Characterization of investigators' approach to translational research: a qualitative study.

Background: Little is known about how investigators approach their research programs along the translational research continuum. Many consider the translational continuum to be linear, with research beginning at the bench and concluding with research at the bedside or in the community. We aimed to understand if translational investigators approach and view their research in this fashion.

Shortening the Work Preference Inventory for use with physician scientists: WPI-10.

The Work Preference Inventory (WPI) is a four-factor, 30-item measure that assesses work motivation. Used to help individuals choose appropriate career paths, its length contributes to response burden, especially when combined with other measures. We aimed to develop a shortened, valid, and reliable version of the WPI.

Measurement of social capital among clinical research trainees.

While physical and human capital are established as important predictors of success among early-career clinical investigators, less is known about the role of social capital. The authors aimed to develop a brief scale to assess social capital in this population and test its reliability and validity. A three-item assessment was developed based on a conceptual framework and measures of social capital from other fields and was administered to 414 clinical research trainees at the University of Pittsburgh in 2007-2012.

A shortened version of the Clinical Research Appraisal Inventory: CRAI-12.

Purpose: The original Clinical Research Appraisal Inventory (CRAI), which assesses the self-confidence of trainees in performing different aspects of clinical research, comprises 92 items. Completing the lengthy CRAI is time-consuming and represents a considerable burden to respondents, yet the CRAI provides useful data for evaluating research training programs. The purpose of this study is to develop a shortened version of the CRAI and to test its validity and reliability.

A comprehensive career-success model for physician-scientists.

With today's focus on the translation of basic science discoveries into clinical practice, the demand for physician-scientists is growing. Yet, physicians have always found it challenging to juggle the demands of clinical care with the time required to perform research. The Research on Careers Workgroup of the Institute for Clinical Research Education at the University of Pittsburgh developed a comprehensive model for career success that would address, and allow for the evaluation of, the personal factors, organizational factors, and their interplay that contribute to career success.

Burnout among early career clinical investigators.

Burnout is a pervasive problem among clinicians. However, little is known about burnout among early career clinical investigators, who must balance clinical responsibilities with challenges related to research. We aimed to determine the prevalence of and demographic associations with burnout in a cohort of early career clinical investigators.

Psychometric properties of the mentor role instrument when used in an academic medicine setting.

The Ragins and McFarlin Mentor Role Instrument (RMMRI) was originally developed to measure perceptions of mentoring relationships in research and development organizations. The current study was designed to evaluate the RMMRI's reliability and validity when the instrument was administered to clinical and translational science trainees at an academic medical center. The 33-item RMMRI was administered prospectively to a cohort of 141 trainees at the University of Pittsburgh in 2007-2008.

Opioid contracts in chronic nonmalignant pain management: objectives and uncertainties.

In this article, we review the principal objectives and ideal elements of opioid contracts, as articulated by proponents of the practice. We examine the limited empirical evidence for the effectiveness of opioid contracts in achieving their intended objectives and identify areas of uncertainty and of ethical concern regarding their implementation. We argue that the challenge in deciding about implementing opioid contracts in clinical practice relates to the multiplicity of potential objectives they might serve, to a lack of empirical evidence regarding their effectiveness, and to ethical concerns over their implementation.

"It was haunting...": physicians' descriptions of emotionally powerful patient deaths.

Purpose: To understand the emotional experiences of physicians who care for dying patients and to identify educational opportunities for improving patient care and physician well-being.

Method: Between 1999-2001, physicians at two quaternary care medical centers in Boston, Massachusetts, and Pittsburgh, Pennsylvania, participated in 90-minute, semistructured personal interviews on their most emotionally powerful patient death. Quantitative data was obtained through face-to-face surveys rated on ten-point scales that asked physicians about emotional characteristics of and emotional responses to the death.

"This is just too awful; I just can't believe I experienced that...": medical students' reactions to their "most memorable" patient death.

Purpose: To examine medical students' emotional reactions to their "most memorable" patient death and the support they receive.

Method: In 2000-01, 65 third-year medical students at two Northeastern U.S.

ASAM Patient Placement Criteria treatment levels: do they correspond to care actually received by homeless substance abusing adults?

We report findings from a community-based two-city survey of homeless adults comparing the level of substance abuse treatment assigned to them using the ASAM Patient Placement Criteria with care actually received during the previous 12 months. Overall 531 adults were surveyed with 382 meeting DSM-IIIR criteria of being in need of treatment or having a demand for treatment. Of those with a treatment need, 1.

Doctors' emotional reactions to recent death of a patient: cross sectional study of hospital doctors.

