Publications by authors named "Melissa Taylor"

72 Publications

The impact of interprofessional practice models on health service inequity: an integrative systematic review.

J Health Organ Manag 2021 Apr;ahead-of-print(ahead-of-print)

School of Nursing and Midwifery, Faculty of Health Engineering and Sciences, University of Southern Queensland, Ipswich, Australia.

Purpose: The purpose of this review was to explore the literature for evidence of the impact of interprofessional practice models on health service inequity, particularly within community care settings for diverse ageing populations.

Design/methodology/approach: An integrative systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework combined with the EndNote reference management system. Following the collection and comprehensive screening process completion, a thematic analysis of the included articles occurred utilising within NVivo 12 software.

Findings: The review found that there was a paucity of evidence related to the relationship between interprofessional practice models (IPM) and health service equity for ageing populations. There is a need to improve collaborative practices between social care, public health care and health service providers to more clearly define team member roles. Key aspirations included the need for future innovations in health service delivery to place health service equity as a goal for interprofessional practice. There is a need to find ways to measure and articulate the impact for vulnerable populations and communities.

Research Limitations/implications: The review offers insight into the need for health care delivery models to place health service equity at the centre of the model design. In practice settings, this includes setting interprofessional team goals around achieving equitable care outcomes for, and with, vulnerable populations. Implications for practice relate to improving how interprofessional teams work with communities to achieve health care equity.

Originality/value: There is a consensus across the literature that there continues to be health service inequity, yet IPE and interprofessional collaborative practice (IPC) have been growing in momentum for some time. Despite many statements that there is a link between interprofessional practice and improved health service equity and health outcomes, evidence for this is yet to be fully realised. This review highlights the urgent need to review the link between education and practice, and innovative health models of care that enable heath care professionals and social care providers to work together towards achieving health equity for ageing populations. It is clear that more evidence is required to establish evidence for best practice in interprofessional care that has the mitigation of health care inequity as a central objective.
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http://dx.doi.org/10.1108/JHOM-04-2020-0165DOI Listing
April 2021

Interviews During the Pandemic: A Thoracic Education Cooperative Group and Surgery Residents Project.

Ann Thorac Surg 2021 Mar 24. Epub 2021 Mar 24.

Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX. Electronic address:

Background: The 2020 interview cycle for cardiothoracic fellowships was affected by the coronavirus-19 pandemic. Many programs shifted from in-person to virtual interviews. We evaluated applicant perceptions of the various formats.

Methods: All 2019-2020 cardiothoracic fellowship applicants received an electronic survey after completion of the match process. The survey assessed number of in-person/virtual interviews completed, perception of efficacy and likelihood of ranking a program based on format, and strengths/inadequacies of virtual interviews.

Results: Response rate was 36% (48/133). Seventy-three percent (35/48) of respondents interviewed with more than 10 programs. Fifty-two percent (25/48) of respondents were able to schedule additional interviews once virtual formats were available. A slight majority (56%, 27/48) ranked a program at which they had an in-person interview as their first choice. Interviewing at more than 10 programs was associated with an increased likelihood of successfully matching at a program (p = 0.02). Overwhelmingly, respondents favored an in-person component to the interview process (96%, 46/48). Few respondents (29%, 14/48) felt they could adequately evaluate a program virtually. The factors which had the highest percentages of adequate portrayal during virtual interviews were the didactic schedule/curriculum (81%, 39/48) and case number/autonomy (58%, 28/48). The factors with the lowest percentages were culture/personality (19%, 9/48) and city/lifestyle (15%, 7/48).

Conclusions: Applicants strongly favored an in-person component to interviews, highlighting potential deficiencies in the virtual interview process. Programs should consider the addition of virtual tours of their hospitals, narrations from staff and vignettes from current fellows about lifestyle and well-being.
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http://dx.doi.org/10.1016/j.athoracsur.2021.02.089DOI Listing
March 2021

Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection.

Cochrane Database Syst Rev 2021 03 24;3:CD013705. Epub 2021 Mar 24.

NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.

Background: Accurate rapid diagnostic tests for SARS-CoV-2 infection could contribute to clinical and public health strategies to manage the COVID-19 pandemic. Point-of-care antigen and molecular tests to detect current infection could increase access to testing and early confirmation of cases, and expediate clinical and public health management decisions that may reduce transmission.

Objectives: To assess the diagnostic accuracy of point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection. We consider accuracy separately in symptomatic and asymptomatic population groups.

Search Methods: Electronic searches of the Cochrane COVID-19 Study Register and the COVID-19 Living Evidence Database from the University of Bern (which includes daily updates from PubMed and Embase and preprints from medRxiv and bioRxiv) were undertaken on 30 Sept 2020. We checked repositories of COVID-19 publications and included independent evaluations from national reference laboratories, the Foundation for Innovative New Diagnostics and the Diagnostics Global Health website to 16 Nov 2020. We did not apply language restrictions.

Selection Criteria: We included studies of people with either suspected SARS-CoV-2 infection, known SARS-CoV-2 infection or known absence of infection, or those who were being screened for infection. We included test accuracy studies of any design that evaluated commercially produced, rapid antigen or molecular tests suitable for a point-of-care setting (minimal equipment, sample preparation, and biosafety requirements, with results within two hours of sample collection). We included all reference standards that define the presence or absence of SARS-CoV-2 (including reverse transcription polymerase chain reaction (RT-PCR) tests and established diagnostic criteria).

Data Collection And Analysis: Studies were screened independently in duplicate with disagreements resolved by discussion with a third author. Study characteristics were extracted by one author and checked by a second; extraction of study results and assessments of risk of bias and applicability (made using the QUADAS-2 tool) were undertaken independently in duplicate. We present sensitivity and specificity with 95% confidence intervals (CIs) for each test and pooled data using the bivariate model separately for antigen and molecular-based tests. We tabulated results by test manufacturer and compliance with manufacturer instructions for use and according to symptom status.

