Publications by authors named "D J Kitchener"

9 Publications

Predictors of performance on the Maintenance of Certification in Anesthesiology Program® (MOCA®) examination.

J Clin Anesth 2015 Feb 20;27(1):1-6. Epub 2014 Nov 20.

The American Board of Anesthesiology, Raleigh, NC, 27609; Department of Anesthesiology, Mayo Clinic, Rochester, MN, 55905.

Study Objective: The aim of this study was to determine the independent factors associated with performance on the Maintenance of Certification in Anesthesiology Program (MOCA) examination.

Design: Cross-sectional study.

Setting: The American Board of Anesthesiology, Raleigh, NC.

Subjects: The American Board of Anesthesiology (ABA) diplomates who were certified between 2000 and 2006 and had taken the MOCA examination at least once by July 2013.

Measurements: MOCA examination score for the first attempt.

Main Results: Independent positive predictors for MOCA examination score in multiple regression analysis included passing the ABA Part 1 and Part 2 certification examinations on the first attempt and male sex, whereas negative predictors included history of action(s) taken against any medical license, taking the examination later in the MOCA cycle and older age at primary certification.

Conclusions: Several factors in addition to performance on the written examination for primary certification (Part 1 Examination) are independently associated with performance on the MOCA examination. Because many of these factors are not modifiable, those diplomates who possess unfavorable risk factors should pay special attention to engaging in continuing learning to prepare for the MOCA examination.
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February 2015

A randomized controlled trial examining combinations of repaglinide, metformin and NPH insulin.

Diabet Med 2007 Jul 2;24(7):714-9. Epub 2007 Apr 2.

University Hospitals of Leicester NHS Trust, Leicester, UK.

Aims: To compare combination use of repaglinide, metformin and bedtime Neutral Protamine Hagedorn (NPH) insulin with conventional approaches of insulin initiation in patients with Type 2 diabetes (T2DM).

Methods: Eighty-two patients with T2DM with suboptimal glycaemic control on oral glucose-lowering agents were randomized to one of three treatment regimens for 4 months. Group 1 received metformin and twice daily biphasic 30/70 human insulin mixture (n = 27), group 2 metformin and bedtime NPH insulin (n = 26) and group 3 metformin, bedtime NPH insulin and mealtime repaglinide (n = 25).

Results: Seventy-five patients completed the study. Baseline and end-point mean HbA1c levels fell from 9.0 +/- 1.1 to 7.9 +/- 1.1% in group 1, 10.0 +/- 2.2 to 9.2 +/- 1.4% group 2 and 10.0 +/- 1.7 to 8.1 +/- 1.5% in group 3, respectively. All groups showed improvements in HbA1c. There was no significant difference between groups in the proportions of patients experiencing hypoglycaemia (29.6, 25.0 and 16.7%, respectively; P = 0.55) or in mean weight gain (2.9, 0.7 and 2.2 kg, respectively; P = 0.06). By 4 months, insulin doses were 0.63 +/- 0.32 IU/kg in group 1, 0.58 +/- 0.21 IU/kg in group 2 and 0.37 +/- 0.22 IU/kg in group 3 (group 3 vs. groups 1 and 2: P < 0.002).

Conclusions: The approach using repaglinide, metformin and NPH insulin improved glycaemic control with a similar safety profile to conventional insulin initiation in T2DM and produced final glycaemic control similar to metformin and a twice daily biphasic insulin mixture.
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July 2007

An aggression policy that works.

Aust Health Rev 2004 Dec;28(3):357-62

Royal Darwin Hospital, Casuarina, NT.

In 1999, a survey of the clinical staff in Royal Darwin Hospital showed that most instances of aggressive and abusive behaviour by patients or visitors occurring in the hospital went unreported because staff believed there would not be any follow-up investigation or action taken by management, Australia. In response, a hospital working party was formed to develop and implement an aggression management policy with practical effective strategies. The principal tool used was an Action Plan that delineated an immediate response to the aggression, as well as long-term strategies such as negotiated care and behaviour modification programs. An advocate is provided for the patient and debriefing for staff members. If the aggressive behaviour continues, early discharge of the patient could be initiated. The fundamental principle of the policy is to prevent fostering a culture of acceptance of aggressive behaviour through appropriate early intervention. In 2002, a follow-up survey showed that 82% of aggressive incidents were being reported and dealt with by management in a timely manner -- a significant improvement.
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December 2004


Evolution 1995 Jun;49(3):399-412

Western Australian Museum, Francis Street, Perth, Western Australia, 6000, Australia.

This study investigated allozyme and morphometric variability within the genus Cynopterus, with particular emphasis on C. nusatenggara, which is endemic to Wallacea, the area encompassing the Oriental-Australian biogeographic interface. The genetic distances between Cynopterus species are small by mammalian standards and suggest that this genus has undergone a recent series of speciation events. The genetic distance between populations of C. nusatenggara is strongly correlated with both the contemporary sea-crossing distance between islands and the estimated sea crossing at the time of the last Pleistocene glacial maximum, 18,000 b.p. This observation, together with low levels of population substructure within islands as shown by F-statistics, indicates that the sea is a primary and formidable barrier to gene exchange. The genetic distance and the great-circle geographical distance between the populations of C. nusatenggara are not correlated, although a principal-coordinates analysis of genetic distance reveals relationships between the populations that are similar to their geographical arrangement. A strong negative correlation exists between the level of heterozygosity within island populations of C. nusatenggara and the minimum sea-crossing distance to the nearest large source population. This is interpreted as reflecting an isolation effect of the sea, leading to reduced heterozygosity in populations that have larger sea barriers between them and the large source islands. Independently of this, heterozygosity is negatively associated with longitude, which in turn is associated with systematic changes in the environment such as a gradual decline in rainfall from west to east. The association between heterozygosity and longitude is interpreted as reflecting an association between genetic and environmental variance and supports the niche-width theory of genetic variance. Morphometric variability did not show any of the main effects demonstrated in the genetic data. Furthermore, there was no evidence that, at the level of individuals, genetic and morphometric variability were associated.
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June 1995