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Background: Aesthetics medicine, a controversial branch of clinical medicine known for its high degree of commercialization, faces numerous conflicts, particularly in some developing countries. The global aesthetics medicine industry requires enhancements of its legal and supervision framework and risk management systems. Aims: This paper aimed to provide a comprehensive visual analysis of academic achievements related to regulatory and legal issues in the field of aesthetic medicine and to identify its development trends and research hotspots. Methods: The Web of Science Core Collection was employed to retrieve relevant studies, resulting in a total of 602 research articles after selection. Utilizing bibliometric methods and CiteSpace, this study analyzed the primary countries, institutions, authors, journals, hotspots, frontiers, and trends in this domain. Results: The findings indicated rapid increases in the number of published papers. The United States emerged as the leading contributor with 131 research papers and the highest intermediate centrality. Eleven keyword clusters were identified, with "adolescence" and "office‐based surgery" being the most recent topics. We also analyzed the trends and frontiers of legal research in medical aesthetics. Conclusion: The importance of informed consent has been increasingly emphasized, and research in the field of medical aesthetics has been gradually expanding beyond individual cosmetic procedures. The management system has become more comprehensive, moreover, guidelines and medical laws have been continually published, with research shifting toward a holistic perspective that encompasses patients, medical aesthetic providers, and regulatory authorities in the study of medical aesthetics regulation and legislation. This paper also proposes some innovative directions for future research and applications. [ABSTRACT FROM AUTHOR]

Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care. [ABSTRACT FROM AUTHOR]

Background: Social determinants of health (SDOH) are the non-medical factors that impact health. Although geographical measures of deprivation are used, individual measures of social risk could identify those most at risk and generate more personalised care and targeted referrals to community resources. We know SDOH are important to health care, but it is not yet known whether their collection via the electronic health record (EHR) is acceptable and useful from the patient perspective. Aim: To synthesise relevant literature to explore patient perspectives on integrating information about SDOH into primary care EHRs, and the opportunities and challenges of its implementation in a general practice setting. Design & setting: Systematic review of primary care-based qualitative and mixed-method studies using thematic framework analysis. Method: Key databases were searched for articles reporting patient perspectives of SDOH collection within the primary care EHR. Qualitative and mixed-methods studies written in English were included. A framework analysis was conducted to identify themes. Results: From 14 included studies, the following five main themes were identified: rationale for SDOH screening and the anticipated outcomes; impact of the provider-patient relationship on patient perceptions; data, which included privacy concerns; screening process and referral; and recommendations for future research. Conclusion: Integration of information on SDOH into the EHR appears acceptable to patients. This review has added to the discussion of whether and how to implement SDOH screening and referral programmes into UK primary care systems. [ABSTRACT FROM AUTHOR]

Transgender patients are at elevated risk of intimate partner violence (IPV), but national guidelines do not recommend routine screening for this population. This paper explores the feasibility and effectiveness of routine IPV screening of transgender patients in a primary care setting by describing an existing screening program and identifying factors associated with referral and engagement in IPV-related care for transgender patients. An IPV "referral cascade" was created for 1,947 transgender primary care patients at an urban community health center who were screened for IPV between January 1, 2014 to May 31, 2016: (a) Of those screening positive, how many were referred? (b) Of those referred, how many engaged in IPV-specific care within 3 months? Logistic regression identified demographic correlates of referral and engagement. Of the 1,947 transgender patients screened for IPV, 227 screened positive. 110/227 (48.5%) were referred to either internal or external IPV-related services. Of those referred to on-site services, 65/103 (63.1%) had an IPV-related appointment within 3 months of a positive screen. IPV referral was associated with being assigned male at birth (AMAB) versus assigned female at birth (AFAB) (AOR = 2.69, 95% CI 1.52, 4.75) and with nonbinary, rather than binary, gender identity (AOR = 2.07, 95%CI 1.09, 3.73). Engagement in IPV-related services was not associated with any measured demographic characteristics. Similar to published rates for cisgender women, half of transgender patients with positive IPV screens received referrals and two-thirds of those referred engaged in IPV-specific care. These findings support routine IPV screening and referral for transgender patients in primary care settings. Provider training should focus on how to ensure referrals are made for all transgender patients who screen positive for IPV, regardless of gender identity, to ensure the benefits of screening accrue equally for all patients. [ABSTRACT FROM AUTHOR]