Main Results: Seventy-eight study cohorts were included (described in 64 study reports, including 20 pre-prints), reporting results for 24,087 samples (7,415 with confirmed SARS-CoV-2). Studies were mainly from Europe (n = 39) or North America (n = 20), and evaluated 16 antigen and five molecular assays. We considered risk of bias to be high in 29 (50%) studies because of participant selection; in 66 (85%) because of weaknesses in the reference standard for absence of infection; and in 29 (45%) for participant flow and timing. Studies of antigen tests were of a higher methodological quality compared to studies of molecular tests, particularly regarding the risk of bias for participant selection and the index test. Characteristics of participants in 35 (45%) studies differed from those in whom the test was intended to be used and the delivery of the index test in 39 (50%) studies differed from the way in which the test was intended to be used. Nearly all studies (97%) defined the presence or absence of SARS-CoV-2 based on a single RT-PCR result, and none included participants meeting case definitions for probable COVID-19. Antigen tests Forty-eight studies reported 58 evaluations of antigen tests. Estimates of sensitivity varied considerably between studies. There were differences between symptomatic (72.0%, 95% CI 63.7% to 79.0%; 37 evaluations; 15530 samples, 4410 cases) and asymptomatic participants (58.1%, 95% CI 40.2% to 74.1%; 12 evaluations; 1581 samples, 295 cases). Average sensitivity was higher in the first week after symptom onset (78.3%, 95% CI 71.1% to 84.1%; 26 evaluations; 5769 samples, 2320 cases) than in the second week of symptoms (51.0%, 95% CI 40.8% to 61.0%; 22 evaluations; 935 samples, 692 cases). Sensitivity was high in those with cycle threshold (Ct) values on PCR ≤25 (94.5%, 95% CI 91.0% to 96.7%; 36 evaluations; 2613 cases) compared to those with Ct values >25 (40.7%, 95% CI 31.8% to 50.3%; 36 evaluations; 2632 cases). Sensitivity varied between brands. Using data from instructions for use (IFU) compliant evaluations in symptomatic participants, summary sensitivities ranged from 34.1% (95% CI 29.7% to 38.8%; Coris Bioconcept) to 88.1% (95% CI 84.2% to 91.1%; SD Biosensor STANDARD Q). Average specificities were high in symptomatic and asymptomatic participants, and for most brands (overall summary specificity 99.6%, 95% CI 99.0% to 99.8%). At 5% prevalence using data for the most sensitive assays in symptomatic people (SD Biosensor STANDARD Q and Abbott Panbio), positive predictive values (PPVs) of 84% to 90% mean that between 1 in 10 and 1 in 6 positive results will be a false positive, and between 1 in 4 and 1 in 8 cases will be missed. At 0.5% prevalence applying the same tests in asymptomatic people would result in PPVs of 11% to 28% meaning that between 7 in 10 and 9 in 10 positive results will be false positives, and between 1 in 2 and 1 in 3 cases will be missed. No studies assessed the accuracy of repeated lateral flow testing or self-testing. Rapid molecular assays Thirty studies reported 33 evaluations of five different rapid molecular tests. Sensitivities varied according to test brand. Most of the data relate to the ID NOW and Xpert Xpress assays. Using data from evaluations following the manufacturer's instructions for use, the average sensitivity of ID NOW was 73.0% (95% CI 66.8% to 78.4%) and average specificity 99.7% (95% CI 98.7% to 99.9%; 4 evaluations; 812 samples, 222 cases). For Xpert Xpress, the average sensitivity was 100% (95% CI 88.1% to 100%) and average specificity 97.2% (95% CI 89.4% to 99.3%; 2 evaluations; 100 samples, 29 cases). Insufficient data were available to investigate the effect of symptom status or time after symptom onset.

Authors' Conclusions: Antigen tests vary in sensitivity. In people with signs and symptoms of COVID-19, sensitivities are highest in the first week of illness when viral loads are higher. The assays shown to meet appropriate criteria, such as WHO's priority target product profiles for COVID-19 diagnostics ('acceptable' sensitivity ≥ 80% and specificity ≥ 97%), can be considered as a replacement for laboratory-based RT-PCR when immediate decisions about patient care must be made, or where RT-PCR cannot be delivered in a timely manner. Positive predictive values suggest that confirmatory testing of those with positive results may be considered in low prevalence settings. Due to the variable sensitivity of antigen tests, people who test negative may still be infected. Evidence for testing in asymptomatic cohorts was limited. Test accuracy studies cannot adequately assess the ability of antigen tests to differentiate those who are infectious and require isolation from those who pose no risk, as there is no reference standard for infectiousness. A small number of molecular tests showed high accuracy and may be suitable alternatives to RT-PCR. However, further evaluations of the tests in settings as they are intended to be used are required to fully establish performance in practice. Several important studies in asymptomatic individuals have been reported since the close of our search and will be incorporated at the next update of this review. Comparative studies of antigen tests in their intended use settings and according to test operator (including self-testing) are required.
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http://dx.doi.org/10.1002/14651858.CD013705.pub2DOI Listing
March 2021

Realize, Analyze, Engage (RAE): A Digital Tool to Support Recovery from Substance Use Disorder.

J Psychiatr Brain Sci 2021 24;6. Epub 2021 Feb 24.

Department of Electrical Engineering, The University of Texas at Tyler, Tyler, TX 75799, USA.

Background: Substance use disorders are a highly prevalent group of chronic diseases with devastating individual and public health consequences. Current treatment strategies suffer from high rates of relapse, or return to drug use, and novel solutions are desperately needed. Realize Analyze Engage (RAE) is a digital, mHealth intervention that focusses on real time, objective detection of high-risk events (stress and drug craving) to deploy just-in-time supportive interventions. The present study aims to (1) evaluate the accuracy and usability of the RAE system and (2) evaluate the impact of RAE on patient centered outcomes.

Methods: The first phase of the study will be an observational trial of = 50 participants in outpatient treatment for SUD using the RAE system for 30 days. Accuracy of craving and stress detection algorithms will be evaluated, and usability of RAE will be explored via semi-structured interviews with participants and focus groups with SUD treatment clinicians. The second phase of the study will be a randomized controlled trial of RAE vs usual care to evaluate rates of return to use, retention in treatment, and quality of life.

