Postgraduate Meetings Research Articles

Physicians’ Recognition and Management of Kidney Disease: A Randomized Vignette Study Evaluating the Impact of the KDIGO 2012 CKD Classification System

Rationale & ObjectiveThe Kidney Disease Outcome Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease (CKD) classification systems published in 2002 and 2012, respectively, are recommended worldwide and based on strong epidemiologic data. However, their impact on CKD recognition and management is not well evaluated in clinical practice, and we therefore investigated whether they help physicians recognize and appropriately care for patients with CKD.Study DesignRandomized vignette experiment with fractional factorial design based on 6 kidney-related scenarios and 3 laboratory presentation methods reflecting the CKD guidelines. Participants evaluated 1 of 3 subsets of the 18 vignettes (ie, 6 vignettes each with 4 answer alternatives).Setting & Participants249 interns, general practitioners, and residents/fellows attending postgraduate meetings and courses in Norway and the United States.InterventionKidney-related results (serum creatinine level and urinary albumin excretion) were presented as the “minimal data” (high/low levels), KDOQI-2002 (estimated glomerular filtration rate [eGFR] reported automatically), or KDIGO-2012 (eGFR + albuminuria categorization + risk for complications) laboratory report.OutcomeCKD management choice by physicians.ResultsWhen kidney laboratory data were presented as the KDOQI-2002 report (automatic eGFR calculation), there was a significantly higher odds for correct patient management decisions compared with the minimal data report (OR, 1.57; P < 0.001). Additional significant improvement was obtained with the KDIGO-2012 report (OR, 2.28 for correct answer vs minimal data report [P < 0.001]; OR, 1.45 compared to KDOQI-2002 report [P = 0.005]). The KDIGO classification system improved physician management in 4 of the 6 clinical scenarios covering a wide range of kidney-related topics. Interaction analysis showed that general practitioners and those with 1 to 3 years of internal medicine experience had the greatest improvements with the new presentation techniques.LimitationsPhysicians’ management was evaluated by theoretical scenarios rather than direct patient care.ConclusionsAutomatic GFR estimation, albuminuria categorization, and notification of the associated risk for complications improve most physicians` recognition and management of a wide range of CKD clinical scenarios.

O QUADRO VALOR DE LUGAR NOS MÓDULOS DO PROJETO LOGOS II: UMA EXPERIÊNCIA HISTÓRICA NA FORMAÇÃO DE PROFESSORES

Este artigo tem como objetivo analisar como que o quadro valor de lugar (QVL) integrou a disciplina de Didática da Matemática dos módulos do Projeto Logos II, sendo esse um curso de formação de professores em voga nas décadas de 1970 a 1990. Este estudo abordará, também, uma experiência realizada com professores e futuros professores que participaram de uma oficina pedagógica intitulada “Didática da Matemática: uma perspectiva histórica” no Encontro de Pós-Graduação em Educação (INTEGRAP 2017), realizado na UNESP de Rio Claro. Como fontes foram utilizados os módulos do Projeto Logos II, assim como o relato dos ministrantes sobre a experiência com os participantes da oficina. No referencial teórico-metodológico utilizou-se das concepções de crítica ao documento de Bloch e o Paradigma Indiciário de Ginzburg. Os resultados indicam que, além das teorias de Jean Piaget e John Dewey, o QVL relacionava-se com o material dourado de Maria Montessori, bem como os ideais do Movimento da Matemática Moderna, principalmente na adoção da teoria dos conjuntos. Ademais, todos os participantes da oficina relataram que não conheciam o QVL, e o consideraram um instrumento didático útil no ensino das quatro operações.

Dental practice in the UK in 2015/2016. Part 4: changes since 2002?

