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System barriers to effective healthcare engagement and navigation contribute to healthcare disparities among Latino children with immigrant parents in the US. We evaluated a nine-minute educational video supporting healthcare navigation and engagement skills of Spanish-speaking Latino parents of infants. Participants viewed the video at their child's 2-month well-visit, completed a pre-and post-video knowledge evaluation, and answered open-ended questions on video style. A paired t test was used to examine differences in knowledge and open-ended responses were coded using an iterative, consensus-based process. Of the 79 participants, 63.3% had an education level below high school diploma/GED and 84.8% were at risk for limited health literacy. There was a significant gain in healthcare navigation and engagement knowledge after watching the video (p < 0.001). Parents expressed that the video was interesting and provided useful information. Parents valued the knowledge gained and preferred videos over written materials for receiving culturally and linguistically tailored health education. [ABSTRACT FROM AUTHOR]

The 8th biennial national conference of the Association of Psychologists in Academic Health Centers (APAHC) was held in Detroit, MI, March 9-11, 2017. All speakers were invited to contribute manuscripts based on their conference presentations to this special issue of the Journal of Clinical Psychology in Medical Settings, and five presenters did so. All manuscripts were peer reviewed by experts in the field. The Conference Co-Chairs, Drs. Amy M. Williams and John A. Yozwiak, serve as Guest Editors for the special issue with Associate Editorial support from Dr. Elizabeth D. Cash. This article provides a brief overview of the rationale for the choice of the conference theme and the speakers, and a brief introduction to the articles in this special issue. [ABSTRACT FROM AUTHOR]

Analysis of international public-sector contributions to Food and Drug Administration (FDA)-approved drugs and vaccines allows for a more thorough examination of the global biomedical innovation ecosystem by institution of origin. Using new and existing methods, we have identified 364 FDA-approved drugs and vaccines approved from 1973 to 2016 discovered in whole or in part by Public Sector Research Institutions (PSRIs) worldwide. We identified product-specific intellectual property contributions to FDA-approved small molecule and biologic drugs and vaccines from the FDA Orange Book, our peer network, published studies, and three new sources: reports of medical product manufacturers' payments to physicians and teaching hospitals under The Sunshine Act of 2010, a paper by Kneller and 64 royalty monetization transactions by academic institutions and/or their faculty that one of us (AS) maintains. We include a total of 293 drugs discovered either wholly by a US PSRI or jointly by a U.S. and a non-U.S. PSRI. 119 FDA-approved drugs and vaccines were discovered by PSRIs outside the U.S. Of these, 71 were solely discovered outside the US, while 48 also involved intellectual property contributions by US PSRIs. In the context of the global public sector landscape, the US dominates drug discovery, accounting for two-thirds of these drugs and many of the important, innovative vaccines introduced over the past 30 years. Contributions by Canada, UK, Germany, Belgium, Japan, and others each amount to 5.4% or less of the total. [ABSTRACT FROM AUTHOR]

Academic Health Centers (AHCs) across the nation are experiencing a reawakening to the importance of Diversity, Equity, and Inclusion (DEI). Such work impacts both employees and patients served by healthcare institutions. Yet, for departments without previously existing formal channels for this work, it is not always apparent where to begin. The current manuscript details a process for creating a committee as a vehicle for championing DEI efforts at the department level within an AHC. The authors present a six-step model for forming a DEI Committee and progress monitoring measures to remain accountable to identified objectives. In each step, the authors provide examples of their work with the goal for readers to tailor and apply each step to their own departments' DEI efforts. The current paper also identifies lessons learned with regard to barriers and facilitators of department-level DEI work. Reflections and next steps for DEI work beyond the proposed model are also discussed. [ABSTRACT FROM AUTHOR]

The aim of the study is to assess the feasibility of Drugs Rational Usage Guideline System (DRUGS)-supported clinical pathway (CP) for breast carcinoma, cataract, inguinal hernia and 2-diabetes mellitus whether the application of such a system could improve work efficiency, medical safety, and decrease hospital cost. Four kinds of diseases which included 1773 cases (where 901 cases using paper-based clinical pathways and 872 cases using DRUGS-supported clinical pathways) were selected and their demographic and clinical data were collected. The evaluation criteria were length of stay, preoperative length of stay, hospital cost, antibiotics prescribed during hospitalization, unscheduled surgery, complications and prognosis. The median total LOS was 1 to 3 days shorter in the DRUGS-supported CP group as compared to the Paper-based CP group for all types ( p < 0.05). Totel hospital cost decreased significantly in the DRUGS-supported CP group than that in Paper-based CP group. About antibiotics prescribed during hospitalization, there were no statistically differences in the time of initial dose of antibiotic and the duration of administration except the choice of antibiotic categories. The proportion of DRUGS-supported clinical pathway conditions where a broad-spectrum antibiotic was prescribed decreased from 63.6 to 34.5 % ( p < 0.01) in the Paper-based group. While after the intervention, the differences were statistically not significant in unscheduled surgery, complications and prognosis. In this study, DRUGS-supported clinical pathway for breast carcinoma, cataract, inguinal hernia, 2-diabetes mellitus was smoothly shifted from a paper-based to an electronic system, and confer benefits at the hospital level. [ABSTRACT FROM AUTHOR]

The article reports on the investigation whether electrical pulses from deep-brain electrical stimulation electrodes implanted in the central thalamus could recruit and activate unused but functional cerebral networks in patients in the minimally conscious state (MCS). This work, which was conducted by Nicholas Schiff, a neurologist at the Weill Cornell Medical College in New York, together with Weill medical ethicist Joseph Fins, neurologist Joseph Giacino, and neurosurgeon Ali Rezai, focused on a single patient who was unable to follow commands consistently, communicate, or vocalize after severe traumatic brain injury. Schiff considers the team's effort not just an innovation in neurosurgery, but also in how MCS patient behavior is assessed and how doctors think on finding ethical ways.