Anticipated Findings And Future Directions: The RAE platform is a potentially powerful tool to de-escalate stress and craving outside of the clinical milieu, and to connect with a support system needed most. RAE also aims to provide clinicians with actionable insight to understand patients' level of risk, and contextual clues for their triggers in order to provide more personalized recovery support.
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http://dx.doi.org/10.20900/jpbs.20210002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978415PMC
February 2021

Chronic organ injuries in children with sickle cell disease.

Haematologica 2021 Feb 25. Epub 2021 Feb 25.

Department of General Pediatrics and Pediatric Infectious Diseases, Reference Center for Sickle Cell Disease, Necker Hospital for Sick Children, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, Paris; Laboratory of Excellence GR-Ex, Paris; Institut National de la Transfusion Sanguine (INTS), Université de Paris, Inserm U1134, Paris.

Median life expectancy of patients with sickle cell disease has increased to up to 55 years but there are still frequent cases of premature death, mostly in patients with pre-existing organ failure such as pulmonary hypertension, kidney injury, and cerebral vasculopathy. Most organ injuries remain asymptomatic for a long time and can only be detected through early systematic screening. Protocols combining assessment of velocities on transcranial Doppler and regular transfusions in patients with abnormal velocities have been demonstrated to dramatically reduce the risk of stroke. In contrast, no consensus has been reached on systematic screening or therapy for silent cerebral infarcts. The prognostic significance of increased tricuspid regurgitant jet velocity on echocardiography has not yet been identified in children, whereas increased albuminuria is a good predictor of kidney injury. Finally, screening for hip and eye disorder is recommended; however, different countries adopt different screening strategies. Hydroxyurea is probably of potential benefit in preventing chronic organ damage but this requires further study in order to be fully demonstrated. Efficacy and safety of the other new drugs available are also under investigation.
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http://dx.doi.org/10.3324/haematol.2020.271353DOI Listing
February 2021

Alarming Rate of Substance Use in Motor Vehicle Collisions at an Appalachian Trauma Center.

Cureus 2020 Dec 3;12(12):e11863. Epub 2020 Dec 3.

Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA.

Prescription drug use is a growing public health concern and studies show it is a contributing risk to motor vehicle collisions. The Appalachian region is also known to have an ever-increasing number of patients on controlled substances. This retrospective study of patients from the years 2011-2015 on controlled substances presenting to an Appalachian Level 1 trauma center after a motor vehicle or motorcycle collision was analyzed in order to determine the rate of opioid use among victims of motor vehicle collisions in the system, as well as evaluate for any differences in resource utilization between these patients and patients not using controlled substances. A total of 2,570 patients were included in the study. Seven-hundred sixty-eight (29.9%) individuals were found to be on a controlled substance. There was a similar mortality rate in both groups (2.8% vs 3.6%). There was no significant difference in hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, or injury severity score. Statistically significant findings include the type of crash (motor vehicle crash vs motorcycle crash) (p=0.003) and position in the vehicle (driver vs passenger) (p<0.001). Motor vehicle crashes and driver position were significantly associated with the presence of a controlled substance.
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http://dx.doi.org/10.7759/cureus.11863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781544PMC
December 2020

Distinctive Features of Kawasaki Disease Following SARS-CoV-2 Infection: a Controlled Study in Paris, France.

J Clin Immunol 2021 04 4;41(3):526-535. Epub 2021 Jan 4.

Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Necker Hospital for Sick Children, Université de Paris, 75015, Paris, France.

Background: An outbreak of multisystem inflammatory syndrome in children, including Kawasaki disease (KD), emerged during COVID-19 pandemic. We explored whether Kawasaki-like disease (KD), when associated with confirmed SARS-CoV-2 infection, has specific characteristics.

Methods: We included children and adolescents with KD criteria admitted in the department of general pediatrics of a university hospital in Paris, France, between January 1, 2018, and May 26, 2020. The incidence of KD was compared between the outbreak and a pre-outbreak control period (January 1, 2018, to April 25). Characteristics of patients with positive SARS-CoV-2 testing (KD-SARS-CoV-2) were compared to those of the pre-outbreak period (classic KD).

Results: A total of 30 and 59 children with KD were admitted during the outbreak and pre-outbreak periods, respectively (incidence ratio 13.2 [8.3-21.0]). During the outbreak, 23/30 (77%) children were diagnosed as KD-SARS-CoV-2. When compared with patients with classic KD, those with KD-SARS-CoV-2 were more frequently of sub-Saharan African ancestry (OR 4.4 [1.6-12.6]) and older (median 8.2 vs. 4.0 years, p < 0.001), had more often initial gastrointestinal (OR 84 [4.9-1456]) and neurological (OR 7.3 [1.9-27.7] manifestations, and shock syndrome (OR 13.7 [4.2-45.1]). They had significantly higher CRP and ferritin levels. Noticeably, they had more frequently myocarditis (OR 387 [38-3933]).

Conclusions: Children and adolescents with KD-SARS-CoV-2 have specific features when compared with those with classic KD. These findings should raise awareness and facilitate the study of their pathogenesis.
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http://dx.doi.org/10.1007/s10875-020-00941-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780601PMC
April 2021

Add-on bone scintigraphy after negative radiological skeletal survey for the diagnosis of skeletal injury in children suspected of physical abuse: a systematic review and meta-analysis.

Arch Dis Child 2021 Apr 30;106(4):361-366. Epub 2020 Sep 30.

Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France.

Objectives: To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of skeletal injury in children suspected of physical abuse with an initial negative radiological skeletal survey (RSS).

Study Design: We searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who underwent RSS and add-on BS. We assessed the risk of bias and the heterogeneity and performed random-effects meta-analyses.