Objectives To determine, by means of anonymous self-report questionnaires, the changes in demographic profile, practising details and utilisation of clinical techniques/materials of general dental practitioners (GDPs) in the UK between 2002 and 2015. Method A wide-ranging, validated questionnaire, designed to elicit information on the practising arrangements and techniques and materials used, was distributed to UK-based GDPs in 2002, 2008 and 2015 with a request that they complete the questionnaire and return it by post in the reply-paid envelope to the corresponding author. Results Questionnaires were distributed by post to 1,000 UK-based GDPs in 2004 and 2008, with an additional 500 questionnaires being distributed at postgraduate meetings in 2015. Response rates of 70%, 66% and 78% were achieved, respectively. Of the respondents, 73% were male in 2002, while 67% and 60% were male in 2008 and 2015, respectively. In 2002, 65% were practice principals, falling to 51% in 2015. Regarding how patients paid for their dental care, 86% of respondents in 2002 treated patients within the NHS arrangements, compared with 57% and 50% in 2008 and 2015, respectively. The data collected in 2015 indicated that 55% of respondents had an intra-oral camera; while, with regard to recently introduced concepts and techniques, 80% used nickel-titanium files, 47% used zirconia-based bridgework, 25% used tricalcium silicate, and 17% used CAD/CAM restoration. Of great interest, perhaps, is the response to digital radiography/imaging, with the results indicating that, by 2015, 74% of respondents used this form of radiography. Conclusion Results from the three surveys indicated that NHS service provision has dropped to 50%. Regarding the staffing of dental practices, just over half the respondents were practice principals. The results also indicated that UK dentists continue to be innovative and forward-looking in the techniques that they employ.

Dental practice in the UK in 2015/2016. Part 3: aspects of indirect restorations and fixed prosthodontics.

This paper reports data which helps identify changes and trends in the provision of indirect fixed prostheses in general dental practice in the UK. To determine by means of an anonymous, self-report questionnaire, the current trend in the provision of fixed prosthodontic treatments, with a special emphasis on the choice of treatment modalities, techniques and materials. The data presented were extracted from the data obtained from a validated,121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations. A response rate exceeding 66% was achieved. Amalgam and light-cured composite were the preferred material for core build-up of vital teeth for around 62% of the respondents. Dentine pins were still being used by 66% of the respondents. The vast majority of respondents (92%) used a post and core to restore root-treated teeth. Fibre posts were the most commonly used (63%) type of preformed post among the respondents. Using the opposing and adjacent teeth as a reference to control tooth structure reduction during vital tooth preparation was the most common method, used by 42% of the respondents. Addition-cured silicone impression materials were the most frequently used impression material (78%). The surveyed practitioners were equally split between precious and non-precious metals as the substructure for indirect restorations. Glass-ionomer luting cements (47%) and resin-based cements (52%) were the most commonly used to cement porcelain fused to metal and zirconia indirect restorations, respectively. Laboratory made aesthetic veneers were prescribed by half of the respondents, while a third of them preferred direct resin composite as a veneer material. Within the limitations of the study, it was concluded that there has been an increase in the use of adhesive bonding and metal-free restorations. Amalgam and dentine pinscontinued to be used, contrary to international trends. Studies of the type reported are considered important in investigating trends and developments in dentistry.

