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Academic Practice (academic + practice)
Selected AbstractsEmergency Medicine Practitioner Knowledge and Use of Decision Rules for the Evaluation of Patients with Suspected Pulmonary Embolism: Variations by Practice Setting and Training LevelACADEMIC EMERGENCY MEDICINE, Issue 1 2007Michael S. Runyon MD Abstract Background Several clinical decision rules (CDRs) have been validated for pretest probability assessment of pulmonary embolism (PE), but the authors are unaware of any data quantifying and characterizing their use in emergency departments. Objectives To characterize clinicians' knowledge of and attitudes toward two commonly used CDRs for PE. Methods By using a modified Delphi approach, the authors developed a two-page paper survey including 15 multiple-choice questions. The questions were designed to determine the respondents' familiarity, frequency of use, and comprehension of the Canadian and Charlotte rules. The survey also queried the frequency of use of unstructured (gestalt) pretest probability assessment and reasons why physicians choose not to use decision rules. The surveys were sent to physicians, physician assistants, and medical students at 32 academic and community hospitals in the United States and the United Kingdom. Results Respondents included 555 clinicians; 443 (80%) work in academic practice, and 112 (20%) are community based. Significantly more academic practitioners (73%) than community practitioners (49%) indicated familiarity with at least one of the two decision rules. Among all respondents familiar with a rule, 50% reported using it in more than half of applicable cases. A significant number of these respondents could not correctly identify a key component of the rule (23% for the Charlotte rule and 43% for the Canadian rule). Fifty-seven percent of all respondents indicated use of gestalt rather than a decision rule in more than half of cases. Conclusions Academic clinicians were more likely to report familiarity with either of these two specific decision rules. Only one half of all clinicians reporting familiarity with the rules use them in more than 50% of applicable cases. Spontaneous recall of the specific elements of the rules was low to moderate. Future work should consider clinical gestalt in the evaluation of patients with possible PE. [source] Patient Satisfaction and Reported Long-Term Therapeutic Efficacy Associated with 1,320 nm Nd:YAG Laser Treatment of Acne Scarring and PhotoagingDERMATOLOGIC SURGERY, Issue 3 2006ASHISH C. BHATIA BACKGROUND AND OBJECTIVE Nonablative laser treatments have become increasingly used for the treatment of acne scarring and photoaging. While nonablative laser treatments are more convenient and relatively safer than ablative laser resurfacing, efficacy and patient satisfaction with the level of improvement of textural abnormalities in acne scarring and rhytids associated with photoaging needs further study. DESIGN/MATERIALS AND METHODS Structured interviews were performed with 34 patients from a referral-based academic practice who each previously received a series of 6 monthly treatments with a 1,320 nm neodymium:yttrium,aluminum,garnet (Nd:YAG) laser for treatment of acne scarring or photoaging. Topical anesthesia was applied 1 hour before each treatment. Patients were interviewed at least 3 months after cessation of treatment (range 3,12 months). RESULTS Patients tolerated the treatments well. Combined results for acne scarring and photoaging patients were as follows: (a) patient satisfaction with treatment was rated at 62%, and (b) textural improvement was reported at 31% at the end of the six treatments, and 30% at the date of interview. When results were stratified by diagnosis, patient satisfaction was slightly higher for treatment of acne scarring than for photoaging. Overall degree of improvement on a 1,10 scale was 5.4 for acne scarring and 3.8 for wrinkling. CONCLUSION Nonablative treatment with the 1,320 nm Nd:YAG laser induced significant patient-reported improvement in both acne scarring and photoaging. The majority of patients reported satisfaction with the degree of improvement. [source] Chinese Students in a UK Business School: Hearing the Student Voice in Reflective Teaching and Learning PracticeHIGHER EDUCATION QUARTERLY, Issue 1 2006Yvonne TurnerArticle first published online: 7 FEB 200 This paper presents the outcomes of a study carried out in 2001,2002 with nine postgraduate students from China, enrolled on taught master's programmes in a UK university business school. The aims of the research were to explore the development of the students' orientations to learning during their year of study in the UK, and to explore how the researcher's interactions with the study group contributed to her professional reflections and influenced her academic practice. The main conclusions of the project were that participants' underlying approaches to learning did not change substantially over the year, owing to the culturally implicit nature of UK academic conventions and that they experienced high levels of emotional isolation and loneliness, which affected their academic confidence. [source] Overcoming Fragmentation in Professional Life: The Challenge for Academic DevelopmentHIGHER EDUCATION QUARTERLY, Issue 1 2002Stephen Rowland This paper portrays the fragmented nature of higher education, experienced in terms of a number of fractures. I have chosen to concentrate here on five of these fractures or fault lines: the diverse assumptions about the nature of higher education; the separation between teachers and learners; the separation between academic staff and those who manage them; the split between teaching and research; and the fragmented nature of knowledge itself. Policy initiatives have tended to aggravate these fractures. I suggest that the task for academic development is to work within these fractures, to attempt to create coherence in academic practice. To