Results: After screening 1140 unique search results, we reviewed 51 full-text articles, and included 7 studies (783 children, mostly ≤3 years old). All studies were of either high or unclear risk of bias. Substantial heterogeneity was observed in meta-analyses. The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15); the summary relative detection rate was 1.19 (95% CI 1.13 to 1.25); the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7).

Conclusions: From the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required. The quality of the reviewed evidence was low, pointing to the need for high-quality studies in this field.
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http://dx.doi.org/10.1136/archdischild-2020-319065DOI Listing
April 2021

Optimizing the Duration of Trastuzumab: A Fresh Perspective.

Oncology (Williston Park) 2020 Aug;34(8):296-301

Winship Cancer Institute, Emory University.

Prior to the introduction of trastuzumab, the first targeted anti-HER2 agent, in 1998, patients diagnosed with HER2-positive breast cancer felt like they were being handed a death sentence. Despite treatment with aggressive chemotherapy, their tumors recurred faster, more often spread to brain and liver, and were associated with higher rates of death than HER2-negative tumors. HER2-positive breast cancer was also more prevalent in younger patients, making the diagnosis even more devastating. However, in the 1980s, cancer researcher Axel Ullrich, PhD, and oncologist Dennis Slamon, MD, PhD, recognized that HER2 could be targeted by a small molecule that binds to the receptor on the cell surface and blocks the signal telling the cell to divide. This small molecule was called trastuzumab, and it eventually completely changed how HER2-positive breast cancer was treated.
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http://dx.doi.org/10.46883/ONC.2020.3408.0296DOI Listing
August 2020

Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol.

BMJ Open 2020 07 20;10(7):e036060. Epub 2020 Jul 20.

School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia.

Introduction: Multifarious chronic obstructive pulmonary disease (COPD) guidelines have been published by local, national and global respiratory societies. These guidelines subsume holistic evidence based on recommendations to diagnose, treat, prevent and manage acute exacerbation with COPD. Despite the existing comprehensive recommendations, readmission rates and hospitalisations have increased in the last decade. Evidence to date has reported suboptimal clinical guidelines concordance. Acute exacerbations of COPD (AECOPD) is a common hospital presentation due to varied causes such as infective exacerbations, worsening disease condition, medication non-adherence, lack of education and incomprehensive discharge planning. AECOPD directly and indirectly causes economic burden, disrupts health-related quality of life (HRQol), hasten lung function decline and increases overall morbidity and mortality. COPD being a multimodal chronic disease, consistent interdisciplinary interventions from the time of admission to discharge may reduce readmissions and enhance HRQol among these patients and their families.

Methods And Analysis: This protocol adheres to the Joanna Briggs Institute methodology for mixed methods systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. Qualitative, quantitative and mixed methods studies will append this study to explore determinants of COPD guidelines concordance. Comprehensive three-tier search strategies will be used to search nine databases (COCHRANE, EBSCO HOST, MEDLINE, SCIENCE DIRECT, JBI, SCOPUS, WEB OF SCIENCE, WILEY and DARE) in May 2020. Two independent reviewers will screen abstracts and full-text articles in consonance with inclusion criteria. The convergent integrative method narrative review will contribute a deeper understanding of any discrepancies found in the existing evidence. Quality of the studies will be reported and Theoretical Domains Framework (TDF) will be used as a priori to synthesis data. Identified barriers, facilitators and corresponding clinical behavioural change solutions will be categorised using TDF indicators to provide future research and implementation recommendations.

Ethics And Dissemination: Ethical approval is not required and results dissemination will occur through peer-reviewed publication.
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http://dx.doi.org/10.1136/bmjopen-2019-036060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375635PMC
July 2020

Early Autonomy May Contribute to an Increase in the General Surgical Workforce.

Cureus 2020 Feb 26;12(2):e7108. Epub 2020 Feb 26.

Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA.

Background: Nationally, 85% of general surgery graduates pursue fellowships reducing the incoming general surgical workforce with a predicted shortage of 41,000 general surgeons by 2025. In recent studies, the lack of confidence appears to be a major factor contributing to resident decision to pursue fellowship. The aim of the study was to determine if a hybrid academic/community program contributes to early autonomy and the decision to pursue fellowship in general surgery graduates.

Methods: We evaluated the level of confidence, level of autonomy, and decision to pursue fellowship at a hybrid academic/community program that historically graduates 70% of their residents into general surgery practice through an anonymous survey. Participants responded using Likert scales along with simple polar questions.

Results: Most current residents (90%) reported, upon graduation, that they feel very confident (45%) or fairly confident (45%) performing major cases independently. Most attendings (64%) reported that during their third year of residency, they began performing the majority (more than 75%) of their major cases as surgeon junior while current residents (55%) reported they were performing the majority as a second-year resident. Fifty-five percent of residents felt that confidence played a role in the decision to pursue fellowship. Thirty-three percent of our current chief residents and only 34% of the total general surgery residents plan to pursue fellowships.  Conclusions: Our study showed that our residents appear to have earlier levels of autonomy than that experienced by our practicing surgeons when they were residents. Confidence continues to play a role in the decision to pursue fellowship and overall our residents are confident in technical skills at graduation. Our unique program continues to graduate the majority of our surgical residents into successful general surgery practice.
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http://dx.doi.org/10.7759/cureus.7108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100856PMC
February 2020

Commentary: Is radiation needed after resecting an early-stage small cell lung cancer?

J Thorac Cardiovasc Surg 2019 12 20;158(6):1678. Epub 2019 Sep 20.

Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Tex. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2019.08.092DOI Listing
December 2019

Hepatobiliary Complications in Children with Sickle Cell Disease: A Retrospective Review of Medical Records from 616 Patients.

J Clin Med 2019 Sep 18;8(9). Epub 2019 Sep 18.

Department of Pediatric Gastroenterology-Hepatology-Nutrition, Hepatology Unit, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 75005 Paris, France.

