO.
mRNA vaccines induce potent immune responses in preclinical models and clinical studies. Adjuvants are used to stimulate specific components of the immune system to increase immunogenicity of ...vaccines. We utilized a constitutively active mutation (V155M) of the stimulator of interferon (IFN) genes (STING), which had been described in a patient with STING-associated vasculopathy with onset in infancy (SAVI), to act as a genetic adjuvant for use with our lipid nanoparticle (LNP)-encapsulated mRNA vaccines. mRNA-encoded constitutively active STING
was most effective at maximizing CD8
T cell responses at an antigen/adjuvant mass ratio of 5:1. STING
appears to enhance development of antigen-specific T cells by activating type I IFN responses via the nuclear factor κB (NF-κB) and IFN-stimulated response element (ISRE) pathways. mRNA-encoded STING
increased the efficacy of mRNA vaccines encoding the E6 and E7 oncoproteins of human papillomavirus (HPV), leading to reduced HPV
TC-1 tumor growth and prolonged survival in vaccinated mice. This proof-of-concept study demonstrated the utility of an mRNA-encoded genetic adjuvant.
The recent decrease seen in pancreatic research and young investigator involvement may reflect inadequate mentorship. This study aimed to describe the current state of mentorship in pancreatic ...research and evaluate how mentorship is associated with research productivity.
In this prospective study, a survey addressing mentorship and research was distributed to trainees worldwide. Survey responses were analyzed using descriptive statistics and logistic regression was used to describe the association between mentorship and trainee research productivity.
A total of 137 trainees from 16 countries participated. Although two-thirds of trainees expressed interest in pancreatic research and had identified a mentor in the field, only 34.8% had published a manuscript. Barriers to pancreatic research included lack of research opportunities (58.3%), limited mentorship (23.3%), and inadequate institutional support (15%). Although having a single mentor was not associated with research productivity (odds ratio, 1.43; 95% confidence interval, 0.74-2.76), having a local mentor was significantly associated with publishing (odds ratio, 4.57; 95% confidence interval, 1.95-10.74).
Although many trainees interested in pancreatology have access to a mentor, barriers including lack of research opportunities, mentorship, and institutional support hinder trainee productivity. Opportunities for mentorship, collaboration, and networking are needed.
Selecting a Medical School Advisor Lareau, Stephanie; Blumstein, Howard; Hopson, Laura ...
The Journal of emergency medicine,
20/May , Letnik:
56, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Having an advisor offers medical students many advantages, including increased likelihood of matching into their top choices. Interestingly, students who choose emergency medicine (EM) as a specialty ...are more likely to seek advising. However, finding and optimally utilizing an EM faculty advisor is often challenging for the medical student. In this article, we tackle the different ways to seek advising, including the ‘virtual advisor program’ implemented by the Society for Academic Emergency Medicine, the ‘e-Advisor Program’ instigated by the Clerkship Director in EM Group, the ‘member exclusive mentorship program’ of the Emergency Medicine Residency Association, as well as peer-based mentoring. More so, we discuss the consensus recommendations developed by the Student Advising Task Force to guide both students planning to apply to EM and their advisors to ensure high-caliber advising.
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