• Digital Mental Health Services (DMHS) can greatly increase access to care. • Training is needed so providers can effectively integrate DMHS into their treatments. • More research on DMHS is needed, along with regulatory standards. • DMHS may help reduce health disparities but questions remain about cultural tailoring. The papers in this special series make a compelling case for the value of digital mental health services (DMHS; including technology-based interventions, assessments, and prevention programs) to help address some of the currently unmet needs in mental health care. At the same time, the papers highlight the work that needs to be accomplished for DMHS to fulfill their promise. We review the papers' contributions in terms of (a) the imperative to increase access to evidence-informed, high-quality care, especially for underserved populations, both in the United States and globally; (b) ways to use DMHS to improve the ways that clinical care is provided to make treatment provision more effective and efficient; and (c) the current state of the research on DMHS for emotional disorders. We then consider lessons learned and recommendations to move the field forward, such as increasing (and making transparent) the research base on DMHS, adopting regulatory standards for DMHS, attending carefully to training issues for DMHS and best practices for dissemination and implementation, designing specifically for digital platforms, and being intentional about efforts to reduce disparities regarding who benefits from DMHS. [ABSTRACT FROM AUTHOR]

To find the trend and hot points of deafness gene research in the nearly 10 years, a bibliometric analysis of literature in the fields from Web of Science was performed. Python 3.7, Gephi 0.9.2, and SPSS 22.0 were used for cleaning, restructuring, and analysis. A total of 2828 article documents were collected, which were from 651 Science Citation Index Expanded journals, 93 countries/regions, 18 199 authors, and 3148 organizations. PLoS One published more papers than other journals. Among the journals that published more than 30 papers, 10 journals were included in the genetics & heredity class. The top country/region with highest number of papers was United States. However, the top author and top affiliation was Dai Pu (China) and People's Liberate Army General Hospital (China), respectively. The results of co-occurrence network, hierarchical clustering, and multidimensional scale analysis of keywords showed that 2 groups were classified. The 2 groups focused on the gene mutation of deafness and the research objects, methods, factors, and gene locus, respectively. Multidimensional scale analysis told the research character and some research details. The gene mutation and variant of family and population diseases were the hot points. [ABSTRACT FROM AUTHOR]

Background: Clinical judgment is declining in new graduate nurses, which affects patient safety and is therefore tested on the Next Generation NCLEX. There is limited research describing barriers and facilitators impacting nursing faculty's experiences teaching clinical judgment. Aims: The purpose of this study was to explore barriers and facilitators affecting undergraduate nursing faculty's clinical judgment teaching methods. Methods: Sixteen qualitative interviews were conducted with full-time nursing faculty at seven universities in the Northeast and Southeast regions of the United States. Results: The findings revealed program, student, and faculty factors affecting clinical judgment teaching methods. Subthemes included time, class size, students' class preparation, critical thinking, task orientation, professional development, and faculty resistance. Conclusion: Minimizing barriers and strengthening facilitators based on participants' practices and previous research can support more effective clinical judgment pedagogy, which has the potential to achieve Next Generation NCLEX success and potentially increase patient safety. [ABSTRACT FROM AUTHOR]

Digital health technologies (DHTs) can transform neurological assessments, improving quality and continuity of care. In the United States, the Food & Drug Administration (FDA) oversees the safety and efficacy of these technologies, employing a detailed regulatory process that classifies devices based on risk and requires rigorous review and post-market surveillance. Following FDA approval, DHTs enter the Current Procedural Terminology, Relative Value Scale Update Committee, and Centers for Medicare & Medicaid Services coding and valuation processes leading to coverage and payment decisions. DHT adoption is challenged by rapid technologic advancements, an inconsistent evidence base, marketing discrepancies, ambiguous coding guidance, and variable health insurance coverage. Regulators, policymakers, and payers will need to develop better methods to evaluate these promising technologies and guide their deployment. This includes striking a balance between patient safety and clinical effectiveness versus promotion of innovation, especially as DHTs increasingly incorporate artificial intelligence. Data validity, cybersecurity, risk management, societal, and ethical responsibilities should be addressed. Regulatory advances can support adoption of these promising tools by ensuring DHTs are safe, effective, accessible, and equitable. [ABSTRACT FROM AUTHOR]