do this, we need to develop a series of critical conversations between teachers and learners, between academics and managers and between the disciplines. Such conversations might be seen as contributing to the development of a new academic professionalism. The first and foremost subject of this thinking together must concern the purposes of higher education itself. [source] Are Australasian academic physicians an endangered species?INTERNAL MEDICINE JOURNAL, Issue 11 2007A. Wilson Abstract It has been stated that academic medicine is in a worldwide crisis. Is this decline in hospital academic practice a predictable consequence of modern clinical practice with its emphasis on community and outpatient-based services as well as a corporate health-care ethos or does it relate to innate problems in the training process and career structure for academic clinicians? A better understanding of the barriers to involvement in academic practice, including the effect of gender, the role and effect of overseas training, expectation of further research degrees and issues pertaining to the Australian academic workplace will facilitate recruitment and retention of the next generation of academic clinicians. Physician-scientists remain highly relevant as medical practice and education evolves in the 21st century. Hospital-based academics carry out a critical role in the ongoing mentoring of trainees and junior colleagues, whose training is still largely hospital based in most specialty programmes. Academic clinicians are uniquely placed to translate the rapid advances in medical biology into the clinical sphere, by guiding and carrying out translational research as well as leading clinical studies. Academic physicians also play key leadership in relations with government and industry, in professional groups and medical colleges. Thus, there is a strong case to assess the problems facing recruitment and retention of physician-scientists in academic practice and to develop workable solutions. [source] The contribution of MD,PhD training to academic orthopaedic facultiesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2001John M. Clark Little is known about the distribution of research-trained physicians across the various specialties. To document the extent to which MD,PhD programs are a source of research-trained faculty for orthopaedic departments, this study examined the specialty choices of graduates of the Medical Scientist Training Program (MSTP) from 1964 to 1994. The MSTP, a combined MD,PhD program supported by the National Institute of General Medical Sciences, (NIGMS), produces roughly 25% of all MD,PhDs in the US. Methods. Copies of the appendices from training grant applications containing information on MSTP graduates were obtained from the NIGMS. Also, a questionnaire was mailed to 116 university-affiliated orthopaedic surgery departments asking how many faculty were MD's, PhDs or MD,PhDs. Results. Records were obtained for all MST programs. Information on postdoctoral training and/or a current position was reported for 1615 graduates who earned both MD and PhD. Of these graduates, 277 chose non-clinical paths. The other 1338 entered a residency or internship. Of these, 593 were still in residency training, 566 were academic faculty members and 130 were in private practice. In the records, 12 (0.9%) were listed as orthopaedic surgical residents (6) or faculty (6). At this time, all 12 have completed training, and 11 are in academic practice. Eighty-three departments replied to the questionnaire. In that sample of 1761 faculty positions, 1478 were MDs, 217 were PhDs and 36 (2.0%) were MD-PhDs. Conclusion. Despite robust support of MD,PhD programs, the number of dual degree recipients on orthopaedic faculties is small when compared to the relative size of the specialty. Other sources of research-trained staff should perhaps be developed. © 2001 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Factors associated with surgical options for breast carcinoma,CANCER, Issue 7 2006Anees B. Chagpar M.D., M.Sc. Abstract BACKGROUND Breast conservation surgery (BCS) and mastectomy have equivalent survival outcomes for women with breast carcinoma, but treatment decisions are affected by many factors. The current study evaluated the impact of patient and physician factors on surgical decision-making. METHODS Statistical analyses were performed on a prospective multicenter study of patients with invasive breast carcinoma. Patient, physician, and geographic factors were considered. RESULTS Of 4086 patients, BCS was performed in 2762 (67.6%) and mastectomy was performed in 1324 (32.4%). The median tumor size was 1.5 cm (range, < 0.1,9.0 cm) in patients undergoing BCS and 1.9 cm (range, 0.1,11.0 cm) in patients undergoing mastectomy (P < 0.00001). The median age of patients undergoing BCS was 59 years (range, 27,100 yrs), whereas patients who underwent mastectomy were older (median age of 63 yrs, range, 27,96 yrs [P < 0.00001]). Physicians in academic practices performed more lumpectomies than those who were not in an academic practice (70.9% vs. 65.7%; P = 0.001). More breast conservation procedures were performed by surgeons with a higher percentage of breast practice (P = 0.012). Geographic location was found to be significant, with the Northeast having the highest rate of breast conservation (70.8%) and the Southeast having the lowest (63.2%; P = 0.002). On multivariate analysis, patient age (odds ratio [OR]: 1.455; 95% confidence interval [95% CI], 1.247,1.699 [P < 0.001]), tumor size (P < 0.001), tumor palpability (OR: 0.613; 95% CI, 0.524,0.716 [P < 0.001]), histologic subtype (P = 0.018), tumor location in the breast (P < 0.001), physician academic affiliation (OR: 1.193; 95% CI: 1.021,1.393 [P = 0.026]), and geographic location (P = 0.045) were found to be significant. CONCLUSIONS Treatment decisions were found to be related to patient clinicopathologic features, surgeon academic affiliation, and geographic