In recent years, Hunza has seen a surge of suicide cases among youth. This paper attempts to decipher the multiple layers of meanings entailed in suicide cases. The dominant perception among the natives is the attribution of influence to supernatural beings. This paper attempts to provide insights into the supernatural cosmology and its relationship to youth suicide among the Burushaski speakers of Hunza. Using qualitative research methodology, this paper describes the local perception of supernatural beings, and their classifications as well as the role of local shamans, known in Burushaski as bitan. In this scenario, suicide is not seen as a self-destruction, but is rather a punishment by the supernatural beings owing to the violation of the sacred supernatural social order imposed by the spirits connected to the supernatural world. For the natives, both the terrestrial and supernatural spheres share common habitats and mountain ecology; however, the latter is perceived to have more powers than the former. Therefore, breach of this order is highly discouraged and bears dire consequences. What appears as mere supernatural and human conflict actually carries deeper references to social and ecological disruptions. [ABSTRACT FROM AUTHOR]

Background: To assess quality of life and unmet needs after stroke, patient-reported outcome measures (PROMs) have gained increasing attention. However, patients' perspectives on assessing PROMs remain unclear, potentially hindering implementation into clinical practice. Therefore, this study explored patients' preferences on assessing PROMs after ischemic stroke. Methods: A paper-based questionnaire was sent to stroke survivors treated at the Department of Neurology, University of Leipzig, Germany. Health-related quality of life (HRQoL, EQ-5D-5L) and preferences regarding different aspects of data collection to assess PROMs were investigated and linked to socio-demographic and medical characteristics. Results: 158 persons were contacted and 80 replies were subsequently analyzed. Mean age was 70.16 years and mean HRQoL was 68.79 (visual analogue scale with a theoretical maximum of 100). Participants showed positive attitudes towards PROMs as they saw potential to improve care of other patients (n = 66/79; 83.54%) or to improve their own situation (n = 53/74; 71.62%). Participants preferred an annual interview after stroke (n = 39/80; 48.75%) and would preferably spend 15–30 min (n = 41/79; 51.90%) to answer a written survey (n = 69/80; 86.25%). The initially treating clinic was preferred as initiator of such surveys (n = 43/79; 54.43%). Stratification revealed that participants with more than 1 h of daily digital media usage preferred email as way of communication. Conclusions: For the first time, this study showed individual preferences on assessing PROMs after ischemic stroke, focusing on the way, time interval, duration, and initiation site of surveys. These insights might help to successfully implement PROMs after stroke and subsequently detect unmet needs and deficits in stroke care. [ABSTRACT FROM AUTHOR]

Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate disparities in urine drug testing (UDT) during perinatal care at a single academic medical center. This retrospective cohort study included patients who had a live birth and received prenatal care at our institution between 10/1/2015 and 9/30/2020. The primary outcomes were maternal UDT during pregnancy (UDTPN) and UDT only at delivery (UDTDEL). Secondary outcomes included the number of UDTs (UDTNUM) and the association between a positive UDT test result and race/ethnicity. Mixed model logistic regression and negative binomial regression with clustering based on prenatal care locations were used to control for confounders. Of 6,240 live births, 2,265 (36.3%) and 167 (2.7%) received UDTPN and UDTDEL, respectively. Black (OR 2.09, 95% CI 1.54–2.84) and individuals of Other races (OR 1.64, 95% CI 1.03–2.64) had greater odds of UDTPN compared to non-Hispanic White individuals. Black (beta = 1.12, p < 0.001) and Hispanic individuals (beta = 0.78, p < 0.001) also had a positive relationship with UDTNUM. Compared to individuals with non-Medicaid insurance, those insured by Medicaid had greater odds of UDTPN (OR 1.66, 95% CI 1.11–2.49) and had a positive relationship with UDTNUM (beta = 0.89, p < 0.001). No significant associations were found for UDTDEL and race/ethnicity. Despite receiving more UDT, Black individuals were not more likely to have a positive test result compared to non-Hispanic White individuals (OR 0.95, 95% CI 0.72–1.25). Our findings demonstrate persistent disparities in substance use testing during the perinatal period. Significance: What is already known on this subject?: Prior literature has shown evidence of racial disparities in urine drug testing during pregnancy-related hospital admissions and at delivery. What this study adds?: This paper found that disparities in urine drug testing also exist during the prenatal care period at an urban academic institution. We also found a positive relationship between the number of tests received and being of Black or Hispanic race/ethnicity. Future research should investigate health care system-related interventions to mitigate disparities in urine drug testing. [ABSTRACT FROM AUTHOR]

Beside citation metrics, in recent years, the thermodynamic indicators have been introduced. So, we want to compare citation metrics like h-index to thermodynamic indicators such as the exergy for determining the best indicator to rank the scientific agents effectively. This study is the bibliometric research and analyzes the scientific performance of the best countries, institutions, and universities in medical fields based on the citation metrics and the thermodynamic indicators upon extracted data from Scopus and Scimago databases. The Excel software version 2016 was used for analyzing the research performance of these medical agents and descriptive statistics were reported. Among countries, the United States had the best research performance based on the highest number of P, C, h, X. But, it had the lower impact than some countries like the United Kingdom and Italy. Iran is ranked 17th among the countries of the world in terms of studying indicators. About the world medical institutions, the National Institutes of Health Bethesda had the best research performance based on h and X, but the most qualitative institution was the American Cancer Society. Iranian medical universities compared to their world peers had the lower P, C, i, h, X. But Tehran University of Medical Sciences ranked first upon h and X. Mashhad University of Medical Sciences had the best quality of the scientific publication. Results showed that the exergy as the thermodynamic indicator and research performance metric can rank better the academic units based on the total number of papers and citations than the citation metrics such as h-index. [ABSTRACT FROM AUTHOR]

Emergency departments (EDs) have a key role in the public health system. They are facing a constant growth of their volume. Forecasting the daily volume is a major tool to adapt the allocation of resources. In this paper, we focus on pediatric EDs. They are specific by their strong seasonal variation, determined by the academic pace. The main contribution of this paper is to integrate the effects of this pace to the annual seasonality. We also tried out to improve the daily forecasting by forecasting the week means of the flow first. We trained and tested these models specifically on the pediatric EDs of Paris university hospital trust. For the eight pediatric EDs gathered, on average for the years 2016 to 2019, we forecasted the daily volume with a Mean Absolute Percentage Error (MAPE) of 6.6% for a 7-days forecasting, 7.1% for a 14-days forecasting and 7.6% for a 28-days forecasting. Account of rhythm allows a performance increase, with results respectively 7%, 10.1% and 8.4% better relatively to a baseline model based on a periodic regression on the weeks. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the utility of electronic tablets and their capacity to increase hospital floor productivity, efficiency, improve patient care information safety, and to enhance resident education and resource utilization on a busy Otolaryngology - Head & Neck Surgery inpatient service. This was a prospective cohort study with a 2-week pre-implementation period with standard paper census lists without mobile tablet use, and a 2-week post-implementation period followed with electronic tablets used to place orders, look up pertinent clinical data, educate patients as appropriate, and to record daily to-dos that would previously be recorded on paper. The setting for the study was Duke University Medical Center in Durham, North Carolina, with 13 Otolaryngology residents comprising the study population. The time for inpatient rounding was shorter with the use tablets ( p = 0.037). There was a non-significant trend in the number of times a resident had to leave rounds to look up a clinical query on a computer, with less instances occurring in the post-implementation study period. The residents felt that having a tablet facilitated more detailed and faster transfer of information, and improved ease of documentation in the medical record. Seventy percent felt tablets helped them spend more time with patients, 70 % could spend more time directly involved in rounds because they could use the tablet to query information at point-of-care, and 80 % felt tablets improved morale. The utility of a mobile tablet device coupled with the electronic health record appeared to have both quantitative and qualitative improvements in efficiency, increased time with patients and attendance at academic conferences. Tablets should be encouraged but not mandated for clinical and educational use. [ABSTRACT FROM AUTHOR]

