Medical & Health Profession Education - Science topic

The commercialization of education has led to a growth in many universities producing graduates without the required skillset and knowledge.

Many students report great pace and success rate with Boards and Beyond + Pathoma + Sketchy + First Aid + UWorld for Step 1, while most of them reserve Kaplan for Step 2 CK.

1.Journal of Education and Health Promotion

2.Journal of Medical Education and Curricular Development

3.Perspectives on Medical Education

4.International Journal of Medical Research & Health Sciences

5.Advances in Medical education and practice journal

Jasvinder Kaur Bhatia that is an excellent question and one which I am afraid has no quick and easy answer (although Anton Vrdoljak , I love screen cast o matic). The Journal of Literacy and Technology has just published a rapid response journal on this very subject. I will be the first to admit that some of the findings are not the perfect answer that everyone is looking for but they do speak to Heena Chawda 's excellent point that whether we like it or not, chalkboard or no, the educational world has fundamentally changed. This scholarship within the journal was created by people in the pandemic, for people in the pandemic. If preferred technology is what you are looking for (LMS, video sub-systems, and the like) this is probably too in depth for your needs. If you want a more expansive look at the issues it might be helpful as an expose on first findings in suddenly online research.

Any one can tell what are the ethics of prescription

Rizqy Rahmatyah Good topic. Want to know about it.

http://jsurgery.bums.ac.ir/article-1-153-fa.pdf

Useful Resources.

This Link Maybe Useful:

I'd start by embedding the simplification in every aspect of the institution's fabric, then the rest falls in place.

McNemar test works for it. You can do it with following link:

https://www.graphpad.com/quickcalcs/McNemar1.cfm

Sounds strange in practice, but in theory i don't think the amount of research one has carried out will merely qualify such a person for Professorship without any Ph.D. Maybe Honorary Professorship which is also rare. Because i know honorary degrees are usually awarded based on your highest qualification.

For instance, if i have a Masters in say - Law, any university granting me an honorary degree will award me a Ph.D. If i was First degree holder, then i will be awarded a Masters degree. To award me a Prof. from just first degree or Masters sounds strange.

This is a wonderful question. I typically use focused mentoring within an inter professional team. The interprofessional team research provides a setting where students, fellows, and other trainees gain first hand experience in needed skills such as building and engaging team members, holding colleagues accountable for promised work, negotiating roles and responsibilities on a project, presentation, or paper, and handling disciplinary differences in academic support for team science, culture and communication patterns, and measures of success, .

As challenges emerge, I try to provide opportunities for discussion of both the rewards and challenges of interprofessional team work. More recently, I have been interested in developing resources for trainees in the most important skills needed for interprofessional teams.

Looking for suggestions on resouces for interprofessional training, including any curriculum development on training in interprofessional team research and any program that involve explicit training in the important knowledge and skill domains needed for interprofessional team research.

So the BIG question is: how to treat chronic pain conditions effectively, without causing addiction?

Dear Fazleh,

Chronic pain is a very broad term where it could be malignant chronic pain(related to cancer and AIDS) and non-malignant chronic pain(which can be neuropathic, inflammatory, nociceptive..etc). Hence, pain management plan varies widely based on the pain type; e.g: neuropathic pain is more likely to benefit from gabapentin or pregabalin but not opioids.

Concerns about addiction could be minimized through different strategies as recommended by the guidelines (for example: opioid rotation, relying more on sustained release formulation rather than the immediate release, as well as continuous follow up). Fear of addiction should not lead to improper pain control in this population. Moreover, there are some tools that can assist the physician to predict those patients who have higher risks.

you may have a look at:

Opioid Treatment Guidelines

Clinical Guidelines for the Use of Chronic Opioid Therapy

in Chronic Noncancer Pain

Regards.

We have a great software solution that has been integrated into both software and hardware at https://pulse.kitware.com/

Dear Fazleh,

This is a million dollar question. It is indeed a disturbingly interesting problem that teachers and universities are facing across the world. Just this morning, a lecturer posed this question when we were having a course in University pedagogy. The problem, however, had started in the US even some decades before1920s when Universities shifted their commitment from centers of advanced learning to research Universities. They did this by turning themselves into “‘corporations of the education industry’ to gather a lion’s share of social resources available to higher education ……and also to focus on educational products for the most important national markets.” What is noteworthy is that across the Atlantic and elsewhere, private financing and philanthropic sources have historically turned the University’s other institutional mandates (advanced learning and teaching) into research focus and issues that mattered to certain policy makers with economic and political clout.

But it seems that at least across the Scandinavia there is a better grasp of the problem; Universities provide courses for lecturers, researchers and PhD students so that they can develop their teaching skills in order to engage students better. Thus, teachers are respected and valued very much in the Nordics.

Elsewhere however, the problem is a little different and precious little is being done to solve it. This is because

1) There are so many adjuncts to do the teaching at a lower cost (most will never get tenure).

2) This also frees the main professors to engage in research and become more popular - this is good for the University’s brand but at the researchers’ cost: limited time, pressure and lessened incentives.

3) Research is also the main criteria for showcasing the intellectual power of universities in their quest to brand themselves. Hence, it remains the priority.

