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Curriculum renewal and a process of care curriculum for teaching clerkship students.

BACKGROUND AND OBJECTIVES: A school-wide curriculum renewal led to a new clerkship curriculum that teaches core family practice competencies by focusing on the process of care in generalist practice. The organizing framework consists of five prototypic visits and their encounter tasks: 1) new problem visit, 2) checkup visit, 3) chronic illness visit, 4) psychosocial problem visit, and 5) behavioral change visit. METHODS: The seminars occur at the beginning of the rotation and use active learning techniques. Evaluation includes student perceptions of the seminars and teachers and student performance on a clinical performance examination (CPX). RESULTS: Students rated the usefulness of the seminars and the seminar leaders' teaching behaviors favorably. The CPX checklist scores showed that students could perform most of the behaviors expected for each prototypic visit. The students listed the appropriate encounter tasks nearly half of the time when describing what tasks they tried to accomplish during the CPX cases. The students listed concrete behaviors just over 50% of the time. CONCLUSIONS: The students learned the material presented in the seminars and applied it during the CPX. Students can do most of the behaviors but do not seem to describe the tasks as abstractly as faculty. These results come from one class cohort in one medical school, so the generalizability is limited until further work, including other learners, confirms these findings.

Attitude of Health Personnel↗

Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias (EGIL).

Criteria for the immunological classification of acute leukemias are proposed by a recently established European group designated EGIL. The main aims of EGIL are to establish guidelines for the characterization of acute leukemias based on marker expression and provide a uniform basis for the diagnosis of the various types of these hemopoietic malignancies which should be helpful for future multinational clinical and laboratory investigations. Within the two major types (B and T cell lineage) of acute lymphoblastic leukemia (ALL), several groups are delineated according to the degree of cell differentiation. Within the acute myeloid leukemias (AML), only three subtypes as defined by the FAB classification: M0-AML, M6-AML and M7-AML, can be unequivocally defined by immunological markers; prospective studies are undertaken to see whether characteristic immunological profiles are associated with particular AML subtypes defined by specific cytogenetic abnormalities. Criteria for the definition of biphenotypic acute leukemia (BAL) are devised and a scoring system is outlined aimed to distinguish BAL from those acute leukemias with expression of a marker from another lineage. In addition, an uncommon subset of acute leukemias with no evidence of lymphoid or myeloid differentiation is recognized and the useful panel of markers to investigate and establish the cell nature of the acute leukemias is outlined. EGIL will focus in the future on testing the reproducibility of the proposed guidelines, particularly those for BAL, assessing their clinical value within a framework of multicentric trials and setting up uniform methodological criteria.

Acute Disease↗

Ion channel functional candidate genes in multigenic neuropsychiatric disease.

Scores of monogenic Mendelian ion channel diseases serve to anchor the pathophysiology of the channelopathies, but there are also now clear examples of environmental, pharmacogenetic, and acquired channelopathy mechanisms. The cardinal feature of heritable ion channel disease is a periodic disturbance of rhythmic function in constitutionally hyperexcitable tissue. While the complexity of neuroanatomy obscures functional analysis of mutations causing monogenic seizure, ataxia, or migraine syndromes, extrapolation from the cardiac (Long QT [LQT]) and muscle (Periodic Paralysis) channelopathy syndromes provides a simplified predictive framework of molecular pathology: electrically stabilizing potassium ion (K(+)) and chloride ion (Cl(-)) channels, likely having lesions that diminish their current, and excitatory Na(+) channels, likely having gain-of-function lesions. The voltage-gated calcium channel gene family that contains CACNA1C, the newest LQT locus, causing Timothy Syndrome with a phenotype including autism, has proven to be particularly informative for its members' ability to tie the various central nervous system (CNS) phenotypes together in an interpretable fashion, now including direct extension to the classically multigenic neuropsychiatric phenotypes. Features of a promising ion channel candidate gene arise from its broad locus, gene family, nature of alleles, physiology and pharmacology, tissue expression profile, and phenotype in model organisms. KCNN3 is explored as a paradigm to consider.

Central Nervous System↗

PONGO: a web server for multiple predictions of all-alpha transmembrane proteins.

