Physician Reentry into Clinical Practice: Regulatory Challenges

2011 ◽  
Vol 97 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Gretchen P. Kenagy ◽  
Barbara S. Schneidman ◽  
Barbara Barzansky ◽  
Claudette E. Dalton ◽  
Carl A. Sirio ◽  
...  

ABSTRACT Physician reentry to clinical practice is fast becoming recognized as an issue of central importance in discussions about the physician workforce. While there are few empirical studies, existing data show that increasing numbers of physicians take a leave of absence from practice at some point during their careers; this trend is expected to continue. The process of returning to clinical practice is coming under scrutiny due to the public's increasing demand for transparency regarding physician competence. Criteria for medical licensure often do not include an expectation of ongoing clinical activity. Physicians who maintain a license but do not practice for a period of time, therefore, may be reentering the workforce with unknown competency to practice. This paper: (1) presents survey data on current physician reentry policies of state medical boards; (2) discusses the findings from the survey within the context of regulatory challenges that impact physician-reentry; and (3) offers recommendations to facilitate the development of comprehensive, coordinated regulatory policies on physician reentry.

Author(s):  
Sachin Bagali ◽  
Umapati Baragi ◽  
M. R. Sajjanshetti

In the present day scenario prime need of Ayurveda is practical applicability of Ayurvedic fundamental principles and research should be more focused on all aspects where scientific inputs should confirm Ayurveda’s principles and philosophy. In Ayurveda, Gunas are described as the way of presentation of action without which no Karma (action) can be possible. Ayurveda has provided significance to every Guna so that they become useful in clinical practice. Clinical practice or research is a continuous process including a series of events which need to be performed in a sequential manner. Though there are many factors on which accomplishment of treatment depends, among these Charaka has given prime importance to Paradi Gunas. In clinical practice, Guna which are to be with Bhishak are mainly the Paradi Gunas which can also be called as miscellaneous Gunas. As rightly quoted by Acarya Charaka, for getting success in the treatment Paradi Gunas are the best. The Sutra quotes "Sidhyupaya Chikitsayam" which means that Chikitsa i.e. Dhatusamya will be done mainly with the help of Paradi Gunas. Knowledge of Paradi Gunas are required to be present in pharmacists, physicians and Researchers. Acharya Charaka says that Chikitsa Siddhi i.e. successful management of disease is not possible without the knowledge of Paradi Gunas. Paradi Gunas play an important role in selection, adaption and manifestation of drug as per condition of the disease and the patient in particular Desha and Kala. The ultimate goal of any clinical activity is to contribute in the knowledge domain and to improve professional practice. Thus this literary review of Paradi Gunas serves to explore the subject of the clinical practice.


Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2708
Author(s):  
Alice Boilève ◽  
Marc Hilmi ◽  
Matthieu Delaye ◽  
Annemilaï Tijeras-Raballand ◽  
Cindy Neuzillet

Hepatocellular carcinoma (HCC) and biliary tract cancers (BTC) exhibit a poor prognosis with 5-year overall survival rates around 15%, all stages combined. Most of these primary liver malignancies are metastatic at diagnostic, with only limited therapeutic options, relying mainly on systemic therapies. Treatment modalities are different yet partially overlapping between HCC and BTC. The complex molecular profile of BTC yields to several actionable therapeutic targets, contrary to HCC that remains the field of antiangiogenic drugs in non-molecularly selected patients. Immunotherapy is now validated in the first line in HCC in combination with bevacizumab, while clinical activity of single agent immunotherapy appears limited to a subset of patients in BTC, still poorly characterized, and combinations are currently under investigation. In this review, we provide a critical evaluation and grading of clinical relevance on (i) the main prognostic biomarkers in HCC and BTC, (ii) the main theragnostic biomarkers in both tumors, and lastly (iii) what is recommended in clinical practice.


2022 ◽  
Vol 9 (1) ◽  
pp. 38-39
Author(s):  
Timothy H. Wideman ◽  
Peter Stilwell

Too often, pain is reduced to a simple symptom of illness or injury – a puzzle piece to fit into the differential diagnostic jigsaw. Pain reports that fit the emerging pathoanatomical picture are validated and treated accordingly. But many reports don’t fit this picture, and the widespread stigma associated with persistent pain is most commonly directed toward these individuals, whose symptoms aren’t well explained by known pain mechanisms. A root problem is not seeing the person in pain or the suffering they experience. This presentation aims to help participants develop a more comprehensive perspective on pain that better integrates its complexities within clinical practice. Participants will be introduced to the Multi-modal Assessment model of Pain (MAP; Wideman et al, Clinical Journal of Pain 2019; 35(3): 212). MAP offers a novel framework to understand the fundamentally subjective natures of pain and suffering and how they can be best addressed within clinical practice. MAP aims to help clinicians view pain, first and foremost, as an experience (like sadness), which may or may not correspond to specific pathology or diagnostic criteria (like clinical depression). MAP aims to facilitate a more compassionate approach to pain management by providing a rationale for why all reported pain should be validated, even when poorly understood. Viewing pain in this manner helps highlight the central importance of listening to patients’ narrative reports, trying to understand the meaning and context for their experiences of pain and using this understanding to help alleviate suffering.