4) Apart from basic research, so many other forms of research have become mostly innovation-focused in collaboration with industry. Once the financial incentive structures are established, the researchers and the Universities see this as a path worth pursuing. Of course, that makes economic sense but at the expense of teaching.

“Why is teaching not valued by Universities?” Clearly, the research-focus has meant that teaching is sometimes undervalued and in some cases teachers are undermined and disrespected. In the short term it would be possible to gloss over such a problem, but the long-term effects can be very detrimental for teaching and learning.

What to do?

-Make teaching as important as research, in such a way that we incentivize both.

-Give more training to teachers/lecturers to develop their skills (as in Finland).

-Make teaching count as much as research during evaluation. Of course, sometimes universities need to adjust both, based on individual aptitude. Some people are more research oriented while others are more teaching oriented. Universities can figure out where and how to allocate who in order to get the optimal results-taking into consideration their areas of strength.

Please see: Roger L Geiger. To advance knowledge: The growth of American research universities, 1900-1940. Oxford University Press. Acknowledgements to colleagues from my pedagogy course.

There isnt any

I am just authoring

How to get the best from your GP practice to try to fill this gap!

It depends on the person. If a researcher is a good teacher then he/she can contribute the society in a high level.

I see this differently. Human brains are changing, affected by technology, exposure to voluminous screen time, multiple inputs. I hate to be the one to say it to this group, but the talking head is dead. Even highly educated adults, in voluntary situations, cannot stand to sit for hours on end anymore. Class should be more focused on the higher end of the learning pyramid: towards analysis, synthesis, and this often the best use of class time, not lecturing on what can be read outside of class. The world needs the skills of collaborative thinking, design thinking, not ability to rehash and regurgitate. Tolerance for this is long gone, and I fear many of us have failed to retool. Rethink, retool, reboot our schools (or class)!

Ask them what about IR is less appealing to them; what has deflated their interest in IR; many times a particular instructor or professor can be harder than the IR resident anticipated. Getting to the basis of their thought process regarding seeing themselves in IR often will be a key to helping them in their decision making.

Dennis

Dennis Mazur

A good lecture session for half a day or one day should be informative.

e. We won’t have an IR residency.

A medical or surgical rotation should include students on rounds with the team to see all radiographs (interventional or non-interventional) taken on each day of the medical student rotation on any service where radiographs are taken.

The radiologist should begin questioning of the interpretation of the radiographs with the medical student going first.

Dennis

Dennis Mazur

Public health activities in developing countries are mostly government supported.I think you should think about join in Nigerian Govt. Public Health wing first.

You can also follow the below link:

 Wish your success!!

Regards,

Dr.Munzur-E-Murshid

I think well structured debriefing is so far the best

The PASS 15 program has a Multiple Comparisons of Proportions for Treatments vs. a Control. If you have a control group you could try this. 

Care left undone during nursing shifts: Associations with workload and perceived quality of care

I agree Sudeep. But it also pays to think outside the box. Sometimes doing something as simple as getting the person a cup of coffee or a meal can open the door to impart information or getting other services like Social services involved. Our Social Workers are an amazing group of people with outstanding resources. I encourage those that work in any field to look at the other services available and utilize them. You might be surprised at what they can achieve. 

Acknowledging the factors mentioned in the earlier comments, I would also add another factor here that is collaborative research. I say this because I was personally conducting research on dental implants at the Material Testing Laboratory, Departments of Material Science, IIT Bombay, a few years ago. The aim of the research among other things was to improve the mechanical strength of the dental implants to lend them longevity as well as making them cheaper by using newer materials. We were fortunate to be partnered by the local dental colleges in and around Mumbai; although, we had to struggle with a lot of dentists due to their inertia to participate in such research. They were not really enthused about the project primarily due to lack of mental bandwidth that a practising doctor can offer and also because research in India is unstructured. 

I would, therefore, say that more structured collaborative research is required which would not only enrich the field but ultimately benefit the patients too. 

Dear Karen Stone

Adequate knowledge about the health hazard of hospital waste, proper technique and methods of handling the waste, and practice of safety measures can go a long way toward the safe disposal of hazardous hospital waste and protect the community from various adverse effects of the hazardous waste. With this background, you must consider the levels of healthcare professions in you study and you must prepare appropriate questionnaire for each of them...

Greattopic - medication wrrors. But can you b more specific on this plese?

With the contributions of all the RG colleagues on our question early this year 2016 on e-health, we were able to produce the attached paper on the concept maturity of e-health. Hope this paper give a better understanding for the current status of this concept.

Regards to all

Dear Gemma, 

check the link: 

Dear Sajjad,

I found the following two papers containing a very helpful step by step guide to conducting a systematic review.

Make sure you stick to the PRISMA guide when reporting (especially if you are planning to publish your paper), and for quality assessment I found Jadad score been heavily used to assess the quality of RCT included.

There will be some variations if you plan to encompass other design than a RCT. The book titled “doing a systematic review: A student guide” is useful as well (reference below).

Dr. Sersar,

The answer to your question is decided by the judicial system where the medical negligence exists.  You are in Saudi Arabia and I can't speak to the rules regarding medical jurisprudence in your country.   