The Diversity, Equity, and Inclusion (DEI) committee was established in 2017 within the Department of Pediatrics at Rush University Medical Center (RUMC), an academic medical health center located on the near west side of Chicago, IL. Results from climate surveys highlighted the need for increased DEI initiatives within the department, and a renewed national reckoning on racial tensions sparked an additional sense of urgency for system-level change. This paper outlines the initial creation and ongoing efforts of the DEI committee. Information related to the structure of our committee, aims of our work, progress toward identified goals, as well as ongoing barriers is provided. Academic medical health centers are tasked not only with working and training together, but also to care for a diverse group of patients within a larger community. As such, academic medical health centers represent a unique backdrop and opportunity for individual and system-level change. [ABSTRACT FROM AUTHOR]

Risk assessment in operative medicine is a key aspect for patient safety. The aim of this paper is to outline the degree of dissemination of a standardized procedure for risk analysis, process-oriented risk analysis, at German university hospitals. Process-oriented risk analysis represents a standardized procedure for the analysis of adverse events within the framework of clinical risk management. In this study, 262 full professors of German university hospitals were surveyed in November 2020 regarding the use of this instrument. The response rate was 17%. The analysis showed that 29% of the respondents already introduced the process-oriented risk analysis in their department. Further, 97% of the respondents were willing to standardize clinical processes with regard to patient safety. Moreover, 95% of the respondents said that a risk analysis and the resulting implementation of new procedural measures were important. It could be shown that the readiness for the procedural consideration of clinical processes with regard to patient safety is 92%. Currently, there is a lack of scientific evidence on the effectiveness and efficiency of the process-oriented risk analysis which is why further studies are needed to achieve a comprehensive understanding of this tool. [ABSTRACT FROM AUTHOR]

The National Institute for Health and Care Excellence (NICE) invited the manufacturer (Roche) of pralsetinib (Gavreto®), as part of the single technology appraisal (STA) process, to submit evidence for the clinical effectiveness and cost effectiveness of pralsetinib for the treatment of adult patients with rearranged during transfection (RET) fusion-positive advanced non-small-cell lung cancer (NSCLC) not previously treated with a RET inhibitor. Kleijnen Systematic Reviews Ltd, in collaboration with University Medical Center Groningen, was commissioned to act as the independent Evidence Review Group (ERG). This paper summarizes the company submission (CS), presents the ERG's critical review of the clinical and cost-effectiveness evidence in the CS, highlights the key methodological considerations, and describes the development of the NICE guidance by the Appraisal Committee. The CS reported data from the ARROW trial. ARROW is a single-arm, multicenter, non-randomized, open-label, multi-cohort study in patients with RET fusion-positive NSCLC and other advanced solid tumors. The CS included both untreated and pre-treated RET fusion-positive NSCLC patients, among other disease types. The comparators in the untreated population were pembrolizumab + pemetrexed + chemotherapy and pembrolizumab monotherapy. The comparators for the pre-treated population were docetaxel monotherapy, docetaxel + nintedanib, and platinum-based chemotherapy ± pemetrexed. As no comparators were included in ARROW, an indirect treatment comparison was conducted to estimate relative effectiveness. The ERG's concerns included the immaturity of data, small sample size, and lack of comparative safety evidence. The ERG considers the clinical evidence presented to be insufficiently robust to inform the economic model. Even when all the ERG preferred assumptions were implemented in the model, uncertainty remained on a number of issues, such as the appropriateness of the hazard ratios and the methods and data used to derive them, long-term efficacy of pralsetinib, and direct evidence for health-related quality of life (HRQoL). NICE did not recommend pralsetinib within its marketing authorization for treating RET fusion-positive advanced non-small-cell lung cancer (NSCLC) in adults who have not had a RET inhibitor before. The uncertainty of the clinical evidence and the estimates of cost effectiveness were too high to be considered a cost-effective use of NHS resources. Therefore, pralsetinib was not recommended for routine use. [ABSTRACT FROM AUTHOR]

The administrative burden for physicians in the hospital can affect the quality of patient care. The Service Center Medical Informatics (SMI) of the University Hospital Würzburg developed and implemented the smartphone-based mobile application (MA) ukw.mobile1 that uses speech recognition for the point-of-care ordering of radiological examinations. The aim of this study was to examine the usability of the MA workflow for the point-of-care ordering of radiological examinations. All physicians at the Department of Trauma and Plastic Surgery at the University Hospital Würzburg, Germany, were asked to participate in a survey including the short version of the User Experience Questionnaire (UEQ-S) and the Unified Theory of Acceptance and Use of Technology (UTAUT). For the analysis of the different domains of user experience (overall attractiveness, pragmatic quality and hedonic quality), we used a two-sided dependent sample t-test. For the determinants of the acceptance model, we employed regression analysis. Twenty-one of 30 physicians (mean age 34 ± 8 years, 62% male) completed the questionnaire. Compared to the conventional desktop application (DA) workflow, the new MA workflow showed superior overall attractiveness (mean difference 2.15 ± 1.33), pragmatic quality (mean difference 1.90 ± 1.16), and hedonic quality (mean difference 2.41 ± 1.62; all p <.001). The user acceptance measured by the UTAUT (mean 4.49 ± 0.41; min. 1, max. 5) was also high. Performance expectancy (beta = 0.57, p =.02) and effort expectancy (beta = 0.36, p =.04) were identified as predictors of acceptance, the full predictive model explained 65.4% of its variance. Point-of-care mHealth solutions using innovative technology such as speech-recognition seem to address the users' needs and to offer higher usability in comparison to conventional technology. Implementation of user-centered mHealth innovations might therefore help to facilitate physicians' daily work. [ABSTRACT FROM AUTHOR]

In the transition from paper to electronic workflow, the University of Colorado Health System's implementation of a new electronic health record system (EHR) forced all clinical groups to reevaluate their practices including the infrastructure surrounding clinical trials. Radiological imaging is an important piece of many clinical trials and requires a high level of consistency and standardization. With EHR implementation, paper orders were manually transcribed into the EHR, digitizing an inefficient work flow. A team of schedulers, radiologists, technologists, research personnel, and EHR analysts worked together to optimize the EHR to accommodate the needs of research imaging protocols. The transition to electronic workflow posed several problems: (1) there needed to be effective communication throughout the imaging process from scheduling to radiologist interpretation. (2) The exam ordering process needed to be automated to allow scheduling of specific research studies on specific equipment. (3) The billing process needed to be controlled to accommodate radiologists already supported by grants. (4) There needed to be functionality allowing exams to finalize automatically skipping the PACS and interpretation process. (5) There needed to be a way to alert radiologists that a specialized research interpretation was needed on a given exam. These issues were resolved through the optimization of the 'visit type,' allowing a high-level control of an exam at the time of scheduling. Additionally, we added columns and fields to work queues displaying grant identification numbers. The build solutions we implemented reduced the mistakes made and increased imaging quality and compliance. [ABSTRACT FROM AUTHOR]

