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Author |
Cole, D.C.; Giordano, C.R.; Vasilopoulos, T.; Fahy, B.G. |
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Title |
Resident Physicians Improve Nontechnical Skills When on Operating Room Management and Leadership Rotation |
Type |
Journal Article |
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Year |
2017 |
Publication |
Anesthesia and Analgesia |
Abbreviated Journal |
Anesth Analg |
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Volume |
124 |
Issue |
1 |
Pages |
300-307 |
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Abstract |
BACKGROUND: Anesthesiology residency primarily emphasizes the development of medical knowledge and technical skills. Yet, nontechnical skills (NTS) are also vital to successful clinical practice. Elements of NTS are communication, teamwork, situational awareness, and decision making. METHODS: The first 10 consecutive senior residents who chose to participate in this 2-week elective rotation of operating room (OR) management and leadership training were enrolled in this study, which spanned from March 2013 to March 2015. Each resident served as the anesthesiology officer of the day (AOD) and was tasked with coordinating OR assignments, managing care for 2 to 4 ORs, and being on call for the trauma OR; all residents were supervised by an attending AOD. Leadership and NTS techniques were taught via a standardized curriculum consisting of leadership and team training articles, crisis management text, and daily debriefings. Resident self-ratings and attending AOD and charge nurse raters used the Anaesthetists' Non-Technical Skills (ANTS) scoring system, which involved task management, situational awareness, teamwork, and decision making. For each of the 10 residents in their third year of clinical anesthesiology training (CA-3) who participated in this elective rotation, there were 14 items that required feedback from resident self-assessment and OR raters, including the daily attending AOD and charge nurse. Results for each of the items on the questionnaire were compared between the beginning and the end of the rotation with the Wilcoxon signed-rank test for matched samples. Comparisons were run separately for attending AOD and charge nurse assessments and resident self-assessments. Scaled rankings were analyzed for the Kendall coefficient of concordance (omega) for rater agreement with associated chi and P value. RESULTS: Common themes identified by the residents during debriefings were recurrence of challenging situations and the skills residents needed to instruct and manage clinical teams. For attending AOD and charge nurse assessments, resident performance of NTS improved from the beginning to the end of the rotation on 12 of the 14 NTS items (P < .05), whereas resident self-assessment improved on 3 NTS items (P < .05). Interrater reliability (across the charge nurse, resident, and AOD raters) ranged from omega = .36 to .61 at the beginning of the rotation and omega = .27 to .70 at the end of the rotation. CONCLUSIONS: This rotation allowed for teaching and resident assessment to occur in a way that facilitated resident education in several of the skills required to meet specific milestones. Resident physicians are able to foster NTS and build a framework for clinical leadership when completing a 2-week senior elective as an OR manager. |
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From the Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Fla |
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0003-2999 |
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Notes |
PMID:27918336 |
Approved |
no |
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Call Number |
ref @ user @ |
Serial |
95061 |
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Author |
Chae, S.; Desai, S.; Crowell, M.; Sedgh, G.; Singh, S. |
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Title |
Characteristics of women obtaining induced abortions in selected low- and middle-income countries |
Type |
Journal Article |
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Year |
2017 |
Publication |
PloS one |
Abbreviated Journal |
PLoS One |
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Volume |
12 |
Issue |
3 |
Pages |
e0172976 |
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Keywords |
Abortion, Legal/*economics/psychology/*statistics & numerical data; Adolescent; Adult; Africa; Asia; Caribbean Region; Developing Countries/*economics; Educational Status; Europe; Female; Humans; Latin America; Marital Status/statistics & numerical data; Parity/physiology; Poverty/psychology/*statistics & numerical data; Pregnancy; *Pregnancy, Unplanned |