In the USA there are 4 elements to malpractice.

Duty – A duty must have been owed to a patient by a healthcare practitioner charged with that patient’s care. The doctor-patient relationship is a common example of a situation where that duty would exist.

Breach of Duty –The healthcare practitioner who had the duty of care for that patient must have failed in his/her duty by not exercising the degree of care or medical skill that another healthcare professional in the same specialty would have used in an equal situation. (This is when an expert is often called in to testify as to what an appropriate standard of care would be.)

Damage – The patient must have suffered emotional or physical injury while in the care of the healthcare practitioner. The injury can be a new one, or an aggravation of an existing injury.

Cause – There must be solid proof that the breach of duty by the healthcare practitioner caused the patient’s injury.

A successful medical malpractice suit will have proven that all four of these factors exist. If the defendant or healthcare practitioner being sued can prove that one or more of the elements does not exist, then the plaintiff would not prevail.

Each individual involved in medical negligence can be found at fault. Not just the attending physician.   Negligence cases can target multiple individuals.

I have found recently, that it's just as important to train the physicians as the nurses.  Doctor's will know what specific infomation nurses will provide and not be overwhelmed by what is coming at them over the phone. Nurses have a tool to give doctors quick, pertinent information so that doctors can make a quick, informed decision about care. I've used it and feel it saves time for both the physician AND the nurse. SO, when training for its use....include doctors.

Thanks Anjali

you can use the ICAST tool

it is the ISPCAN Child Abuse and Neglect tool, it is available in the website of ISPCAN and we translate it to Arabic

you can contact the national family safety program to send you the arabic tool

Hello Saima,

I would advise you to conduct qualitative research design. I performed a study interviewing doctors, nurses, students and parents to gather information about the current status of our "hidden curriculum" of our pediatric department.

The paper will be published soon. Referring to our results surprisingly it is more about the people in your department and the attitude of the actual working environment that influences  expectations on medical educations. I would start to collect these information and develop your strategy afterwards.

Best regards

Eric

The outcomes obviously vary depending on the work settings, rules, personnels, & prior experiences. It can go either ways. Some well-organised institutions have already formulated interaction code for physicians` interactions.

Your clinical skills are as well as the softer skills are important to maintain an evidence-informed, patient-centered system of care.  The following business skills may also be helpful:

Organizational behavior and human resources: Staffing issues such as hiring and firing, and management issues such as leadership and motivation.

Strategic management: The process by which an organization determines its long-run direction, sets goals and objectives.

Finance: The process of acquiring, investing, and managing resources such as offices and equipment.

Marketing: Defining target markets, selecting market positions, and managing product, pricing, communications, and channel decisions.

Legal and ethical Issues: Tort liability, contracts, labor law, agency and organizational law, and ethical decision-making.

Accounting: The process of managing the recording, reporting, and analysis of financial transactions of a business.

Managerial decision making: The use of research design and statistical tools to improve decision-making.

Operations and systems management: Managing the processes that produce and distribute products and services.

First start with the ABCs of dealing with this issue: The choice of trays that don't extend excessively; the choice of impression materials that don't easily flow backwards; and the choice of the right amount of this material so you dont end up with excess flowing backwards.

Then we move to the tricks that could be used, and I could mention a couple here: EITHER have the patient suck a candy made with the medical topical anesthetic tetracaine 1% until it begins to coat both the hard and soft palates, OR have the patient massage their hands with a chemical ice bag. The idea here is to keep the hypothalamus distracted and busy. As you know, the hypothalamus is the part of the brain that, besides other things, controls the gag reflex. So if you can keep this part busy with those "other things", then it will temporarily "forget" about the gag reflex.

Morning appointments are typically given for those anxious patients. To minimize the gag reflex, patients anxiety needs to be at a minimum. So anything that can be done to decrease the anxiety should be tried. Having a chair with heat and vibrating modes that the patient can control during the procedure also helps, since it provides a pleasing vibration meanwhile.

Nitrous oxide is a good way to calm the patient and their reactions to sensations during dental procedures.And finally, antianxiety elixir could be used.

Grants, scholarships, tuition vouchers, and loan reimbursements, designed to lower the cost of a nursing education, have also tended to depress starting wages. This is because nursing graduates who receive subsidized education through these programs are willing to, or in some cases are required to, work for lower starting wages than they would without the subsidies.As a result all nursing graduates are lower, including for those who did not receive a subsidy for their education through the government programs.

Some people distinguish translation from implementation.  For them, the former is development of practical clinical applications from basic research; whereas the latter involves the widespread adoption of clinical applications.  It is usually the latter to which the "17 years" is said to apply.  

But, that certainly is not the case.  Some innovations in health care are implemented very quickly.  An example is the spread of laparoscopic cholecystectomy beginning in the mid-1980s or various forms of fiberoptic endoscopy.  Those made economic sense to the potential adopters.  They involved less physician time (laparoscopic cholecystectomy) or were enough less traumatic that more patients would accept them (virtually all endoscopy and endoscopic procedures).  That made a "business case" for adoption, one way to accelerate spread.