Background: Spontaneous reporting of adverse drug reactions (ADRs) is essential for the post-marketing safety evaluation of drugs. Therefore, good monitoring of ADRs is vital for strengthening drug supervision, management, and guiding rational drug use. Chinese medical institutions are the primary source of ADR case reports, but the proportion of the reports in grade IIIA hospitals is still low due to serious under-reporting. The 3rd Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People's Hospital, also has such a problem. Objective: To improve the quantity and quality of ADR reports and enhance the level of pharmacovigilance in hospitals, the Third Affiliated Hospital of Chengdu Medical College, People's Hospital of Chengdu Pidu District experienced 10 years to gradually establish a management model to improve the medical staff's reporting rate of spontaneous reporting of ADRs. The management model is led by clinical pharmacists and combines the PDCA with Teach-back methods. The purpose of this paper is to introduce the management model and discuss its advantages and shortcomings of this model. Methods: This study was conducted at the Third Affiliated Hospital of Chengdu Medical College—Chengdu Pidu District People's Hospital. From 2016, the daily management of reporting, auditing, and data improvement of adverse drug reactions in the hospital was carried out by clinical pharmacists, who used the PDCA method combined with the Teach-back method to continuously improve the reporting program of ADRs in the hospital during 2016–2021. Then, the proportion of spontaneous reports of total, new, and serious ADRs was compared before and after the intervention. Also, we performed a time series analysis using an autoregressive moving average model to assess changes in the total number of spontaneous ADR reports before the intervention (2013–2015), the first intervention (2016–2018), and the second intervention (2019–2021). Results: After the combined PDCA and Teach-back method intervention, the median number of reported ADRs per year increased from 50 (range 37–55) in the pre-intervention period to 88 (range 83–162) in the first intervention period and to 374 in the second (range 312–566). Breakpoint regression analysis of the spontaneous reporting rate of ADRs showed that the instantaneous increase after the first intervention was not statistically significant (P = 0.526). However, the reporting rate of ADRs increased at a month-by-month growth rate during the second intervention compared to the first intervention. Its spontaneous reporting rate improved 1.034 times (P = 0.002). After the second intervention, the spontaneous reporting rate of ADRs transiently increased 6.111-fold (P < 0.001), and the month-to-month growth rate increased 1.024-fold (P < 0.001) again. Conclusion: The management model that combines the PDCA and the Teach-back method significantly improves the reporting rate of adverse drug reactions. [ABSTRACT FROM AUTHOR]

Research into nonsuicidal self-injury (NSSI) has primarily focussed on the experience and regulation of emotion. Recently, NSSI-specific cognitions, including self-efficacy to resist self-injury, have been explored to further understand the behaviour. However, within these studies self-efficacy to resist NSSI has been assessed broadly using an adapted measure of self-efficacy to avoid suicide. There is a need for a NSSI-specific measure of self-efficacy, which considers specific contexts that may influence confidence in the ability to resist self-injuring. This paper reports the development of such a measure. An initial item pool (125 items) was generated from interviews with people with lived experience of NSSI and experts in the field of self-injury. These items were then administered to 650 participants aged 18–40 years (M = 21.14, SD = 2.32, 45.69% with a history of NSSI). Analyses revealed a three-factor structure representing: contexts in which it would be difficult to resist NSSI (risk contexts); contexts which make it easier to resist NSSI (protective contexts); and contexts in which people are reminded of self-injury (reminders of NSSI). To reduce the number of items, eight items with the highest loadings on each factor were retained. The final 24 item (three subscales) scale fit the data well and demonstrated invariance across individuals with and without a history of self-injury. Correlations with related but distinct constructs (e.g., self-esteem, locus of control) supported convergent and discriminative validity. This measure could be used to further theoretical understanding of NSSI and may be useful in clinical settings. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy(DR) is a health condition that affects the retinal blood vessels(BV) and arises in over half of people living with diabetes. Exudates(EX) are significant indications of DR. Early detection and treatment can prevent vision loss in many cases. EX detection is a challenging problem for ophthalmologists due to its different sizes and elevations as retinal fundus images frequently have irregular illumination and are poorly contrasting. Manual detection of EX is a time-consuming process to diagnose a mass number of diabetic patients. In the domain of signal processing, both SIFT (scale-invariant feature transform) and SURF (speed-up robust feature) methods are predominant in scale-invariant location retrieval and have shown a range of advantages. But, when extended to medical images with corresponding weak contrast between reference features and neighboring areas, these methods cannot differentiate significant features. Considering these, in this paper, a novel method is proposed based on modified KAZE features, which is an emerging technique to extract feature points and extreme learning machine autoencoders(ELMAE) for robust and fast localization of the EX in fundus images. The main stages of the proposed method are pre-processing, OD localization, dimensionality reduction using ELMAE, and EX localization. The proposed method is evaluated based on the freely accessible retinal database DIARETDB0, DIARETDB1, e-Ophtha, MESSIDOR, and local retinal database collected from Silchar Medical College and Hospital(SMCH). The sensitivity, specificity, and accuracy obtained by the proposed method are 96.5%, 96.4%, and 97%, respectively, with the processing time of 3.19 seconds per image. The results of this study are satisfactory with state-of-the-art methods. The results indicate that the approach taken can detect EX with less processing time and accurately from the fundus images. [ABSTRACT FROM AUTHOR]

Faith-based organizations (FBOs) can play an important role in improving health outcomes. Lay community health advisors (CHAs) are integral to these efforts. This paper assesses the sustainability of a CHA training program for congregants in African-American and Latino FBOs and subsequent implementation of educational workshops. The program is unique in that a health care chaplain in an academic medical center was central to the program's development and implementation. Forty-eight CHAs in 11 FBOs were trained to teach workshops on cardiovascular health, mental health, diabetes, and smoking cessation. Two thousand four hundred and forty-four participants attended 70 workshops. This program has the potential to be a model to educate individuals and to address health inequities in underserved communities. Health care chaplains in other medical centers may use this as a model for enhancing community engagement and education. [ABSTRACT FROM AUTHOR]

The h-index has become a criterion for progress and advancement in the career of an academic surgeon and it is especially important for the surgical community to understand the importance of calculating the h-index of a manuscript post publication in a surgical journal. It is not only becoming a criterion for promotion in the faculty in a medical institution, but also becoming an important index to decide about the suitability of editorial board members in a medical journal. Even though there are few loopholes, the h-index remains the gold standard criterion to access the quality of the author to be designated as an academic surgeon. [ABSTRACT FROM AUTHOR]

