Heterogeneity In Training Research Articles

Unveiling healthcare insights for patients and practitioners: a pilot study.

Doctors in the UK experience significant heterogeneity in training. Whilst core curricula underpin specialty training, diversity in clinical attachments results in a heterogeneous knowledge base and variation in local practice. Some insights or practices, which have the potential to improve patient care, but which only exist anecdotally or in local rather than national guidance, remain undiscovered and underutilised. To aggregate examples of such clinical insights; To assess the extent of recommendation and evidence for these insights; To raise awareness of underutilised clinical insights, to highlight areas for further study and dissuade the use of inappropriate or un-evidenced practices. A qualitative survey seeking free text responses, open to all UK healthcare professionals, was disseminated opportunistically. Responses were recorded and the insights were assessed against the existing evidence base, cost and potential for harm. 29 clinical insights were collated across multiple specialties. Some already formed part of national guidance, but appeared to be underutilised, while others appeared only in local or international guidance. Evidence for some insights was compelling, but often mixed, whilst almost all were rated as low cost and low risk. We uncovered a range of lesser-known clinical insights across a range of specialties, as well as some less well-evidenced practices. Many insights have the potential to positively impact patient care, particularly in general practice. There is a clear opportunity to draw attention to those insights which offer low-cost, low-risk and potentially effective treatments, whilst highlighting opportunities to further study less well-evidenced insights and practices.

Match-play, training workloads and sensorimotor and neuromuscular performance of elite young soccer players

Purpose: The purpose of this study was to assess sensorimotor and neuromuscular performance capabilities over an in-season microcycle in early-career professional soccer players and to examine the relationship with training and match-play workload. Methods: Sensorimotor and neuromuscular performance capabilities (isometric knee extensor: force replication error, peak force, electromechanical delay, rate of force development) of 12 professional soccer players were assessed over a 7-day period. Training and match-play workload was also recorded over the same period for each player (high-intensity running distance). Fluctuations in sensorimotor and neuromuscular performance and workload variables were analysed. Results: There was evidence of fluctuations in sensorimotor and neuromuscular performance capability over the microcycle that reached statistical (p < .005) and practical (18.1% [baseline-to-peak]) significance alongside heterogeneity in training and match workload (264% [coefficient of variation], p < .0005). Some temporal congruence among fluctuating patterns of intra-microcycle training and match-play load and concomitant electromechanical delay performance was noted (p < .005). Asynchronous responses were observed for peak force, but rate of force development and force replication error capabilities were unchanged during the microcycle. Conclusion: While some neuromuscular performance capabilities fluctuate over an in-season microcycle and are influenced partially by high-intensity running workload, sensorimotor performance capabilities were unchanged during the microcycle.

Education and Training in Addiction Medicine and Psychology across Europe: A EUFAS Survey

Introduction: Training in addiction medicine and addiction psychology is essential to ensure the quality of treatment for patients with substance use disorders. Some earlier research has shown varying training between countries, but no comprehensive study of addiction training across Europe has been performed. The present study by the European Federation for Addiction Societies (EUFAS) aimed to fill this gap. Methods: A Delphi process was used to develop a questionnaire on specialist training in addiction treatment in 24 European countries. The final questionnaire consisted of 14 questions on either addiction medicine or addiction psychology, covering the nature and content of the training and institutional approval, the number of academic professorial positions, and the estimated number of specialists in each country. Results: Information was not received from all countries, but six (Belgium, Denmark, Ireland, Italy, Poland, and Romania) reported no specialized addiction medicine training, while 17 countries did. Seven countries (Belgium, France, Ireland, Italy, Russia, Switzerland, and the Netherlands) reported no specialized addiction psychology training, while 14 countries did. Training content and evaluation methods varied. Approval was given either by governments, universities, or professional societies. Eighteen countries reported having professorships in addiction medicine and 12 in addiction psychology. The number of specialists in addiction medicine or psychology varied considerably across the countries. Discussion: The survey revealed a large heterogeneity in training in addiction medicine and addiction psychology across Europe. Several countries lacked formal training, and where formal training was present, there was a large variation in the length of the training. Harmonization of training, as is currently the case for other medical and psychology specializations, is warranted to ensure optimal treatment for this under-served patient group.

Remote cognitive training for children with congenital brain malformation or genetic syndrome: a scoping review.

Increased attention is arising on the delivery of remote cognitive interventions, which allow performing exercises in everyday settings, favouring rehabilitation continuity. The present study offers an overview of remote cognitive training programs for children with congenital brain malformation or genetic syndrome affecting the central nervous system, included in papers published in the time period 2011-2021. A total of 13 records was found and discussed including efficacy studies, feasibility studies and study protocols. Many studies have focused on a specific diagnosis, such as cerebral palsy, Down Syndrome, Fragile X Syndrome, while no or little evidence has been gathered on more rare diseases or brain malformations. Interventions were found to generate benefits on some cognitive functions, but problems with adherence were highlighted, especially due to excessive cognitive load from the training or clinical comorbidities. Conclusions remain tentative due to heterogeneity in training, study and patients characteristics, and methodological limitations of studies.