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BACKGROUND: In 2010-2014, approximately 86% of abortions took place in low- and middle-income countries (LMICs). Although abortion incidence varies minimally across geographical regions, it varies widely by subregion and within countries by subgroups of women. Differential abortion levels stem from variation in the level of unintended pregnancies and in the likelihood that women with unintended pregnancies obtain abortions. OBJECTIVES: To examine the characteristics of women obtaining induced abortions in LMICs. METHODS: We use data from official statistics, population-based surveys, and abortion patient surveys to examine variation in the percentage distribution of abortions and abortion rates by age at abortion, marital status, parity, wealth, education, and residence. We analyze data from five countries in Africa, 13 in Asia, eight in Europe, and two in Latin America and the Caribbean (LAC). RESULTS: Women across all sociodemographic subgroups obtain abortions. In most countries, women aged 20-29 obtained the highest proportion of abortions, and while adolescents obtained a substantial fraction of abortions, they do not make up a disproportionate share. Region-specific patterns were observed in the distribution of abortions by parity. In many countries, a higher fraction of abortions occurred among women of high socioeconomic status, as measured by wealth status, educational attainment, and urban residence. Due to limited data on marital status, it is unknown whether married or unmarried women make up a larger share of abortions. CONCLUSIONS: These findings help to identify subgroups of women with disproportionate levels of abortion, and can inform policies and programs to reduce the incidence of unintended pregnancies; and in LMICs that have restrictive abortion laws, these findings can also inform policies to minimize the consequences of unsafe abortion and motivate liberalization of abortion laws. Program planners, policymakers, and advocates can use this information to improve access to safe abortion services, postabortion care, and contraceptive services. |
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Guttmacher Institute, New York, New York, United States of America |
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1932-6203 |
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PMID:28355285 |
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Call Number |
ref @ user @ |
Serial |
97183 |
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Author |
Chae, S.; Desai, S.; Crowell, M.; Sedgh, G.; Singh, S. |
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Title |
Characteristics of women obtaining induced abortions in selected low- and middle-income countries |
Type |
Journal Article |
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Year |
2017 |
Publication |
PloS one |
Abbreviated Journal |
PLoS One |
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Volume |
12 |
Issue |
3 |
Pages |
e0172976 |
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Keywords |
Abortion, Legal/*economics/psychology/*statistics & numerical data; Adolescent; Adult; Africa; Asia; Caribbean Region; Developing Countries/*economics; Educational Status; Europe; Female; Humans; Latin America; Marital Status/statistics & numerical data; Parity/physiology; Poverty/psychology/*statistics & numerical data; Pregnancy; *Pregnancy, Unplanned |
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Abstract |
BACKGROUND: In 2010-2014, approximately 86% of abortions took place in low- and middle-income countries (LMICs). Although abortion incidence varies minimally across geographical regions, it varies widely by subregion and within countries by subgroups of women. Differential abortion levels stem from variation in the level of unintended pregnancies and in the likelihood that women with unintended pregnancies obtain abortions. OBJECTIVES: To examine the characteristics of women obtaining induced abortions in LMICs. METHODS: We use data from official statistics, population-based surveys, and abortion patient surveys to examine variation in the percentage distribution of abortions and abortion rates by age at abortion, marital status, parity, wealth, education, and residence. We analyze data from five countries in Africa, 13 in Asia, eight in Europe, and two in Latin America and the Caribbean (LAC). RESULTS: Women across all sociodemographic subgroups obtain abortions. In most countries, women aged 20-29 obtained the highest proportion of abortions, and while adolescents obtained a substantial fraction of abortions, they do not make up a disproportionate share. Region-specific patterns were observed in the distribution of abortions by parity. In many countries, a higher fraction of abortions occurred among women of high socioeconomic status, as measured by wealth status, educational attainment, and urban residence. Due to limited data on marital status, it is unknown whether married or unmarried women make up a larger share of abortions. CONCLUSIONS: These findings help to identify subgroups of women with disproportionate levels of abortion, and can inform policies and programs to reduce the incidence of unintended pregnancies; and in LMICs that have restrictive abortion laws, these findings can also inform policies to minimize the consequences of unsafe abortion and motivate liberalization of abortion laws. Program planners, policymakers, and advocates can use this information to improve access to safe abortion services, postabortion care, and contraceptive services. |