The electronic medical record (EMR) has significantly improved efficiency in many areas of radiology workflow. Following implementation of an electronic protocol selection process for cross-sectional imaging at the University of Colorado Hospital, the interventional radiology (IR) division desired to have a similar tool. Evaluation of the IR workflow demonstrated the need for a multilayered solution, which accounted for consultation, physician review, authorization and scheduling, pre-procedural nursing evaluation, physician rounding, and resource allocation and prioritization. This paper outlines the rationale for and components of this process. [ABSTRACT FROM AUTHOR]

The rate of early misdiagnosis in patients with nodular fasciitis of the ear is high. To provide a basis for clinical diagnosis and treatment, we aimed to summarise the clinical manifestations, imaging results, pathological findings, treatment strategies, and postoperative follow-up results for three cases of paediatric nodular fasciitis (two girls, one boy) treated in the Department of Otorhinolaryngology, Head and Neck Surgery, at Beijing Children's Hospital of Capital Medical University from 2018 to 2020. The average age at diagnosis was 24 months. Lesions occurred in the left ear in two cases and right ear in one case. All patients had a history of biopsy before surgery. Rapid growth was observed following biopsy in two patients, and anti-inflammatory treatment was ineffective in all three cases. Fluorescence in situ hybridisation analysis of ubiquitin-specific peptidase 6 (USP6) was performed in two of the three cases, with positive results. The lesions exhibited hypo-intensity or iso-intensity on T1-weighted magnetic resonance imaging (MRI) and heterogeneous hyper-intensity on T2-weighted MRI. "Fascial tail" signs were observed on imaging in all cases. Surgical resection was performed in all cases. Intact ear appearance was observed at follow-up, and there were no cases of recurrence. Conclusion: Combining clinical features with imaging findings may improve the accuracy of preoperative diagnosis in patients with nodular fasciitis. In addition to pathological findings, genetic testing for USP6 may aid in diagnosis. The final diagnosis should be based on comprehensive assessment. Complete surgical resection can prevent recurrence. What is Known: • Paediatric NF around the ear is rare and is easily misdiagnosed as other inflammatory masses that have a higher incidence in children. • Most previous reports of NF were case reports. What is New: • Combining clinical and imaging findings with genetic testing for USP6 rearrangement may improve the accuracy of preoperative diagnosis in patients with NF. Nonetheless, the final diagnosis should be based on comprehensive assessment. • The present paper is significant in that it represents the only report of three cases of ear NF in children with a complete medical history and prognosis. [ABSTRACT FROM AUTHOR]

The city of Baltimore is a typical, large, urban center in the United States with several major academic medical institutions surrounded by disadvantaged neighborhoods with multiple poor health indices. In order to understand the extent to which academic research agendas reflect the health concerns of Baltimore’s local population, a systematic review was conducted to identify research about four key, health-related topic areas. We classified papers on: disease prevalence and health status, utilization of health services, population-based interventions, and the unmet health needs of Baltimore City residents. Approximately 4,150 citations were identified in the search and two levels of screening yielded a total of 288 papers. The majority of articles ( n = 189) examined prevalence of health conditions such as Human Immunodeficiency Virus (HIV), mental health and mental disorders, and sexually transmitted diseases. Papers about specific target populations focused primarily on adults, African Americans, and females. Despite a significant body of research concerning several health conditions and priority populations, significant gaps in knowledge about health services utilization, community interventions, unmet health needs, and the prevalence of specific health issues remain. This review provides valuable insight into the extent of health research conducted about the city of Baltimore and whether community health priorities have been investigated. It provides a basis for examining the potential directions of academic research centers to effectively identify and address collective, urban health priorities of the communities in which they reside. [ABSTRACT FROM AUTHOR]

Treating patients with up-to-date medical knowledge is an ongoing goal for healthcare workers and implies efficient knowledge management at the point of care. Widely available mobile wireless technologies influence practices but a significant gap remains between technological possibilities and actual usage. The purpose of this study was to analyze residents' baseline practices in managing medical knowledge and to evaluate the use and impact of an innovative multiplatform application dedicated to anesthesiology and intensive care residents. This study took place in Rennes Teaching Hospital and comprised two distinct surveys. First, in April 2018, all residents received a ten-items online survey focusing on managing medical knowledge. Then, through a second online survey constituted of ten items, we sought to assess the use of a new multiplatform cloud-based application named "DansMaBlouse", dedicated to sharing and indexing medical knowledge, in anesthesiology and intensive care residents. Among 148 residents that answered the evaluation survey, the most sought out pieces of information in clinical setting were a phone or fax number (74%), drugs' characteristics (68%) and expert guidelines (57%). The main sources were senior staff (68%), medical databases (60%) and an Internet search engine (59%). Computers and smartphones were more frequently used than bound paper notebooks. After implementation of the multiplatform application DansMaBlouse, fifty-nine (82%) of the 72 residents that answered the evaluation survey reported using the application and 39% used it more than ten times. Among application users, 90% found it easy to use and 92% agreed that it improved point-of-care access to knowledge. Accessing appropriate medical knowledge at the point of care remains an issue for residents and can be improved by a multiplatform application combining personal and shared up-to-date resources. [ABSTRACT FROM AUTHOR]

Psychologists are increasingly called upon to become more involved in academic health centers (AHCs) as leaders across a range of leadership roles in areas such as the clinical, teaching, and research missions, and in the administration thereof. Similarly, expansion of psychologists' service in national associations, boards, and other forums is increasing. This paper attempts to delineate the nature and extent of psychologists' involvement in leadership roles and their needs for professional leadership development to assist them in securing and succeeding in these positions. Members of the Association of Psychologists in Academic Health Centers (APAHC) were invited to complete a survey to identify current leadership roles and training needed to enhance leadership capabilities. Most (75%) of the respondents (total n = 105; 42% of APAHC full members; 70% female) were currently serving in leadership roles (range 1 to ≥ 10 positions). Years since degree conferred was positively associated with the number of leadership positions. Diversity of roles was delineated across AHC missions including psychology training (49.5%), clinical service (33.3%), and research (26.7%). An important subgroup (11.5%) served in upper-level administrative leadership positions. Leadership roles external to AHCs were common, particularly service ion committees (30.5%) and boards (27.6%) in state and national professional organizations. Half (51.4%) of survey respondents endorsed at least one leadership development need, with approximately 10% endorsing leadership development needs in all areas. The most common leadership development need was financial management skills, endorsed by nearly two-thirds of the sample. Early career respondents recognized more needs than advanced career respondents. AHC psychologists are expanding their leadership roles and distinguishing themselves as important contributors in AHCs. Despite this, many identified needs for further leadership training. [ABSTRACT FROM AUTHOR]

