Expert Peer Research Articles

Study of the micro-teaching to improve the medical university physiological teachers' teaching skills

At present, most of the physiological teachers of medical university in our country have graduated from medical universities, and have never been trained by special teachers. Because of the influence of medical education training mode and cultural environment factors, teachers' teaching ability and teaching level are different. This paper proposed the full range of skills training for teachers through micro-teaching. To enhance the in-service teachers' teaching ability and professional level of development, the design procedures of the microteaching training should include the establishment of tutor teaching system, training teachers preparing lessons, after-school peer experts review, self-evaluation and improvement of the video after watching video and questionnaire evaluation, etc. Key words: Micro-teaching; Teachers' skills training; Medical universities; Physiological teachers

The behavioural process underlying augmentative and alternative communication usage in direct support staff

ABSTRACTBackground Research findings suggest that direct support staff use augmentative and alternative communication (AAC) inconsistently. Various staff-related factors have been identified, and researchers agree that these factors somehow interrelate. Therefore, we approached AAC use as a behavioural process and examined the synergy between staff-related factors.Method Fifteen direct support staff and 10 speech-language/occupational therapists who work with adults who have an intellectual disability and use AAC were individually interviewed. Transcripts were studied using thematic analysis.Results Three main themes were discerned: consistent versus inconsistent AAC usage in direct support staff; time as a real and virtual barrier; friction in the peer–expert relationship.Conclusions Direct support staff primarily used AAC when there was an acute need for communication support. In contrast, both direct support staff and speech-language therapists felt that direct support staff should consistently provide augmented input. This discrepancy was driven by team dynamics as well as actual and perceived lack of time.

Thirteen Years of an International External Quality Assessment Scheme for Genotyping: Results and Recommendations.

Suboptimal laboratory procedures resulting in genotyping errors, misdiagnosis, or incorrect reporting bear greatly on a patient's health management, therapeutic decisions made on their behalf, and ultimate outcome. Participation in external quality assessment (EQA) is a key element of quality assurance in molecular genetic diagnostics. Therefore, the Reference Institute for Bioanalytics has tried for 13 years to improve the quality of genetic testing by offering an EQA for different clinically relevant sequence variations. Within each of the biannual EQA schemes offered, up to 18 samples of lyophilized human genomic DNA were provided for up to 50 different molecular genetic tests. Laboratories were asked to use their routine procedures for genotyping. At least 2 expert peer assessors reviewed the final returns. Data from 2002 to 2014 were evaluated. In total, 82 462 reported results from 812 characterized samples were evaluated. Globally, the number of participants increased each year along with the number of sequence variations offered. The error rate decreased significantly over the years with an overall error rate of 1.44%. Additionally, a decreased error rate for samples repeated over time was noted. Interestingly, the error rate showed a high difference depending on the locus analyzed and the method used. Based on the evaluation of this long-term EQA scheme, various recommendations can be given to improve the quality of molecular genetic testing, such as the use of 2 different methods for genotyping. Furthermore, some methods are inappropriate for analysis of certain sequence variations.

Assessing app quality through expert peer review: a case study from the gray matters study.

Health apps focused on inciting behavior change are becoming increasingly popular. Nevertheless, many lack underlying evidence base, scientific credibility and have limited clinical effectiveness. It is therefore important that apps are well-informed, scientifically credible, peer reviewed and evidence based. This paper presents the use of the Mobile App Rating Scale (MARS) to assess the quality of the Grey Matters app, a cross platform app to deliver health education material and track behavior change across multi-domains with the aim of reducing the risk of developing Alzheimer's disease. The Gray Matters app shows promising results following reviews from 5 Expert raters, achieving a mean overall MARS score of 4.45 ± 0.14. Future work will involve undertaking of a detailed content analysis of behavior change apps to identify common themes and features which may lead to the successful facilitation of sustained behavior change.

Accessing the Classroom Discourse Community Through Accountable Talk: English Learners’ Voices

This case study draws on Gee's (1989) D/discourse theory to investigate English learners’ (ELs’) perspectives regarding Accountable Talk (AT)—a structured, discourse-intensive instructional approach—after a yearlong implementation in three content-based (mathematics) middle school classrooms. Interviews with 21 ELs (3 Advanced Placement, 18 comprehensive)1 revealed that students perceived AT as a means for (a) improving the quality of classroom interactions, (b) having expanded learning opportunities, and (c) getting ahead in school and life. In particular, students felt that by establishing shared norms for talk, explicitly teaching them verbal and nonverbal features of the school Discourse (e.g., active listening strategies), and increasing their access to peer experts and to opportunities to take on roles of authority (i.e., teachers/helpers), AT enabled their classroom participation on a more equal footing. These results suggest that giving the school-based Discourse a name (such as AT) and explicitly teaching about its principles may benefit culturally and linguistically diverse students by facilitating their socialization into the community of practice. At the same time, the study revealed that teacher perceptions and practices may limit the benefits of AT for ELs.