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Guttmacher Institute, New York, New York, United States of America |
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1932-6203 |
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Notes |
PMID:28355285 |
Approved |
no |
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Call Number |
ref @ user @ |
Serial |
97641 |
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Author |
Momeny, M.; Moghaddaskho, F.; Gortany, N.K.; Yousefi, H.; Sabourinejad, Z.; Zarrinrad, G.; Mirshahvaladi, S.; Eyvani, H.; Barghi, F.; Ahmadinia, L.; Ghazi-Khansari, M.; Dehpour, A.R.; Amanpour, S.; Tavangar, S.M.; Dardaei, L.; Emami, A.H.; Alimoghaddam, K.; Ghavamzadeh, A.; Ghaffari, S.H. |
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Title |
Blockade of vascular endothelial growth factor receptors by tivozanib has potential anti-tumour effects on human glioblastoma cells |
Type |
Journal Article |
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Year |
2017 |
Publication |
Scientific Reports |
Abbreviated Journal |
Sci Rep |
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Volume |
7 |
Issue |
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Pages |
44075 |
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Abstract |
Glioblastoma (GBM) remains one of the most fatal human malignancies due to its high angiogenic and infiltrative capacities. Even with optimal therapy including surgery, radiotherapy and temozolomide, it is essentially incurable. GBM is among the most neovascularised neoplasms and its malignant progression associates with striking neovascularisation, evidenced by vasoproliferation and endothelial cell hyperplasia. Targeting the pro-angiogenic pathways is therefore a promising anti-glioma strategy. Here we show that tivozanib, a pan-inhibitor of vascular endothelial growth factor (VEGF) receptors, inhibited proliferation of GBM cells through a G2/M cell cycle arrest via inhibition of polo-like kinase 1 (PLK1) signalling pathway and down-modulation of Aurora kinases A and B, cyclin B1 and CDC25C. Moreover, tivozanib decreased adhesive potential of these cells through reduction of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). Tivozanib diminished GBM cell invasion through impairing the proteolytic cascade of cathepsin B/urokinase-type plasminogen activator (uPA)/matrix metalloproteinase-2 (MMP-2). Combination of tivozanib with EGFR small molecule inhibitor gefitinib synergistically increased sensitivity to gefitinib. Altogether, these findings suggest that VEGFR blockade by tivozanib has potential anti-glioma effects in vitro. Further in vivo studies are warranted to explore the anti-tumour activity of tivozanib in combinatorial approaches in GBM. |
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Haematology/Oncology and Stem Cell Transplantation Research Centre, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran |
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2045-2322 |
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PMID:28287096 |
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Call Number |
ref @ user @ |
Serial |
96601 |
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Author |
Patino, A.; Alcalde, V.; Gutierrez, C.; Romero, M.G.; Carrillo, A.M.; Vargas, L.E.; Vallejo, C.E.; Zarama, V.; Mora Rodriguez, J.L.; Bustos, Y.; Granada, J.; Aguiar, L.G.; Menendez, S.; Cohen, J.I.; Saavedra, M.A.; Rodriguez, J.M.; Roldan, T.; Arbelaez, C. |
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Title |
Characteristics of Emergency Medicine Residency Programs in Colombia |
Type |
Journal Article |
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Year |
2017 |
Publication |
The Western Journal of Emergency Medicine |
Abbreviated Journal |
West J Emerg Med |
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Volume |
18 |
Issue |
6 |
Pages |
1120-1127 |
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Abstract |
INTRODUCTION: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogota, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. METHODS: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013-2016. Topics included program characteristics and curricula. RESULTS: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3-10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1-2 months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4-6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. CONCLUSION: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs. |
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Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital / Brigham and Women's Hospital, Boston, Massachusetts |
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English |
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ISSN |
1936-900X |
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Notes |
PMID:29085546 |
Approved |
no |
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Call Number |
ref @ user @ |
Serial |
97625 |
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