Individual Specialties Research Articles

Evolution of gender representation among Canadian OTL-HNS residents: a 27-year analysis

BackgroundThe proportion of females enrolling into medical schools has been growing steadily. However, the representation of female residents among individual specialties has shown considerable variation. The purpose of this study was to compare the trends of gender representation in Otolaryngology – Head and Neck Surgery (OTL-HNS) residency programs with other specialty training programs in Canada. In order to contextualize these findings, a second phase of analysis examined the success rate of applicants of different genders to OTL-HNS residency programs.MethodAnonymized data were obtained from the Canadian Residency Matching Service (CaRMS) and from the Canadian Post-M.D. Education Registry (CAPER) from 1988 to 2014. The differences in gender growth rates were compared to other subspecialty programs of varying size. Descriptive analysis was used to examine gender representation among OTL-HNS residents across years, and to compare these trends with other specialties. Bayesian hierarchical models were fit to analyze the growth in program rates in OTL-HNS based on gender.ResultsCaRMS and CAPER data over a 27 year period demonstrated that OTL-HNS has doubled its female representation from 20% to 40% between 1990 and 1994 and 2010-2014. The difference in annual growth rate of female representation versus male representation in OTL-HNS over this time period was 2.7%, which was similar to other large specialty programs and surgical subspecialties. There was parity in success rates of female and male candidates ranking OTL-HNS as their first choice specialty for most years.ConclusionsFemale representation in Canadian OTL-HNS residency programs is steadily increasing over the last 27 years. Large variation in female applicant acceptance rates was observed across Canadian universities, possibly attributable to differences in student body or applicant demographics. Factors influencing female medical student career selection to OTL-HNS require further study to mitigate disparities in gender representation and identify barriers to prospective female OTL-HNS applicants.

The relationship of forensic odontology with various dental specialties in the articles published in a National and an International Forensic Odontology Journal: A 5-year content analysis.

Aims:The aim of this study is to assess the quantum of articles published by various dental specialties in a National and an International Forensic Odontology Journal from January 1, 2010, to December 31, 2014.Settings and Design:The present study is a 5-year retrospective content analysis study.Subjects and Methods:Data were collected from two forensic odontology journals (Journal of Forensic Odonto Stomatology [JOFS] and Journal of Forensic Dental Sciences [JFDS]) which are subscribed by institutional library. The article contents were scrutinized by one investigator and categorized into nine individual dental specialties based on the new working classification proposed for forensic odontology.Statistical Analysis Used:The quantum of articles published by various dental specialties and the various focus areas in each specialty were assessed using Chi-square test.Results:Among all the published articles, a maximum number of articles were related to the Department of Oral Medicine and Radiology (32.6%) in JFDS with Cheiloscopy (46.7%) being more focused area and to the Department of Prosthodontics (25.7%) in JFOS with Bite mark analysis (66.7%) being more focused area.Conclusions:There was a scarcity of information about the relationship of forensic odontology with various dental specialties in the articles published in JFDS and JFOS. The editorial board of journals should expand and elaborate their scope of journals to various focus areas of forensic odontology. This will encourage the researchers to explore in the different focus areas which are most neglected as of now.

Survey of consultants regarding Emergency Medicine (EM) educational program system change in private hospital setting

Emergency Medicine (EM) is an officially recognized medical specialty in over 60 countries, with the rate of specialty recognition accelerating in recent years. EM care delivery systems are specifically focused on managing the acute consequences of non-communicable as well as communicable disease processes, and therefore represent an important public health tool for reducing the present and future global. According to the 2006 World Health Organization studies on the Global Burden of Disease, worldwide demographic and epidemiologic shifts now show non-communicable diseases to have become the single largest cause of morbidity and mortality worldwide. At Max Health Care, George Washington University started a 3 years Master course in Emergency (MEM International) since 2008. Aim: Efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. Primary objective: Has MEM Educational program at Max Health Care brought an Improvement in patient care in Max Emergency Department? Secondary objective: Factors which can help in Improving Quality of course. Inclusion criteria: Consultants of any Specialty worked for more than 2 years in Max Health care. Exclusion criteria: Senior resident and Junior resident of other specialty Incompletely filled survey form. Methods: It was an observational study and questionnaire in Annexure 1 was used for the survey. The questionnaire will be given to 49 consultants of various departments in Max Group. Data has shown that 91.86% of Consultants have accepted that the course has brought improvement. Private Health sector has accepted Emergency Medicine as an Individual Specialty. 4 areas of suggestion turned up at final assessment: More hands-on training in Ultrasound Gynecology, Pediatrics and Anesthesia - advised more dedicated training time in their specialties Internal Medicine and Critical Care suggested follow up till discharge. Increased emphasis on communication skills.

Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study.

In many healthcare systems, treatment recommendations for cancer patients are formulated by multidisciplinary tumor boards (MTBs). Evidence suggests that interdisciplinary contributions to case reviews in the meetings are unequal and information-sharing suboptimal, with biomedical information dominating over information on patient comorbidities and psychosocial factors. This study aimed to evaluate how different elements of the decision process affect the teams' ability to reach a decision on first case review. This was an observational quantitative assessment of 1045 case reviews from 2010 to 2014 in cancer MTBs using a validated tool, the Metric for the Observation of Decision-making. This tool allows evaluation of the quality of information presentation (case history, radiological, pathological, and psychosocial information, comorbidities, and patient views), and contribution to discussion by individual core specialties (surgeons, oncologists, radiologists, pathologists, and specialist cancer nurses). The teams' ability to reach a decision was a dichotomous outcome variable (yes/no). Using multiple logistic regression analysis, the significant positive predictors of the teams' ability to reach a decision were patient psychosocial information (odds ratio [OR] 1.35) and the inputs of surgeons (OR1.62), radiologists (OR1.48), pathologists (OR1.23), and oncologists (OR1.13). The significant negative predictors were patient comorbidity information (OR0.83) and nursing inputs (OR0.87). Multidisciplinary inputs into case reviews and patient psychosocial information stimulate decision making, thereby reinforcing the role of MTBs in cancer care in processing such information. Information on patients' comorbidities, as well as nursing inputs, make decision making harder, possibly indicating that a case is complex and requires more detailed review. Research should further define case complexity and determine ways to better integrate patient psychosocial information into decision making.

Variation in Specialty Outpatient Care Patterns in the Medicare Population.

Multiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care. To describe regional variation in outpatient visits for individual specialties and the association between specialty physician-specific payments and patient-reported satisfaction with care and health status. Retrospective cross-sectional study. A 20% random sample of Medicare fee-for-service beneficiaries in 2012. Regions were grouped into quartiles of specialist index, defined as the observed/expected regional likelihood of having an outpatient visit to a specialist, for ten common specialties, adjusting for age, sex, and race. Outcomes were per capita specialty-specific physician payments and Medicare Current Beneficiary Survey responses. The proportion of beneficiaries seeing a specialist varied the most for endocrinology and gastroenterology (3.7- and 3.9-fold difference between the highest and lowest quartiles, respectively) and least for orthopedics and urology (1.5- and 1.7-fold difference, respectively). Multiple analyses suggested that this variation was not explained by prevalence of disease. Average specialty-specific payments were strongly associated with the likelihood of visiting a specialist. Differences in per capita payments from lowest (Q1) to highest quartiles (Q4) were greatest for cardiology ($89, $135, $172, $251) and dermatology ($46, $64, $82, $124). Satisfaction with overall care (median [interquartile range] across specialties: Q1, 93.3% [92.6-93.7%]; Q4, 93.1% [92.9-93.2%]) and self-reported health status (Q1, 37.1% [36.9-37.7%]; Q4, 38.2% [37.2-38.4%]) was similar across quartiles. Satisfaction with access to specialty care was consistently lower in the lowest quartile of specialty index (Q1, 89.7% [89.2-91.1%]; Q4, 94.5% [94.4-94.8%]). Substantial regional variability in outpatient specialist visits is associated with greater payments with limited benefits in terms of patient-reported satisfaction with care or reported health status. Reducing outpatient physician visits may represent an important opportunity to improve the efficiency of care.

Survey of e-learning implementation and faculty support strategies in a cluster of mid-European medical schools.

