Browsing by Subject "Evidence-Based Medicine"

Now showing 1 - 5 of 5
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    Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop
    (Endocrine Society, 2014-10) Silverberg, Shonni J.; Clarke, Bart L.; Peacock, Munro; Bandeira, Francisco; Boutroy, Stephanie; Cusano, Natalie E.; Dempster, David; Lewiecki, E. Michael; Liu, Jian-Min; Minisola, Salvatore; Rejnmark, Lars; Silva, Barbara C.; Walker, Marcella D.; Bilezikian, John P.; Medicine, School of Medicine
    OBJECTIVE: This report summarizes data on traditional and nontraditional manifestations of primary hyperparathyroidism (PHPT) that have been published since the last International Workshop on PHPT. PARTICIPANTS: This subgroup was constituted by the Steering Committee to address key questions related to the presentation of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed. EVIDENCE: Data from the 5-year period between 2008 and 2013 were presented and discussed to determine whether they support changes in recommendations for surgery or nonsurgical follow-up. CONSENSUS PROCESS: Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was undertaken. After extensive review and discussion, the subgroup came to agreement on what changes in the recommendations for surgery or nonsurgical follow-up of asymptomatic PHPT should be made to the Expert Panel. CONCLUSIONS: 1) There are limited new data available on the natural history of asymptomatic PHPT. Although recognition of normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism) is increasing, data on the clinical presentation and natural history of this phenotype are limited. 2) Although there are geographic differences in the predominant phenotypes of PHPT (symptomatic, asymptomatic, normocalcemic), they do not justify geography-specific management guidelines. 3) Recent data using newer, higher resolution imaging and analytic methods have revealed that in asymptomatic PHPT, both trabecular bone and cortical bone are affected. 4) Clinically silent nephrolithiasis and nephrocalcinosis can be detected by renal imaging and should be listed as a new criterion for surgery. 5) Current data do not support a cardiovascular evaluation or surgery for the purpose of improving cardiovascular markers, anatomical or functional abnormalities. 6) Some patients with mild PHPT have neuropsychological complaints and cognitive abnormalities, and some of these patients may benefit from surgical intervention. However, it is not possible at this time to predict which patients with neuropsychological complaints or cognitive issues will improve after successful parathyroid surgery.
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    Integrating evidence-based medicine skills into a medical school curriculum: a quantitative outcomes assessment
    (BMJ Evidence Based Medicine, 2020-10-22) Menard, Laura M.; Blevins, Amy E.; Trujillo, Dan; Lazarus, Kenneth
    Objectives: This research project aims to determine the potential differential impact of two curricular approaches to teaching evidence-based medicine (EBM) on student performance on an EBM assignment administered during the first year of clerkship. A meaningful result would be any statistically significant difference in scores on the assignment given to measure student performance. Design: In order to assess and compare student learning under the different curricula, the PI and a team of five faculty members blinded to assignment date and other possibly identifying details used a modified version of the previously validated Fresno rubric to retrospectively grade three years’ worth of EBM assignments given to students in clerkship rotations 1-3 (n = 481) during the Internal Medicine clerkship. Specifically, EBM performance in three separate student cohorts were examined. Setting: The study took place at a large Midwestern medical school with nine campuses across the state of Indiana. Participants: Study participants were four hundred eighty-one students who attended the medical school and completed the Internal Medicine clerkship between 2017-2019. Interventions: Prior to the inception of this study, our institution had been teaching EBM within a discrete 2-month time period during medical students’ first year. During a large-scale curricular overhaul, the approach to teaching EBM was changed to a more scaffolded, integrated approach with sessions being taught over the course of two years. In this study, we assess the differential impact of these two approaches to teaching EBM in the first two years of medical school. Main Outcome Measures: We used clerkship-level EBM assignment grades to determine whether there was a difference in performance between those students who experienced the old versus the new instructional model. Clerkship EBM assignments given to the students used identical questions each year in order to have a valid basis for comparison. Additionally, we analyzed average student grades across the school on the EBM portion of Step 1. Results: Four hundred and eighty-one assignments were graded. Mean scores were compared for individual questions and cumulative scores using a one-way Welch ANOVA test. Overall, students performed .99 of a point better on the assignment from Year One (Y1), prior to EBM curriculum integration, to Year Three (Y3), subsequent to EBM integration (p= <.001). Statistically significant improvement was seen on questions measuring students’ ability to formulate a clinical question and critically appraise medical evidence. Additionally, on USMLE Step 1, we found that student scores on the EBM portion of the exam improved from Y1 to Y3. Conclusions: Results of this study suggest that taking a scaffolded, curriculum-integrated approach to EBM instruction during the pre-clinical years increases, or at the very least does not lessen, student retention of and ability to apply EBM concepts to patient care. Although it is difficult to fully attribute students’ retention and application of EBM concepts to the adoption of a curricular model focused on scaffolding and integration, the results of this study show that there are value-added educational effects to teaching EBM in this new format. Overall, this study provides a foundation for new research and practice seeking to improve EBM instruction. Trial Registration: IRB approval (Protocol #1907054875) was obtained for this study.
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    Rehabilitation Research at the National Institutes of Health: Moving the Field Forward (Executive Summary)
    (Oxford University Press, 2017-04-01) Frontera, Walter R.; Bean, Jonathan F.; Damiano, Diane; Ehrlich-Jones, Linda; Fried-Oken, Melanie; Jette, Alan; Jung, Ranu; Lieber, Rick L.; Malec, James F.; Mueller, Michael J.; Ottenbacher, Kenneth J.; Tansey, Keith E.; Thompson, Aiko; Physical Medicine and Rehabilitation, School of Medicine
    Approximately 53 million Americans live with a disability. For decades, the National Institutes of Health (NIH) has been conducting and supporting research to discover new ways to minimize disability and enhance the quality of life of people with disabilities. After the passage of the American With Disabilities Act, the NIH established the National Center for Medical Rehabilitation Research with the goal of developing and implementing a rehabilitation research agenda. Currently, a total of 17 institutes and centers at NIH invest more than $500 million per year in rehabilitation research. Recently, the director of NIH, Dr Francis Collins, appointed a Blue Ribbon Panel to evaluate the status of rehabilitation research across institutes and centers. As a follow-up to the work of that panel, NIH recently organized a conference under the title “Rehabilitation Research at NIH: Moving the Field Forward.” This report is a summary of the discussions and proposals that will help guide rehabilitation research at NIH in the near future. This article is being published almost simultaneously in the following six journals: American Journal of Occupational Therapy, American Journal of Physical Medicine and Rehabilitation, Archives of Physical Medicine and Rehabilitation, Neurorehabilitation and Neural Repair, Physical Therapy, and Rehabilitation Psychology. Citation information is as follows: Frontera WR, Bean JF, Damiano D, et al. Am J Phys Med Rehabil. 2017;97(4):393–403.
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    The value of information and the ethics of personal-genomic screening.
    (The American Journal of Bioethics: AJOB, 2009-04) Schwartz, Peter H.
    Personal genomic screening, especially when marketed direct-to-consumers, threatens to worsen the inefficient use of healthcare resources that Burger and Kass discuss in the case of unproven screening tests. The information that genomic and other screening tests can provide may well have value for many patients, but its effective use in healthcare depends on careful thought about the ethics of testing and the proper regulation of unproven interventions.