Background: Medical educators seek innovative ways to engage learners efficiently and effectively. Gamification has been explored as one way to accomplish this feat; however, questions remain about which contexts gamification would be most useful. Time constraints and student interest present major barriers for teaching laboratory medicine to students. This study aims to compare two versions of an interactive online module, one gamified and one not, for teaching laboratory medicine concepts to pre-clinical medical students. Methods: First-year medical students reviewed either a gamified or non-gamified version of an interactive online module in preparation for an in-person flipped classroom session on Laboratory Medicine. Learning theory guided the design of the modules and both contained identical content, objectives, and structure. The "gamified" module included the additional elements of personalization, progress meters, points, badges, and story/role play. After reviewing the module, students completed an anonymous knowledge check and optional survey. Results: One hundred seventy-one students completed the post module knowledge check as assigned (82 gamified, 89 non-gamified). Knowledge check scores were higher for the students who reviewed the gamified module (p < 0.02), corresponding to an effect size of 0.4 for the gamified module. Eighty-one students completed optional post-module surveys (46 gamified, 35 non-gamified). Instructional efficiency was calculated using task difficulty questions and knowledge check scores, and the resulting instructional efficiency was higher for the gamified module. There was no significant difference in the student-reported time required to complete the modules. Additionally, both versions of the module were well received and led to positive ratings related to motivation and confidence. Finally, examination of open-ended survey results suggested that the addition of game elements added value to the gamified module and enhanced engagement and enjoyment. Conclusions: In this setting, the addition of gamification to an interactive online module enhanced learning outcome, instructional efficiency, student engagement and enjoyment. These results should inspire further exploration of gamification for teaching Laboratory Medicine concepts to pre-clinical medical students. [ABSTRACT FROM AUTHOR]

This article describes the development of a video serial drama intervention that was designed to address factors that influence HIV in the United States among Black youth. These include HIV testing, sexual behaviors not protected by condoms, negative attitudes towards sexual minorities, and HIV stigma. Behavior-change principles (social learning theory and education-entertainment) and input from members of the priority audience formed the basis of this 27-episode (3 minutes each) drama for dissemination on multiple platforms, including in public spaces or privately online. The developmental process, specifically involving members of the population of interest and use of behavioral theory, enriched the narrative elements and likely ensured intervention acceptability, enhancing effectiveness. Public health practitioners and prevention programmers may want to consider using this intervention and/or the narrative communication approach when intervening to change behavior. [ABSTRACT FROM AUTHOR]

Introduction: Candida albicans is an opportunistic human pathogen that typically resides as part of the microbiome in the gastrointestinal and genitourinary tracts of a large portion of the human population. This fungus lacks a true sexual cycle and evolves in a largely clonal pattern. The ability to cause disease is consistent across the species as strains causing systemic infections appear across the known C. albicans intra-species clades. Methods: In this work, strains collected from patients with systemic C. albicans infections isolated at the Nebraska Medicine clinical laboratory were typed by MLST analysis. Since the ability to form filaments has been linked to pathogenesis in C. albicans, these clinical strains, as well as a previously genotyped set of clinical strains, were tested for their ability to filament across a variety of inducing conditions. Results: Genotyping of the clinical strains demonstrated that the strains isolated at one of the major medical centers in our region were as diverse as strains collected across the United States. We demonstrated that clinical strains exhibit a variety of filamentation patterns across differing inducing conditions. The only consistent pattern observed in the entire set of clinical strains tested was an almost universal inability to filament in standard solid inducing conditions used throughout the C. albicans field. A different solid filamentation assay that produces more robust filamentation profiles from clinical strains is proposed in this study, although not all strains expected to filament in vivo were filamentous in this assay. Discussion: Our data supports growing evidence that broad phenotypic diversity exists between the C. albicans type strain and clinical strains, suggesting that the type strain poorly represents filamentation patterns observed in most clinical isolates. These data further highlight the need to use diverse clinical strains in pathogenesis assays. [ABSTRACT FROM AUTHOR]

