Planning and implementing educational programs in medicine optimally requires a background in educational theory and practice. An avenue of training open to such practitioners is a master's degree in ...medical education. A single 1998 report lists the programs known at that time and information about them remains scarce. The authors have re-examined all current programs offering master's degrees in medical or health sciences education in the English-speaking world, including the Netherlands. The authors contacted the programs identified in the 1998 report to establish how many were still in operation. The search was extended using Pubmed and other search engines. A further verification targeted a selected sample of 10 prominent US medical schools. Twenty-one currently operating programs were identified: six in the US, eight in the UK, three in Canada, three in Australia and one in Holland. Seven of nine original master's programs were still in existence. URLs, website and other logistical information about each program are tabled. A master's degree in medical or health sciences education is the most specific method for medical faculty to obtain a credentialed grounding in educational theory and practice. The authors provide up-to-date contact information for current programs and summarize other related essential logistical data.
Patients with glucocorticoid-remediable aldosteronism (GRA) from 12 kindreds possess chimaeric gene duplications arising from unequal crossing-over, fusing regulatory sequences of steroid 11 ...beta-hydroxylase to coding sequences of aldosterone synthase. These chimaeric genes are specific for GRA and explain the biochemistry, physiology and genetics of this form of hypertension. Sites of crossing over range from intron 2 to intron 4. Most mutations have arisen independently from either sister or non-sister chromatid exchange between these genes, which are only 45 kilobases apart. The possibility of a susceptibility allele for GRA of Irish origin is suggested. These findings indicate the utility of a direct genetic test for this disorder.
This study identified factors that influenced physical activity (PA) participation among older adults from rural settings in Nova Scotia Canada and explored how the rural context may influence PA ...participation and promotion. Data were collected via individual semistructured interviews with 20 older adults (Mage = 77.5 years) from rural areas of Cape Breton and subjected to thematic analysis procedures (Braun & Clarke, 2006). Four themes representing factors that influence the prioritization of PA were identified: (1) historical context of activity, work, and productivity; (2) already busy with day-to-day activities; (3) being/staying on the go; and (4) cautionary approach. These findings suggest that PA promotion should be contextually salient, and highlight the need for a shared understanding between rural older adults and PA promoters regarding what constitutes being "physically active". Effective promotion of PA among rural older adults may require a shift away from contemporary methods of PA promotion.
The Canadian Cancer Society and the National Cancer Institute of Canada have charged their Centre for Behavioral Research and Program Evaluation with contributing to the development of the country's ...systemic capacity to link research, policy, and practice related to population-level interventions. Local data collection and feedback systems are integral to this capacity. Canada's School Health Action Planning and Evaluation System (SHAPES) allows data to be collected from all of a school's students, and these data are used to produce computer-generated school "health profiles." SHAPES is being used for intervention planning, evaluation, surveillance, and research across Canada. Strong demand and multipartner investment suggest that SHAPES is adding value in all of these domains. Such systems can contribute substantially to evidence-informed public health practice, public engagement, participatory action research, and relevant, timely population intervention research.
Background:
The most common presentation of knee osteochondritis dissecans (OCD) is a stable lesion on the lateral aspect of the medial femoral condyle (MFC) in an adolescent or pre-adolescent ...athlete. Standard of care for conservative treatment, include activity modification and weight bearing protection. Failed conservative management often leads arthroscopy and drilling of the lesion. Two different primary drilling techniques have been utilized, but no prospective studies have compared their relative effectiveness.
Hypothesis/Purpose:
The study hypothesis was that trans-articular (TAD) and retro-articular drilling (RAD) would demonstrate similar rates of healing, times to return to sports, and patient-reported outcome scores (PROs).
Methods:
Skeletally immature (n=113) patients presenting with radiograph indicated stable OCD of the MFC who did not demonstrate healing despite a minimum of 3 months of non-operative treatment were prospectively enrolled and randomized to TAD or RAD, for which 17 surgeon-investigators (at 14 centers, representing all major regions in the U.S.). Serial radiographs were obtained every 6 weeks to assess healing, and PROs were obtained at 6 months, 12 months, and 24 months. Twelve patients were due to lesion instability detected at the time of surgery,
Results:
Ninety-one study subjects were included, consisting of 51 TAD and 40 RAD patients, with the two groups being of similar age (12.6 years vs. 11.9 years), sex distribution (45% vs. 27% female, p=0.081), and 2-year PRO response rate (both 90%). No significant difference between TAD and RAD was detected in follow-up Pedi-IKDC, Lysholm, Marx knee activity score, or KOOS QOL scores (Table 1). Revision/additional OCD surgery occurred in 10% of patients in RAD and 4% in TAD. 71% of TAD patients reached a ‘healed’ status at a mean of 1.15 years, compared with 58% RAD patients at a mean of 1.06 years.
Conclusion:
While both primary forms of OCD drilling (TAD and RAD) showed consistent post-operative healing, achieving a completely ‘healed’ status was often a more prolonged process, taking approximately 1 year, despite clinical improvement being achieved much sooner. While PROs were similar between drilling techniques, revision surgery rates were more than twice as common with RAD compared with TAD but the overall risk was low and the Absolute Risk was only 6%.