Hepatobiliary complications in children with sickle cell disease (SCD) are rarely reported but can be life-threatening. We retrospectively assessed their prevalence in a cohort of 616 children followed in a French university-hospital SCD reference center. Eligibility criteria were the following: age <18 years, seen at least twice with an interval of more than 6 months from January 2008 to December 2017, with all genotypes of SCD. Patients with hepatobiliary complications were identified via the local data warehouse and medical files were thoroughly reviewed. At least one hepatobiliary complication was reported in 37% of the children. The most frequent was cholelithiasis, in 25% of cases, which led to systematic screening and elective cholecystectomy in the case of gallstones. Overall, 6% of the children experienced acute sickle cell hepatic crisis, sickle cell intra-hepatic cholestasis, or acute hepatic sequestration, with severity ranging from mild liver pain and increased jaundice to multiple organ failure and death. Emergency treatment was exchange transfusion, which led to normalization of liver tests in most cases. Five children had chronic cholangiopathy, associated with auto-immune hepatitis in two cases. One needed liver transplantation, having a good outcome but with many complications. Transfusion iron load and infectious hepatitis cases were mild. Hepatotoxicity of an iron chelator was suspected to contribute to abnormal liver test results in five patients. We propose recommendations to prevent, explore, and treat hepatobiliary complications in SCD children. We underline the need for emergency exchange transfusion when acute liver failure develops and warn against liver biopsy and transplantation in this condition.
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http://dx.doi.org/10.3390/jcm8091481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780325PMC
September 2019

Reducing Resident Physician Workload to Improve Well Being.

Cureus 2019 Jun 29;11(6):e5039. Epub 2019 Jun 29.

Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA.

Introduction Resident physician's well-being has been postulated to worsen with longer shifts. At our institution, the admitting physician evening shift (known as short call) had been associated with higher levels of stress and reduced well-being among residents due to longer work hours and an excessive number of admissions. We introduced an intermediate swing shift to help mitigate those effects. This study sought to assess the outcomes of introducing the swing shift on the timeliness of leaving the hospital for the short call physician, and the median number of admissions done by the short call, swing shift, and night shift resident physicians. Method  The swing shift was designed to cover admitting duties from 4:00 to 11:00 pm on weekdays, with support from both the short call and night shift resident physicians. Internal Medicine residents in their second or third year of training and combined Medicine/Psychiatry residents in their third, fourth or fifth year of training, were surveyed prior to the implementation of the swing shift and four-months post-implementation. Time of leaving the hospital and number of admissions before and after the introduction of the swing shift were compared. Data were recorded as frequencies and presented as medians. Results There were 27 surveys completed prior to swing shift implementation and 43 surveys completed post-implementation with a response rate of 52% and 83%, respectively. Surveys post-implementation were divided into 29 for the short call shift survey, six for the swing shift survey, and eight for the night shift survey. Residents who did not perform the short call physician duties were excluded, limiting the prior to implementation surveys from 27 to 25 and the post-implementation short call surveys from 29 to 19. Prior to swing shift implementation, the median time of leaving for the short call physician was 8:30 to 9:00 pm; the median number of admissions were four and eight, done by short call physician and night shift physician, respectively. Whereas post-swing shift implementation, the median time of leaving for short call physician was 7:00 to 7:30 pm, and for swing shift physician was 11:30 pm to midnight. The median number of admissions were two, five, and five done by the short call, swing shift, and night shift physicians, respectively. All residents reported the swing shift allowed them to take better care of patients and follow up on their tasks. Discussion and conclusion Delayed resident physicians departure at the end of their respective shift was associated with extended shifts. It is thought to be caused by an increased number of admissions, late shift admissions, and time of day shift with 4:00 to 9:00 pm being the busiest. The addition of the swing shift increased the ability of the short call resident physician to leave the hospital at the end of their shift and reduced the median number of admissions done by the short call and night shift resident physicians, hence likely improving resident's well-being while preserving the total number of admissions.
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http://dx.doi.org/10.7759/cureus.5039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721886PMC
June 2019

Attitudes towards breech management among a team of maternity clinicians in Australia undertaking breech training.

Women Birth 2020 Jul 24;33(4):e348-e356. Epub 2019 Aug 24.

University of Southern Queensland, School of Nursing and Midwifery, Queensland 4305, Australia. Electronic address:

Background: Australian women seeking a vaginal breech birth report limited access to this option due to resistance from clinicians and strict medical criteria. Limited evidence exists to determine the attitudes, knowledge, experience and perceived confidence of Australian maternity clinicians towards the management of a breech presentation at term.

Aim: The aim of this study is to identify experience, knowledge and attitudes of birth suite clinicians' before and after training, toward term breech presentation and management practices.

Methods: A mixed methods research design was used that included a survey tool. A survey of 29 midwives and 11 medical professionals who attended an educational course in breech management ("BABE - Becoming a Breech Expert") was undertaken pre and post BABE training.

Results: While participants were experienced in providing maternity services, the results indicated most were inexperienced in facilitating a vaginal breech birth. Prior to training, most participants believed vaginal breech birth had a higher risk of neonatal morbidity and mortality compared to caesarean birth. The prospect of a woman choosing a breech birth outside of medical recommendations made many participants "nervous". Despite this, support to ensure there was informed decision-making and respect for a woman's choice was high. Following training, clinician knowledge of assessment of risks for breech birth and intention to discuss breech management options with women increased.

Conclusions: Participation in breech management training is beneficial to increasing clinician knowledge and assessment of risk and confidence towards discussing vaginal breech birth management, respect for women's choice and informed decision-making.
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http://dx.doi.org/10.1016/j.wombi.2019.08.002DOI Listing
July 2020

An Accessible and Unique Insight into Metastasis Mutational Content Through Whole-exome Sequencing of Circulating Tumor Cells in Metastatic Prostate Cancer.

Eur Urol Oncol 2020 08 4;3(4):498-508. Epub 2019 Jan 4.

INSERM U981, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France; INSERM US23 AMMICA, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France. Electronic address:

Background: Genomic analysis of circulating tumor cells (CTCs) could provide a unique and accessible representation of tumor diversity but remains hindered by technical challenges associated with CTC rarity and heterogeneity.