2019 ◽  
Vol 59 (1) ◽  
Author(s):  
Scheila Fritsch ◽  
Rafaela Martinez Copes ◽  
Bruna Savioli ◽  
Mariana Freitas de Aguiar ◽  
Rozana Mesquita Ciconelli ◽  
...  

Abstract Background The Indian Takayasu Clinical Activity Score (ITAS2010) was developed in 2010 as an assessment tool for disease activity in patients with Takayasu arteritis (TA). It has since been widely used in different studies and in clinical practice for the management of patients with TA. The present study aims to translate the ITAS2010 into Brazilian Portuguese language and to validate it for use in clinical practice in Brazil. Methods For this cross-sectional study, the ITAS2010 was translated in accordance with the guidelines described by Beaton et al. and then applied with 27 patients with TA on three assessments by two rheumatologists working independently. To measure interrater agreement, the assessments were performed on the same day within approximately 1 hour. One of the rheumatologists performed a second evaluation of patients with TA within 7 to 14 days to measure intrarater agreement. Results The correlation coefficient for the ITAS2010 score between the two raters was high (r = 0.916; p < 0.0001), as well as the intraclass correlation coefficient (ICC) [0.918 with a 95% confidence interval (95CI): 0.828–0.962]. The correlation coefficient and the ICC for intrarater agreement were moderate for ITAS2010 (r = 0.633; p < 0.0001 and ICC = 0.594; 95CI: 0.292–0.790). The ITAS2010 at baseline was compared with the physician’s global assessment (PGA) and with Kerr’s criteria for detecting disease activity in TA. Higher ITAS2010 scores were observed in patients with active and grumbling/persistent disease than in those presenting inactive disease according to the PGA [1.5 (0.0–3.0) vs. 0.0 (0.0–0.0); p = 0.0025]. Patients with active disease according to the Kerr’s criteria had also higher ITAS2010 scores than those considered in remission [3.0 (3.0–7.0) vs. 0.0 (0.0–0.0); p = 0.0068]. Conclusions The Brazilian Portuguese version of the ITAS2010 is a valid and reproducible tool for the assessment of disease activity in TA and it is an additional tool for the routine evaluation of Brazilian patients with TA.


2019 ◽  
Vol 22 (4) ◽  
pp. 753-763
Author(s):  
Mark Eshwar Lokanan

Purpose The purpose of this paper is to use statistical techniques to mine and analyze suspicious transactions. With the increase in money laundering activities across various sectors in some of the world’s leading democracies, the ability to detect such transactions is gaining grounds with more urgency. Regulators and practitioners have been calling for an approach that can mine the large volume of unstructured data form suspicious money laundering transactions to inform public policies. Design/methodology/approach By deducing from the results of empirical studies in the field of money laundering detection, this paper presented an overview of data mining technology for detecting suspicious transactions. Findings After chronicling the data mining process, the paper delves into an analysis of the statistical approaches that can be used to differentiate between legitimate and suspicious money laundering transactions. The different stages of the data mining process are carefully explained in relation to their application to anti-money laundering compliance. The results indicate that statistical data mining methodology is a very efficient and useful technique to detect suspicious transactions. Practical implications The paper is of relevance to regulators and the financial service sector. A discussion of how data can be mined to facilitate statistical analysis can be used to inform regulatory policies on the detection and prevention of money laundering activities in the financial service sector. Originality/value The paper discuss approaches that illustrate how analysts can use statistical techniques to analyze data for suspicious money laundering transactions


2002 ◽  
Vol 14 (2) ◽  
pp. 76-80 ◽  
Author(s):  
F. E. Yeomans ◽  
K. N. Levy

One of the principal formulations of borderline personality disorder is based on object relations theory, a component of psychoanalytic theory. To remain relevant, psychoanalytic formulations must find support from empirical research. After summarizing the object relations understanding of borderline personality, the authors review studies in biological neuroscience, developmental psychology and cognitive science related to the fundamental concepts of object relations theory as it aplies to borderline pathology. This review suggests that these empirical studies support psychoanalytic formulations originally derived from clinical practice and observation.


RSBO ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 275
Author(s):  
Orides Ferrari Jr ◽  
Fernando Dalitz ◽  
Marina Samara Baechtold ◽  
Ubiracy Gaião Gaião ◽  
Leonardo Fernandes da Cunha ◽  
...  

Esthetic rehabilitations require a broad and thorough evaluation of all the elements that make up the smile such as lips, dental, and periodontal structures to plan the treatment to provide harmony to the whole set. Objective: To demonstrate through a case the association of Periodontics and Restorative Dentistry in the esthetic rehabilitation of anterior teeth replacing resin restorations by modifying the gingival architecture conservatively and harmonically. Case report: It is essential for a multidisciplinary approach to succeed in treatment. The replacement of previous restorations is an increasing demand in currently clinical practice, for many reasons, mainly due to dissatisfaction with the esthetics. It is observed that many of these patients involve not only dissatisfaction with the dental structure but also with the periodontal health, for this reason, it is necessary a previous adaptation of the gingival tissues for proper restorative rehabilitation. Conclusion: Ceramic laminates have proved to be a great choice for anterior teeth restorations, but they must be indicated in specific situations, to obtain excellent results as most conservative as possible.