Another way is to tie the "innovation" to a system that makes it easy to adopt/use.  For example, it is easier to adopt clinical guidelines based on evidence that can be built into electronic decision-support systems.  If, the clinician has to look up the guideline instead of having it presented in a usable form, it is less likely to be adopted.

Without going into detail, it is worth reading the summary material in Everett Rogers' seminal book on diffusion of innovation published in 1962 and, I believe, still in print.  It gives a number of principles that lead to more rapid adoption.

I am sorry, I haven't come across any comparison between nurse administrators and non-nurse administrators specifically for for school nurses. 

Well this is somewhat tricky question to be answered . as there are various factors affecting the teaching in clinical settings. There are changes in Medical education. The Medical education is changed to student need based. You require mentors for this. The mentors definitely are giving factual directions for actual student needs. The quality of the mentors given is important here. This affects the performance.

I feel that we learn by imitating someone which is natural procedure. Every person learns by seeing something right from the parents.So your Mentor is  important for the role.

I haven't taught Dental Ethics, but are you already familiar with the book by David T. Ozar,  Dental Ethics at Chairside? If not, it would be an excellent place to start_.

Depends on the target mosquito type. If you dealing with all mosquito types, then it is prudent to liaise with the appropriate city department. Remember to rehearse the breeding sites then the dept. staff will direct you where to locate your sites 

An interesting question. Years back I started my career with this question.  We tried to record the sound from the joint using a microphone attached to the knee - an experiment not entirely successful. 

Crepitus apparently has no direct relationship to knee OA. It frequently decreases when a knee becomes inflamed or has fluid in the joint, a common occupancy as knee OA becomes more severe. 

Best best in can be an early sign of OA if it is present. 

Siddharth Das 

I'd be interested to know of these myself - I can't think of one that examines that specifically offhand.  There are some papers using think aloud to look at other aspects, certainly.  Schuwirth et al (2001) looked at context-free vs case-based MCQs,   Vorstenbosch et al (2013) looked at altering response/answer formats (images vs text).

For cueing effects in MCQs, Schuwirth's 1996 paper is often cited, but it didn't use a think-aloud protocol. 

Thanks for the answer, Koshila. I am really interested in to study longitudinally the influence of to learn (or not to learn!, as "William" would say) in the vision of the medicine of the professional. I knew the work of Mason but the Merril'one is new to me. Any thought would be welcome!

There is some interesting work about trafficking that focus on sex labor migration from Latin America to Japan. 

Piper, N. (1999). Labor migration trafficking and international marriage: female cross-border movements into Japan. Asian Journal of Womens Studies, 5(2), 13.

Leheny, D., & Warren, K. (Eds.). (2009). Japanese aid and the construction of global development: inescapable solutions. Routledge.

Blanchette, T. G., & da Silva, A. P. (2012). On bullshit and the trafficking of women: Moral entrepreneurs and the invention of trafficking of persons in Brazil. Dialectical anthropology, 1-19.

I also attended this session at the recent AAAs titled "PRODUCING ANTHROPOLOGY IN/OF THE "NEW GLOBE": TRANSNATIONAL HUMAN AND CULTURAL MOBILITY IN JAPAN AND BEYOND". Probably some of the participants would be interesting for you.

Thanks for prompt reply. 

No doubt, formative and summative  evaluation is very effective and gives good results. But patient counselling is one aspect to be assessed. What about other skills like  research abilities,leadership qualities, punctuality, confidence, motivation,self-reliance etc. How can we evaluate them in formative evaluation.  

We use the MOSLER in Newcastle Medical School. It tests more than an OSCE in that it allows assessment of integrated clinical skills as in a long case but in a more reliable way. A good review comparing OSCE and long case reliability was done in 1999 by Wass and we have published on MOSLERs, particularly about validity and acceptability.

Have you considered the first tool within the Flinders Program - Chronic Condition Care Planning? You'll find details about it at:  http://www.flinders.edu.au/medicine/sites/fhbhru/self-management.cfm

It's called the 'Partners in Health Scale' and it's a 12 item measure that the person self-rates re their knowledge, relationship with health professionals, access, monitoring and responding, physical, social and emotional impacts, lifestyle, etc. The tool has been validated and used in many research trials and in practice as either a standalone to measure change over time, determine client groupings, determine for services which clients would benefit from care planning, etc.

It has been adapted into other languages and used in the US, NZ, Australia, Hong Kong and some other countries.

Thanks Michael Krichbaum , for your valuable suggestion and i incorporated the topics.

I agree that one of the ways in which a professional highlights his or her own competence is through attention to detail, such as spelling and grammar.  My hypothesis would be that the myth of multi-tasking contributes to the downfall of detail.  When we go back-and-forth between tasks, concentration is diminished and more than precise speech is lost.  I have also found that assistance such as 'spell-check' can contribute to the wrong word appearing in a variety of output, from thesis publication to texting.

Just to concur that there is a literature on General Self-efficacy that correlates with Self-esteem and a number of other general psychology traits. My bias is showing because while these traits are sometimes interesting and have some predictive power for other general psychological states, they have little value when studying specific behaviors. 

The Bandura approach and/or Ajzen's Perceived Behavioral Control (specifically its Internal Control component) together offer something like 18,000 articles involving a vast array of different and very specific subject areas.  Bandura's own work tends to assume that the behavior involved is desirable (an easy assumption when so much of it is over-coming psychological problems), and a more complete model is found in the Social Cognitive Career Theory found in the career development literature.

