An Exploration of Support for Clinical Education Partners.

Introduction: Effective academic-clinical partnerships require a greater understanding of how academic programs can best support clinical education (CE) faculty. This study aimed to determine resources and support that clinical partners need.

Review Of Literature: As the number of physical therapist (PT) programs, cohort sizes, and CE weeks have risen, so has demand for CE sites.

"Turning Point": Evaluating the Impact of a Three-Month UK-Based Clinical Education Training Programme for Physicians from a Chinese Medical School.

Purpose: Transnational faculty development programmes are increasingly popular in medicine, although evaluation of such activities rarely consider longer-term outcomes or the impact of language training. This study attempts to fill this gap by evaluating the lasting impacts of a three-month clinical education and English language training programme at University College London Medical School, UK, for medical educators from Ningbo University, China.

Methods: In-depth, semi-structured interviews were conducted in China with 41 participants who had completed the programme between 2013 and 2018.

Incidence and viral aetiologies of acute respiratory illnesses (ARIs) in the United States: a population-based study.

We conducted prospective, community-wide surveillance for acute respiratory illnesses (ARIs) in Rochester, NY and Marshfield, WI during a 3-month period in winter 2011. We estimated the incidence of ARIs in each community, tested for viruses, and determined the proportion of ARIs associated with healthcare visits. We used a rolling cross-sectional design to sample participants, conducted telephone interviews to assess ARI symptoms (defined as a current illness with feverishness or cough within the past 7 days), collected nasal/throat swabs to identify viruses, and extracted healthcare utilization from outpatient/inpatient records.

Intraosseous ganglion cysts of the carpus: current practice.

Intraosseous cysts of the carpal bones are an infrequent cause of chronic wrist pain. The main body of work has investigated their occurrence in the proximal carpus, with limited incidence in the distal row. We review the current literature on the treatment of symptomatic carpal cysts following the report of a 17-year-old male with a 12-month history of progressive right wrist pain due to an intraosseous ganglion of the trapezoid.

Profunda femoris injury following lesser trochanter displacement: complications following intramedullary femoral nailing.

Iatrogenic vascular complications following intramedullary nailing of hip fractures is a rare occurrence. We describe a case report of injury to the profunda femoris artery due to a displaced lesser trochanteric fragment following ambulation. We discuss the mechanism of arterial injury and associated signs in addition to possible preventative strategies.

Can the rolling cross-sectional survey design be used to estimate the effectiveness of influenza vaccines?

Introduction: Observational studies of influenza vaccine effectiveness often study persons seeking medical care for acute respiratory infection (ARI). We conducted a pilot study to determine if vaccine effectiveness could be estimated in the general population with a novel rolling cross-sectional survey sampling design and laboratory confirmation of influenza.

Methods: Cross-sectional samples were selected weekly from defined populations in Marshfield, Wisconsin and Monroe County, New York from January through April, 2011 (12 weeks).

Quality in physical therapist clinical education: a systematic review.

Background: Many factors affect student learning throughout the clinical education (CE) component of professional (entry-level) physical therapist education curricula. Physical therapist education programs (PTEPs) manage CE, yet the material and human resources required to provide CE are generally overseen by community-based physical therapist practices.

Purpose: The purposes of this systematic review were: (1) to examine how the construct of quality is defined in CE literature and (2) to determine the methodological rigor of the available evidence on quality in physical therapist CE.

Delivering stepped care: an analysis of implementation in routine practice.

Background: In the United Kingdom, clinical guidelines recommend that services for depression and anxiety should be structured around a stepped care model, where patients receive treatment at different 'steps,' with the intensity of treatment (i.e., the amount and type) increasing at each step if they fail to benefit at previous steps.

Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates.

Objective: To assess the impact of a tiered patient immunization navigator intervention (immunization tracking, reminder/recall, and outreach) on improving immunization and preventive care visit rates in urban adolescents.

Design: Randomized clinical trial allocating adolescents (aged 11-15 years) to intervention vs standard of care control.

Setting: Eight primary care practices.

A technical note concerning emergency bed demand.

A common method for modelling emergency referrals to a hospital in-patient unit is to assume that they follow a Poisson distribution. If lengths of stay are independent and identically distributed, then the distribution of bed demand can be derived by analysis of a queueing system with an infinite number of servers. Undemanding analysis can be used to express the mean and variance of bed demand in terms of simple formulae involving mean referral rates and the distribution of lengths of stay.

Quality assessment of cardiac surgery in Britain.

Data are available for every Cardiac Surgery unit in Britain and in 70 % are identifiable by surgeon. The data are linked to registration of deaths so survival for a range of operations, and associated patient or procedure related factors, can be evaluated. The choice of statistical triggers (outside 99.

Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time?

Background: Risk adjustment of outcomes in pediatric congenital heart surgery is challenging due to the great diversity in diagnoses and procedures. We have previously shown that variable life-adjusted display (VLAD) charts provide an effective graphic display of risk-adjusted outcomes in this specialty. A question arises as to whether the risk model used remains appropriate over time.

Evolution of the health economics of cervical cancer vaccination.

This paper reviews the history of modelling for cervical cancer vaccination. We provide an interpretation and summary of conclusions pertaining to the usefulness of different models, the predicted epidemiological impact of vaccination and the cost-effectiveness of adolescent, catch-up and sex-specific vaccination strategies. To date, model results predict a critical role for vaccination in reducing the burden of cervical disease, with cost-effectiveness being consistently shown across studies using a common threshold of US $50,000 per QALY, but further clinical and epidemiological data are required to confirm these findings.

Comparison of detailed and succinct cohort modelling approaches in a multi-regional evaluation of cervical cancer vaccination.

Mathematical models have been used extensively in the evaluation of chronic diseases and in exploring the health economics of vaccination. In this study, we examine the value of having two different cohort models based on similar assumptions, one comprehensive and one simplified, which can be used to evaluate the impact of cervical cancer vaccination. To compare models, we ran cost-effectiveness analyses in four geographical regions (Italy, the UK, Taiwan and Canada).

Quantifying the impact of non-adherence to drug therapy: a technical note concerning an application of a branch and bound algorithm.

Pharmacokinetic models typically rely on a key assumption that patients take their medication as prescribed, whereas this is often not the case. We present a branch and bound algorithm that can be used to estimate the time-varying probability that, given a specified pattern of nonadherence to a prescribed regimen, a patient receives no therapeutic benefit from treatment. Use of this algorithm is a much faster method for obtaining this probability than exhaustive computation of the relevant probability distribution.

A technical note concerning non-adherence to drug therapy: exact expressions for the mean and variance of drug concentration.

There is considerable evidence that prescribed drugs are not taken as intended. We present a stochastic pharmacokinetic mathematical model that can be used to assess the implications of non-adherence to prescribed drug regimens, on the part of either patients or health professionals. In the context of an orally administered drug, explicit equations are derived for the time varying mean and variance of the concentration of the drug in the serum, depending on the probability of each scheduled administration being omitted.

Restructuring routine elective services to reduce overall capacity requirements within a local health economy.

The U.K. Government has introduced a new class of health service providers called Treatment Centres that provide routine elective services but that do not deal with emergency cases or non-routine elective patients.

Is the principle of a stable Heinrich ratio a myth? A multimethod analysis.

Background: Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives.

Challenging the role of calibration, validation and sensitivity analysis in relation to models of health care processes.

Many applications of Operational Research in the context of health care involve processes of calibration, validation and sensitivity analysis. Indeed these processes seem to have such an elevated status that their absence is often regarded as a marker that a study is somehow substandard. Undoubtedly this may be the case, however there may also be circumstances where it is perfectly reasonable not to use such methods.

Modelling of errors in databases.

A lot of time and energy are expended assembling national databases containing information about health care processes and outcomes. Unfortunately, given the complexity of the data gathering procedures involved, errors occur. This inevitably leads to problems when it comes to the analysis of data from such sources.

Dead reckoning: can we trust estimates of mortality rates in clinical databases?

Objectives: Databases almost invariably contain some errors and improvements to the quality of recorded data are costly. We sought to assess the extent to which given levels of error in a clinical database can lead to misleading mortality rates being derived.

Methods: We deliberately seeded a large database concerning congenital heart surgery involving over 17,600 operations, which we assumed to be error free, with errors at known rates of 0-20%.

A consensus process for identifying a prioritised list of study questions.

A consensus process has been developed to assist the UK National Confidential Enquiry into Patient Outcome and Death in identifying questions to be addressed in its studies. The process utilises the knowledge and experience of a panel of experts via a facilitated brainstorming exercise and employs a robust voting system to produce a list of candidate questions ordered in terms of the preferences expressed by individual panel members. The process which is described has been used successfully to assist the design of two national studies and it is anticipated that the process will be adopted for many studies in the future.

Providing feedback to hospital doctors about prescribing errors; a pilot study.

Objective: To assess the feasibility and acceptability of obtaining data on prescribing error rates in routine practice, and presenting feedback on such errors to medical staff.

Setting: One clinical directorate of a London teaching trust.

Methods: Ward pharmacists recorded all prescribing errors identified in newly written medication orders on one day each fortnight between February and May 2005.