Medicine
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Item Enabling Implementation of Competency Based Medical Education through an Outcomes-Focused Accreditation System(Ubiquity Press, 2024-02-06) Dalseg, Timothy; Thoma, Brent; Wycliffe-Jones, Keith; Frank, Jason; Taber, SarahCompetency based medical education is being adopted around the world. Accreditation plays a vital role as an enabler in the adoption and implementation of competency based medical education, but little has been published about how the design of an accreditation system facilitates this transformation. The Canadian postgraduate medical education environment has recently transitioned to an outcomes-based accreditation system in parallel with the adoption of competency based medical education. Using the Canadian example, we characterize four features of an accreditation system that can facilitate the implementation of competency based medical education: theoretical underpinning, quality focus, accreditation standards, and accreditation processes. Alignment of the underlying educational theories within the accreditation system and educational paradigm drives change in a consistent and desired direction. An accreditation system that prioritizes quality improvement over quality assurance promotes educational system development and progressive change. Accreditation standards that achieve the difficult balance of being sufficiently detailed yet flexible foster a high fidelity of implementation without stifling innovation. Finally, accreditation processes that recognize the change process, encourage program development, and are not overly punitive all enable the implementation of competency based medical education. We also discuss the ways in which accreditation can simultaneously hinder the implementation of this approach. As education bodies adopt competency based medical education, particular attention should be paid to the role that accreditation plays in successful implementation.Item Sharing Is Caring: Helping Institutions and Health Organizations Leverage Data for Educational Improvement(Ubiquity Press, 2024-10-07) Sebok-Syer, Stefanie S.; Smirnova, Alina; Duwell, Ethan; George, Brian; Triola, Marc; Feddock, Christopher; Chahine, Saad; Rubright, Jonathan D.; Thoma, BrentCompetency-based medical education (CBME) has produced large collections of data, which can provide valuable information about trainees and medical education systems. Many organizations continue to struggle with accessing, collecting, governing, analyzing, and visualizing their clinical and/or educational data. This hinders data sharing efforts within and across organizations, which are foundational in supporting system-wide improvements. Challenges to data sharing within medical education include variability in legislation, existing data policies, heterogeneity of data, inadequate data infrastructure, and various intended purposes or uses. In this eye opener, the authors describe four case studies to illustrate some of the aforementioned challenges and characterize the complexity of data sharing within medical education along two dimensions: organizational (single vs. multiple) and data type (clinical and/or educational). With the goal of better supporting data sharing initiatives, the authors introduce an action-oriented blueprint that includes a three-stage process (i.e., preparation, execution, and iteration) to highlight crucial aspects of data sharing. This evidence-informed model incorporates current best practices and aims to support data sharing initiatives within their own organizations and across multiple organizations. Finally, organizations can use this model to conceptually guide and track their progression throughout the data sharing process.Item Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease(CHEST Journal, 2024-10) Rozenberg, Dmitry; Reid, W Darlene; Camp, Pat; Campos, Jennifer L.; Dechman, Gail; Davenport, Paul W; Egan, Helga; Fisher, Jolene H.; Guenette, Jordan A.; Gold, David; Goldstein, Roger S.; Goodridge, Donna; Janaudis-Ferreira, Tania; Kaplan, Alan G.; Langer, Daniel; Pepin, Veronique; Marciniuk, Darcy D.; Moore, Barbara; Orchanian-Cheff, Ani; Otoo-Appiah, Jessica; Rassam, Peter; Rotenberg, Shlomit; Ryerson, Chris; Spruit, Martijn A.; Stanbrook, Matthew B.; Stickland, Michael K.; Tom, Jeannie; Wentlandt, KirstenTopic Importance Cognitive and physical limitations are common in individuals with chronic lung diseases, but their interactions with physical function and activities of daily living are not well characterized. Understanding these interactions and potential contributors may provide insights on disability and enable more tailored rehabilitation strategies. Review Findings This review summarizes a 2-day meeting of patient partners, clinicians, researchers, and lung associations to discuss the interplay between cognitive and physical function in people with chronic lung diseases. This report covers four areas: (1) cognitive-physical limitations in patients with chronic lung diseases; (2) cognitive assessments; (3) strategies to optimize cognition and motor control; and (4) future research directions. Cognitive and physical impairments have multiple effects on quality of life and daily function. Meeting participants acknowledged the need for a standardized cognitive assessment to complement physical assessments in patients with chronic lung diseases. Dyspnea, fatigue, and age were recognized as important contributors to cognition that can affect motor control and daily physical function. Pulmonary rehabilitation was highlighted as a multidisciplinary strategy that may improve respiratory and limb motor control through neuroplasticity and has the potential to improve physical function and quality of life. Summary There was consensus that cognitive function and the cognitive interference of dyspnea in people with chronic lung diseases contribute to motor control impairments that can negatively affect daily function, which may be improved with pulmonary rehabilitation. The meeting generated several key research questions related to cognitive-physical interactions in individuals with chronic lung diseases.Item The Relative Risk of COVID-19 in Solid Organ Transplant Recipients Over Waves of the Pandemic(Frontiers Media S.A., 2024-09-05) Vinson, Amanda J.; Anzalone, Alfred J.; Schissel, Makayla; Dai, Ran; Agarwal, Dr Gaurav; Lee, Stephen B.; Olex, Amy; Mannon, Roslyn B.Solid organ transplant recipients (SOTR) are at increased risk from COVID-19. Over time, the absolute risk of adverse outcomes after