I find the literature on Entrepreneurial Intention Model (e.g. in the Entrepreneurship Theory and Practice, or  Journal of Business Venturing) to be particularly interesting because it involves a 20 year evolution of a causal model where Bandua's and Ajzen's construct are used in competing studies.

A couple of people have tried to used one of the General Self-efficacy scales for the study of entrepreneurship, with some success.  But the problem is that in the context of the a entrepreneurship classroom, it seems likely that the questions are interpreted by the students as specific to the entrepreneurship domain.

Dear Mr Almeira Pino-Oliveira,

I enclose the article of my colleague Dr Sonja van Dillen in which the 5A framework is used (van Dillen SM, Noordman J, van Dulmen S, Hiddink GJ (2014). Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study. Eur J Clin Nutr. 2014 Jul 2. doi: 10.1038/ejcn.2014.129. [Epub ahead of print]

Best regards,

Gerrit J Hiddink

Comparison of QoL-AD and DQoL in elderly with Alzheimer's disease   Aurore Wolak-Thierry, Jean-Luc Novella,Coralie Barbe, Isabella Morrone, Rachid Mahmoudi and Damien Jolly ^a Faculty of Medicine, University of Reims Champagne-Ardenne, Reims Cedex France

Hi Arthur, here is the publication info:

 

^b Clinical Research Coordination Unit, University Hospitals of Reims, Reims, France

^c Department of Geriatrics and Internal Medicine, University Hospitals of Reims, Reims Cedex, France

Aging & Mental Health Published online: 20 Jun 2014 DOI: 10.1080/13607863.2014.927822

For anyone following this thread, you might be interested to know the the Journal of the Royal Society of Medicine have just published a WHO sponsored supplement entirely devoted to "Narrowing the knowledge gap in sub-Saharan Africa".

The link is provided below.

Thanks @ Marcel. I get your point. On the link, it is stated that at this moment, we have:

''International bodies such as the World Health Organization and the World Bank have adopted the One World-One Health approach in their collaborative efforts to control avian and pandemic influenza and other diseases of global concern'. And...

'The resulting programs bring together experts ranging from biologists and sociologists to economists and natural-resource managers. The rapid partnering of animal- and human-influenza specialists on the current H1N1 outbreak is an example of how a more comprehensive approach can speed the response to a potential pandemic.'

Thank you Ratan. I hope we are not alone with such a view.

Look in Europe in my field of medicine: in Russian Federation they have two PhDs: aspiratura and doctorate of science, in Germany PhD in clinical medicine practically does not exist (MD title is somethimes based on good but usually small research project. Habilitation is something completly different.

Sea bathing has become one of the most popular hobbies these days. William Buchan wrote in 1701, in his book 'Domestic Medicine', that he advocated the practice of sea bathing as it was thought to have medicinal benefits. The ocean contains all the vital elements, vitamins, mineral salts, trace elements, and amino acids (which is, by the way, a really good reason for using sea salt in our diet, as opposed to 'table' salt). Sea water is bacteriostatic and the cleansing and healing properties of saline have been recognized for many years. Naturopaths believe that bathing in sea water acts directly on chronic health disorders. They believe that cool sea water calms down overwrought nerves, tranquillizing the whole body. By the same token, they believe that warm sea water, during the summer months improves circulation and relaxes muscles. The high salt content also provides natural buoyancy, which also helps with relaxation. It is also considered that the magnesium content of sea water is sufficiently strong to have a nutritional and calming effect on our nerves, which would explain why we find sea water bathing so relaxing. It is easy to see why it would be thought that the motion of the waves in the sea help to massage the body and assist in the removal of toxins.

I'm not sure that I am able to give any good up to date peer-reviewed literature on this, since most of what I know about these chemicals I know from medical and chemistry textbooks.

First, both theophylline and theobromine belong to a class of agents called methylxanthines (along with caffeine). A methylxanthine is a derivative of xanthine. For some pictures of Xanthine, I recommend Wikipedia: http://en.wikipedia.org/wiki/Xanthine to get a picture of a xanthine.

Both theophylline and theobromine have a methylgroup hanging off of one of the Nitrogens in the double ring Xanthine structure, the difference is which Nitrogen the methyl group is attached to. (see wikipedia page for a nice picture of what I don't think is well explainable in words)

Pharmacologically, methyl-xanthines have two important mechanisms:

1. They are phosphodiesterase inhibitors (if you recall phosphodiesterase breaks down cAMP, which is a second messenger in many cell receptors), so they actually have many different pharmacologic effects - this is responsible for many adrenergic effects in the cardiovascular and pulmonary system. (though effect 2 below probably also affects heart rate)

2. They are inhibitors of adenosine receptors - this is largely responsible for neurostimulant effects (though effect 1 is probably also important).

Now to leave the basic science, clinically what are they good for -

Theophylline is particular useful for the treatment of pulmonary function. It is a bronchodilator and also has some anti-inflammatory effects. For this reason it is used in the treatment of asthma (but because of its side effects and the need for close monitoring is usually a 3rd or 4th line agent). It is also used in the treatment of spinal cord-injured patients, especially those who continue to rely on a tracheostomy for either respiration or for maintenance of the respiratory tract (or if they are having difficulty weaning form a ventilator).