Racial disparities in hospice care are well documented for patients with cancer, but the existence, direction, and extent of disparity findings are contradictory across the literature. Current methods to identify racial disparities aggregate data to produce single-value quality measures that exclude important patient quality elements and, consequently, lack information to identify actionable equity improvement insights. Our goal was to develop an explainable machine learning approach that elucidates healthcare disparities and provides more actionable quality improvement information. We infused clinical information with engineering systems modeling and data science to develop a time-by-utilization profile per patient group at each hospital using US Medicare hospice utilization data for a cohort of patients with advanced (poor-prognosis) cancer that died April-December 2016. We calculated the difference between group profiles for people of color and white people to identify racial disparity signatures. Using machine learning, we clustered racial disparity signatures across hospitals and compared these clusters to classic quality measures and hospital characteristics. With 45,125 patients across 362 hospitals, we identified 7 clusters; 4 clusters (n = 190 hospitals) showed more hospice utilization by people of color than white people, 2 clusters (n = 106) showed more hospice utilization by white people than people of color, and 1 cluster (n = 66) showed no difference. Within-hospital racial disparity behaviors cannot be predicted from quality measures, showing how the true shape of disparities can be distorted through the lens of quality measures. This approach elucidates the shape of hospice racial disparities algorithmically from the same data used to calculate quality measures. [ABSTRACT FROM AUTHOR]

Background: Understanding concordance between informants' and cognitively impaired participants' information reporting is crucial for Alzheimer's and Alzheimer's-related dementia studies. Methods: The Brain Attack Surveillance in Corpus Christi-Cognitive is a community-based cohort study. Households in Nueces County, Texas, USA, were randomly identified. 330 dyads of participants and their named informants answered questions. Models were generated to examine which predictors, including age, gender, ethnicity, cognitive function, and relationship to informant, influenced answer discordance. Results: For demographic items, female participants and participants with spouses/partners as informants had significantly less discordance, with incidence rate rations (IRRs) of 0.65 (CI = 0.44, 0.96) and 0.41 (CI = 0.23, 0.75), respectively. For health items, better cognitive function of the participant was associated with less discordance, with an IRR of 0.85 (CI = 0.76, 0.94). Conclusions: Demographic information concordance is most associated with gender and informant–participant relationship. Level of cognitive function is most associated with concordance for health information. ClinicalTrials.gov identifier NCT03403257. [ABSTRACT FROM AUTHOR]

Purpose of Study: Medical students who identify as Black, Indigenous, and People of Color (BIPOC) regularly experience mistreatment and discrimination. This study sought to understand these student experiences during rotations in rural and urban underserved community teaching sites. Methods: Self‐identified BIPOC medical students who completed the University of Washington School of Medicine's Rural Underserved Opportunities Program from 2019 through 2021 were invited to participate in a 60‐ to 90‐minute focus group discussion via Zoom. From August to September 2021, 4 focus groups and 1 individual interview were conducted with a total of 12 participants. A current BIPOC medical student facilitated the sessions utilizing questions developed by the research team. Four study team members coded transcripts for key themes related to experiences of microaggressions. Findings: All participants reported having an overall positive experience, but everyone also witnessed and/or experienced at least 1 microaggression. Unlike those in urban placements, participants placed in rural sites expressed anxiety about being in predominantly White communities and experienced feelings of racial and/or ethnic isolation during the rotation. Participants recommended that rural preceptors identify themselves as trusted advocates and the program should prioritize placing BIPOC students at diverse clinical sites. Conclusions: Medical schools must take action to address the mistreatment of BIPOC medical students in the clinical environment. Schools and rural training sites need to consider how to best support students to create an equitable learning environment and recruit more BIPOC physicians to rural practice. [ABSTRACT FROM AUTHOR]