BackgroundThe use of electronic learning formats (e-learning) in medical education is reported mainly from individual specialty perspectives. In this study, we analyzed the implementation level of e-learning formats and the institutional support structures and strategies at an institutional level in a cluster of mid-European medical schools.MethodsA 49-item online questionnaire was send to 48 medical schools in Austria, Germany and Switzerland using SurveyMonkey®. Data were collected between February and September of 2013 and analyzed using quantities, statistical and qualitative means.ResultsThe response rate was 71 %. All schools had implemented e-learning, but mainly as an optional supplement to the curriculum. E-learning involved a wide range of formats across all disciplines. Online learning platforms were used by 97 % of the schools. Full-time e-learning staff was employed by 50 %, and these had a positive and significant effect on the presence of e-learning in the corresponding medical schools. In addition, 81 % offered training programs and qualifications for their teachers and 76 % awarded performance-oriented benefits, with 17 % giving these for e-learning tasks. Realization of e-learning offers was rewarded by 33 %, with 27 % recognizing this as part of the teaching load. 97 % would use curriculum-compatible e-learning tools produced by other faculties.ConclusionsWhile all participating medical schools used e-learning concepts, this survey revealed also a reasonable support by institutional infrastructure and the importance of staff for the implementation level of e-learning offerings. However, data showed some potential for increasing tangible incentives to motivate teachers to engage in further use of e-learning. Furthermore, the use of individual tools and the distribution of e-learning presentations in various disciplines were quite inhomogeneous. The willingness of the medical schools to cooperate should be capitalized for the future, especially concerning the provision of e-learning tools and concepts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0420-4) contains supplementary material, which is available to authorized users.

The dental specialties related articles published in Medical Journal Armed Forces India from 2000 to 2014 over a 15-year period

There is a paucity of information about the dental specialties related articles published in the Medical Journal Armed Forces India (MJAFI). This study aimed to audit the dental specialities related articles published in MJAFI from 2000 to 2014 over a 15-year period. Bibliometric analysis of sixty issues of MJAFI from 2000 to 2014 were performed using web-based search. The articles published were analyzed for type of article and topic of individual dental specialities. The articles published were also evaluated to identify whether the study was an Armed Forces Medical Research Committee Project or funded research project or not. Out of the total 118 published articles related to dental specialities, original articles (55) and case reports (49) contribute the major share. The highest number of dental specialities related articles was published in 2009 with 16, followed by 2010 with 13 and 2011 with 11 and the least published year was 2013 with 3 articles. Regarding the relationship with dental specialities, the maximum number of published articles were related to oral medicine and radiology (56) followed by oral and maxillofacial surgery (49), orthodontics (23) and prosthodontics (17). Among the articles published in MJAFI, maxillofacial injuries (11) followed by orthodontic treatment (8) and craniofacial deformities (8) form the major attraction of the contributors. Among the 118 dental speciality articles, there were only 4 Armed Forces Medical Research Committee Project articles and 19 funded research project articles. An equal distribution of articles related to clinical dentistry and nonclinical dentistry is maintained for the MJAFI from 2000 to 2014 over a 15-year period.

Medicare innovation center oncology care model: a toe in the water when a plunge is needed.

For too long, physician payment reforms have tried to develop one-size-fits-all solutions, with the end result being that physicians have been asked to adhere to guidelines or quality measures that bore little resemblance to their day-to-day practice and as a result had minimal impact on the value of care provided to patients. The Centers for Medicare and Medicaid Services (CMS) is to be commended for its recent efforts to develop specialty-specific payment models that could address the unique barriers and opportunities that individual specialties face in providing the high-value, cost-effective care that Medicare beneficiaries deserve. In this issue of Journal of Oncology Practice, Kline et al describe the Oncology Care Model (OCM), which is the approach that the CMS has developed for payment reform in oncology. The OCM payment model has the following three components:

Guidance on Performing Focused Ethnographies with an Emphasis on Healthcare Research

Focused ethnographies can have meaningful and useful application in primary care, community, or hospital healthcare practice, and are often used to determine ways to improve care and care processes. They can be pragmatic and efficient ways to capture data on a specific topic of importance to individual clinicians or clinical specialties. While many examples of focused ethnographies are available in the literature, there is a limited availability of guidance documents for conducting this research. This paper defines focused ethnographies, locates them within the ethnographic genre, justifies their use in healthcare research, and outlines the methodological processes including those related to sampling, data collection and maintaining rigour. It also identifies and provides a summary of some recent focused ethnographies conducted in healthcare research. While the emphasis is placed on healthcare research, focused ethnographies can be applicable to any discipline whenever there is a desire to explore specific cultural perspectives held by sub - groups of people within a context - specific and problem - focused framework.