Background: The ongoing Boko Haram insurgency in northeastern Nigeria has depleted the country's capability to deliver quality healthcare to her citizenry. The ailing health sector is overwhelmed with a rising incidence and prevalence of infectious and non-communicable diseases. Aim: The aim of this paper was to determine the trend of kidney disease, end-stage renal disease (ESRD), anaemia, malnutrition and human immunodeficiency virus (HIV) in northeastern Nigeria. Materials and methods: Data covering different periods between 1999 and 2017 were obtained from the University of Maiduguri Teaching Hospital (UMTH), Maiduguri in northeastern Nigeria. This hospital is the largest tertiary healthcare facility in the region. The data were demographic in nature, i.e. sex, age or simply the registered cases. A quadratic model of time-series analysis was used to create the various trends of the respective diseases with the aid of Minitab software (version 18.0). t-Tests and analysis of variance (ANOVA) were also performed, with a p-value of less than or equal to 0.05 being considered significant. Results: About three out of every five patients treated for kidney disease were male, while three out of every five patients treated for HIV were female. Patients between the ages of 31 and 50 years were at the greatest risk of developing kidney disease. The mean distribution of disease incidence was the same for both sexes for kidney disease, anaemia, malnutrition and HIV. The mean distribution disease incidence was different between age groups for kidney disease but the same for anaemia. The incidence of anaemia and malnutrition reported was almost the same for both sexes. Children under the age of 10 years old were at the most risk of anaemia, with the distribution decreasing with increasing age. The trend analysis of the incidence of kidney disease, ESRD, anaemia and malnutrition showed that these ailments were on the increase, while the number of patients that were on antiretroviral therapy (ART) was on the decline in northeastern Nigeria. Conclusion: These increasing trends are evidences of the effect of Boko Haram on the public health of the people of northeastern Nigeria and will continue to be a public health concern for the region and the country as a whole. [ABSTRACT FROM AUTHOR]

Physiological studies have found that the autonomic nervous system plays an important role in controlling blood pressure values. This paper, based on machine learning approaches, analysed short-term heart rate variability to determine differences in autonomic nervous function between hypertensive patients and normal population. The electrocardiogram (ECG) of hypertensive patients are 137 ECG recordings provided by Smart Health for Assessing the Risk of Events via ECG (SHAREE database). The RR intervals of healthy subjects include the data of 18 subjects from the MIT-BIH Normal Sinus Rhythm Database (nsrdb) and 54 subjects from the Normal Sinus Rhythm RR Interval Database (nsr2db). In this paper, each RR segment includes continuous 500 beats. Seventeen features were extracted to distinguish the hypertensive heart beat rhythms from the normal ones, and Kolmogorov-Smirnov test and sequential backward selection (SBS) were applied to get the best feature combinations. In addition, support vector machine (SVM), k-nearest neighbor (KNN) and random forest (RF) were applied as classifiers in the study. The performance of each classifier was evaluated independently using the leave-one-subject-out validation method. The best predictive model was based on RF and enabled to identify hypertensive patients by five features with an accuracy of 86.44%. The best five HRV features are sample entropy (SampEn), very low frequency spectral powers (VLF), root mean square of successful differences (RMSSD), ratio of low frequency spectral powers and high frequency spectral powers (LF/HF) and vector angle index (VAI). The results of the study show sympathetic overactivity and decreased parasympathetic tone in hypertensive patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare thoracic and abdominal radiologists' follow-up recommendations for abdominal findings identified on chest CT. Methods: This Institutional Review Board-exempt, retrospective study was performed at a large academic medical center with subspecialty radiology divisions. We used a combination of natural language processing and manual reviews to identify chest CT reports with and without abdominal findings that were interpreted by thoracic radiologists in 2019. Three random samples of reports were reviewed by two subspecialty trained abdominal radiologists for their agreement with thoracic radiologists' reporting: abdominal findings with follow-up recommendation (Group 1), abdominal findings without follow-up recommendation (Group 2), and no abdominal findings reported (Group 3). Primary outcome was agreement between thoracic and abdominal radiologists for the need for follow-up of abdominal findings. Secondary outcomes were agreement between subspecialists for the presence of abdominal findings and referring clinician adherence to recommendations. Fischer's exact test was used to compare proportions. Results: Abdominal radiologists agreed with need for follow-up in 48.5% (16/33) of Group 1 cases and agreed follow-up was not necessary for 100% (34/34) of Group 2 cases (p < 0.001). Abdominal radiologists identified abdominal findings in 31.4% (11/35) of Group 3 cases, none of which required follow-up. Referring clinician adherence to thoracic radiologist follow-up recommendations for abdominal findings was 13/33 (39.4%). Conclusion: Abdominal radiologists frequently disagreed with thoracic radiologist recommendations for follow-up of abdominal findings on chest CT. Chest radiologists may consider abdominal subspecialty consultation or clinical decision support to reduce unnecessary imaging. [ABSTRACT FROM AUTHOR]

Turning university research output into useful products such as drugs, devices and diagnostics requires skills, knowledge, and resources traditionally attributed to private industry. When it comes to intangibles such as care delivery models, informatics and algorithms, and the software behind smart wearables, the commercialization challenges are even greater. With notable exceptions, Academic Medical Centers have typically not excelled in advancing commercialization of such non-patent intellectual property (IP). We believe that this is in part because the traditional closed form university IP policy, formulated since Bayh–Dole (1980), is ill-suited to non-patent IP. In this paper, we reflect on the evolving challenges that new forms of healthcare-related discoveries, specifically non-patent IP, are placing on the traditional university intellectual property and technology transfer regime, and to offer suggestions on how universities can begin to modernize their IP policies to support the valorization of non-patent IP. [ABSTRACT FROM AUTHOR]

This paper examines the successive stages of the career path for psychologists who commit to spending their professional lives working in academic health centers. Key factors for success at each stage are described, as are the steps required for progressing to subsequent stages of professional development. The paper breaks new ground by including consideration of a post-retirement stage, 'Professor Emeritus status.' [ABSTRACT FROM AUTHOR]