The annotation efforts of the BIOSAPIENS European Network of Excellence have generated several distributed annotation systems (DAS) with the aim of integrating Bioinformatics resources and annotating metazoan genomes (http://www.biosapiens.info). In this context, the PONGO DAS server (http://pongo.biocomp.unibo.it) provides the annotation on predictive basis for the all-alpha membrane proteins in the human genome, not only through DAS queries, but also directly using a simple web interface. In order to produce a more comprehensive analysis of the sequence at hand, this annotation is carried out with four selected and high scoring predictors: TMHMM2.0, MEMSAT, PRODIV and ENSEMBLE1.0. The stored and pre-computed predictions for the human proteins can be searched and displayed in a graphical view. However the web service allows the prediction of the topology of any kind of putative membrane proteins, regardless of the organism and more importantly with the same sequence profile for a given sequence when required. Here we present a new web server that incorporates the state-of-the-art topology predictors in a single framework, so that putative users can interactively compare and evaluate four predictions simultaneously for a given sequence. Together with the predicted topology, the server also displays a signal peptide prediction determined with SPEP. The PONGO web server is available at http://pongo.biocomp.unibo.it/pongo.

Humans↗

Validation of the Restless Legs Syndrome Quality of Life questionnaire.

OBJECTIVES: The Restless Legs Syndrome Quality of Life questionnaire (RLSQoL) assesses the impact of RLS on daily life, emotional well-being, social life, and work life. This study investigates its validity and reliability. METHODS: The RLSQoL was tested in 85 American adults with primary RLS. Patients were also asked to rate symptom severity with the International Restless Legs Scale (patient-reported version) and report on changes in symptoms over the 2-week period. RESULTS: The RLSQoL summary scale score (range: 0-100) demonstrated acceptable internal consistency reliability (Cronbach's alpha = 0.92) and test-retest reliability (intraclass correlation coefficient = 0.84). All items indicated acceptable item-convergent validity. The RLSQoL distinguished between groups with mild, moderate, and severe symptoms (F = 52.22, P < 0.0001). It demonstrated preliminary responsiveness to changes in RLS status over 2 weeks (effect size: improvement, 0.25; deterioration, -0.32), indicating moderate scale changes consistent with the small clinical change over this time. CONCLUSIONS: These findings support the conceptual framework of the RLSQoL. It is a valid and reliable measure of the impact of RLS on QoL and is responsive to short-term changes in symptom severity. The RLSQoL appears to be an appropriate tool for trial-based assessments of treatments for RLS.

Adult↗

NLCD: A method to discover nonlinear causal relations among genes.

Distinguishing correlation from causation is a fundamental challenge in many scientific fields, including biology, especially when interventions like randomized controlled trials are infeasible and only observational data are available. Methods based on statistical tests of conditional independence within the Mendelian Randomization framework can detect causality between two observed variables that are each associated with a third instrumental variable. However, these methods for detecting causal relationships between traits (e.g., two gene expression or clinical traits associated with a genetic variant, all observed in the same population) often assume a linear relationship, thereby hindering the discovery of causal gene networks from genomics data. We have developed NLCD, a method for NonLinear Causal Discovery from genomics data based on nonlinear regression modeling and conditional feature importance scoring. NLCD uses these techniques to extend the statistical tests in an existing linear causal discovery method called the Causal Inference Test (CIT). We benchmarked NLCD against current state-of-the-art methods: CIT, Findr, and MRPC. On simulated datasets, NLCD performs comparably to most methods in detecting linear relations (Average AUPRC (Area Under the Precision-Recall Curve) of NLCD&#x2009;=&#x2009;0.94, CIT&#x2009;=&#x2009;0.94, Findr&#x2009;=&#x2009;0.94, and MRPC&#x2009;=&#x2009;0.99), and outperforms them in detecting nonlinear (sine and sawtooth type) relations between two genes (Average AUPRC of NLCD&#x2009;=&#x2009;0.76, CIT&#x2009;=&#x2009;0.60, Findr&#x2009;=&#x2009;0.56, and MRPC&#x2009;=&#x2009;0.73). When tested on a nonlinear subset of a yeast genomic dataset to recover known causal relations involving transcription factors, NLCD and CIT performed comparable to each other and slightly better than Findr and MRPC (Average AUPRC of NLCD&#x2009;=&#x2009;0.82, CIT&#x2009;=&#x2009;0.81, Findr&#x2009;=&#x2009;0.71, and MRPC&#x2009;=&#x2009;0.54). On application to a human genomic dataset, NLCD revealed active causal gene pairs (IRF1 &#x2192; PSME1 and HLA-C &#x2192; HLA-T) in the muscle tissue, and clarified the promises and challenges in discovering causal gene networks in tissues under in vivo human settings.