Objective: To evaluate CTCs as surrogate samples for genomic analyses in metastatic castration-resistant prostate cancer (mCRPC).

Design, Setting, And Participants: Three isolation strategies (filter laser-capture microdissection, self-seeding microwell chips, and fluorescence-activated cell sorting) were developed to capture CTCs with various epithelial and mesenchymal phenotypes and isolate them at the single-cell level. Whole-genome amplification (WGA) and WGA quality control were performed on 179 CTC samples, matched metastasis biopsies, and negative controls from 11 patients. All patients but one were pretreated with enzalutamide or abiraterone. Whole-exome sequencing (WES) of 34 CTC samples, metastasis biopsies, and negative controls were performed for seven patients.

Outcome Measurements And Statistical Analysis: WES of CTCs was rigorously qualified in terms of percentage coverage at 10× depth, allelic dropout, and uncovered regions. Shared somatic mutations between CTCs and matched metastasis biopsies were identified. A customized approach based on determination of mutation rates for CTC samples was developed for identification of CTC-exclusive mutations.

Results And Limitations: Shared mutations were mostly detected in epithelial CTCs and were recurrent. For two patients for whom a deeper analysis was performed, a few CTCs were sufficient to represent half to one-third of the mutations in the matched metastasis biopsy. CTC-exclusive mutations were identified in both epithelial and nonepithelial CTCs and affected cytoskeleton, invasion, DNA repair, and cancer-driver genes. Some 41% of CTC-exclusive mutations had a predicted deleterious impact on protein function. Phylogenic relationships between CTCs with distinct phenotypes were evidenced.

Conclusions: CTCs can provide unique insight into metastasis mutational diversity and reveal undiagnosed genomic aberrations in matched metastasis biopsies.

Patient Summary: Our results demonstrate the clinical potential of circulating tumor cells to provide insight into metastatic events that could be critical to target using precision medicine.
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http://dx.doi.org/10.1016/j.euo.2018.12.005DOI Listing
August 2020

Rise in Node-Positive Prostate Cancer Incidence in Context of Evolving Use and Extent of Pelvic Lymphadenectomy.

Clin Genitourin Cancer 2019 06 26;17(3):e494-e504. Epub 2019 Jan 26.

Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA. Electronic address:

Background: The incidence of node-positive prostate cancer has risen and might be partially explained by evolving use of lymphadenectomy at a population level. We assessed trends of node-positive prostate cancer in context of extent of lymphadenectomy among men treated surgically for prostate cancer.

Patients And Methods: This was a retrospective study using data from a population-based cancer registry to identify men older than 50 years of age diagnosed with prostate cancer from 2010 to 2015 without distant metastases. We considered extent of node dissection as ordinal (1-4, 5-9, 10-14, 15-19, ≥20) and dichotomous (1-14, ≥15) variables. We fit multivariable models to assess trends in receipt of extended lymphadenectomy and then estimated odds of node-positive cancer on the basis of extent of lymphadenectomy.

Results: We identified 280,156 men diagnosed from 2010 to 2015; 5355 men (1.9%) had positive lymph nodes. Incidence of positive nodes increased from 6.4 to 8.4 cases per 100,000 men from 2010 to 2015 (standardized rate ratio, 1.31; 95% confidence interval [CI], 1.20-1.44). Compared with 2010, prostatectomy patients with high-risk (odds ratio [OR], 1.66; 95% CI, 1.42-1.95) and intermediate-risk tumors (OR, 1.66; 95% CI, 1.47-1.88) were more likely to undergo extended lymphadenectomy in 2015. Among high-risk patients, men with ≥20 nodes removed were 7 times more likely to have positive nodes, versus <5 removed (6.1% for 1-4 vs. 32.4% for ≥20; OR, 7.32; 95% CI, 6.16-8.71). After adjusting for extent of dissection, odds of node-positive disease did not increase between 2010 and 2015 (OR, 1.17; 95% CI, 0.98-1.39) among high-risk patients.

Conclusion: Increased incidence of node-positive prostate cancer in the United States is partially explained by more frequent use of extended lymphadenectomy.
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http://dx.doi.org/10.1016/j.clgc.2019.01.012DOI Listing
June 2019

Breaking with Tradition: A Scoping Meta-Analysis Analyzing the Effects of Student-Centered Learning and Computer-Aided Instruction on Student Performance in Anatomy.

Anat Sci Educ 2019 Jan 16;12(1):61-73. Epub 2018 Apr 16.

Monash Centre for Human Anatomy Education and Monash Centre for Scholarship in Health Education, Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia.

While prior meta-analyses in anatomy education have explored the effects of laboratory pedagogies and histology media on learner performance, the effects of student-centered learning (SCL) and computer-aided instruction (CAI) have not been broadly evaluated. This research sought to answer the question, "How effective are student-centered pedagogies and CAI at increasing student knowledge gains in anatomy compared to traditional didactic approaches?" Relevant studies published within the past 51 years were searched using five databases. Predetermined eligibility criteria were applied to the screening of titles and abstracts to discern their appropriateness for study inclusion. A summary effect size was estimated to determine the effects of SCL and CAI on anatomy performance outcomes. A moderator analysis of study features was also performed. Of the 3,035 records screened, 327 underwent full-text review. Seven studies, which comprised 1,564 participants, were included in the SCL analysis. An additional 19 studies analyzed the effects of CAI in the context of 2,570 participants. Upon comparing SCL to traditional instruction, a small positive effect on learner performance was detected (standardized mean difference (SMD = 0.24; [CI = 0.07, 0.42]; P = 0.006). Likewise, students with CAI exposure moderately outscored those with limited or no access to CAI (SMD = 0.59; [CI = 0.20, 0.98]; P = 0.003). Further analysis of CAI studies identified effects (P ≤ 0.001) for learner population, publication period, interventional approach, and intervention frequency. Overall, learners exposed to SCL and supplemental CAI outperformed their more classically-trained peers as evidenced by increases in short-term knowledge gains. Anat Sci Educ. © 2018 American Association of Anatomists.
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http://dx.doi.org/10.1002/ase.1789DOI Listing
January 2019

The game of telephone: a sustained, low-cost, quality improvement initiative to enhance communication between patients and their resident physician.