In this personal review I describe my early expectations and experiences when I first came to work with Prof. Folke Sjöqvist as a training fellow in the early 1970s. At that time Prof. Sjöqvist and his unit had already earned an international reputation, and in the following decades this success has been magnified many times. Although a description of the research performed by Prof. Sjöqvist during his long career is not the main objective of this article, it is clear that the research carried out in his unit has been instrumental in the development of his international reputation. Over an 18-year period from 1994 onwards, some 272 papers bearing the name of Folke Sjöqvist have been cited over 13,000 times, with an average of over 50 citations per paper. In terms of training clinical pharmacologists from around the world, at the last count 112 individuals from 37 different countries have received a substantial part of their training in his unit. As another measure of his world-wide success, 33 individuals from 18 different countries who received a substantial part of their training in his unit between 1968 and 1996 have gone on to become professors of clinical pharmacology. Prof. Sjöqvist has been requested to consult on various aspects of clinical pharmacology in 15 different countries, from Russia to Spain and from Egypt to Latvia. Here I describe the long-term involvement that Prof. Sjöqvist has had with IUPHAR (now the International Union of Basic and Clinical Pharmacology) and with institutions such as the World Health Organisation (WHO). In particular, I recount his role in the long-term saga involved in updating the original WHO manifesto on clinical pharmacology published in 1970 up to the eventual success of the new manifesto published by WHO in 2012. Finally, I briefly describe the international honours that have been bestowed on Prof. Sjöqvist, including various prizes, designated lectureships and honorary Doctorates (5). Taken together, these honours provide a magnificent measure of Prof. Sjöqvist's world wide-success-a success that has been emulated by very few clinical pharmacologists. [ABSTRACT FROM AUTHOR]

Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another's disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings. [ABSTRACT FROM AUTHOR]

In this paper, we walk you through our challenges, successes, and experience while participating in a Global Health Outreach Project at the University College Hospital (UCH) Ibadan, Nigeria. The scope of the project was to install a Picture Archive and Communication System (PACS) to establish a centralized viewing network at UCH's Radiology Department, for each of their digital modalities. Installing a PACS requires robust servers, the ability to retrieve and archive studies, ensuring workstations can view studies, and the configuration of imaging modalities to send studies. We anticipated that we might experience hurdles for each of these requirements, due to limited resources and without the availability to make a site visit prior to the start of the project. While we ultimately experienced delays and troubleshooting was required at each turn of the install, with the help of dedicated volunteers both on and off-site and the UCH staff, our shared goal was accomplished. [ABSTRACT FROM AUTHOR]

Exposure to high-voltage electric arcs as a result of an accident or by means to commit suicide can affect people's health and cause death. There are characteristic external findings that can be found on external examination. These include extensive skin burns, periorbital recesses or "crow's feet," vapor deposition of conductor material, known as metallization, and tightly spaced, roundish, crocodile skin like burns. The Institute of Legal Medicine of the Rostock University Medical Center recorded 16 deaths caused by exposure to electricity between 1990 and 2018. Six of these deaths were caused by exposure to high-voltage electric arcs and five of these deaths (83 %) showed crocodile skin like burns and one had periorbital recesses burns on the face as a result of a fault arc. To our knowledge, the present paper is the first report describing the frequent occurrence of crocodile skin like burns due to high-voltage fault arcs. [ABSTRACT FROM AUTHOR]

Educators have long noticed differences in how students receive and use feedback. Despite the development of best practice guidelines, some learners in the health professions still struggle to incorporate corrective feedback. To date, little research has been done to examine learner characteristics and how those traits might explain differences in feedback-related behavior. A qualitative study using a constructivist, grounded theory approach was conducted to examine the behaviors and learner characteristics that contribute to successful use of feedback. Medical and physician assistant students in their clinical years at one academic health center were interviewed to determine how they used feedback to learn. An overarching theory was developed to explain the process used by students who successfully used feedback. Participants needed to be ready, willing, and able to learn from feedback. Readiness required the learner to hear the corrective feedback without negative emotion and understand how to use the criticism. Willingness required a valuing process that resulted in meaning making. It also required motivation and a growth mindset. Able learners needed to utilize strategic learning behaviors to incorporate feedback into practice change. Barriers to feedback use included emotional interference, inability to create a positive narrative around the feedback encounter and understand it as part of a larger context, and the inability to utilize adaptive learning strategies. The paper considers important education theories, such as Self-regulated Learning and Achievement Goal Theory-theories that should be incorporated into future research. [ABSTRACT FROM AUTHOR]

The data and discussion contained in this invited paper are based on the opening plenary by the first author whose paper titled “The Status of Ph.D.s in US Medical Schools” was presented at the 3rd national conference of the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007. The significant growth of the number of Ph.D.s in clinical departments is described, as is their distribution. The roles they play; the barriers they face in terms of leadership opportunities, promotion and tenure; and the concerns they voice that are specific to this population are also discussed. Salary differentials between Ph.D.s on main and medical school campuses are provided. Recommendations for future investigation of disparate treatment and for faculty development opportunities specifically aimed at this group are found at the conclusion of the paper. [ABSTRACT FROM AUTHOR]

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This paper examines the epidemiology of nonfatal firearm violence (NFFV) on the Westside of Chicago over three finite time periods: 2005–2008, 2009–2012, and 2013–2016. The trend analysis will look at any significant changes over the time periods and describe the demographic characteristics of NFFV. A descriptive analysis of Mount Sinai Hospital (MSH) Emergency Department (ED) data was conducted. NFFV patients were identified by specific firearm ICD-9 primary eCode injury categories: accident, assault, legal intervention, undetermined intent, suicide or self-inflicted injury, and legal intervention. The Pearson Chi-square test was conducted to statistically compare the categorical frequencies of the Chicago metropolitan region of injury, cause of firearm related injury, and place of injury by time period. There were a total of 3962 nonfatal hospitalizations at MSH between the three time periods due to gun violence related injuries. Overall, nonfatal hospitalizations were most frequent for those between age groups 16–24 (52.5%). The number of nonfatal hospitalizations decreased with increasing age for the age groups 35–44 (9.7%), 45–54 (3.2%), and > 54 (1.2%). There were significantly more nonfatal hospitalizations in males (n = 3649) than females (n = 312) across the three time periods. However, there was a 74.7% increase in female nonfatal hospitalizations from 2009–2012 to 2013–2016. There were significant racial differences in nonfatal hospitalizations between the three time periods. NFFV continues to be problem on the Westside of Chicago, particularly for young, Black men. The incidence of gun violence however has not changed significantly between 2005 and 2016. [ABSTRACT FROM AUTHOR]

This paper analyzes a sample interventional cardiologist’s demographic, academic, and professional characteristics to provide an understanding of their technological device adoption styles. The study sample consisted of 15 physicians from two large Midwestern hospitals, one an academic medical center and the other a medium-sized community hospital. Interventional cardiologists were identified through their online physician profile and respective departments. A questionnaire was developed to assess each physician’s self-perceived adoption style, their awareness of the new technology, their participation in clinical trials, organizational support, and how various factors influence their adoption of new technology. Lastly, a database of bare metal and drug eluting stents was examined to document the number of stents used by each physician. Pragmatic and observational findings are presented from the questionnaire, physician profile, to database on stent use. The paper concludes with a discussion of the managerial and forecasting implications and methods to promote technology adoption. [ABSTRACT FROM AUTHOR]