Humans↗

[Effects of stepped counseling intervention on quality of life among newly diagnosed HIV-positive patients].

The purpose of this research was to understand how stepped counseling intervention affects quality of life in newly diagnosed HIV-positive patients. The study made use of quasi-experimental methodology that included a three-step interview process over 45 days. The theoretical framework supporting interviews with 32 newly diagnosed HIV-positive patients in northern Taiwan included a combination of rational-emotive therapy, cognitive-behavior therapy, and health education. Participants were divided into an experimental and control group of equal size. Data collection also included responses to the WHOQOL-HIV instrument at the beginning and end of each interview session. Responses were analyzed with the SPSS software package. The results showed a 25-point difference between pre- and post-test scores in the experimental group (SD = 3.2) and a 6 point difference in the control group (SD = 4.3). The results indicate that stepped counseling techniques are effective in helping this patient population to adjust to the physical, emotional, social, and environmental stresses associated with their newly diagnosis. The researchers suggest that stepped counseling be used with all newly diagnosed HIV-positive Taiwanese patients in all hospitals and clinics to promote adaptive abilities and to control the further spread of HIV.

Adult↗

Major trauma transfer in Western Australia.

BACKGROUND: The transfer of critically injured patients in a rural Australian setting presents a unique challenge to medical services due to the constraints of distance and time. The purpose of this study is to analyse which injuries are being transferred, how they occur, pretransfer intervention, transfer methods and transfer times. METHODS: The Trauma Registry Database collected data prospectively on all major rural trauma cases attending the Royal Perth Hospital between August 1994 and January 2000. Patients were divided into rural and metropolitan groups on the basis of trauma location, and the latter group used as a control. RESULTS: A total of 1275 major trauma patients were treated of which 566 (44%) were from rural areas. Driver road traffic trauma was the most common cause of injury throughout, although most prominent in rural areas (30%vs 18%). For rural patients, the Royal Flying Doctor Service was responsible for 440 (79%) of transfers of which 83% had a doctor and a nurse escort. The most commonly transferred injuries from rural areas were head injury (63%) and thoracic injury (55%). A total of 450 (93%) rural patients were transferred to Royal Perth Hospital within 24 h of trauma although the mean transfer time was over 9 h. CONCLUSIONS: This data produces a realistic framework of how major trauma in rural areas is treated in Western Australia. It highlights some areas of good practice, such as transfer methods and escorts, but also highlights problem areas such as transfer times and pretransfer intervention.

Adolescent↗

Classifying client goals in community-based ABI rehabilitation: a taxonomy for profiling service delivery and conceptualizing outcomes.

PURPOSE: To develop, confirm and trial a framework for analysing the content of goals set within community-based rehabilitation. This framework (taxonomy) is proposed as a tool to assist in service evaluation and outcome exploration. METHOD: Qualitative thematic analysis and categorization of 1765 rehabilitation goal statements in a four phase process of synthesis, refinement, verification and application. RESULTS: A taxonomy of goal content was developed comprising 21 categories within five domains, utilizing 125 descriptors. The taxonomy demonstrated good inter-rater consistency and was able to discriminate between similar but related data sets comprising goal statements. CONCLUSION: Structured analysis of the content of goal setting (particularly in community rehabilitation) utilizing a framework such as the proposed taxonomy has considerable potential as a 'window' into service delivery to broaden the parameters of existing service evaluation and to more clearly link outcome exploration to intervention.

Activities of Daily Living↗

A large Icelandic family with early osteoarthritis of the hip associated with a susceptibility locus on chromosome 16p.