BMJ Open Qual 2017 17;6(2):e000143. Epub 2017 Sep 17.

Department of General Medicine, The University of Kansas Health System, Kansas City, Kansas, USA.

This multidisciplinary quality improvement project was designed to enhance telephone communication between patients and their resident physician while concomitantly creating a standardised telephone communication protocol for resident internal medicine continuity clinics. The plan, do, study, act (PDSA) quality improvement framework model was applied for four distinct cycles. Baseline data were collected regarding open telephone encounters. The initial intervention entailed targeted communication to specific individual residents with open telephone encounters more than one SD above the average. The next cycle involved developing a novel communication process map that was distributed to faculty preceptors and clinic anchor nurses. The faculty preceptors then disseminated the new policies and communication algorithm to resident physicians. Finally, new resident and anchor nurses were educated about the standardised processes through scheduled orientation activities. After 19 months of implementation of this project with four PDSA cycles, resident open telephone encounters decreased by 40.7%. Resident telephone communication in continuity clinics can be improved through targeted individualised communication, implementation of a standardised telephone communication protocol, dissemination of communication algorithms to clinic faculty, residents and nurses and ongoing education to all parties through orientation activities to instil a self-sustaining culture change.
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http://dx.doi.org/10.1136/bmjoq-2017-000143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5699132PMC
September 2017

A meta-analysis of anatomy laboratory pedagogies.

Clin Anat 2018 Jan 6;31(1):122-133. Epub 2017 Jul 6.

Department of Anatomy & Developmental Biology, Monash University, Clayton, Victoria, Australia.

The debate regarding anatomy laboratory teaching approaches is ongoing and controversial. To date, the literature has yielded only speculative conclusions because of general methodological weaknesses and a lack of summative empirical evidence. Through a meta-analysis, this study compared the effectiveness of instructional laboratory approaches used in anatomy education to objectively and more conclusively synthesize the existing literature. Studies published between January 1965 and December 2015 were searched through five databases. Titles and abstracts of the retrieved records were screened using eligibility criteria to determine their appropriateness for study inclusion. Only numerical data were extracted for analysis. A summary effect size was estimated to determine the effects of laboratory pedagogies on learner performance and perceptions data were compiled to provide additional context. Of the 3,035 records screened, 327 underwent full-text review. Twenty-seven studies, comprising a total of 7,731 participants, were included in the analysis. The meta-analysis detected no effect (standardized mean difference = -0.03; 95% CI = -0.16 to 0.10; P = 0.62) on learner performance. Additionally, a moderator analysis detected no effects (P ≥ 0.16) for study design, learner population, intervention length, or specimen type. Across studies, student performance on knowledge examinations was equivalent regardless of being exposed to either dissection or another laboratory instructional strategy. This was true of every comparison investigated (i.e., dissection vs. prosection, dissection vs. digital media, dissection vs. models/modeling, and dissection vs. hybrid). In the context of short-term knowledge gains alone, dissection is no better, and no worse, than alternative instructional modalities. Clin. Anat. 31:122-133, 2018. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.22934DOI Listing
January 2018

Evidence-based practice: Embracing integration.

Nurs Outlook 2016 Nov - Dec;64(6):575-582. Epub 2016 Apr 23.

Office of Nursing Services, Department of Veterans Affairs, Washington, DC, Arlington, VA.

Background: The Veterans Health Administration's Office of Nursing Services launched several initiatives to support evidence-based practice (EBP) initiatives throughout its system. From evaluation of these initiatives and reflection on discussions with nurse leaders and direct care nurses, our thinking about and approach to EBP has evolved from a project-focused to a practice-focused interpretation.

Purpose: (a) Offer an expanded view that moves beyond interpreting EBP as process-driven projects to a "way of practicing" where nurses assume ownership for a practice that integrates best available evidence, clinical expertise, and patient preferences, and (b) describe and generate discussion on the educational, cultural, and role modeling implications of this expanded view.

Methods: We illustrate EBP integration using a point-of-care interaction scenario.

Conclusion: Commitment to EBP is reflected at the point-of-care where each nurse demonstrates the ability to integrate evidence-based interventions, patient preferences, and clinical expertise to arrive at patient-centric health care decisions.
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http://dx.doi.org/10.1016/j.outlook.2016.04.004DOI Listing
May 2017

Impact of Advocacy Initiatives on Nurses' Motivation to Sustain Momentum in Public Policy Advocacy.

J Prof Nurs 2016 May-Jun;32(3):235-45. Epub 2015 Oct 26.

Doctor of Nursing Practice Graduate, School of Nursing in the Bouve College of Health Sciences, Robinson Hall, Northeastern University, Boston, MA, 02115, USA.. Electronic address:

Unlabelled: The purpose of this study is to elicit insight from the public policy leaders of 2 regional professional nursing organizations on key qualities of their current advocacy initiatives that motivate nurses to sustain momentum in public policy advocacy beyond a single episode. The goal is to inform quality improvement in the development of future advocacy initiatives to increase sustained engagement of nurses.

Methods: Social cognitive theory was used as the rationale for this qualitative, descriptive study. A purposive convenience sample of executive leadership and board committee members from 2 regional professional nursing organizations were recruited to complete an initial Web-based electronic survey, followed by separate semistructured interview focus groups. One organization was composed primarily of advanced practice registered nurses, and the other group composed of diverse, multispecialty nursing members with varied educational levels.

Results: Nine themes emerged, categorized as facilitators or challenges to the positive impact of advocacy initiatives on nurses' motivation.

Conclusion: Highlighting and marketing facilitators to the positive impact of advocacy initiatives on nurses' motivation to sustain momentum in public policy advocacy, while designing and testing new initiatives that address the challenges, may increase the number of nurses who sustain engagement in the policy advocacy process.
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http://dx.doi.org/10.1016/j.profnurs.2015.10.010DOI Listing
June 2017

Impact of Advocacy Initiatives on Nurses' Motivation to Sustain Momentum in Public Policy Advocacy.