Pre Hospitalization of the Pediatric Patient and Guidelines Pediatric Anesthesia in Our Center. We do Routinely

Modern techniques of anesthesia and the use of safer drugs, along with the pronouncement of numerous national and international scientific societies, allow to say with absolute certainty that many blood chemistry and instrumental investigations are absolutely useless [1]. The Society of Anesthesiology and Intensive Care Neonatal and Pediatric Italian (SARNePI) said: “Outside of special cases related to individual specialties (neurosurgery, cardiac surgery and major surgery in general), the budget preanestesiologico usual, in patients over the age of 12 months, measures of election may not necessarily require the execution of blood tests and instrumental. “

Medical student perception of physician values in practice by individual characteristics and preferred medical specialty field

Medical students' values figure prominently in their choice of medical specialty; yet, little research has been performed on this topic. The purpose of this study was to analyze the differences in values according to medical students' individual characteristics (medical educational system, gender, and grade) and preferred medical specialty. A total of 905 medical students participated in the study; 426 were graduate-entry medical students (GEMS), and 479 were undergraduate medical students (UMS). Further, 561 were male and 316 were female; 356 were in year 1, 219 were in year 2, 230 were in year 3, and 100 were in year 4. Students completed the Physician Values in Practice Scale (PVIPS). The PVIPS comprises six dimensions: autonomy, management, prestige, service, lifestyle, and scholarly pursuits. The data were analyzed by t-test and analysis of variance. GEMS had higher scores for service, management, and scholarly pursuits than UMS. Males had higher scores for prestige, lifestyle, and management, whereas female scored higher on service and scholarly pursuits. Higher grade was associated with increased scores for prestige, lifestyle, and management. The differences in lifestyle and scholarly pursuits were significant between preferred specialties. Students in support specialties scored significantly higher on lifestyle. With regard to scholarly pursuits, basic science specialties scored significantly higher than other specialties. There were significant differences in PVIPS according to individual characteristics and preferred medical specialty. This result could be useful in developing a medical specialty choice program for medical students.

Descriptive analysis of 30-day readmission after inpatient surgery discharge in the Veterans Health Administration.

For the first time to our knowledge, this study analyzes and reports the 30-day all-cause readmission rates for surgical procedures performed in the Veterans Health Administration (VHA). To analyze and report 30-day all-cause readmission rates following discharge from 9 surgical specialties in the VHA for a 10-year period. In a retrospective observational study, Veterans Affairs Surgical Quality Improvement Program data for surgery records and VHA administrative discharge data were linked to evaluate all-cause readmission within 30 days of discharge from the surgical inpatient stay. The study population represents 9 surgical specialty groups: general, urology, neurosurgery, orthopedic, otolaryngology, plastic, thoracic, peripheral vascular, and cardiac. Trends of postoperative hospital admission rates for each surgery were investigated using 10 years (fiscal years 2001-2010; N = 894,943) of linked data. All-cause 30-day readmission after surgery for each specialty. During the 10-year period, the overall 30-day all-cause readmission rate following inpatient surgery discharge significantly decreased from 12.9% to 12.2% (P < .001). Unadjusted readmission rates varied by surgical specialty: general, 12.5%; urology, 9.0%; neurosurgery, 10.5%; orthopedic, 9.6%; otolaryngology, 9.5%; plastic, 12.2%; thoracic, 14.4%; peripheral vascular, 16.0%; and cardiac, 16.6%. The following specialties were found to have a significant decline in readmission rates: orthopedic (P = .004), otolaryngology (P = .005), plastic (P = .02), thoracic (P = .04), peripheral vascular (P < .001), and cardiac (P = .003). Postoperative hospital length of stay in individual specialties decreased during this period (each P < .05) except for thoracic and cardiac surgery, which remained unchanged. Readmission diagnoses varied by specialty; postoperative infection was the most common readmission diagnosis in 7 specialties and the second most common in the other 2 specialties (urology and thoracic). Urinary tract infection and digestive system complications were also common readmission diagnoses. This retrospective observational study showed decreasing 30-day readmission rates associated with a decline in postoperative hospital length of stay for 9 surgical specialties in the VHA during a 10-year period. Further study will be required to capture data from patients who had surgery at a VHA facility but were readmitted in the private sector.

