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صنف حسب:
Clinical Reasoning Education at US Medical Schools: Results from a National Survey of Internal Medicine Clerkship Directors
بواسطة
Rencic, Joseph
,
Durning, Steven
,
Fagan, Mark
في
Clinical Clerkship - methods
,
Clinical Clerkship - standards
,
Clinical Decision-Making - methods
2017
Background
Recent reports, including the Institute of Medicine’s
Improving Diagnosis in Health Care
, highlight the pervasiveness and underappreciated harm of diagnostic error, and recommend enhancing health care professional education in diagnostic reasoning. However, little is known about clinical reasoning curricula at US medical schools.
Objective
To describe clinical reasoning curricula at US medical schools and to determine the attitudes of internal medicine clerkship directors toward teaching of clinical reasoning.
Design
Cross-sectional multicenter study.
Participants
US institutional members of the Clerkship Directors in Internal Medicine (CDIM).
Main Measures
Examined responses to a survey that was emailed in May 2015 to CDIM institutional representatives, who reported on their medical school’s clinical reasoning curriculum.
Key Results
The response rate was 74% (91/123). Most respondents reported that a structured curriculum in clinical reasoning should be taught in all phases of medical education, including the preclinical years (64/85; 75%), clinical clerkships (76/87; 87%), and the fourth year (75/88; 85%), and that more curricular time should be devoted to the topic. Respondents indicated that most students enter the clerkship with only poor (25/85; 29%) to fair (47/85; 55%) knowledge of key clinical reasoning concepts. Most institutions (52/91; 57%) surveyed lacked sessions dedicated to these topics. Lack of curricular time (59/67, 88%) and faculty expertise in teaching these concepts (53/76, 69%) were identified as barriers.
Conclusions
Internal medicine clerkship directors believe that clinical reasoning should be taught throughout the 4 years of medical school, with the greatest emphasis in the clinical years. However, only a minority reported having teaching sessions devoted to clinical reasoning, citing a lack of curricular time and faculty expertise as the largest barriers. Our findings suggest that additional institutional and national resources should be dedicated to developing clinical reasoning curricula to improve diagnostic accuracy and reduce diagnostic error.
Journal Article
Progress in evidence-based medicine: a quarter century on
بواسطة
Djulbegovic, Benjamin, Prof
,
Guyatt, Gordon H, Prof
في
Clinical decision making
,
Clinical medicine
,
Clinical trials
2017
Summary In response to limitations in the understanding and use of published evidence, evidence-based medicine (EBM) began as a movement in the early 1990s. EBM's initial focus was on educating clinicians in the understanding and use of published literature to optimise clinical care, including the science of systematic reviews. EBM progressed to recognise limitations of evidence alone, and has increasingly stressed the need to combine critical appraisal of the evidence with patient's values and preferences through shared decision making. In another progress, EBM incorporated and further developed the science of producing trustworthy clinical practice guidelines pioneered by investigators in the 1980s. EBM's enduring contributions to clinical medicine include placing the practice of medicine on a solid scientific basis, the development of more sophisticated hierarchies of evidence, the recognition of the crucial role of patient values and preferences in clinical decision making, and the development of the methodology for generating trustworthy recommendations.
Journal Article
Harrison's manual of medicine
This full color, portable guide covers all diseases and conditions commonly seen in general medical practice. This edition has been updated to reflect the latest clinical developments in medicine. Designed for quick access and employing an effective blend of concise text, bulleted key points, decision trees, and summary tables, the \"Manual\" makes it easy to find what you need at the point of care. -- From publisher's description.
Vitamin D status and outcomes for hospitalised older patients with COVID-19
2021
PurposeOlder adults are more likely to be vitamin D deficient. The aim of the study was to determine whether these patients have worse outcomes with COVID-19.MethodsWe conducted a prospective cohort study between 1 March and 30 April 2020 to assess the importance of vitamin D deficiency in older patients with COVID-19. The cohort consisted of patients aged ≥65 years presenting with symptoms consistent with COVID-19 (n=105). All patients were tested for serum 25-hydroxyvitamin D (25(OH)D) levels during acute illness. Diagnosis of COVID-19 was confirmed via viral reverse transcriptase PCR swab or supporting radiological evidence. COVID-19-positive arm (n=70) was sub-divided into vitamin D-deficient (≤30 nmol/L) (n=39) and -replete groups (n=35). Subgroups were assessed for disease severity using biochemical, radiological and clinical markers. Primary outcome was in-hospital mortality. Secondary outcomes were laboratory features of cytokine storm, thoracic imaging changes and requirement of non-invasive ventilation (NIV).ResultsCOVID-19-positive arm demonstrated lower median serum 25(OH)D level of 27 nmol/L (IQR=20–47 nmol/L) compared with COVID-19-negative arm, with median level of 52 nmol/L (IQR=31.5–71.5 nmol/L) (p value=0.0008). Among patients with vitamin D deficiency, there was higher peak D-dimer level (1914.00 μgFEU/L vs 1268.00 μgFEU/L) (p=0.034) and higher incidence of NIV support and high dependency unit admission (30.77% vs 9.68%) (p=0.042). No increased mortality was observed between groups.ConclusionOlder adults with vitamin D deficiency and COVID-19 may demonstrate worse morbidity outcomes. Vitamin D status may be a useful prognosticator.
Journal Article
A Consensus-Based Checklist for Reporting of Survey Studies (CROSS)
بواسطة
Vermeulen, Joeri
,
Ng, Sze Jia
,
Drummond, Frances J.
في
Delphi method
,
Dentistry
,
Hospitals
2021
Journal Article
Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19)
بواسطة
Zhang, Liangqing
,
Cheung, Chi Wai
,
Xia, Zhengyuan
في
Betacoronavirus
,
China
,
Complications
2020
In late December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia (SARS-CoV-2) in Wuhan, China, aroused worldwide concern. Previous studies have reported epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19). The purpose of this brief review is to summarize those published studies as of late February 2020 on the clinical features, symptoms, complications, and treatments of COVID-19 and help provide guidance for frontline medical staff in the clinical management of this outbreak.
Journal Article