Contributing Reviewers in 2015

Journal of Pediatric Biochemistry wishes to recognize those who contributed as an expert peer reviewer of submitted scientific papers in 2015.

Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study.

BackgroundAsthma is among the most common chronic diseases in adults. International guidelines have emphasized the importance of regular spirometry for asthma control evaluation. However, spirometry use in primary care remains low across jurisdictions. We sought to design and evaluate a knowledge translation intervention to address both the poor quality of spirometry and the underuse of spirometry in primary care.MethodsWe designed a 1-year intervention consisting of initial interactive education and hands-on training followed by unstructured peer expert mentoring (through an online portal, email, telephone, videoconference, fax, and/or in-person). We recruited physician and allied health mentees from across primary care sites in Ontario, Canada. We compared spirometry-related knowledge immediately before and after the 1-year intervention period and the quality of spirometry testing and the usage of spirometry in patients with asthma in the year before and the year of the intervention.ResultsSeven of 10 (70 %) invited sites participated, including 25/90 (28 %) invited allied health mentees and 23/68 (34 %) invited physician mentees. We recruited 7 physician mentors and 4 allied health mentors to form 3 mentor-mentee pods. Spirometry knowledge scores increased from 21.4 +/− 3.1 pre- to 27.3 +/− 3.5 (out of 35) (p < 0.01) post-intervention. Spirometry acceptability and repeatability criteria were met by 59/191 (30.9 %) spirometries and 86/193 (44.6 %) spirometries [odds ratio 1.7 (1.0, 3.0)], in the pre-intervention and intervention periods, respectively. Spirometry was ordered in 75/512 (14.6 %) and 129/336 (38.4 %) respiratory visits (p < 0.01), and in 20/3490 (0.6 %) and 36/2649 (1.4 %) non-respiratory visits (p < 0.01), in the pre-intervention and intervention periods, respectively.ConclusionsA mentorship-based intervention involving physicians and allied health team members can enhance knowledge, quality, and actual use of spirometry in real world primary care settings. A future controlled study should assess the impact of this intervention on patient outcomes, its cost-effectiveness, and its sustainability.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0220-6) contains supplementary material, which is available to authorized users.

Contributing Reviewers in 2015

Journal of Pediatric Genetics wishes to recognize those who contributed as an expert peer reviewer of submitted scientific papers in 2015.

An evaluation of the EOLAS psychoeducation programme for service users: An innovative approach to collaboration between clinicians and ‘experts by experience’

IntroductionPsychoeducation for service users has been shown in several recent meta-analyses to improve adherence with treatment, decrease rehospitalization rates and improve various measures of quality of life. The 8-week EOLAS Programme for service users with schizophrenia or bipolar disorder is unique in being designed, co-facilitated and evaluated collaboratively by both clinician and peer representatives. EOLAS forms part of the service plan of the national Health Service in Ireland.Aims and objectivesTo evaluate the impact of the EOLAS programme on participants’ perceived knowledge, confidence, advocacy, recovery attitudes and hope.MethodologyAnonymised questionnaires were administered to participants before and after completion of the EOLAS Programme.All survey participants were invited to attend for interview to examine qualitatively their experience of the programme. Interviews were recorded and subjected to thematic analysis.ResultsForty-five subjects completed pre- and post-programme questionnaires (participation rate = 55%).Significant improvements (P &lt; 0.05) were identified across each of the 5 domains examined (i.e. perceived knowledge, confidence, advocacy, recovery attitudes, hope). Expressed satisfaction with the programme was high (95%).At interview, participants (n = 12) particularly valued:– the opportunity to ask questions of the psychiatrist e.g. about medication;– improving self-care skills e.g. monitoring early warning signs of relapse;– co-facilitation by a peer, which provided extra credibility and inspired hope;– sharing experiences with peers.ConclusionsThe EOLAS programme succeeds in meeting the needs of the participants across the target domains. This success depends on the unique collaboration between clinicians and peer experts on which EOLAS is based.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Quality Improvement Interventions for Early HIV Infant Diagnosis in Northeastern Uganda