The perspectives of the Compounded Drug Preparation Information Exchange Expert Panel of the United States Pharmacopeia (CDPIE-EP) on the urgent need to create and maintain data standards to support the electronic transmission of an interoperable dataset for compounded nonsterile preparations (CNSPs) for children and the elderly is presented. The CDPIE-EP encourages all stakeholders associated with the generation, transmission, and preparation of CNSPs, including standards-setting and informatics organizations, to discern the critical importance of accurate transmission of prescription to dispensing the final product and an urgent need to create and adopt a seamless, transparent, interoperable, digitally integrated prescribing and dispensing system benefiting of all patients that need CNSPs, especially for children with special healthcare needs and medical complexity (CSHCN-CMC) and for adults with swallowing difficulties. Lay summary: Current electronic prescription processing standards do not permit the complete transmission of compounded nonsterile preparations (CNSPs) from a prescriber to dispenser. This lack creates multiple opportunities for medication errors, especially at transitions of care for children with medical complexity and adults that cannot swallow tablets and capsules. The United States Pharmacopeia Expert Panel on Compounded Drug Preparation Information Exchange aims to reduce this source of error by creating ways and means for CNSPs to be transmitted within computer systems across the continuum of care. Twitter: Digitizing compounded preparation monographs and NDC-like formulation identifiers in computerized prescription systems will minimize error. [ABSTRACT FROM AUTHOR]

Objectives: Burnout occurs frequently in emergency medicine (EM) residents and has been shown to have a negative impact on patient care. The specific effects of burnout on patient care are less well understood. This study qualitatively explores how burnout may change the way EM residents provide patient care. Methods: Qualitative data were obtained from a sample of 29 EM residents in four semistructured focus groups across four institutions in the United States in early 2019. Transcripts were coded and organized into major patient care themes. Results: Residents described many ways in which feelings of burnout negatively impacted patient care. These detrimental effects most often fit into one of four main themes: reduced motivation to care for patients, poor communication with patients, difficult interactions with health care colleagues, and impaired decision making. Conclusions: According to EM residents, burnout negatively impacts several important aspects of patient care. Resident engagement with clinical care, communication with patients and colleagues, and clinical care may suffer as a result of burnout. [ABSTRACT FROM AUTHOR]

Prognosis of Alzheimer's disease (AD) progression has been recognized as a challenging problem due to the massive numbers of cognitive, and pathological features recorded for patients and controls. While there have been many studies investigated the diagnosis of dementia using pathological characteristics, predicting the advancement of the disease using cognitive elements has not been heavily studied particularly using technologies like artificial intelligence and machine learning. This research aims at evaluating items of the Alzheimer's Disease Assessment Scale-Cognitive 13 (ADAS-Cog-13) test to determine key cognitive items that influence the progression of AD. A methodology that consists of machine learning and feature selection (FS) techniques was designed, implemented, and then tested against real data observations (cases and controls) of the Alzheimer's Disease Neuroimaging Initiative (ADNI) repository with a narrow scope on cognitive items of the ADAS-Cog-13 test. Results obtained by ten-fold cross validation and using dissimilar classification and FS techniques revealed that the decision tree algorithm produced classification models with the best performing results from the cognitive items. For ADAS-Cog-13 test, memory and learning features including word recall, delayed word recall and word recognition were the key items pinpointing to AD advancement. When these three cognitive items are processed excluding demographics by C4.5 algorithm the models derived showed 82.90% accuracy, 87.60% sensitivity and 78.20% specificity. [ABSTRACT FROM AUTHOR]

Introduction: Points of entry (POE) in Pakistan serve as key conduits for international travel, transport, and trade. Central Health Establishment (CHE) is a key stakeholder in the implementation of the International Health Regulations 2005 (IHR) core capacities at POE and National Action Plan 2020 against COVID-19. A comprehensive screening plan for COVID-19 was carried out effectively despite limitations. Methods: A descriptive study on CDC guidelines for health screening at POE was conducted from February 2020 to March 2021. Guidelines are based on 11 attributes to be implemented; these include legal and regulatory bodies to detain the travelers as suspect, isolate, and coordinate at POEs, funds for screening, well-equipped quarantine facilities, referral health care facilities, protocols for primary and secondary screening, capacity building, supply of personal protective equipment and screening tools, and provision of basic facilities at isolation areas. Data were collected using both qualitative and quantitative methods from health officers and quarantine assistants of PoEs. The analysis of CHE's information system was performed to assess the management of traveler surveillance. Results: Eleven attributes were addressed for health screening according to CDC guidelines and well implemented at POE by CHE under the flagship of the MNHR&C. Primary health screening of 4,088,119 inbound travelers was conducted. Secondary health screening led to the referral of performed at airports for inbound travelers, with a positivity rate of 0.32. Conclusion: Preparedness and response for COVID-19 at POE are in line with the National Action Plan of the Government of Pakistan and IHR (2005). [ABSTRACT FROM AUTHOR]