From sherds to streets Essays on later medieval archaeology

The present volume is a small collection of articles based on papers presented in spring 2013 at the international meeting hosted by the Tallinn University, Institute of History. Between April 26 and 28, PhD students of medieval and later archaeology from seven countries shared their thoughts and research results among a small group of interested colleagues. During the weekend, thirteen presentations on various aspects of later medieval and early modern period archaeology were handled, from the artefact studies to the landscape research and further on to the analysis of the stratigraphy of complicated buildings. The event in Tallinn was a second attempt to bring together young scholars who have chosen to focus their research on the early medieval, medieval and post medieval material remains, e.g. the period from the 6th-7th centuries AD onwards. The first of these post-graduate meetings was jointly hosted by the University of Gottingen and the town of Einbeck in 2012 (see Kuhne & Lehnberg 2013), the seminar in Tallinn (for a thorough overview, see Kuhne 2014) was followed by a conference in Hall in Tyrol organized by the University of Innsbruck in March 2014. Next year's gathering will be in Luneburg (2015), and after that probably in Riga (2016), thus it seems that a new tradition of annual conferences on medieval and later archaeologies has been established. The initial idea behind the conference series was an effort to create a platform for the young scholars who are at the early stage of career-building--to discuss the ongoing research projects, meet the fellow graduate students with similar interests, as well as learn about future prospects on the job market (see Kuhne & Lehnberg 2013, 253), which, in case of archaeology, can range from a few positions at universities, museums and heritage departments to working in the private sector (archaeological excavation firms and consultancies of cultural resource management, to name a few). Visiting different places and organizations is a good chance to get to know and think about the current trends in our profession, about the current driving force for medieval archaeology, the main problems for the newcomers, etc. On a very broad scale we can compare this with successful post-graduate conference series of medieval archaeology--early medieval archaeology student symposium (EMASS), an interactive forum run for, and by, graduate research students in Great Britain (see earlymedievalarchaeology.co.uk). It is to be hoped that the above-mentioned conference series, started in 2012 in Einbeck will develop into a similar kind of lively forum for the younger generation archaeologists who will be shaping the discipline during the next decades. To support this new interesting initiative it was decided that the papers presented in Tallinn should be published, both as a chance to practice the writing skills and as an opportunity to disseminate the ideas, generated during the daily work with the ongoing dissertation projects--hence the word 'essay' (essay, n--a trial, testing, proof; experiment; see Oxford English Dictionary, online: www.oed.com) in the title. This volume presents one third of the papers given in Tallinn, due to the limited number of pages available and because of the tight deadline; a few others will be hopefully published in next issues of the Estonian Journal of Archaeology. In the near future, if possible, special compendiums linked to this conference series will be produced. The present volume serves as a stepping stone for this exciting development. The publication of this issue was supported by the Tallinn University and by institutional research funding IUT (IUT18-8) of the Estonian Ministry of Education and Research. Kaesolev ajakirjanumber on koostatud 2013. aasta kevadel Tallinnas TLU Ajaloo Instituudis toimunud rahvusvahelisel konverentsil esitatud ettekannete pohjal valminud artiklitest. 26.-28. …

American Diabetes Association Postgraduate Meetings—2011

At the American Diabetes Association(ADA) Postgraduate Meetings held 25–26 February 2011 in New York, a discussion of health-care reform and diabetes was opened by Herbert Pardes, chief executive officer of New York-Presbyterian Hospital, who stated that “the focus on health care by the entire country … and the world has never been so great.” His medical center is one of the largest hospital networks in the country, with 2,300 beds and two medical schools, and is the largest private enterprise in New York. He discussed the Naomi Berry Diabetes Center, treating >10,000 diabetic individuals, with one of the largest pediatric diabetes practices in the U.S. At the Weill Cornell Hospital, surgical treatment for diabetes is being studied. Safety programs are being developed in hand washing and in error prevention. Information technology is being expanded, with (as an example) software tools to reduce deep vein thrombosis. More online access to medical records by patients and initiatives such as health information exchanges are being studied to avoid “costly, redundant tests.” Hospitals around the country are, along with politicians and the general public, focusing on health-care reform because of increasing costs, large numbers of uninsured individuals, and increasing numbers of individuals with chronic diseases, in part because of increasing longevity. Cost-effectiveness is an issue, with the U.S. ranking first in per capita spending but far lower in health outcomes. “A lot of populations,” Pardes said, “are not getting the kind of care that they should.” Health-care reform efforts include measures to increase coverage, eliminate exclusions for preexisting illnesses and “lifetime caps,” allow older dependent children to remain on parents’ plans, and to eliminate costs to patients for annual preventive care. All these concepts are relevant to the treatment of diabetes. Quality has also become an important focus, with proposals that “the provider needs …