Introduction. Early infant diagnosis (EID) of human immunodeficiency virus (HIV) ensures prompt treatment and infant survival. In Kaabong Hospital, 20% of HIV exposed infants (HEIs) had access to HIV diagnosis by eight weeks. We aimed to improve EID of HIV by deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) testing by eight weeks from 20 to 100% between June 2014 and November 2015. Method. In this quality improvement (QI) project, EID data was reviewed, gaps prioritized using theme matrix selection, root causes analyzed using fishbone tool, and improvement changes were selected using counter measures matrix but implemented using Plan-Do-Study-Act cycle. Root causes of low first DNA-PCR testing included maternal EID ignorance, absent lost mother-baby pairs (LMBP) tracking system, and no EID performance reviews. Health education, Continuous Medical Education (CMEs), and integration of laboratory and EID services were initial improvement changes used. Results. DNA-PCR testing increased from 20 to 100% between June 2014 and July 2015 and was sustained at 100% until February 2016. Two declines, 67% in September 2014 and 75% in June 2015, due to LMBP were addressed using expert clients and peer mothers, respectively. Conclusion. Formation of WIT, laboratory service integration at MBCP, and task shifting along EID cascade improved EID outcomes at 6 weeks.

Korean clinical practice guideline for benign prostatic hyperplasia.

In 2014, the Korean Urological Association organized the Benign Prostatic Hyperplasia Guideline Developing Committee composed of experts in the field of benign prostatic hyperplasia (BPH) with the participation of the Korean Academy of Family Medicine and the Korean Continence Society to develop a Korean clinical practice guideline for BPH. The purpose of this clinical practice guideline is to provide current and comprehensive recommendations for the evaluation and treatment of BPH. The committee developed the guideline mainly by adapting existing guidelines and partially by using the de novo method. A comprehensive literature review was carried out primarily from 2009 to 2013 by using medical search engines including data from Korea. Based on the published evidence, recommendations were synthesized, and the level of evidence of the recommendations was determined by using methods adapted from the 2011 Oxford Centre for Evidence-Based Medicine. Meta-analysis was done for one key question and four recommendations. A draft guideline was reviewed by expert peer reviewers and discussed at an expert consensus meeting until final agreement was achieved. This evidence-based guideline for BPH provides recommendations to primary practitioners and urologists for the diagnosis and treatment of BPH in men older than 40 years.

The Behavior Therapy Training Institute for OCD: A preliminary report

Despite decades of research demonstrating the efficacy of Cognitive Behavioral Therapy (CBT) for obsessive compulsive disorder (OCD), many clinicians have not adopted it into their practice. In an effort to increase the number of trained clinicians, the International OCD Foundation (IOCDF) developed a nationwide intensive training program, the Behavior Therapy Training Institute (BTTI). We report the first data on the BTTI. We emailed a 30-item online survey to all clinicians (N=350) who attended one of twelve BTTI workshops between 2008 and 2011. One hundred and sixty one individuals (53%) responded. Participants reported more than moderate use of all BTTI skills. Expert phone consultation and peer consultation after the training were associated with greater skills use. The most commonly reported barrier to skill use was difficulty integrating the techniques into their practice because of time or an inability to leave the office. The majority of participants also reported an increase in OCD-related referrals after the BTTI. Limitations of this work, suggestions for improvement, and the implications of our findings for broader dissemination efforts are discussed.

Thank you to our Expert Peer Reviewers for 2015

Thank you to our Expert Peer Reviewers for 2015

An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation.

Pulmonary rehabilitation (PR) has demonstrated physiological, symptom-reducing, psychosocial, and health economic benefits for patients with chronic respiratory diseases, yet it is underutilized worldwide. Insufficient funding, resources, and reimbursement; lack of healthcare professional, payer, and patient awareness and knowledge; and additional patient-related barriers all contribute to the gap between the knowledge of the science and benefits of PR and the actual delivery of PR services to suitable patients. The objectives of this document are to enhance implementation, use, and delivery of pulmonary rehabilitation to suitable individuals worldwide. Members of the American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly and the European Respiratory Society (ERS) Rehabilitation and Chronic Care Group established a Task Force and writing committee to develop a policy statement on PR. The document was modified based on feedback from expert peer reviewers. After cycles of review and revisions, the statement was reviewed and formally approved by the Board of Directors of the ATS and the Science Council and Executive Committee of the ERS. This document articulates policy recommendations for advancing healthcare professional, payer, and patient awareness and knowledge of PR, increasing patient access to PR, and ensuring quality of PR programs. It also recommends areas of future research to establish evidence to support the development of an updated funding and reimbursement policy regarding PR. The ATS and ERS commit to undertake actions that will improve access to and delivery of PR services for suitable patients. They call on their members and other health professional societies, payers, patients, and patient advocacy groups to join in this commitment.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 12: Emergency Action Plans, Resuscitation, Cardiopulmonary Resuscitation, and Automated External Defibrillators: A Scientific Statement From the American Heart Association and American College of Cardiology.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 12: Emergency Action Plans, Resuscitation, Cardiopulmonary Resuscitation, and Automated External Defibrillators: A Scientific Statement From the American Heart Association and American College of Cardiology.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension: A Scientific Statement from the American Heart Association and the American College of Cardiology.