Ensemble learning methods are one of the most powerful tools for the pattern classification problems. In this paper, the effects of ensemble learning methods and some physical bone densitometry parameters on osteoporotic fracture detection were investigated. Six feature set models were constructed including different physical parameters and they fed into the ensemble classifiers as input features. As ensemble learning techniques, bagging, gradient boosting and random subspace (RSM) were used. Instance based learning (IBk) and random forest (RF) classifiers applied to six feature set models. The patients were classified into three groups such as osteoporosis, osteopenia and control (healthy), using ensemble classifiers. Total classification accuracy and f-measure were also used to evaluate diagnostic performance of the proposed ensemble classification system. The classification accuracy has reached to 98.85 % by the combination of model 6 ( five BMD + five T-score values) using RSM-RF classifier. The findings of this paper suggest that the patients will be able to be warned before a bone fracture occurred, by just examining some physical parameters that can easily be measured without invasive operations. [ABSTRACT FROM AUTHOR]

This paper describes how psychology faculty positions in academic health centers (AHCs) have evolved to meet the changing needs in healthcare. In that context, the roles of psychologists have expanded significantly to include a wide array of clinical responsibilities, teaching and supervisory roles, administrative functions, research initiatives, and academic scholarship. Traditionally, faculty compensation plans have been calculated through the use of Relative Value Units which are primarily based on clinical service delivery, hence, incomplete when attempting to account for these growing academic responsibilities. This paper reviews the need to expand the ways in which the work provided by psychologists is appropriately identified and compensated for in AHCs. Drawing upon six models utilized in other areas of medical education, this paper describes the potential utility of incorporating Educational Value Units as a metric for capturing this expanding set of academic responsibilities and systematically incorporating them into a psychologist's job design. Recommendations for future considerations are provided. [ABSTRACT FROM AUTHOR]

Background: Biofeedback therapy has been reported to be effective in the treatment of migraine. However, previous studies have assessed its effectiveness using paper-and-pencil diaries, which are not very reliable. Purpose: The objective of the present pilot study was to investigate the feasibility of using computerized ecological momentary assessment (EMA) for evaluating the efficacy of BF treatment for migraine in a randomized controlled trial. Method: The subjects comprised one male and 26 female patients with migraine. They were randomly assigned to either biofeedback or wait-list control groups. Patients were asked to carry a palmtop-type computer to record momentary symptoms for 4 weeks before and after biofeedback treatment. The primary outcome measure was headache intensity. The secondary outcome measures included psychological stress, anxiety, irritation, headache-related disability and the frequency (number of days per month) of migraine attack and of headache of at least moderate intensity (pain rating ≥50). Results: Headache intensity showed significant main effects of period (before vs. after therapy, p = 0.02) and group (biofeedback vs. control groups, p = 0.42) and a significant period × group interaction ( p < 0.001). Biofeedback reduced the duration of headaches by 1.9 days, and the frequency of days when headache intensity was ≥50 by 2.4 times. In addition, headache-related disability, psychological stress, depression, anxiety, and irritation were significantly improved. Conclusion: The present study used computerized EMA to show that biofeedback could improve the symptoms of migraine, including psychological stress and headache-related disability. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the incidence, treatment and outcome of vascular trauma in a well-defined geographical region in Finland. Methods: A retrospective analysis was conducted of patients admitted to Tampere University Hospital (TAUH), Pirkanmaa, Finland, due to vascular trauma between January 2006 and December 2010. Data regarding trauma mechanism, anatomical location, treatment, and short-term outcome were collected from patients' files and vascular register. Results: Altogether, 143 non-iatrogenic vascular traumas occurred during the study period resulting in an annual trauma incidence of 5.8/100,000/year in the TAUH region. The majority of the injuries were located in the upper extremities ( N = 83, 58 %). Penetrating injuries comprised 58 % (83 patients) of all vascular trauma admissions and were significantly more common among men compared to women (83 and 17 %, respectively). The majority ( N = 93, 65 %) of the injuries were treated surgically, while in 15 (11 %) patients the trauma was resolved by endovascular means. The remaining 35 (24 %) patients were successfully managed conservatively, i.e., by observation or wound exploration only without the need for later (30-day) vascular repair. Two out of 17 patients (12 %) with lower extremity vascular trauma required major amputation. Procedure-related complications occurred in five patients. In-hospital and 30-day mortality was zero. Conclusions: This paper demonstrates that the incidence of non-iatrogenic civilian vascular trauma in the Pirkanmaa region is low and mainly caused by penetrating injury. Further, the majority of vascular traumas are still treated surgically. In general, the short-term survival of patients who survive the initial trauma is good. [ABSTRACT FROM AUTHOR]

Background: Optimal balance between macro- and microcirculation in critically ill patients is crucial for ensuring optimal organ perfusion. Nitric oxide (NO) is a regulator of vascular hemostasis and tone. The availability of NO is controlled by asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and the availability of the NO substrates arginine and homoarginine. We investigated the changes in plasma concentrations of ADMA, SDMA, arginine, and homoarginine days 1–5 of intensive care unit (ICU) admission and the association between the change in concentration days 1–3 and 30-day all-cause mortality. Methods: Single-center cohort study of adult critically ill patients from the ICU at Copenhagen University Hospital – North Zealand. ADMA, SDMA, arginine, and homoarginine (NO-biomarkers) were measured on days 1–5. Initially, we determined the changes in NO-biomarkers days 1–5 with linear mixed models, and subsequently how the changes in NO-biomarkers days 1–3 were associated with 30-day all-cause mortality. Post-hoc we analyzed the association between plasma concentration at admission and 30-day all-cause mortality. Results: In total 567 out of 577 patients had plasma samples from days 1–5. Plasma concentrations of ADMA and arginine increased from days 1–5. SDMA concentrations increased from days 1–2, followed by a decrease from days 2–5. Concentrations of homoarginine did not change from days 1–3 but slightly increased from days 3–5. In total 512 patients were alive 3 days after ICU admission. Among these patients, a daily twofold increase in ADMA concentration from days 1–3 was associated with decreased mortality in multivariate analysis (HR 0.45; 95% CI 0.21–0.98; p = 0.046). An increase in SDMA, arginine, or homoarginine was not associated with mortality. Post-hoc we found that a twofold increase in ADMA or SDMA concentrations at admission was associated with mortality (HR 1.78; 95% CI 1.24–2.57; p = 0.0025, and HR 1.41; 95% CI 1.05–1.90; p = 0.024, respectively). Conclusions: Increasing ADMA concentrations on days 1–3 are inversely associated with mortality, however not with the same strength as high ADMA or SDMA concentrations at admission. We suggest that admission concentrations are the focus of future research on ADMA and SDMA as predictors of mortality or potential therapeutical targets in ICU patients. [ABSTRACT FROM AUTHOR]