J Prof Nurs 2016 May-Jun;32(3):235-45. Epub 2015 Oct 26.

Doctor of Nursing Practice Graduate, School of Nursing in the Bouve College of Health Sciences, Robinson Hall, Northeastern University, Boston, MA, 02115, USA.. Electronic address:

Unlabelled: The purpose of this study is to elicit insight from the public policy leaders of 2 regional professional nursing organizations on key qualities of their current advocacy initiatives that motivate nurses to sustain momentum in public policy advocacy beyond a single episode. The goal is to inform quality improvement in the development of future advocacy initiatives to increase sustained engagement of nurses.

Methods: Social cognitive theory was used as the rationale for this qualitative, descriptive study. A purposive convenience sample of executive leadership and board committee members from 2 regional professional nursing organizations were recruited to complete an initial Web-based electronic survey, followed by separate semistructured interview focus groups. One organization was composed primarily of advanced practice registered nurses, and the other group composed of diverse, multispecialty nursing members with varied educational levels.

Results: Nine themes emerged, categorized as facilitators or challenges to the positive impact of advocacy initiatives on nurses' motivation.

Conclusion: Highlighting and marketing facilitators to the positive impact of advocacy initiatives on nurses' motivation to sustain momentum in public policy advocacy, while designing and testing new initiatives that address the challenges, may increase the number of nurses who sustain engagement in the policy advocacy process.
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http://dx.doi.org/10.1016/j.profnurs.2015.10.010DOI Listing
June 2017

Holistic Care of Older Lesbian, Gay, Bisexual, and Transgender Patients in the Emergency Department.

Authors:
Melissa Taylor

J Emerg Nurs 2016 Mar;42(2):170-3

Cincinnati, OH. Electronic address:

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http://dx.doi.org/10.1016/j.jen.2016.02.007DOI Listing
March 2016

Meta-analysis and review of learner performance and preference: virtual versus optical microscopy.

Med Educ 2016 Apr;50(4):428-40

Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Context: Over nearly two decades, a wealth of literature describing the various capabilities, uses and adaptations of virtual microscopy (VM) has been published. Many studies have investigated the effects on and benefits to student learning of VM compared with optical microscopy (OM).

Objectives: This study statistically aggregated the findings of multiple comparative studies through a meta-analysis in order to summarise and substantiate the pedagogical efficacy of teaching with VM.

Methods: Using predefined eligibility criteria, teams of paired researchers screened the titles and abstracts of VM studies retrieved from seven different databases. After two rounds of screening, numerical and thematic data were extracted from the eligible studies for analysis. A summary effect size and estimate of heterogeneity were calculated to determine the effects of VM on learner performance and the amount of variance between studies, respectively. Trends in student perceptions were also analysed and reported.

Results: Of the 725 records screened, 72 studies underwent full-text review. In total, 12 studies were viable for meta-analysis and additional studies were reviewed to extract themes relating to learners' perceptions of VM. The meta-analysis detected a small yet significant positive effect on learner performance (standardised mean difference 0.28, 95% confidence interval 0.09-0.47; p = 0.003), indicating that learners experience marked knowledge gains when exposed to VM over OM. Variation among studies was evident as high heterogeneity was reported. An analysis of trends in learner perceptions noted that respondents favoured VM over OM by a large margin.

Conclusions: Although many individual studies have reported non-significant findings in comparisons of VM and OM, the enhanced power afforded by meta-analysis revealed that the pedagogical approach of VM is modestly superior to that of OM and is preferred by learners.
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http://dx.doi.org/10.1111/medu.12944DOI Listing
April 2016

The potential diagnostic power of circulating tumor cell analysis for non-small-cell lung cancer.

Expert Rev Mol Diagn 2015 13;15(12):1605-29. Epub 2015 Nov 13.

a INSERM, U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment" , F-94805 , VILLEJUIF , France.

In non-small-cell lung cancer (NSCLC), genotyping tumor biopsies for targetable somatic alterations has become routine practice. However, serial biopsies have limitations: they may be technically difficult or impossible and could incur serious risks to patients. Circulating tumor cells (CTCs) offer an alternative source for tumor analysis that is easily accessible and presents the potential to identify predictive biomarkers to tailor therapies on a personalized basis. Examined here is our current knowledge of CTC detection and characterization in NSCLC and their potential role in EGFR-mutant, ALK-rearranged and ROS1-rearranged patients. This is followed by discussion of the ongoing issues such as the question of CTC partnership as diagnostic tools in NSCLC.
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http://dx.doi.org/10.1586/14737159.2015.1111139DOI Listing
September 2016

Utilization of distributed leadership modelling in the health and aged care sector: a systematic review of qualitative evidence protocol.

JBI Database System Rev Implement Rep 2015 Sep 16;13(8):21-9. Epub 2015 Sep 16.

The Queensland Centre for Evidence-Based Nursing and Midwifery: a Collaborating Center of the Joanna Briggs Institute.

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http://dx.doi.org/10.11124/jbisrir-2015-2017DOI Listing
September 2015

Enhanced intensity discrimination in the intact ear of adults with unilateral deafness.

J Acoust Soc Am 2015 Jun;137(6):EL408-14

School of Psychological Sciences, University of Manchester, Manchester, United Kingdom

Physiological measures of neural activity in the auditory cortex have revealed plasticity following unilateral deafness. Central projections from the remaining ear reorganize to produce a stronger cortical response than normal. However, little is known about the perceptual consequences of this increase. One possibility is improved sound intensity discrimination. Intensity difference limens were measured in 11 individuals with unilateral deafness that were previously shown to exhibit increased cortical activity to sounds heard by the intact ear. Significantly smaller mean difference limens were observed compared with controls. These results provide evidence of the perceptual consequences of plasticity in humans following unilateral deafness.
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http://dx.doi.org/10.1121/1.4914945DOI Listing
June 2015