Návrh úpravy rozsahu výstrojních náležitostí

The article introduces a variant of alternative accoutrements provided to the soldiers of the Army of the Czech Republic to replenish and compensate individual standardized items. The article proposes changes in furnishing soldiers, so that they would take into account their individual occupational specialities and predominant types of used military uniforms. Even though the authors use a simplified model in this paper, the final version of accoutrement modification represents the updating of the current law regulations.

Advanced practice in nursing.

Advanced practice in nursing is a particular level of practice between that of a senior practitioner and consultant (Scottish Government, 2009). There are many different posts across the NHS in the UK where nurses operate at an advanced level, not all of which are clinical posts. Most organisations will have developed an advanced nursing practice strategy or plan to ensure they are aligned with relevant national government/assembly policy. Many advanced nurse practitioner (ANP) roles are critical to the delivery of high-quality nursing care. The Scottish Government’s Advanced Nursing Practice Roles: Guidance for NHS Boards (Scottish Government, 2010) sets out the strategy for advanced nursing practice for the next 5 years and beyond. The Modernising Nursing Careers Advanced Practice Toolkit, which was lead by the Chief Nursing Officer for Scotland, on behalf of the four UK Chief Nursing Officers, has clarified that advanced practice is a particular stage on a continuum between novice and expert. A ‘specialist’ can be considered as one pole on the specialist-generalist continuum and therefore does not represent a specific level of practice. Therefore both specialists and generalists can perform at an advanced level of practice. Individuals working at advanced practice level should show evidence of Master’s-level learning, such as studying at postgraduate certificate or diploma level while working towards a Master’s. All ANPs in all organisations will be expected to undertake continuing professional development (CPD) and be expected to evidence this through the annual Personal Development Plan (PDP) process. Although CPD does not have to be accredited, ANPs may wish to consider how they would evidence Master’s level learning if their initial education for the role was not at this level. For CPD, ANPs could, for example: ■ Undertake a Master’s level module or programme (PgC, PgD or Master’s) ■ Put together a portfolio of evidence to demonstrate Master’s-level thinking and submit to a higher education institution for Recognition of Prior Learning ■ Undertake a Master’s level CPD unit ■ Undertake an unaccredited or degree-level CPD unit ■ Undertake self-directed learning (reading, audit, research study, unaccredited online education), providing that learning is evidenced. There is no doubt that most appointees to ANP posts will require additional education for the role. Where an appointee has not completed an Approved Programme of Preparation (APP) for the role, they should be appointed to a training post. Different models of training posts exist and can be used. Rory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division Each model should have the following principles: ■ Ensure that there is an APP associated with the training post ■ Make clear what the ANP trainee must achieve to complete the training post ■ Clearly set out the timescales to complete the APP ■ Ensure the ANP trainee is appropriately remunerated when the training post is satisfactorily completed ■ Ensure the ANP trainee has an agreed job plan in place that includes appropriate study leave for the APP ■ Details around clinical supervision and arrangements for supervised practice ■ Ensure the APP is fully funded at the outset ■ Organisations/service areas are at liberty to select a training post model that suits local needs. Before any new ANP role is created, there should be evidence that the service requires such a role. NHS Education for Scotland has developed the Advanced Nursing Practice Service Needs Analysis Tool (NHS Education for Scotland, 2010) that will help clinical areas to create a robust business case. One of the major challenges for workforce planners in the area of advanced practice has been the ambiguity surrounding the role. The Advanced Practice Toolkit (NHS Education for Scotland, 2010) and NHS organisations will have an advanced nursing practice strategy or plan that will aim to reduce that ambiguity, but it will ultimately be down to individual clinical specialties to specify the remit of an ANP within that specialist area. However, there must be broad parity across specialist areas and all advanced practice roles should not be developed in isolation. The organisation/service area should identify a suitable steering group that will develop a formal proposal for any new advanced practice role (or significant change to an existing role). Steering groups should include representatives of all relevant stakeholders. Advice can be sought from a range of informal and formal, local and national groups. New roles (or significant changes to existing roles) should be approved through general management and professional structures. Any development should be able to assure that a safe, effective and personand family-centred approach has been taken. BJN