Theobromine as far as I know is not routinely being used clinically (at least not in the US), but the most practical clinical use that I know of it is as a cough suppressant.

Not sure if this is what you were looking for, but I hope that this gets you off to a start in the right direction.

Sugar is not the direct cause of these problems such as hypertension and other chronic diseases. Sugar releases glucose on digestion, which if massive causes a large insulin response. Regular intake of large amount sugar may cause hyperinsulinemia .

Exogenous administration of Insulin and endogenous hyper-insulinemia elevate blood pressure in several ways. They cause sodium retention by directly increasing the activity of the epithelial sodium channel (ENaC), the sodium phosphate co-transporter, sodium hydrogen exchanger type III and Na-K-ATPase. (Tiwari et al., 2007). Insulin also induces oxidative stress, which causes impairment of the vascular endothelium, decreased availability of nitric oxide, and therefore atherosclerosis and hypertension (Virdis et al., 2013)

Insulin causes excitation of the sympathetic nervous system via a central action on the hypothalamus, where it is believed to act on the anteroventral third ventricle hypothalamic region (Muntzel et al., 1995) Other researchers have found that hyperinsulinemia in normotensive humans increases sympathetic nerve activity but not arterial pressure since it also causes skeletal muscle vasodilatation. However, in the presence of insulin resistance and/or hypertension, insulin may cause exaggerated sympathetic activation or impaired vasodilatation and thus elevate arterial pressure. (Anderson et al., 1992)

Hyperinsulinemia also causes obesity by converting glucose into fat in the dispose tissue. However, whether glucose is converted into fat or glycogen depends on timing of food intake. When sugar is consumed soon after exercise, glucose is converted to glycogen but when sugar is ingested by a sedentary person, the glucose is converted into fat.

It has also suggested that a large insulin response following a large glucose intake tends to block the action of leptin on the feeding center in the hypothalamus thereby preventing satiety.(Lustig, 2010) This leads to demand for more glucose producing food and eventually a state of obesity and its sequelae of metabolic syndrome, hypertension, type 2 diabetes mellitus, and other chronic diseases.

All really interesting responses....I think the general consensus is that not everyone should do research and certainly not for CV purposes but for the progression of medical knowledge and improvement in patient care. However all clinicians should be aware of the several facets of research inclusive of research governance and critical appraisal of existing research. Do correct me if I am wrong

Here is useful one:

hi;

I haven't looked for evidence related to cost-effectiveness of interprofessional education but agree with Dean. The opportunity to offer courses to groups of health science students makes sense for a number of reasons, one of which is cost, the other is to build those relationships early in the health care providers socialization into the health care environment. Those courses should be the ones that all students pursuing health care careers need in order to practice. The discipline specific education needs to be provided to the students by those of their profession who understand that disciplines theorys, models and unique contribution to health and wellness of constituents.

My own review suggests there are large areas of clinical practice that are in poor compliance with evidence-based guidance, and that even in cases of compliance, the underlying clinical practice guidelines often exhibit low methodological quality, thus robbing even wider swatches of medical practice with a much needed strong evidence-based foundation.

COMPROMISED COMPLIANCE WITH EVIDENCE-BASED GUIDELINES

In cardiology, a critical review of evidence-based guidelines in hypertension [1] found that despite the widespread availability of evidence-based guidelines for treating hypertension, recent evidence suggests that physicians may not be prescribing first-line drugs for their patients with high blood pressure, and for patients with high blood pressure alone, only 38 percent being on a diuretic, and less than a third prescribed a beta-blockert (he JNC VI recommended first-line antihypertensives for essential hypertension), while approximately half of individuals with high blood pressure and certain comorbidities received non-first-line interventions.

It's been independently shown that GPs are in poor compliance with evidence-based hypertension guidelines and are undertreating hypertension [2] and, despite being aware of the risks of hypertension in the elderly and the benefits of its treatment, with fewer than half complying with the broad recommendations of even the most conservative evidence-based guidelines [3,4], a problem widespread among GPs in the UK and elsewhere [5].

In OBGYN, another UK review [6] examined the practice of induction of labour (IOL) to determine whether induction was performed as per the Royal College of Obstetricians and Gynaecologists/National Institute for Clinical Excellence (RCOG/NICE) guidelines, finding only 60 – 70% compliance with guidelines.

If we turn to the domain of emergency medicine, in particular Emergency Oxygen Guidelines in emergency departments, another British study [7] found that as many as 46% of patients were inappropriately receiving excess oxygen, and as many as 40% were inappropriately not receiving oxygen, so it is clear that uptake of authoritative evidence-based guidelines has been poor as in the inpatient setting.

Another recent (2012) retrospective analysis of compliance with evidence based protocols in cases admitted to the ICU [8] found that in 45% of the severe pre‐eclampsia patients and in 46% of sepsis cases, the guidelines were not followed and there was exceedingly poor adherence - a mere 10.8% - to guidelines of massive hemorrhage cases.