OBJECTIVE: To describe a large kinship with inherited hip osteoarthritis (OA) and its associated susceptibility locus. METHODS: Four generations of a kinship with familial hip OA were identified and characterized by family history and by clinical, radiographic, and histopathologic examination. In the genome-wide search for a susceptibility locus, OA cases were defined as those who had undergone total hip replacement associated with a clinical and radiographic diagnosis of hip OA. A genome-wide scan was performed using a framework set of microsatellite markers with an average spacing of 10 cM. RESULTS: The hip OA of this family was indistinguishable from that of idiopathic, nonfamilial hip OA. There was no apparent evidence of spondyloepiphyseal dysplasia or other dysplasias usually associated with mutations in collagen genes. The genome-wide scan revealed a locus on chromosome 16p between 28 cM and 47 cM from the telomere, and this locus met the criteria for suggestive linkage (multipoint allele-sharing logarithm of odds [LOD] score 2.58, P = 1.6 x 10(-4)). Two additional regions with LOD scores of >1.5 were obtained. CONCLUSION: We have identified and described the largest kinship with familial hip OA reported to date. Evidence for linkage in this family suggests that a gene for susceptibility to hip OA exists on chromosome 16p. This represents an independent identification of a susceptibility locus previously reported for hip OA in this geographic region.

Adolescent↗

Neurological damage in a cardiopulmonary arrest model in the rat.

In view of the interest in cerebral protection in the framework of cardiopulmonary arrest (CPA), we assessed the neurological damage in a CPA model in the rat. CPA was induced in anesthetized Wistar rats by discontinuation of the jet ventilation and intracardiac injection of KCl. The animals were resuscitated after a CPA of either 7 min, 10.5 min, or 14 min. Six rats were used as nonischemic controls. All nonischemic rats survived, whereas in the resuscitated rats the 7-day survival rate decreased with increasing CPA duration. In the resuscitated rats, the neurological score was worse than in the control rats, and the score after 10.5-min CPA was worse than after 7-min CPA. Seizures were observed in 68% of resuscitated rats. Histopathological evaluation revealed moderate but selective neuronal necrosis in the hippocampus of all ischemic rats, and no cortical necrosis. However, neither the occurrence of seizures nor the extent of neuronal necrosis was related to the CPA duration. We conclude that in this model survival rate, neurological score, occurrence of seizures, and histopathological assessment can be used to evaluate neurological damage, although the contribution of other organ failure to these effects cannot be excluded.

Animals↗

Individual traits and family contexts predict sons' externalizing behavior and preliminary relative risk ratios for conduct disorder and substance use disorder outcomes.

An ontogenetic framework for elucidating the etiology of substance use disorders (SUD) requires identifying how individual traits and family contexts combine to increase risk for SUD outcomes. In this study, we examine individual traits in family context to identify processes that account for the relationship between fathers' SUD + status and sons' externalizing behaviors. Results obtained from SUD + (n = 89) and SUD - (n = 139) families show that fathers' abusive propensities toward their sons mediated the relationship between fathers' SUD + status and sons' externalizing behavior scale (EBS) scores 2 years later. Moreover, individual traits, family contextual variables and deviant peer affiliations accounted for 58% of the variance on sons' EBS scores. Also, high risk cluster (HRC) and low risk cluster (LRC) memberships were derived from cluster analyses of the continuous risk factor scores that predicted sons' EBS scores. Preliminary relative risk ratios show that sons classified into the HRC at age 10-12 were at greater risk for DSM-III-R conduct disorder and SUD outcomes at age 16 than sons assigned to the LRC, SUD + or SUD - groups. Implications for selected family-based prevention initiatives are presented.

Adolescent↗

Nurse competence scale: development and psychometric testing.

BACKGROUND: Self-assessment assists nurses to maintain and improve their practice by identifying their strengths and areas that may need to be further developed. Professional competence profiles encourage them to take an active part in the learning process of continuing education. Although competence recognition offers a way to motivate practising nurses to produce quality care, few measuring tools are available for this purpose. AIM: This paper describes the development and testing of the Nurse Competence Scale, an instrument with which the level of nurse competence can be assessed in different hospital work environments. METHODS: The categories of the Nurse Competence Scale were derived from Benner's From Novice to Expert competency framework. A seven-step approach, including literature review and six expert groups, was used to identify and validate the indicators of nurse competence. After a pilot test, psychometric testing of the Nurse Competence Scale (content, construct and concurrent validity, and internal consistency) was undertaken with 498 nurses. The 73-item scale consists of seven categories, with responses on a visual analogy scale format. The frequency of using competencies was additionally tested with a four-point scale. RESULTS: Self-assessed overall scores indicated a high level of competence across categories. The Nurse Competence Scale data were normally distributed. The higher the frequency of using competencies, the higher was the self-assessed level of competence. Age and length of work experience had a positive but not very strong correlation with level of competence. According to the item analysis, the categories of the Nurse Competence Scale showed good internal consistency. CONCLUSION: The results provide strong evidence of the reliability and validity of the Nurse Competence Scale.