Imej Karakter Animasi Jepun (Anime) dalam Kalangan Remaja di Selangor

Japanese animation or anime started to gain interest among teenagers and adults since 1990s. Now the popularity increases parallel with the new technologies. This paper looks into the outcome of conversatsion among the students at two secondary schools in Selangor, Malaysia. The students were chosen based on the questionnaire. 34 students were selected based on their answers from the questionaire. Based on the interview session, they were fanatic fans of animation and manga. The results of the study revealed that they were five main characteristics in anime characters that the liked; bravery, hardworking, sense of humour, appreciative in relationship as well as individual speciality.

Specialty-Specific Trends in the Prevalence and Distribution of Outpatient Surgery

With nearly 53 million ambulatory procedures performed annually, future efforts to achieve greater value in surgical care should include a focus on outpatient surgery. To inform such efforts, a better understanding of specialty-specific trends in outpatient surgery is required. To assess the prevalence and distribution of outpatient surgery across specialties. Repeated cross-sectional. Using all-payer data from Florida (1998-2008), we identified physicians who performed one or more procedures. We assigned a specialty to each physician based on his procedure mix. After measuring the proportion of procedures performed on an outpatient basis, we assessed for specialty-specific changes over time in this proportion. Finally, we determined the frequency with which individual specialties used surgery centers for their outpatient care. More than two thirds (67.8%) of all surgical procedures are carried out on an outpatient basis. The popularity of outpatient surgery has grown among many specialties over the past decade, including several (urology, gastroenterology, plastic surgery, and ophthalmology) that perform most of their cases in outpatient settings. Within surgical disciplines, overall trends in the use of outpatient surgery are strongly associated with the specialty's affinity for freestanding ambulatory surgery centers (Pearson's correlation coefficient = 0.76; P < .001). A majority of surgeons in many specialties now provide predominantly outpatient care. Incorporating these findings into the design of future payment and delivery system reforms will help ensure adequate surgeon exposure to the efficiency gains that evolve from them.

INCREASING ACCESS TO SPECIALIST PALLIATIVE CARE FOR PATIENTS WITH NON-MALIGNANT DISEASE: A ‘BIG BANG’ APPROACH

BackgroundAccess to specialist palliative care for patients with advanced non-cancer diagnoses is much lower than for those with cancer, despite a similar symptom burden and poor health-related quality of life....

Honoring the past: A prologue for the future of neuroscience nursing.