Within trauma medicine, another recent (2014) review of compliance with evidence-based guidelines in patients with traumatic brain injuries [9], it was found that the overall compliance rate was 73%, with only 3 out of 11 Level I trauma centers achieving a compliance rate exceeding 80%, despite the fact that multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate. This cross-confirms the previous observation [10] of patients admitted to Level I trauma center (2006–2008) with moderate to severe injuries, where little over half of evidence-based recommended care was delivered to trauma patients with moderate to severe injuries, just 17% for neurosurgical interventions, and alarmingly, with those patients with increasing severity of traumatic brain injuries being the least likely to receive optimal evidence-based care.

In oncology, another recent (2014) review of melanoma treatment in Australia and New Zealand [11] evaluated both the extent of evidence-based support for clinical practice guideline recommendations concerning cutaneous melanoma follow up and the methodological quality of these guidelines; the review found that melanoma follow-up recommendations concerning frequency of physical examinations, duration of follow-up appointments and use of imaging or diagnostic tests are based mostly on low-level evidence or consensus expert opinion; in addition, recommendations were often inconsistent between different guidelines, and to this day, there is no international evidence-based consensus regarding what constitutes best practice for follow up of melanoma survivors.

CONCLUSIONS - AND ANOTER PROBLEM: COMPROMISED GUIDELINES

These and over a hundred other studies I reviewed across the spectrum of medical specialties collectively and strongly suggest that large proportions of medical clinical practice demonstrate low to at most modest compliance with evidence-based recommendations and practice guidelines. Aggravating this problem is the related - and underlying - problem, of clinical practice being informed by putative evidence-based clinical practice guidelines that themselves are of significantly compromised methodological quality. Thus, a Canadian study [12,13] evaluated the strength of the evidence underlying therapy recommendations (n=338) in evidence-based clinical practice guidelines in three domains (diabetes, dyslipidemia, and hypertension), finding that overall, less than one-third of treatment recommendations (and less than half of those citing RCTs in support of the advocated treatment) were based on high-quality evidence.

And although evidence-based medicine regards RCTs as the strongest form of evidence for clinical decision making, a recent intensive review [14] found that overall, at least 20.2% of all published medical research has significant methodological flaws, and perhaps alarmingly, prospective studies appear to have as many methodological limitations as nonprospective studies, and RCTs have as many limitations as non-RCTs, with as much as 38.7% of published RCTs receiving detailed review found to have methodological issues.

Similarly, among 100 orthopedic articles analyzed for compliance with CONSORT and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines [15], 96% failed to report trial registration, 63% failed to discuss study limitations, 59% failed to report the source of funding, 48% failed to report details of the research setting, 38% failed to report adverse events and unintended effects, 37% inadequately reported the number of patients enrolled, and 23% reported no measurement of error for the primary outcome.

And again: up to 30% of articles in the thoracic surgery literature have been reported to have limitations, with the most frequently cited problem being inappropriate use of statistical tests or violation of principles of research design, and the experimental design of many surgical investigations often do not adequately account for bias or type II error [16]. Statistical tests were used or reported incorrectly in 27% of articles evaluated in the surgical literature and were not used at all in an additional 10% of articles [17].

The data I have presented above, which can be extended by dozens and dozens of additional studies, collectively suggests that substantial portions of clinical practice have decidedly questionable foundations in robust evidentiary medicine, with low compliance and low study methodology aggravating the evidence-based foundations of modern medicine. We need to do better as a profession.

REFERENCES

1. Holmes JS, Shevrin M, Goldman B, Share D. Translating research into practice: are physicians following evidence-based guidelines in the treatment of hypertension? Med Care Res Rev 2004; 61(4):453-73.

2. Cranney M, Barton S, Walley T. The management of hypertension in the elderly by general practitioners in Merseyside: the rule of halves revisited. Br J Gen Pract 1998; 48: 1146–1150.

3. Cranney M, Warren E, Walley T. Hypertension in the elderly: attitudes of British patients and general practitioners. J Hum Hypertens 1998; 12: 539–545.

4. Sever P, Beevers G, Bulpitt CJ. Management guidelines in essential hypertension: report of the second working party of the British Hypertension Society. Br Med J 1993; 306: 983–987.

5. Cranney M, Warren E, Barton W, Gardner K, Walley T. Why do GPs not implement evidence-based guidelines? A descriptive study. Family Practice (2001) 18 (4): 359-363.

6. Nooh A, Baghdadi S, Raouf S. Induction of labour: how close to the evidence-based guidelines are we? J Obstet Gynaecol 2005; 25(5):451-4.

7. Wallace SM, Doy LE, Kedgley EN, Ricketts WM. Evidence-based emergency oxygen guidelines are not being followed in the emergency department. Thorax 2010;65:A114-A115.

8. Kondov K, Sharpe P, Mousa, H. Are we following the guidelines ‐ a retrospective analysis of compliance with evidence based protocols in cases admitted to Intensive Care Unit (ICU) from Labour Ward (LW): 1AP2‐2. Eur J Anaesthesiol 2012; 29:9.

9. Shafi S, Barnes SA, Millar D, et al. Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries. J Neurosurg 2014; 120(3):773-7.

