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Objective: Early intervention with appropriate first aid following burn injury improves clinical outcomes. Previous evidence suggests geographic remoteness may be a barrier to receiving appropriate burns first aid. This study investigated the prevalence of gold standard first aid in patients managed in Australian burn services and whether geographic remoteness was associated with receiving gold standard first aid. Design: Registry‐based cohort study. Setting: Binational clinical quality registry. Participants: Burn‐injured patients admitted to a specialist Australian burn service. Main outcome measures: Receiving gold standard first aid following a burn injury. Results: Approximately two‐thirds of patients received gold standard first aid. Patients whose burns were sustained in very remote regions had a greater risk of receiving no first aid, compared to gold standard first aid, relative to patients who sustained their burn injuries in major cities. Conclusions: Nearly two‐thirds of patients received gold standard burns first aid following injury. However, patients who were injured in the most remote regions of Australia were at an increased risk of not receiving gold standard first aid treatment within 3 hours of injury. Further examination of factors contributing to poorer first aid standards in remote areas is required. [ABSTRACT FROM AUTHOR]

Background: In 2009, the Burns Registry of Australia and New Zealand (BRANZ) published a set of clinical quality indicators (QIs) to monitor performance, improve quality of care, and inform and change policy. With several years of data collected since the initial development of the indicators for burns, the BRANZ QI Working Party reviewed the clinical QIs for relevance and meaning, and considered new QIs that had not been collected previously.Method: Using published literature and expert opinion, the QI Working Party, consisting of multidisciplinary burn clinicians, reviewed the QIs for burn care to be included as routine data items in the BRANZ.Results: In July 2016, the list of clinical QIs in the BRANZ was updated to 23 QIs/data items, covering structure, process, and outcome measures. Four QIs were removed as they were not found to be useful, nine QIs/data items were revised, and eight new QIs/data items were added as they were considered to be clinically useful.Conclusion: This review outlines the changes made to the QIs collected by the BRANZ four years since their development and implementation. Ongoing refinement of the BRANZ QIs will ensure that high quality data is collected to drive improvements in clinical and patient outcomes. [ABSTRACT FROM AUTHOR]

The authors sought to understand rewards and challenges of teaching third-year medical students in the University of Colorado School of Medicine (CUSOM) Denver Health Longitudinal Integrated Clerkship (DH-LIC) compared to teaching in rotation-based clerkships (RBCs). The authors considered implications for the recruitment and retention of faculty in clinical educational programs. Preceptors completed surveys at baseline and year-end. Of eligible faculty, 28 of 40 completed both baseline and year-end surveys. The majority (85.2%) of faculty were satisfied with the DH-LIC and 85.7% continued to teach in year-two of the program. Faculty reported increased satisfaction from teaching and improved teaching and mentoring skills. Faculty familiarity with DH-LIC students was significantly higher than with students previously taught (p = .004); 89.3% of faculty knew their DH-LIC student well enough to tailor instruction to individual learning needs. Teaching techniques utilized at baseline and end of year differed significantly; faculty reported asking questions to promote thinking, providing feedback to students, and providing students with practice in clinical reasoning more frequently in the DH-LIC. Innovative models of education such as LICs offer a strategy to recruit and retain excellent, invested faculty in outpatient settings. [ABSTRACT FROM PUBLISHER]

The clinical setting of pediatric and adolescent gynecology poses complex tasks for the physician with its numerous procedures and the communication demands of interacting with an adolescent and/or guardian. Needless to say, teaching within this setting is highly demanding. Regardless of the level of learner or the professional role (e.g., nurse, medical student, resident, physician assistant) represented, clinical teaching requires that the instructor provide feedback in ways that benefit the student. Recent research on feedback suggests a more complex understanding of feedback than in the past. This article highlights key research and its implication for effective feedback by presenting a three part framework; know your learner, understand what is to be learned, and plan for improvement. [ABSTRACT FROM AUTHOR]

OBJECTIVE We characterized and correlated endothelial progenitor cells (EPCs) and circulating progenitor cells (CPCs) with lack of vascular complications in the Joslin Medalist Study in patients with type 1 diabetes for 50 years or longer. RESEARCH DESIGN AND METHODS EPC and CPC levels were ascertained by flow cytometry and compared among Medalists (n = 172) with or without diabetic retinopathy (DR; n = 84 of 162), neuropathy (n = 94 of 165), diabetic nephropathy (DN; n = 18 of 172), cardiovascular disease (CVD; n = 63 of 168), age-matched controls (n = 83), type 2 diabetic patients (n = 36), and younger type 1 diabetic patients (n = 31). Mitogens, inflammatory cytokines, and oxidative markers were measured in blood or urine. Migration of cultured peripheral blood mononuclear cells (PBMCs) from Medalists and age-matched controls were compared. RESULTS Medalists' EPC and CPC levels equaled those of their nondiabetic age-matched controls, were 10% higher than those in younger type 1 diabetic patients, and were 20% higher than those in age-matched type 2 diabetic patients. CPC levels were 15% higher in Medalists without CVD and nephropathy than in those affected, whereas EPC levels were significantly higher in those without peripheral vascular disease (PVD) than those with PVD. Stromal-derived factor 1 (SDF-1) levels were higher in Medalists with CVD, DN, and DR than in those not affected and their controls. IGF-I levels were lower in Medalists and correlated inversely with CPC levels. Additionally, cultured PBMCs from Medalists migrated more than those from nondiabetic controls. CONCLUSIONS Normal levels of EPC and CPC in the Medalists, unlike other groups with diabetes, especially those without CVD, support the idea that endogenous factors exist to neutralize the adverse effects of metabolic abnormalities of diabetes on vascular tissues. [ABSTRACT FROM AUTHOR]