The fluid immersion simulation system (FIS) has demonstrated good clinical applicability. This is the first study to compare surgical flap closure outcomes of FIS with an air‐fluidised bed (AFB), considered as standard of care. The success of closure after 14 days post‐op was the primary endpoint. Secondary endpoints were incidences of complications in the first 2 weeks after surgery and the rate of acceptability of the device. Thirty‐eight subjects were in the FIS group while 42 subjects were placed in the AFB group. Flap failure rate was similar between groups (14% vs. 12%; p = 0.84). Complications, notably dehiscence and maceration, were significantly higher in the FIS group (40% vs. 17%; p = 0.0296). The addition of a microclimate regulation device (ClimateCare®) to FIS for the last 43 patients showed a significant decrease in the rate of flap failure (71% vs. 16%; p = 0.001) and incidence of complications (33% vs. 0%; p = 0.011). There was no statistically significant difference between the FIS and air‐fluidised bed (AFB) in the rate of acceptability (nurse acceptance: 1.49 vs. 1.72; p = 0.8; patient acceptance: 2.08 vs. 2.06; p = 0.17), which further illustrates the potential implementation of this tool in a patient‐care setting. Our results show that the use of ClimateCare® in combination with FIS can be a better alternative to the AFB in surgical closure of pressure ulcers. [ABSTRACT FROM AUTHOR]

Screening with digital breast tomosynthesis (DBT) improves breast cancer detection and reduces false positives. However, currently, no breast cancer risk model takes advantage of the additional information generated by DBT imaging for breast cancer risk prediction. We developed and internally validated a DBT-based short-term risk model for predicting future late-stage and interval breast cancers after negative screening exams. We included the available 805 incident breast cancers and a random sample of 5173 healthy women matched on year of study entry in a nested case-control study from 154,200 multiethnic women, aged 35 to 74, attending DBT screening in the United States between 2014 and 2019. A relative risk model was trained using elastic net logistic regression and nested cross-validation to estimate risks for using imaging features and age. An absolute risk model was developed using derived risks and U.S. incidence and competing mortality rates. Absolute risks, discrimination performance, and risk stratification were estimated in the left-out validation set. The discrimination performance of 1-year risk was 0.82 (95% CI, 0.79 to 0.85) with good calibration (P = 0.7). Using the U.S. Preventive Service Task Force guidelines, 14% of the women were at high risk, 19.6 times higher compared to general risk. In this high-risk group, 76% of stage II and III cancers and 59% of stage 0 cancers were observed (P < 0.01). Using mammographic features generated from DBT screens, our image-based risk prediction model could guide radiologists in selecting women for clinical care, potentially leading to earlier detection and improved prognoses. Better images, better diagnosis: Identifying breast cancer early is key to improving survival. Digital breast tomosynthesis (DBT) is an x-ray–based three-dimensional imaging method that produces more detailed images of deeper tissue layers than traditional mammography. Eriksson et al. developed and internally validated a model to predict an individual's risk of breast cancer over the coming year and estimated that supplemental screening using this model could have detected more cancers than traditional mammography alone. This study provides a template for the potential incorporation of DBT for improving breast cancer screening. [ABSTRACT FROM AUTHOR]