location. Future studies will elucidate the communication and psychosocial factors that may influence patient decision-making. Cancer 2006. © 2006 American Cancer Society. [source] The role of guidelines in quality improvement for cancer surgeryJOURNAL OF SURGICAL ONCOLOGY, Issue 8 2009FRCPC, George P. Browman MD Abstract In February 2008, Cancer Surgery Alberta hosted a conference on surgical outcomes and quality. The objective here is to review the interactions between quality/outcomes and guidelines, highlighting surgeons' roles. Potential interactions between quality measurement and guidelines are discussed. We analyzed data from practitioner surveys about guidelines to determine surgeons' participation compared with other specialists. The response rate of surgeons in both community-based and academic practices to guideline development surveys was equivalent to other cancer disciplines. J. Surg. Oncol. 2009;99:467,469. © 2009 Wiley-Liss, Inc. [source] Ingres's Second Madame Moitessier: ,Le Brevet du Peintre d'Histoire'ART HISTORY, Issue 5 2000Sarah Betzer Despite their ubiquity throughout his career, Ingres's portraits of women are generally understood to stand outside of, and in opposition to, the artist's academic practices and priorities. An examination of Ingres's Portrait of Madame Moitessier (1856) suggests rather that the portraiture lay at the crux of Ingres's particular relation to ,nature' and the ,ideal'. Portrait-making, with its attendant demands for verisimilitude and the insistent presence of the sitter's own body and desires, presented a challenge for the history painter, whose work was based upon a process of distillation from the studio model. And, while the portrait genre had long been haunted by the imagined threat of artistic servitude, Ingres responded to the problem of invoking the specificities of the sitter by simultaneously effecting her translation towards the general and by painting the portrait as history. In painting the portrait of Madame Moitessier in such terms, Ingres demonstrated how artistic practices and commitments which are generally understood to be mutually exclusive were instead, for Ingres, profoundly imbricated. Through an excavation of the processes and techniques used in the creation of the portrait of Madame Moitessier, this article argues that portraiture is the place to understand Ingres's notion of ,history painter' as something other than simply ,painter of history,. [source] Factors associated with surgical options for breast carcinoma,CANCER, Issue 7 2006Anees B. Chagpar M.D., M.Sc. Abstract BACKGROUND Breast conservation surgery (BCS) and mastectomy have equivalent survival outcomes for women with breast carcinoma, but treatment decisions are affected by many factors. The current study evaluated the impact of patient and physician factors on surgical decision-making. METHODS Statistical analyses were performed on a prospective multicenter study of patients with invasive breast carcinoma. Patient, physician, and geographic factors were considered. RESULTS Of 4086 patients, BCS was performed in 2762 (67.6%) and mastectomy was performed in 1324 (32.4%). The median tumor size was 1.5 cm (range, < 0.1,9.0 cm) in patients undergoing BCS and 1.9 cm (range, 0.1,11.0 cm) in patients undergoing mastectomy (P < 0.00001). The median age of patients undergoing BCS was 59 years (range, 27,100 yrs), whereas patients who underwent mastectomy were older (median age of 63 yrs, range, 27,96 yrs [P < 0.00001]). Physicians in academic practices performed more lumpectomies than those who were not in an academic practice (70.9% vs. 65.7%; P = 0.001). More breast conservation procedures were performed by surgeons with a higher percentage of breast practice (P = 0.012). Geographic location was found to be significant, with the Northeast having the highest rate of breast conservation (70.8%) and the Southeast having the lowest (63.2%; P = 0.002). On multivariate analysis, patient age (odds ratio [OR]: 1.455; 95% confidence interval [95% CI], 1.247,1.699 [P < 0.001]), tumor size (P < 0.001), tumor palpability (OR: 0.613; 95% CI, 0.524,0.716 [P < 0.001]), histologic subtype (P = 0.018), tumor location in the breast (P < 0.001), physician academic affiliation (OR: 1.193; 95% CI: 1.021,1.393 [P = 0.026]), and geographic location (P = 0.045) were found to be significant. CONCLUSIONS Treatment decisions were found to be related to patient clinicopathologic features, surgeon academic affiliation, and geographic location. Future studies will elucidate the communication and psychosocial factors that may influence patient decision-making. Cancer 2006. © 2006 American Cancer Society. [source] Fracturing the Real-Self,Fake-Self Dichotomy: Moving Toward "Crystallized" Organizational Discourses and IdentitiesCOMMUNICATION THEORY, Issue 2 2005Sarah J. Tracy This article begins with the following question: Why, even with the proliferation of poststructuralist theoretical understandings of identity, do people routinely talk in terms of "real" and "fake" selves? Through an analysis of critical empirical studies of identity-construction processes at work, this article makes the case that the real-self,fake-self dichotomy is created and maintained through organizational talk and practices and, in turn, serves as a constitutive discourse that produces four subject positions with both symbolic and material consequences: strategized self-subordination, perpetually deferred identities, "auto-dressage," and the production of "good little copers." The article challenges scholars to reflexively consider the ways they may perpetuate the dichotomy in their own academic practices. Furthermore, the authors present the metaphor of the "crystallized self" as an alternative to the real-self,fake-self dichotomy and suggest that communication scholars are well-poised to develop alternative vocabularies, theories, and understandings of identity within the popular imagination. [source] | |||||||||||||