Neuromuscular Performance and Training Workload Over an In-Season Mesocycle in Elite Young Soccer Players.

The purpose of this study was to assess neuromuscular performance capabilities over an in-season mesocycle in early-career professional soccer players and examine the relationship with training workload. Neuromuscular performance capabilities (isometric knee extensor: peak force, rate of force development, and peak twitch force) of 12 professional soccer players were assessed weekly over a 6-week period. Training and match workload were also recorded over the same period for each player (high-intensity running distance). Changes in neuromuscular performance and workload variables were analyzed. There was evidence of fluctuations in neuromuscular performance capability over the mesocycle that reached statistical (P < .05) and practical (13.3% [peak-to-peak]) significance alongside interweek heterogeneity in training and match workload (∼17.5% [coefficient of variation], P < .05). Congruence among fluctuating patterns of intramesocycle training load and concomitant neuromuscular performance responses was noted over time for acute training load and acute:chronic workload ratio with peak force and rate of force development. Neuromuscular performance capabilities fluctuate over an in-season mesocycle and are influenced by high-intensity running workload, emphasizing the need for acute monitoring in elite soccer players.

Technology-Based Psychological Interventions for Young Adults With Early Psychosis and Cannabis Use Disorder: Qualitative Study of Patient and Clinician Perspectives.

BackgroundThe persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability.ObjectiveThe aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention.MethodsA total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers.ResultsData were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians).ConclusionsThis study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis.

Training Pathways to Working as a General Practitioner in China

To achieve the goal of 300,000 general practitioners by 2020-an increase of 215,200 in a decade-China is utilizing multiple training pathways. To comprehensively illustrate general practitioner training strategies in China, this article introduces and describes these pathways. We used descriptive policy analysis. This involved taking an inventory of existing literature and source documents and developing a model to illustrate pathways for training general practice physicians. The rural doctor pathway represents rural clinicians who had only basic training and practiced multiple years prior to training reforms. The 3+2 pathway to assistant general practitioners requires 3 years of junior college and 2 years of clinical training. The transfer pathway for current physicians requires 1-2 years of training. The 5+3 pathway comprises 5 years of bachelor of science degree training in clinical medicine and 3 years of standardized residency training. Despite the development of advanced degree programs, their use remains limited. These pathways illustrate significant heterogeneity in training of general practitioners. Training ranges from a 2-year technical degree to a doctorate with research. Emphasis on the 5+3 track shows promise for China's goals of improved quality and new goal of 500,000 additional general practitioners by 2030.

Consultation-liaison psychiatry in India: Where to go from here?

Consultation–liaison psychiatry (CLP) is a young and upcoming subspecialty of psychiatry. When one looks at the history of CLP in India, the progress in the area of CLP paralleled that seen in various developed countries. However, over the years, compared to developed countries, CLP started lagging behind in India. In India, CLP services are mostly been provided as per the consultation model and true liaison model practice is missing. There has been meager research in the area of CLP in India, and there is marked heterogeneity in training across different centers. There is lack of specialized training programs in this country. Considering the increasing emphasis on providing person-centered care, there is a need to shift the focus of training from identifying and managing only primary psychiatric disorders to interphase of psychiatry and other disciplines.

Food Safety Challenges within North American Free Trade Agreement (NAFTA) Partners

Abstract: Organizational elements and limitations influencing the effective operation of the food safety regulatory infrastructures in the United States, Canada, and Mexico are compared. Progress to improve the safety of food in North American countries is hampered by common problems, yet differences exist. Foodborne illness surveillance and reporting are most comprehensive in the United States, but it is uniformly more reactive than proactive in all 3 countries. Food safety policy is based on outbreak data, but that may be short‐sighted because these represent roughly 10% of foodborne illness cases. Food inspection in each country is done at 2 tiers (federal and other) by many agencies at 3 (federal/state‐provincial/municipal) levels. Interagency collaboration at times of crisis is weak and frequent heterogeneity in training, inspection targets, and inspection rigor affect regulatory credibility. Enhanced recognition that industry has the prime responsibility for food safety is warranted (and must not be confused with self‐inspection) along with justifiably aggressive regulatory agency interrogation of food safety system performance. End product testing should be used to verify safety system operation and should not be used to predict product safety. Specific microbial and nonmicrobial challenges to safe food in North America are highlighted and a rationalization of fiscal/human resource allocation to most effectively reduce the burden of foodborne illness is provided.