A case report curriculum to promote scholarship Besharatian, Behdad; Velez, Jorge; Rosenblum, Michael ...
The clinical teacher,
December 2017, 2017-Dec, 2017-12-00, 20171201, Letnik:
14, Številka:
6
Journal Article
Recenzirano
Summary
Background
Engaging in scholarly activity during residency can facilitate the acquisition of important skills; however, residents may encounter barriers such as unclear expectations as to ...what constitutes scholarship, a paucity of dedicated time and a lack of mentorship.
Residents may encounter barriers such as unclear expectations as to what constitutes scholarship
Objective
In July 2013, we developed a Case Report Curriculum (CRC) for first‐year residents to guide them towards creating a high‐quality case report and helping them to achieve the Accreditation Council for Graduate Medical Education scholarly activity requirement.
Methods
The CRC is composed of four 1‐hour educational sessions (seminars and group work) at intervals of 4–6 weeks, with specific homework assignments. Sessions are divided into four topics: (1) importance of scholarship and selecting a case; (2) defining appropriate learning objectives; (3) writing a discussion; and (4) editing and submitting. The culmination of the CRC is a poster competition at our institutional Academic Week.
Results
In 2012/13, the year prior to CRC implementation, six of 18 (33%) first‐year residents participated in scholarly activity. During the following 2 years, 20 of 20 (100%) of the 2013/14 first‐year residents and 21 of 22 (95%) of the 2014/15 first‐year residents participated in the CRC and presented a case report. Furthermore, 16 of 20 (80%) of the first‐year residents who completed the CRC in 2013/14 voluntarily continued to work on scholarly projects, with a total of 44 projects published or presented regionally or nationally.
Discussion
The CRC represents a practical structured framework for promoting scholarship, which can be easily implemented in a residency programme.
Ice cores provide a valuable archive of climate history. for a complete understanding of this archive, it is important to understand air–snow exchange processes through the snow and firn in order to ...fully decode the ice-core record. Transport processes through the snow and firn are dependent upon their physical properties. In this paper, bidirectional permeabilities from selected sections of a 13 mcore from Summit, Greenland, are presented. Differences between lateral and vertical permeabilities are evident throughout the core in permeameter data and in microstructure statistics. Both lateral and vertical permeabilities are consistent with overall patterns of previous polar permeability data with depth. the differences between lateral and vertical permeability measurements for some samples can be attributed to equivalent sphere radius. Further studies examining mean free-path length may be helpful in chemical modeling and in deriving an equation relating permeability to microstructure.
Ventilator-associated pneumonia (VAP) is the leading cause of morbidity and mortality in the ICU, particularly in older patients. Strategies to reduce or prevent the incidence of VAP are crucial. One ...of the less understood risk factors for VAP is poor oral health. This study provided the first evaluation of preoperative oral health status as a risk factor for ventilator-associated pneumonia in older adults. While oral health, dental plaque and oral bacteria have been suggested in the literature as linked to VAP, the association between amount of plaque before and after surgery and VAP risk has not previously been directly studied. The model used to guide this study is based on the Human Response Model (HRM) of Heitkemper and Shaver. A prospective, correlational design was used to measure the relationship between oral health and VAP. A convenience sample of 96 adults over 50 years old were recruited from patients scheduled for elective cardiac, abdominal, thoracic or vascular surgery, who required oral intubation and mechanical ventilation post-surgery. Oral health was evaluated by dental plaque accumulation using the University of Mississippi Oral Hygiene Index (UM-OHI). VAP was diagnosed using the Clinical Pulmonary Infection Score (CPIS) within 24 hours of intubation and up until postoperative day seven. Multiple and logistic regression analysis indicated that preoperative oral health significantly predicted postoperative oral health and accounted for 64% of the variability in postoperative oral health. Overall, oral health declined from preoperative to postoperative but deteriorated less in cardiac surgery patients. Higher patient acuity, greater number of comorbidities and being female was associated with an increased likelihood of developing ventilator-associated pneumonia. Although this study did show a decline in oral health from preoperative to postoperative, it did not find a direct relationship between the quantity of dental plaque and VAP. This study did find that VAP risk is likely related to preoperative comorbidities and vulnerabilities, and to hospital acuity and course. A VAP reduction strategy which focuses on plaque quantity reduction as its target may not be effective. This study can serve as a basis for future studies investigating the impact of oral health on ventilator-associated pneumonia.
Seasonally dry tropical forests are distributed across Latin America and the Caribbean and are highly threatened, with less than 10% of their original extent remaining in many countries. Using 835 ...inventories covering 4660 species of woody plants, we show marked floristic turnover among inventories and regions, which may be higher than in other neotropical biomes, such as savanna. Such high floristic turnover indicates that numerous conservation areas across many countries will be needed to protect the full diversity of tropical dry forests. Our results provide a scientific framework within which national decision-makers can contextuaiize the floristic significance of their dry forest at a regional and continental scale.
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