A survey of general practitioners' assessment and management of shoulder pain: training and practice

Abstract Introduction: Weaknesses in training of general practitioners (GPs) in musculoskeletal care have been identified. Little is known about methods of training GPs in shoulder pain management or the assessments they use in clinical practice. The aim of this study was to assess the effect of training methods in shoulder pain management on GPs' clinical practice. Methods: A validated, self-administered postal questionnaire on dealing with shoulder pain was sent to 1081 GPs. Results: Response rate was 48% (n = 520). The majority (82%) identified training at postgraduate meetings, 17% had attended clinics and 11% attended musculoskeletal courses. Practitioners who had been trained at clinics (odds ratio [OR] 17.5) and musculoskeletal courses (OR 8.2) were likely to perform injections. Similarly, GPs' confidence in shoulder examination was related to their attendance at clinics (P = 0.019) and musculoskeletal courses (P < 0.001) but not postgraduate meetings. In their clinical examination, GPs found that ...

Prostate‐specific antigen testing: uncovering primary care influences

To examine influences on the behaviour of General Practitioner (GP) in relation to prostate-specific antigen (PSA) testing. In Northern Ireland in 2003-2004, all GPs (1067) were invited to complete a self-administered postal questionnaire survey that was then matched with a regional PSA-testing database. The main outcome measures were individual GP responses for demographic, practice and training characteristics, PSA testing behaviour and perceived influences, matched against GP-initiated first PSA tests performed in 2003 and 2004 (22 207 tests). In all, 704 GPs (66%) responded and 49% of these reported awareness of the national guidelines, which was highest among those attending postgraduate meetings. PSA tests were more likely to be ordered by full-time male GPs who had attended a local postgraduate urology meeting; ran a 'well-man' clinic; tested men with unrelated complaints; and were not in a training practice. Testing levels were highest among GPs who had been practising for 21-30 years and those in rural practices. Awareness of national guidelines or having had a postgraduate post in urology did not affect testing behaviour. After adjusting for gender, working hours, duration in practice and urban/rural setting, independent influences increasing testing behaviour were: testing men with a positive family history or unrelated complaints; testing any man who requests it; and previous experience of prostate cancer being detected in an asymptomatic patient by PSA testing. Working in an accredited training practice was associated with lower testing levels. There are complex influences on the PSA testing behaviour of GPs; addressing these influences could contribute to the rationalization of testing. A low awareness of national guidelines indicates a need for new strategies to disseminate and implement guidelines. The influence of local educational meetings on PSA testing is an unharnessed force.

Continuing professional development (CPD): GPs' perceptions of post-graduate education-approved (PGEA) meetings and personal professional development plans (PDPs).

Conventional post-graduate meetings-typically 'lunchtime' meetings outside practices-have been heavily criticized. Revalidation is also impending, and there has been associated pressure for the widespread introduction of personal development plans (PDPs). However, there is very little empirical evidence about the usefulness to GPs of different kinds of educational meeting or of PDPs. Our aim was to assess the utility to GPs of different types of post-graduate meeting and PDPs. A postal questionnaire was sent to 921 GP principals in three health authorities, who were asked to recall their most recent post-graduate education-approved (PGEA) meetings (practice-based and 'outside') and the latest major learning 'undertaken' in their PDP. A total of 698 GPs (76%) returned questionnaires. A substantial minority (208; 30%) had a PDP. Most had undertaken education recently [median time elapsed (weeks): meeting 'outside' practice, 4; 'practice-based', 5; PDP, 3]. Education had not changed clinical practice for many GPs ('practice-based' 39% reported no change; 'outside' meetings 50% and PDPs 57%). A change in practice after a practice meeting was related to relevance to everyday practice [disagree/neutral, agree, strongly agree odds ratios: 1.00, 4.22 (95% CI 2.1-8.6) and 5.9 (2.6-13.3), respectively], to lecturer factors (enthusiasm, summarizing important points, handouts) and to social enjoyment. PDPs were less likely to be perceived relevant to practice (practice-based meeting, 'outside' meeting, PDPs: 89, 87 and 72%, respectively), as a break from practice (54,72 and 18%), good socially (63, 72 and 15%), good for professional networking (54, 70 and 19%) and glad to have done it (84, 86 and 44%). Being glad to use a PDP was more likely if the learning was clinically relevant, a break from practice, and incorporated professional networking. Changes in practice after post-graduate meetings are not only related to clinical relevance and lecturer factors, but also to professional and social factors. PDPs may not be providing better learning opportunities or enjoyment than traditional meetings, although GPs who are glad to use PDPs incorporate clinical relevance, a break from practice and networking. Post-graduate tutors should probably continue to support and monitor the lecturer quality and clinical relevance of a balanced portfolio of both practice-based and 'outside' meetings.