Adult↗

A comparison of written materials vs. materials and counselling for women with sexual dysfunction and multiple sclerosis.

AIM: Evaluate whether symptoms of vaginal dryness, low libido, less intense or delayed orgasm could be improved in women with multiple sclerosis who took part in an education or education plus counselling programme. BACKGROUND: Sexual dysfunction, a prevalent symptom in women with multiple sclerosis, can negatively affect quality-of-life. METHODS: Women attending a large multiple sclerosis clinic were invited and 62 were randomized into one of two groups. Group 1 received written materials on primary, secondary and tertiary sexual dysfunction in multiple sclerosis as well as additional resources (books, websites, list of local psychologists specializing in sexual counselling). Group 2 received the same written materials as well as three counselling sessions from the clinic nurse, the latter two by telephone. The primary outcome measures were the expanded disability status scale and the multiple sclerosis intimacy and sexuality questionnaire-19. Repeated-measures analysis of variance was used to evaluate sexual dysfunction score over time and to compare two groups. RESULTS: At baseline, total expanded disability status scale scores were not correlated with primary, secondary or tertiary sexual dysfunction. Total multiple sclerosis intimacy and sexuality questionnaire-19 score was correlated with use of anti-cholinergic medications [r (54) = 0.28, P < 0.05], but no other medications, alcohol or tobacco use. Both groups had equivalent and significant reductions in primary sexual dysfunction [F (1) = 14.79, P < 0.001] postintervention. There was a trend towards an interaction effect for tertiary sexual dysfunction [F (1) = 2.88, P = 0.096], in the direction of group 2 (education and counselling). Subjectively, women welcomed the opportunity to discuss sexual concerns and noted that the written information allowed a framework for initiating discussion with their spouses. CONCLUSION: Relatively straightforward interventions provided by a clinic nurse may help women cope with the symptoms of sexual dysfunction associated with multiple sclerosis. Women who do not benefit from basic interventions could then be referred to an expert sexual dysfunction practitioner. RELEVANCE TO CLINICAL PRACTICE: Women with multiple sclerosis experience many disease-related physical and emotional challenges of which sexuality is only one. Sensitivity to sexual dysfunction and being willing to approach the topic is appreciated by women with multiple sclerosis. Nurses do not require in-depth expertise to offer some basic suggestions which may significantly improve life quality and assist the woman with multiple sclerosis to talk about or cope with sexuality issues.

Adult↗

Shifts in problem drinking during a life transition: adaptation to medical school training.

This study addresses the course of alcohol-related problems in future physicians from the perspectives of occupational stress versus selection and life-span developmental frameworks. A cohort of medical students was surveyed at medical school entrance and during the early fall of the second training year. Self-report questionnaires assessed: alcohol-related problems (using a modified time-linked version of the MAST), pretraining psychosocial and psychopathological characteristics and experiences (symptomatic distress, motivations for drinking, personality attributes/deficits, familial history of problem drinking, family disruption and earlier parental bonding) and medical-training characteristics (perceived stressors and levels of social support). On the basis of MAST scores, respondents manifested the following drinking patterns: consistent nonproblem drinking (67.4%), problem exit or remission during medical training (19.4%), problem entrance or onset during medical training (6.3%) and problem chronicity involving problems before and during medical training (6.9%). Female students were overrepresented in the consistent nonproblem group. The major predictors of Time 2 problem onset and chronicity as opposed to problem remission involved pretraining factors: familial history of alcohol problems, Time 1 symptomatic distress and escape motives for drinking. Future reports will depict the prevalence and etiology of problem drinking manifested during the clinical portion of medical training.

Adaptation, Psychological↗

A qualitative analysis of the nursing documentation of post-operative pain management.