The article reports the decision of U.S. Court of Appeals for the Second Circuit the court case 'Hooks v. Forman, Holt, Eliades & Ravin, LLC.' It informs that in the decision the court confronted an issue whether of the Fair Debt Collection Practices Act (FDCPA) imposes a writing requirement on a consumer who seeks to challenge the validity of a debt.

The article talks about the direction given by the Guiding Principles for Evaluators of the American Evaluation Association (AEA) for young evaluators. Principle E of the guideline stressed that evaluators must meet the general and public welfare by balancing the needs between clients and other stakeholders. For this reason, Assistant Professor Luanda, evaluator of the educational pilot program Focus On Our Learning, should balance the interests among members of the youth evaluation team, teachers and the school district.

Introduction: This study investigated which patient and injury characteristics are associated with 12-month mortality rates and living independently after isolated hip fracture.Methods: Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E.Results: 4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability.Conclusions: Characteristics that are associated with social disadvantage, frailty, poor health and reduced independence before injury were associated with increased rates of death and reduced odds of living independently 12 months after isolated hip fracture. [ABSTRACT FROM AUTHOR]

Phenomenon: Integral to the formation of a professional identity is the concept of professional identity construction, an essential part of becoming a competent physician. In this framework, identity is dynamic and shaped by experiences and relationships. Minimal work has addressed the impact that clinical care settings and relationships with patients have in the construction of professional identity for medical students. This study explores how patient interactions and intentional curriculum design support professional identity construction in students participating in a longitudinal integrated clerkship focused on care for the underserved. Approach: This qualitative analysis investigated students' professional identity construction as detailed in 45 reflective essays from 15 students while enrolled in an 11-month longitudinal integrated clerkship (LIC) in a safety-net hospital system. Researchers used an inductive analytic approach. Findings: Students provided rich and complex descriptions of their experiences. Six themes emerged: care for the underserved; therapeutic alliance; humility and gratitude; altruism; resilience; and aspirations. Insights: Professional identity construction was observable through students' reflective essays. Student interactions with patients provided rich material for professional identity construction, and role models in patient care enhanced this process. This study suggests that clinical learning in a safety-net hospital system, coupled with an LIC curriculum that prioritizes continuity with vulnerable patients, faculty role models, and ongoing reflection, supported the professional identity construction of students as patient-centered caregivers providing equitable care and advocacy for the underserved, described here as an Equity Identity. [ABSTRACT FROM AUTHOR]

Background: Persistent pain and mental health conditions often co-occur after injury, cause enormous disability, reduce social and economic participation, and increase long-term healthcare costs. This study aimed to characterise the incidence, profile and healthcare cost implications for people who have a treated mental health condition, persistent pain, or both conditions, after compensable transport injury.Methods: The study comprised a population cohort of people who sustained a transport injury (n = 74,217) between 2008 to 2013 and had an accepted claim in the no-fault transport compensation system in Victoria, Australia. Data included demographic and injury characteristics, and payments for treatment and income replacement from the Compensation Research Database. Treated conditions were identified from 3 to 24-months postinjury using payment-based criteria developed with clinical and compensation system experts. Criteria included medications for pain, anxiety, depression or psychosis, and services from physiotherapists, psychologists, psychiatrists, and pain specialists. The data were analysed with Cox Proportional Hazards regression to examine rates of treated conditions, and general linear regression to estimate 24 month healthcare costs.Results: Overall, the incidence of treated mental health conditions (n = 2459, 3.3%) and persistent pain (n = 4708, 6.3%) was low, but rates were higher in those who were female, middle aged (35-64 years), living in metropolitan areas or neighbourhoods with high socioeconomic disadvantage, and for people who had a more severe injury. Healthcare costs totalled more than $A707 M, and people with one or both conditions (7.7%) had healthcare costs up to 7-fold higher (adjusting for demographic and injury characteristics) in the first 24 months postinjury than those with neither condition.Conclusions: The incidence of treated mental health and persistent pain conditions was low, but the total healthcare costs for people with treated conditions were markedly higher than for people without either treated condition. While linkage with other public records of treatment was not possible, the true incidence of treated conditions is likely to be even higher than that found in this study. The present findings can be used to prioritise the implementation of timely access to treatment to prevent or attenuate the severity of pain and mental health conditions after transport injury. [ABSTRACT FROM AUTHOR]