10. Shafi S, Barnes SA, Millar D, et al. Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries. J Neurosurg 2014; 120(3):773-7.

11. Marciano NJ, Merlin TL, Bessen T, Street JM. To what extent are current guidelines for cutaneous melanoma follow up based on scientific evidence? Int J Clin Pract 2014 Feb 18.

12. van Diepen SF, McAlister FA, Padwal R, Johnson JA, Majumdar SR. How Evidence-Based Are Evidence-Based Guidelines. 60th Annual Meeting of the Canadian Cardiovascular Society and CCCN Annual Meeting and Scientific Sessions. October 2007, Volume 23, Supplement SC. Can J Cardiol. Abstract 0053.

13. McAlister FA, van Diepen S, Padwal RS, Johnson JA, Majumdar SR. How evidence-based are the recommendations in evidence-based guidelines? PLoS Med 2007; 4(8):e250.

14. Steen RG, Dager SR. Evaluating the evidence for evidence-based medicine: are randomized clinical trials less flawed than other forms of peer-reviewed medical research? FASEB J 2013; 27(9):3430-6.

15. Parsons, N. R., Hiskens, R., Price, C. L., Achten, J., and Costa, M. L. (2011) A systematic survey of the quality of research reporting in general orthopaedic journals. J. Bone Joint Surg. Br. 93, 1154–1159.

16. Ferraris, V. A., and Ferraris, S. P. (2003) Assessing the medical literature: let the buyer beware. Ann. Thorac. Surg. 76, 4–11.

17. Kurichi, J. E., and Sonnad, S. S. (2006) Statistical methods in the surgical literature. J. Am. Coll. Surg. 202, 476–484.

We identified via literature review, 7 common contextual factors key to implementation of the QI programme Productive Ward http://onlinelibrary.wiley.com/doi/10.1111/jonm.12069/abstract A larger review of Lean Healthcare including PW citations we identified 3 main components cited as common impacts... Leadership, empowerment & engagement http://www.emeraldinsight.com/journals.htm?articleid=17102117 The most indepth study of all is from Mary Dixon-Woods http://qualitysafety.bmj.com/content/early/2012/04/27/bmjqs-2011-000760

Sir that's true, agree.

But I want to know whether it's having some role to maternal angiogenesis during pregnancy.

Gulay I am afraid I disagree with you, and see health education as being one small component of health promotion. Most health care professionals seem to believe that they are providing health education, when in reality all they are doing is providing health information. Particularly in clinical settings professional seem to think that by providing an individual with a pamphlet on a health topic that this is health promotion! In my view, health information is a minor aspect of health education, for many consumers it may be awareness raising, for a few it may be educational.

To really engage in health education, information needs to be accompanied with a change of perspective and insight into how actions or beliefs need to change. However for health education to result in health promotion, action on this information needs to occur.

Telling an obese person that they need to loose weight and giving them information of health consequences such as diabetes or heart disease is not health promotion. Health promotion occurs when you look beyond an individuals behaviours. While it might be necessary for the obese person to learn cooking skills to improve their diet, it may also be necessary that healthier food options are available for them to buy when they do their grocery shopping. These food options also need to be affordable. This individual may also need a safe neighbourhood to feel comfortable to walk to the shop to get this food, or to undertake the physical activity we all know needs to occur along with a healthy diet to maintain a healthy weight. A number of factors may impact on if actions are adopted to make a change in this individuals life, having a friend to walk with or a neighbourhood walking group, may make the difference between participating in physical activity or not, etc, etc. Health promotion involves working towards creating all of the supports which facilitate adopting or maintaining better health actions.

Sorry to be so long winded, this is a topic I am extremely passionate about :-)

In some cases, I ask the student to write down 3 things that went well (and why they went well) and 3 things that need improvement (and why they need improving). This practice helps them reflect upon their practice and figure out ways to improve further practice.

Furthermore, every surgical procedure receives a written evaluation from the supervisor, which helps in assessing student level for end term evaluations.

I agree with you Dean. The entry level criteria for undergraduates is similar so the basic concepts could be harmonized. As you said, along with being cost effective it will be a very effective model for developing countries like mine where there is scarcity of academicians. There would be no need for separate content and teaching methodologies and different evaluation systems. But as Nelson said common sense should prevail!!!

In your specific case, "existing patient records" randomization is not a real issue. Make sure that in your work you describe, with detail, how you gained access to the data. Another key issue is how you formulate the problem, make sure that yours is clearly stated.

Randomization would be central if you were studying health people. as I understand you are studying a diseased population.

The general ethical and legal consensus in the U.S.A. is that it depends on two things. First, it depends on the seriousness of the action that a practitioner believes immoral. More serious actions, such as physician assisted suicide, are ones where we tend to allows practitioners to refuse to participate. Second, it depends on the broader costs of allowing practitioners to refuse to participate. For example, in cases such as pharmacists refusing to fill prescriptions for birth control or the morning after pill, there are more significant concerns about the costs of allowing such refusals (particularly in rural areas). So we tend to not allow refusals to participate when broader costs become higher.

It's hard to be much more specific, and certainly the laws in the U.S.A. have significant variation amongst states and vary based on the particular issue.