An elevation of blood pressure (BP) in the systemic circulation (hypertension) is the most common cardiovascular condition in the general population and considered to be the most ubiquitous cardiovascular risk factor in competitive athletes. Competitive athletes include those athletes involved in organized sports that typically occur in schools, communities, and professional leagues, including but not limited to intramural and league sports in which medical supervision is typically required. Although most competitive athletes are between the ages of 20 and 40 years, many younger people now participate in competitive athletics. The 2013 update from the American Heart Association using the National Health and Nutrition Examination (NHANES) data from 2007 to 2010 estimates that 9.1% of men aged 20 to 34 years and 6.7% of women of that age are hypertensive, based on having an elevated BP measurement or answering “yes” to the question, “Are you taking antihypertensive medication or were you told that you had hypertension?”1 The prevalence in children and adolescents is estimated to be ≈3.5%, with higher percentages in older and obese children.2 The diagnosis of hypertension is based on the subject having an elevated BP at or above certain levels measured by routine sphygmomanometry under appropriate conditions on at least 2 separate occasions separated by at least 1 week.3 However, BP measurements in the competitive athlete are typically obtained by different healthcare providers, which makes it particularly necessary that the testing conditions be standardized before the diagnosis of hypertension is made. People >18 years of age with a BP >140 mm Hg systolic and/or >90 mm Hg diastolic are considered to have hypertension.3 In children and adolescents, hypertension is defined as average systolic or diastolic BP levels greater than the 95th percentile for sex, age, and height; however, earlier physical maturation of the competitive athlete leaves …

Evaluating Maps in a Massive Open Online Course

New forms of cartographic education are becoming possible with the synthesis of easy to use web GIS tools and learning platforms that support online education at a massive scale. The internet classroom can now support tens of thousands of learners at a time, and while some common types of assessments scale very easily, others face significant hurdles. A particular concern for the cartographic educator is the extent to which original map designs can be evaluated in a massive open online course (MOOC). Based on our experiences in teaching one of the first MOOCs on cartography, we explore the ways in which very large collections of original map designs can be assessed. Our methods include analysis of peer grades and qualitative feedback, visual techniques to explore design methods, and quantitative comparison between expert ratings and peer grades. The results of our work suggest key challenges for teaching cartography at scale where instructors cannot provide individual feedback for every student.

2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. When there is overlap, the recommendations made here supersede those of previous guidelines. This focused update analyzes results from 8 randomized, clinical trials of endovascular treatment and other relevant data published since 2013. It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations. Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statement Oversight Committee and Stroke Council Leadership Committee. Evidence-based guidelines are presented for the selection of patients with acute ischemic stroke for endovascular treatment, for the endovascular procedure, and for systems of care to facilitate endovascular treatment. Certain endovascular procedures have been demonstrated to provide clinical benefit in selected patients with acute ischemic stroke. Systems of care should be organized to facilitate the delivery of this care.

Further Evolution of the ACC/AHA Clinical Practice Guideline Recommendation Classification System: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

For 3 decades, the American College of Cardiology (ACC) and the American Heart Association (AHA) have jointly developed clinical practice guidelines in an effort to align patient care with scientific evidence.l The “2015 ACC/AHA/HRS Guideline on the Management of Patients With Supraventricular Tachycardia”2 introduces the latest recommendation classification system Table 1, which has continued to evolve. The present brief commentary summarizes and explains the changes incorporated in the current scheme. More detailed reviews of the evolution of ACC/AHA guideline methodology have been published.1,3-5 View this table: Table 1. ACC/AHA Recommendation System: Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015) Guideline recommendations are categorized by the Class of Recommendation (COR) and Level of Evidence (LOE). The COR reflects the magnitude of benefit over risk and corresponds to the strength of the recommendation. Class I recommendations are strong and indicate that the treatment, procedure, or intervention is useful and effective and should be performed or administered for most patients under most circumstances. Class II recommendations are weaker, denoting a lower degree of benefit in proportion to risk. Benefit is generally greater for Class Ila (moderate) recommendations and smaller for Class lib (weak) recommendations, for which benefit only marginally exceeds risk. A …