DAME SHEILA SHERLOCK: MCA PATRON AND HEPATOLOGIST EXTRAORDINAIRE

News of Sheila’s death on 30 December last year will have come as a shock to many. Although known to be in poor health during the past 12 months, from her retirement in 1983 from the Royal Free Hospital she had continued as a leading light in her beloved specialty, hepatology, to which she contributed so much. Her clarity of presentation made her much in demand as a speaker at postgraduate meetings and similarly, as a chairman, she had a legendary reputation. Many a startled hepatologist has been woken at meetings from his slumbers by Sheila’s clarion call for a comment. Dame Sheila Sherlock, reproduced by kind permission from the Sheila Sherlock Centre, the Royal Free Hospital, London, UK. Quite apart from her continued writings, her most famous of liver textbooks, Diseases of the Liver and Biliary System , is now in its 11th edition. Few probably realize, in these days of multi-authored textbooks, that up to 1993 this was written entirely by Sheila — a model of concise presentation that has never been equalled. Sheila had a great love for America, admiring its science and research and always encouraging her fellows to spend their scholarships in America. Possibly some of this stemmed from her formative year at Yale in 1947 as a Rockefeller Travelling Fellow, working on carbohydrate metabolism and liver disease. She was a founder member of the American Association for the Study of Liver …

Improving the care of patients without spleens in a district

Patients without spleens are at risk of septicaemia which is largely preventable by vaccination and prophylactic antibiotics as detailed in several recent guidelines. This study sought to identify all people, in one health district, with a previous splenectomy and treat them according to the guidelines on post‐splenectomy care. Patients without a spleen were identified by a variety of methods and targeted mailing, manipulation of the local press, opinion leaders, postgraduate meetings, peer pressure, disease‐ and patient‐specific reminders, feedback and patient empowerment were all used as dissemination and implementation strategies. The number of patients iden‐tified rose from 15 to 68. All were offered the opportunity to discuss their care, 80% took this opportunity and had pneumococcal vaccine, 77% were started on long‐term antibiotics, 75% discussed Hib and meningococcal vaccines and these were given to 54%. In summary the strategies used dramatically increased the numbers of patients identified and the improved care offered.

Multicentre criterion based audit of the management of induced abortion in Scotland.

To assess and improve the quality of care provided to women undergoing induced abortion. Two rounds of prospective, criterion based case note review audit. Ten NHS gynaecology units throughout Scotland. 2004 patient episodes of abortion care identified consecutively during two rounds of audit. The first round comprised 967 cases and the second round 1037. Dissemination of results from the first round of audit and recommendations for change in the form of a written report and at postgraduate meetings in participating hospitals. Improvements in quality of care as assessed against 16 previously agreed criteria, both overall across the 10 study hospitals and within individual hospitals. Overall, four significant improvements occurred: increased availability of early medical abortion, decreased utilisation of surgical abortion at very early gestation, increased use of mifepristone priming before second trimester medical abortion, and increased provision of follow up. At the individual hospital level 42 of 150 elements of care studied were "close to optimal" at the time of the first round of audit, rising to 54 at the second round (NS). A total of 31 significant improvements in individual elements of care occurred, but 11 significant deteriorations also occurred (at the P < 0.05 level). The prospective multicentre audit proved feasible and achieved the aims of any form of audit in terms of identifying deficiencies and variations in care. The audit results prompted objective review of local abortion services in participating hospitals. At least for some elements of care in some hospitals significant improvements were detectable.