Learning is a complex phenomenon in which learners can vary in their learning orientation, learning approaches, and perception of the learning environment. Learners may be characterized as mastery oriented or performance oriented, and this learning orientation can influence their learning approaches, such as whether to seek feedback or ask for help. The learning environment includes institutional assessment policies and informal interactions that emphasize outcomes and differentiation among students. When learners perceive the learning environment as performance oriented, they feel competition from other learners and fear negative feedback. This complex interplay of learning orientation, its influence on feedback-seeking behavior, and the environmental influence and reinforcement of both can be captured through learner profiles. In this multi-institutional cross-sectional survey study of students from six U.S. medical schools, we investigated learner profiles that characterize how these domains manifest together across individual learners. We then determined how these profiles are associated with students' clerkship grades. Measures included the Patterns of Adaptive Learning for learning orientation, self-reports for learning approaches, and perceptions of the learning environment. We used latent profile analysis to cluster students who share common characteristics around orientation, behavior, and environment. The relationship between these profiles and the percentage of honors earned was examined using multiple regression analysis. We found four distinct learner profiles within 666 of 974 (68%) analyzable responses: (1) performance oriented with negative perceptions of environment, (2) mastery oriented with desirable learning approaches, (3) "average" group, and (4) mastery orientation only. Profile 1 (M = 39%) and Profile 4 (M = 38%) students received fewer clerkship honors compared with other profiles. Profile 2 students earned a significantly higher percentage of honors grades (M = 54%) compared with other students. Profile 3 students (average group) earned the second highest percentage of honors (M = 46%). Effect sizes comparing the percentage of honors varied from 0.32 to 0.65, indicating medium to large differences. The highest performers, as measured by clerkship honors grades, were mastery oriented, perceived a more positive learning environment, and were comfortable asking questions and seeking feedback for their learning. The lowest performing students were performance oriented and had negative perceptions of their learning environments. Contrary to previous findings, we found that the relationship between mastery orientation and learning approaches is not unidirectional but rather seems to be mediated by perceptions of the learning environment. [ABSTRACT FROM AUTHOR]

Background Patient-reported outcomes (PROs) can promote patient engagement, shared-decision making and improve the overall experience of care. However, PRO integration in the primary care clinical setting is limited. Exploring the perspectives of primary care physicians (PCPs) on PROs is key to understanding how they are being used in the clinical setting. We sought to elucidate this clinical perspective at one of the largest US health systems that has integrated a wide range of PROs into routine primary care. Methods Mixed methods study with both anonymous online surveys and in-person qualitative semistructured interviews conducted with PCPs to understand their clinical perspectives on the applications of the existing PROs. PCPs from the 19 affiliated clinics were prompted to complete the survey. Interviewed PCPs were selected via a combination of random and purposive selection from the PCP directory. Results Of 172 PCPs, 117 (68%) completed the online survey and 28 completed semistructured interviews. Most PCPs (77%) reviewed PRO responses with their patients. PCPs endorsed that PROs improve clinic efficiency and clinical management. However, PCPs have heterogeneous perspectives on the relevance of PROs in clinical practice, likely due to variations in clinic practice. For specific PRO instruments, PCPs reported anxiety and depression screening PROs to be most helpful. PCPs felt that PROs assisted with completing screening questions that are required by regulatory bodies. Barriers to using PROs include poor user-interface for both clinicians and patients and inadequate training. Conclusions Most PCPs regularly use PRO data though there are mixed opinions about their clinical relevance. An adaptable, user-friendly PRO system has the potential to have meaningful clinical applications in primary care. [ABSTRACT FROM AUTHOR]

Refugees endure incredible adversity, including torture. Although many refugees report traumatic stress reactions, they also demonstrate considerable resilience. Among refugees, torture survivors have demonstrated greater symptom severity as well as greater resilience than those who have not reported torture. The contrast of these results suggests potential mediators. Psychological inflexibility is one process predictive of posttraumatic stress symptoms. However, this process has rarely been studied among refugees or survivors of torture. Thus, we examined psychological inflexibility as a mediator between torture and traumatic stress symptoms among resettled refugees (n  = 71; 55% female; mean age = 41.48; 63% reported torture). Psychological inflexibility fully mediated the relationship between torture status and traumatic stress symptoms in two simple mediation models. Results demonstrate the impact of psychological inflexibility on refugee mental health and have implications for clinical care. [ABSTRACT FROM AUTHOR]