The 1870s marked the first report of neurological nursing. Sir Victor Horsley, a neurosurgeon at the National Hospital in Queens's Square London, invited nurses to observe neurosurgery to better care for these patients postoperatively. The National Hospital in Queens's Square quickly became a recognized center for neurological care and was the first neurological institute in the world. Concurrently, nurses learned from Dr. Charcot at Salpetriere in Paris. In both cases, the education was informal through physicians imparting information, but nurses began to learn principles of neuroscience patient care. Europe became the hub of modern medicine serving as centers for medical education and breakthroughs attracting the best renowned physicians. It was also a time when neurology and psychiatry were closely intertwined as one science, an entanglement that would take many decades to separate into individual specialties. The development of neurosurgery was instrumental in fostering neurological nursing's development. Physicians trained in Europe returned to the United States with new neurological knowledge, and became recognized leaders especially in neurosurgery. As neurosurgery and neurology developed, it became clear that specially trained nurses were needed to care for these patients. Neurological nursing began to emerge as a subspecialty in the United States with informal lectures by physicians gradually emerging into more formalized education. In the early 1900s, Dr. Charles Mills lectured to nurses about the care of patients with neurological disease at the Philadelphia General Hospital. The course content became a book entitled The Nursing and Care of the Nervous and the Insane published in 1889. Dr. Mills wrote, “in no class of cases is it more important for a nurse, caretaker, or companion to have good principles of action and clear notions of practice, than among patients suffering from nervous or mental afflictions.” Technology in the form of invasive blood pressure monitoring, let alone ICP monitoring did not exist. Consequently, nursing care relied on close observation of patients and changes in the level of consciousness (LOC), the most sensitive neurological indicator of change and other subtle changes, to be communicated to the physician. The New York Neurological Institute was founded in 1909; Amy Hilliard became the first superintendent of nurses in 1910. She organized the first postgraduate course in the care of patients with nervous system diseases for nurses taught by physicians. Papers, based on these lectures, were published in the American Journal of Nursing in 1911; other publications followed. In 1910, Dr. Harvey Cushing performed the first transspenoidal approach for pituitary tumors. In 1923, neurosurgeon, Dr. Dandy, opened the first specialized care unit for postoperative neurosurgical care at Johns Hopkins Hospital in Baltimore, Maryland. Neurological nursing took root as the subspecialties of neurology and neurosurgery continued to develop fueled by the needs of soldiers from the World Wars. Both physicians and nurses recognized the need for informed nurses to care for neurological patients. In the 1960s, a few universities began to offer master's degrees in neurological and neurosurgical nursing. Critical care units began to appear in the 1960s first as coronary care units. It was not until the 1970s that neurological intensive care units (NICU) were established. Many landmarks followed for neuroscience nurses: American Association of Neurological Nurses (AANN) founded (1968) and name changed to American Association of Neuroscience Nurses (1984); World Federation of Neuroscience Nurses founded (1969); first issue of Journal of Neurosurgical Nursing (1969); first neurological certification examination (1978); and first stroke certification examination (2012). “What's past is prologue” (Shakespeare, The Tempest). What is sustained for the future is the knowledge, keen observational skills, and critical thinking skill of the neuroscience nurses that established the subspecialty of neuroscience nursing. Invasive monitoring including ICP monitors, imaging diagnostics (computed tomography, magnetic resonance imaging), and NICUs were not part of the landscape until the 1970s. Yet, no substitute has been found to replace the observational skills and caring attitudes of neuroscience nurses who approach patients holistically. The technologies, albeit amazing, are tools, not replacements. Perhaps the greatest addition occurring is the development of high level communication skills by well-educated nurses confident in their knowledge, clinical skills, and roles as equal partners with other health professionals in collaborative interprofessional team practice, which results in safer and better patient outcomes. The evolving roles of neuroscience nurses will continue with a future that includes more, smaller, and less invasive technology/nanotechnology, individualized care based on individual genomic profiles, and pharmacogenomics designed to match patient responsiveness to drug therapies. However, the fundamental core of neuroscience nursing values on competencies of observations, clinical reasoning, intervention, compassion, and caring are enduring now and in the future.

Primary Care Residency Choice and Participation in an Extracurricular Longitudinal Medical School Program to Promote Practice With Medically Underserved Populations

In 2006, the University of Washington School of Medicine (UWSOM) launched the Underserved Pathway (UP), an extracurricular longitudinal experience supporting student interest in caring for underserved populations. This study examined the association between UP participation and residency choice. The study population was 663 UWSOM graduates who matched to a residency from 2008 to 2011; 69 were UP participants. Outcomes included matching to primary care residencies (family medicine, internal medicine, pediatrics, or medicine-pediatrics). The authors calculated graduate rates and odds of UP participants versus nonparticipants matching to primary care residencies overall and to residencies in individual primary care specialties. This analysis included all graduates and 513 graduates who had dual interest in primary care and underserved care at matriculation. Of 336 graduates matching to primary care, the authors calculated rates of entering the individual specialties with respect to UP participation. UP participants matched at significantly higher rates than nonparticipants to primary care (72.5% versus 48.1%, adjusted odds ratio [OR] 2.2) and family medicine residencies (33.3% versus 15.0%, adjusted OR 2.9). Of graduates with dual matriculation interest in primary care and underserved care, 73.4% of participants versus 53.5% of nonparticipants matched to primary care (adjusted OR 1.9), and 31.2% of participants versus 18.0% of nonparticipants matched to family medicine (adjusted OR 2.1). Of primary care matched graduates, 46.0% of participants versus 31.1% of nonparticipants entered family medicine. Supporting student interest in underserved careers is associated with higher rates of graduates entering primary care residencies, specifically family medicine.

The changing face of general dentistry has altered specialty practice

The changing face of general dentistry has altered specialty practice