COVID-19 has decreased in both the non-immunosuppressed/immunocompromised (non-ISC) general population, and amongst SOTR. Using the N3C, we examined the absolute risk of mortality, major adverse renal or cardiac events, and hospitalization after COVID-19 diagnosis amongst non-ISC and SOTR populations over five waves of the pandemic (Wave 1: Ancestral COVID; Wave 2: Alpha; Wave 3: Delta; Wave 4: Omicron; Wave 5: Omicron). Within each wave, we determined the relative risk of each outcome for SOTR versus the non-ISC population based on crude event rates, and then used multivariable cox proportional hazards models and logistic regression to determine the adjusted risk of each outcome based on SOT status. Throughout the pandemic, including during the Omicron wave (Wave 5), SOTR were at greater absolute risk for each outcome than non-ISC patients (p-values all <0.001). The adjusted risk of SOT status for each outcome was relatively stable over time (aHR 1.28–1.61 for mortality; aHR 1.31–1.47 for MACE; aHR 1.72–1.90 for MARCE; aHR 1.75–2.07 for AKI; and aOR 1.53–1.81 for hospitalization). Despite a reduction in the absolute risk of COVID-19 complications, the relative risk for SOTR versus the non-ISC population has not improved.Item Educator's blueprint: Key considerations for using social media in survey-based medical education research(Wiley, 2024-09-04) Ogle, Kathleen Y.; Hill, Jeffery; Santen, Sally A.; Gottlieb, Michael; Artino Jr., Anthony R.; Thoma, BrentIn this paper, we present a set of recommendations for using social media as a tool for participant recruitment in survey-based medical education research. Drawing from a limited but growing body of literature, we discuss the opportunities and challenges inherent to social media recruitment. This article builds on the authors’ previous educator's blueprints about survey design and administration. We highlight the advantages of social media, including its wide reach, cost-effectiveness, and capability to access diverse and geographically dispersed populations, which can significantly enhance the representativeness of research samples. However, we also caution against potential pitfalls, such as ethical concerns, sampling bias, and the fluid nature of social media platforms. Our recommendations are informed by both empirical evidence and best practices, aiming to provide researchers with practical advice for effectively leveraging social media in survey-based medical education research. We emphasize the importance of selecting suitable platforms and engaging with targeted demographics thoughtfully. By sharing our insights, we hope to assist fellow medical education researchers in navigating the complexities of social media recruitment, thereby enriching the quality and impact of survey-based research in this field.Item Clozapine, relapse, and adverse events: a 10-year electronic cohort study in Canada(The British Journal of Psychiatry, 2024-09) Balbuena, Lloyd; Halayka, Shawn; Lee, Andrew; AHMED, AG; Hinz, Tamara; Kolla, Nathan; Pylypow, JennaBackground Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings. Aims To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts. Method Data were obtained from the Canadian Institute of Health Information for adults (n = 45 616) and children/youth (n = 1476) initially hospitalised for mental health conditions in British Columbia, Manitoba and Saskatchewan from 2008 to 2018. Patient demographics and hospitalisations were linked with antipsychotic prescriptions dispensed following the initial visit. Recurrent events survival analysis for relapse and adverse events were created and compared between clozapine and other antipsychotics. Results In adults, clozapine was associated with a 14% lower relapse rate versus other drugs (adjusted hazard ratio: 0.86, 95% CI: 0.83–0.90) over the 10-year follow-up. In the first 21 months, the relapse rate was higher for clozapine but then reversed. Over 1000 person-months, clozapine-treated adults could be expected to have 38 relapse hospitalisations compared with 45 for other drugs. In children/youth, clozapine had a 38% lower relapse rate compared with other antipsychotic medications (adjusted hazard ratio: 0.62, 95% CI: 0.49–0.78) over the follow-up period. This equates to 29 hospitalisations for clozapine and 48 for other drugs over 1000 person-months. In adults, clozapine had a higher risk for adverse events (hazard ratio: 1.34, 95% CI: 1.18–1.54) over the entire follow-up compared with other antipsychotics. This equates to 1.77 and 1.30 hospitalisations over 1000 person-months for clozapine and other drugs, respectively. Conclusions Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.Item To stop or not to stop an asthma biologic, that is the question(Elsevier, 2024-09) Philipenko, Brianne S.; Davis, Beth; Cockcroft, Donald W.During a time when anti-asthma biologics are readily accessible, the article by Brightling et al1 in the current issue provides additional much needed evidence to discuss with patients with severe asthma when the inevitable question arises of “How long do I need to continue on my asthma biologic therapy?” With now 6 biologics available, including most recently tezepelumab that can be prescribed without biomarker restrictions, it has become increasingly easy to prescribe these medications. After achieving good asthma control, physicians are left to contemplate the question of “now what?” Are these medications lifelong therapies?Item Fast oxygen dynamics as a potential biomarker for epilepsy(Nature Research, 2018-12-18) Farrell, Jordan S.; Greba, Quentin; Snutch, Terrance P.; Howland, John G.; Teskey, G. CampbellChanges in brain activity can entrain cerebrovascular dynamics, though this has not been extensively investigated in pathophysiology. We assessed whether pathological network activation (i.e. seizures) in the Genetic Absence Epilepsy Rat from Strasbourg (GAERS) could alter dynamic fluctuations in local oxygenation. Spontaneous absence seizures in an epileptic rat model robustly resulted in brief dips in cortical oxygenation and increased spectral oxygen power at frequencies greater than 0.08 Hz. Filtering oxygen data for these fast dynamics was sufficient to distinguish epileptic vs. non-epileptic rats. Furthermore, this approach distinguished brain regions with seizures from seizure-free brain regions in the epileptic rat strain. We suggest that fast oxygen dynamics may be a useful biomarker for seizure network identification and could be translated to commonly used clinical tools that measure cerebral hemodynamics.