As part of trust-wide practice development project to improve post-operative pain management, a descriptive study was conducted in the orthopaedic directorate of a large teaching hospital in the north of England. Sixty-five patients were included in this prospective study. Patients were interviewed post-operatively about their pain experience, and present and worst pain scores were recorded. The nursing documentation relating to pain management was also transcribed and a content analysis of this nursing documentation is reported. Findings indicate that individual assessment of pain was poorly documented and that the nurses' record of the patient's post-operative pain experience differed from the patient report. Reliance on pharmacological methods of pain relief was evident and interventions to help patients cope with night time pain were rarely documented. The results are discussed in light of a theoretical framework for acute pain management and current research. Implications for practice are discussed and areas for further research are suggested.

Adult↗

[Impact of frailty factors in elderly people older than 75 years with prosthesis of the hip].

OBJECTIVE: Hip pathology of hip requiring a surgical assumption of responsibility (coxarthrose invalidating, hip fracture) is increasing, and after the year 2025, the number of interventions will double. In parallel, the number of elderly people (older than 75 years) with malnutrition associated with cognitive impairment and reduced autonomy is on the increase. So the concept of frail elderly identified by specific criteria allows for better defining the health needs of heterogeneous elderly people. The objective of this study was to determine the influence of frailty factors on autonomy and clinical outcome after intervention for prosthesis of the hip. METHODOLOGY: This prospective work, completed over 8 months, included 55 patients with total or intermediate prostheses of hip, whatever the cause, recruited from rehabilitation wards. Results from a pre-established questionnaire defined the personal status and social framework of these patients. A medical examination evaluated cognitive function Mini Mental State (MMS), nutritional state (IMC) and the level of autonomy immediately after surgery (the first 2 weeks) by the measurement of functional independence (MIF). The second MIF was carried out by the same operator at the end of the assumption of responsibility by the institution. RESULTS: Three factors of frailty influenced progress at the time of reacquisition of autonomy: cognitive impairment (P < 0001; 1 patient out of 2 [50%] had an MMS score < 22); reduced nutrition? (P < 0.0026; [29% had a BMI score < 20 or a perimeter of the calf < 30 cm]; and accommodations before the intervention (P < 0.028; [15% lived in an institution]). CONCLUSION: Nutritional state, cognitive level and social activity must be evaluated regularly in elderly subjects with hip prosthesis to evaluate optimal load and adaptation.

Aged↗

Beyond multidimensionality: a systematic review of recurrent frailty archetypes in community-dwelling older adults.

BACKGROUND: Frailty is a clinically heterogeneous geriatric syndrome commonly summarised using physical or multidomain severity scores. Whether person-centred analyses identify recurring within-frailty configurations has not been systematically examined in community-dwelling older adults. METHODS: We searched PubMed, Embase, MEDLINE, and CINAHL (January 2000-November 2025) for cross-sectional studies using latent class, latent profile, or analogous clustering methods to derive frailty subgroups. Quality was assessed using the AHRQ checklist and a purpose-built appraisal of person-centred model reporting. Study-derived classes were mapped in duplicate to a structured archetype framework developed through comparison of class-defining features across studies. RESULTS: Fourteen reports representing 12 independent datasets from eight countries were included. Six configurations were identified: minimally impaired reference, mobility-physical, nutritional-metabolic, cognitive-predominant, combined cognitive-physical, and psychosocial/mood-predominant. Convergence was measurement-dependent. The reference and mobility-physical configurations recurred across physical-only and multidomain indicator sets, while the combined cognitive-physical configuration appeared across several multidomain frameworks but required cognition to be measured. The remaining configurations emerged only when their defining domains were included. Evidence of prognostic value beyond aggregate frailty severity came from one deficit-index study. Collapsing shared-provenance reports and excluding the boundary-eligible study did not alter recurrence; excluding the Croatian dataset left five configurations recurrent, with the cognitive-predominant configuration supported by one independent dataset. CONCLUSIONS: Person-centred analyses identify recurring within-frailty configurations, but their apparent stability is partly measurement-dependent. A five-configuration core persisted after exclusion of the Croatian dataset, whereas the cognitive-predominant configuration remained weakly replicated. Harmonised indicators and rigorous external validation are needed before clinical application.

Humans↗