Auditing postgraduate meetings

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Limited adverse occurrence screening: A medical quality control system for medium sized hospitals

To determine whether adverse occurrence screening of inpatient discharge summaries by means of a limited number of criteria can provide an effective medical quality control system without requiring substantial additional resources. The medical records department used 14 criteria to screen all inpatient discharge summaries shortly after discharge. Summaries that met particular criteria were sent for medical review. If an adverse patient event was found, appropriate action was determined by a committee of four doctors. 200 bed base hospital in country Victoria. All inpatients discharged over a two year period. The incidence of negative patient outcomes and the cost of resources required to conduct the program. A reduction in the incidence of some negative patient outcomes was achieved and the nature of postgraduate education meetings was changed. Minimal additional resources were required to run the program. Limited adverse occurrence screening has provided a simple, inexpensive and effective medical quality control system in a medium-sized hospital.

Diagnosis of caries and treatment decisions in approximal surfaces of posterior teeth in vitro

The diagnosis of caries and treatment planning decisions have been reported to vary widely between individual dentists. However, opinions differ as to whether, in general, this results in too much or too little treatment. Eighty-six dentists, mainly attending post-graduate meetings, participated in this study. They were asked to make diagnostic and treatment planning decisions on a selection of extracted teeth set in realistic contact with each other. These decisions were compared with the appearance of the proximal surfaces before setting the teeth in contact, and the histological appearance of the teeth that were sectioned after the dentists had made their decisions. Opinions as to whether caries was present and whether it required treatment showed a wide distribution. However, had the decisions been acted upon, between 1-6% of the sound surfaces would have been filled, but 20-68% of teeth with clearly cavitated surfaces or histological evidence of dentine involvement would not have been filled.

General practitioners' continuing medical education within and outside their practice.

To study continuing medical education 96 out of 101 general practitioners chosen at random from the list held by a family practitioner committee were interviewed. The results provided little evidence of regular attendance at local postgraduate centre meetings, though practice based educational meetings were common. Thirty one of the general practitioners worked in practices that held one or more practice based educational meetings each month at which the doctors provided the main educational content. Performance review was undertaken in the practices of 51 of the general practitioners, and 80 of the doctors recognised its value. The general practitioners considered that the most valuable educational activities occurred within the practice, the most valued being contact with partners. They asked for increased contact with hospital doctors. The development of general practitioners' continuing medical education should be based on the content of the individual general practitioner's day to day work and entail contact with his or her professional colleagues.

Myths and 'Mind'

With the short courses a statement of attendance is offered. The Joint Board is therefore offering a mix ture of postgraduate training leading to the equiva lent of Diplomas and Membership of the various Colleges and the general practitioner requirement to attend a number of postgraduate meetings during the year. They do it differently—some would say that they do it better and that the doctors should emulate them. In the meantime it is important that doctors should be aware of the activities of the Joint Board, should encourage nurses to attend available courses and should be aware of courses in their own field which they should bring to the attention of suitable nurses. Furthermore, when the nurses return it is most important that they should be helped to use the knowledge which has been gained in a constructive

Annual Postgraduate Meeting

Annual Postgraduate Meeting

British Medical Association: Third Annual Postgraduate Meeting, Douglas, Isle of Man, 20-21 September

British Medical Association: Third Annual Postgraduate Meeting, Douglas, Isle of Man, 20-21 September

Annual Postgraduate Meeting, Isle of Man

Annual Postgraduate Meeting, Isle of Man