Abstract Objectives Research suggests that light and moderate to vigorous physical activity (MVPA) has beneficial effects concerning longevity in heart disease patients. Yet, very little is known ...about the physical activity trajectories of patients who do not attend cardiac rehabilitation programs and whether the demographic/clinical predictors of these trajectories are similar for light and MVPA. Design Longitudinal. Methods Patients ( N = 269) completed a questionnaire assessing demographic, clinical, and physical activity variables at baseline, three, six, nine, and 12 months after hospitalization for heart disease. Charts were reviewed for height, weight and clinical diagnosis. Results Latent class growth analyses showed two classes of patients emerged for light physical activity (i.e., patients who remained inactive and patients whose physical activity levels significantly declined) and MVPA (i.e., patients whose physical activity significantly increased and patients whose activity levels significantly decreased). Light intensity class membership was predicted by diagnosis (OR = 2.22), whereas MVPA class membership was predicted by gender (OR = .15). Finally, dual trajectory analyses showed that patients whose activity levels declined for one intensity had a high probability of transitioning into the declining group for the other intensity. Conclusions Physical activity trajectories for heart disease patients vary as a function of intensity as do the demographic/clinical predictors of these trajectories.
Objectives:
Arthroscopic partial meniscectomy is one of the most commonly performed procedures in orthopaedic surgery. However, information on the threshold at which patients consider themselves to ...be well for patient reported outcome measures (PROMs) after this surgery remains limited. Our goal was to determine the patient acceptable symptomatic state (PASS) for the Knee Injury and Osteoarthritic Outcome Score (KOOS), the International Knee Documentation Committee (IKDC) Subjective Knee Form, the Western Ontario Meniscal Evaluation Tool (WOMET) and the Marx Activity Scale (MAS) in patients with knee meniscal pathology who treated with partial knee meniscectomy.
Methods:
A consecutive series of patients with knee meniscal pathology treated with arthroscopic partial meniscectomy plus or minus intra-articular debridement were eligible. Other inclusion criteria were: a Kellegren-Lawrence Grade of 0-2, and ligamentous integrity. The KOOS (0-100, 5 subscales), IKDC (0-100), WOMET (0-100) and MAS (0-16) were administered at baseline and 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: “Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?” A receiver operator curve analysis was used to determine the PASS value at which patients considered their status to be satisfactory.
Results:
There were 115 patients (mean ± SD age, 53.8 ± 12.0 years), and 57.3% were male. Based on a receiver operator curve analysis, the PASS values - at which patients considered their status to be satisfactory - at 1 year after surgery were 43 (KOOS-symptoms subscale), 83 (KOOS-pain subscale), 84 (KOOS-functions of daily living subscale), 75 (KOOS-function, sport and recreational activity subscale), 56 (KOOS-quality of life subscale), 56 (IKDC), 61 (WOMET), 7 (MAS). The PASS threshold was not affected by baseline scores across the different instruments and there was no relationship between baseline score and likelihood of achieving the PASS. Age and sex were not significantly related to the odds of achieving the PASS for any of the PROMs.
Conclusion:
This is the first study to determine PASS in four commonly used knee-related PROMs in patients undergoing arthroscopic partial meniscectomy. The findings can allow researchers and clinicians to determine if partial meniscectomy is meaningful to patients and will be helpful for responder analysis in future trials related to knee arthroscopy and the treatment of meniscal pathology.
Objectives:
Very few predictors of healing have been identified to help guide OCD treatment decisions for patients, families and physicians. As this condition is not common, multi-center study groups ...will be necessary to determine optimal diagnostic and treatment strategies. For staging systems to be useful, there must be agreement among observers of each stage, and from different centers. Although arthroscopic staging systems exist for OCD, none have been tested for intra-observer and inter-observer reliability. Using an expert consensus method, the ROCK OCD study group developed an arthroscopy classification system for OCD of the knee. The purpose of this study was to determine the reliability of an OCD classification system in a multicenter study group.
Methods:
We developed a classification system for arthroscopic evaluation of OCD of the knee based on the experience of a 13 centers experienced in the care of OCD. The classification system produced 6 arthroscopic categories (Cue Ball, Shadow, Wrinkle in the Rug, Locked Door, Trap Door, and Crater). A training module including arthroscopic photos, iconic sketches, and representative videos was developed to describe each stage. A total of 30 representative arthroscopic videos were viewed by 10 orthopedic surgeons who had not participated in the video case selection and preparation. After 60 days, the 30 videos were reviewed a second time in a new, randomly selected order and classified. An inter-rater reliability assessment was performed using the intra-class correlation method.
Results:
The intra-class correlation coefficient was 0.92, indicating a very good to excellent reliability of this classification system amongst orthopedic surgeons within the ROCK group.
Conclusion:
The ROCK OCD Knee arthroscopy classification system demonstrated high reliability. Relatively rare conditions will require multi-center study groups to perform high quality outcome studies. This classification system will facilitate multi-center studies for OCD.
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