2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S465-S466
Author(s):  
M Chaparro ◽  
A Garre ◽  
M Iborra ◽  
M Sierra ◽  
M Barreiro-de Acosta ◽  
...  

Abstract Background The development program (UNIFI) has shown promising results of ustekinumab in ulcerative colitis (UC) treatment that should be confirmed in clinical practice. Aims Primary: to evaluate the durability of ustekinumab treatment in UC patients in clinical practice. Secondary: to assess the short-term response (at week 16) and the long-term effectiveness (at maximum follow-up) and to assess the safety of ustekinumab in clinical practice. Methods Patients included in the prospectively maintained ENEIDA registry who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score (PMS) &gt;2] were included. Clinical activity and effectiveness were defined based on PMS. Results 95 patients were included (table 1). At week 16, 53% of patients had clinical response (including 35% of patients in remission) (figure 1). In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with clinical remission. Long-term remission is represented in figure 2. 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at week 16, 63% at week 56, and 59% at week 72 (figure 3); primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. Conclusion Ustekinumab is effective both in the short and the long-term in real-life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.


2020 ◽  
Vol 21 (2) ◽  
pp. 598-612
Author(s):  
László Szendrői ◽  
Krishna S. Dhir ◽  
Katalin Czakó

This study reviews prevailing trends in “for-profit” business-related gamification. It examines the current literature, focusing on gamification elements, industries and variables that is of interest to researchers in different business environments. A systematic mapping approach was applied to this study. Articles were selected from different databases in a two-step screening process, subject to sets of inclusion and exclusion criteria. A total of 25 articles were further for: (1) represented industries, (2) orientation of the gamified system, (3) types of implementation, (4) gamification elements analysed, (5) impact on companies, and (6) company variables analysed. Results confirmed that the number of empirical studies on gamification in for-profit organisations is growing. Researchers have placed greater emphasis on analysing customer-related gamification environments than on employee-oriented gamification. This finding is consistent with the prevailing trend of increasing demand from practitioners to gamify customer-related processes. This is likely due to the potential for higher positive impact on the performance of companies. Most frequently deployed gamification elements are badges, rewards, and leader boards. The literature suggests that over all, gamification has a positive effect on various company variables, such as motivation, engagement of employees, brand loyalty, and customer experience. This paper highlights the particular areas of business-related gamification that have already been examined and possible future directions.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lara Teheux ◽  
Ester H. A. J. Coolen ◽  
Jos M. T. Draaisma ◽  
Marieke de Visser ◽  
Nynke D. Scherpbier-de Haan ◽  
...  

Abstract Background Residents need to be trained across the boundaries of their own specialty to prepare them for collaborative practice. Intraprofessional learning (i.e. between individuals of different disciplines within the same profession) has received little attention in the postgraduate medical education literature, in contrast to the extensive literature on interprofessional learning between individuals of different professions. To address this gap, we performed a scoping review to investigate what and how residents learn from workplace-related intraprofessional activities, and what factors influence learning. Methods The PRISMA guidelines were used to conduct a scoping review of empirical studies on intraprofessional workplace learning in postgraduate medical education published between 1 January 2000 to 16 April 2020 in Pubmed, Embase, PsycINFO, ERIC and Web of Science. This study applied ‘best fit’ framework-based synthesis to map the existing evidence, using the presage-process-product (3P) model developed by Tynjälä (2013). Results Four thousand three hundred thirty records were screened, and 37 articles were included. This review identified influencing (presage) factors that derived from the sociocultural environment, learner and learning context. Studies described that complexity of care can both facilitate and hinder learning. Furthermore, intraprofessional learning is threatened by professional stereotyping and negative perceptions, and awareness of learning opportunities and explicit reflection are critical in intraprofessional workplace learning. Studies described a range of informal and formal intraprofessional activities (process) under the headings of collaboration in clinical practice, rotations or placements, formal educational sessions and simulated workplace training. In general, learners responded well and their attitudes and perceptions improved, learners reported increased knowledge and skills and positive behavioural changes (product). Learning outcomes were reported in the domains of patient-centred care, collaborative attitudes and respect, mutual knowledge and understanding, collaborative decision making, communication, leadership, teamwork and reflexivity. Conclusions This review gives insight into the high learning potential of intraprofessional activities. Many of the included studies relied on self-reported perceptions of change, therefore, future research should focus on generating more robust evidence including objectively examined outcome measures. This review offers a comprehensive overview of the factors that influence intraprofessional workplace learning in postgraduate medical education. Finally, we provide recommendations for enhancing intraprofessional learning in clinical practice.


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