Objectives: To describe doctors' emotional reactions to the recent death of an "average" patient and to explore the effects of level of training on doctors' reactions.

Design: Cross sectional study using quantitative and qualitative data.

Setting: Two academic teaching hospitals in the United States.

Comparison of dynamic posteroanterior spinal stiffness to plain film radiographic images of lumbar disk height.

Background: Assessments of spinal stiffness have become more popular in recent years as a noninvasive objective biomechanical means to evaluate the human spine. Studies investigating posteroanterior (PA) forces in spinal stiffness assessment have shown relationships to spinal level, body type, and lumbar extensor muscle activity. Such measures may be important determinants to discriminate between patients with low back pain (LBP) and asymptomatic subjects.

Urban homelessness and poverty during economic prosperity and welfare reform: changes in self-reported comorbidities, insurance, and sources for usual care, 1995-1997.

Little is known of how homeless and other urban poor populations have fared during the robust economy and within structural changes in health care delivery and entitlement programs of the 1990s. This is important in determining the need for population-specific services during a vigorous economy with low unemployment and increasing Medicaid managed-care penetration. This study compared health insurance status and availability of a source for usual medical care, psychiatric and substance abuse comorbidities, and perceived causes of homelessness in homeless adults surveyed in 1995 and 1997.

Upper-extremity infections in patients seropositive for human immunodeficiency virus.

The records of 74 human immunodeficiency virus (HIV)-seropositive patients who were treated for upper-extremity infections were retrospectively reviewed. Intravenous drug use was the most common risk factor for HIV infection as well as the most common cause of the infection necessitating admission. These patients were admitted a total of 97 times for the treatment of 89 different infections and underwent 120 surgical procedures.

Increased leukocyte adhesiveness/aggregation in patients with recurrent TIA.

Objective: White blood cells might have a pathogenetic role in ischemic vascular conditions. Several studies have suggested that increased adhesiveness of these cells could contribute to such a damage. The present study was undertaken in order to examine the adhesive properties of leukocytes in the peripheral blood of patients with various degrees of ischemic neuro-vascular diseases.

The effects of folic acid supplementation on plasma total homocysteine are modulated by multivitamin use and methylenetetrahydrofolate reductase genotypes.

Elevated concentration of plasma total homocysteine (tHcy) is a common risk factor for arterial occlusive diseases. Folic acid (FA) supplementation usually lowers tHcy levels, but initial tHcy and vitamin levels, multivitamin use, and polymorphisms in the gene for 5, 10-methylenetetrahydrofolate reductase (MTHFR) may contribute to variability in reduction. We tested the effects of a 3-week daily intake of 1 or 2 mg of FA supplements on tHcy levels in patients with and without coronary heart disease (CHD) who were analyzed for the C677T MTHFR mutation.

Public policy governing organ and tissue procurement in the United States. Results from the National Organ and Tissue Procurement Study.

Objective: To determine why Required Request policies, which mandate that hospitals request donation from donor-eligible families, have not resulted in increased organ procurement.

Setting: Stratified sample of 23 acute-care general hospitals in two metropolitan areas.

Design: Chart review identified all eligible donors in study hospitals during a 20-month period.

Recurrent posterior glenohumeral dislocation associated with increased retroversion of the glenoid. A case report.

Recurrent traumatic posterior glenohumeral dislocation is rare and probably represents < 5% of all recurrent shoulder instability cases. Operative management of this problem is considered when symptomatic recurrent instability occurs despite an adequate physician-directed rehabilitation program. Before surgery, it is essential to recognize all directions of instability and any anatomic factors that may predispose the shoulder to recurrent instability, such as humeral head or glenoid defects, abnormal glenoid version or other anthropomorphic abnormalities, rotator cuff tears, neurologic injuries, or generalized ligamentous laxity.

Toward the elimination of homologous blood use in elective lumbar spine surgery.

Two hundred twenty-four consecutive patients underwent elective posterior lumbar spinal surgery over a 3 1/2-year span at the University of Miami/Jackson Memorial Medical Center. Patients ranged in age from 17 to 87 years, and 58% were male. Fifty-eight patients underwent revision surgery, and 65 patients required fusions, including 35 necessitating internal fixation.

Educating Athletes on HIV Disease and AIDS.

In brief Team physicians are in a unique brief position to counsel athletes about HIV disease and AIDS-they may be the only medical resource that this predominantly healthy group regularly encounters. A team physician who establishes rapport with athletes and has a basic knowledge of the current information on HIV disease and AIDS has a unique opportunity to frankly discuss the issues surrounding HIV transmission, both on and off the field.